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HeartWorks Simulation - A Breakthrough In Education For Cardiothoracic Anesthesiologists

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The world's first virtual heart has been developed to improve teaching of peri-operative transesophageal echocardiography (TEE) skills in the care of patients with heart disease. HeartWorks, a uniquely realistic computer-generated model of the heart and echocardiography simulator, is the result of a 4 year project driven by a team of three London-based cardiac anaesthesiologists. Recognising the power of education through simulation and its increasingly widespread adoption throughout clinical practice, the team is spearheading a pathway change in education in one of the most interesting and challenging areas of cardiac care. Now in production by Inventive Medical, a subsidiary of UCLH Charity London, HeartWorks is set to dramatically transform TEE training by university teaching hospitals worldwide.
Defining the challenge of teaching TEE
The role of TEE in the management of life-threatening hemodynamic instability is well established. However, proficiency in performing a TEE examination requires significant training and expertise.
As the founder and clinical leader of TEE courses at UCLH, Dr Sue Wright MBBS FRCA was acutely aware that the opportunities to practise and observe peri-operative TEE were limited. With practice hours diminishing within the typical curriculum, it was becoming increasingly necessary to find a new solution to teach this advanced technique. Dr Wright, Dr Bruce Martin MBBS FRCA and Dr Andrew Smith MBBS FRCA, fellow UCLH anaesthetists with a keen interest in TEE, were frustrated by the lack of anatomical accuracy in current heart simulators.
Dr Wright explained, "Together, we resolved to design a virtual heart that would break boundaries in terms of realism and student engagement. The three of us set out to develop the most anatomically lifelike heart simulator in the world to enable medical students and cardiothoracic specialists to understand both the structure of the heart and the way in which echocardiography images are derived from it."
Designing a technology solution
With the input of clinical expertise from Sue, Andrew, Bruce and a considerable number of eminent medical specialists, media company Glassworks rose to the design challenge. The company developed an ultrasound software solution that resulted in freely interactive TEE image simulation with true-to-life control of the probe depth, and flexion and rotation of the imaging plane. Further collaboration with Asylum, a leading models and effects company, resulted in the development of a haptic interface that allows a mannequin TEE simulator to drive the HeartWorks software.
Dr Wright continued, "At the core of the HeartWorks product is a freely interactive model of the human heart which has an unprecedented degree of detail and photorealism. The model has been carefully animated to simulate normal human cardiac motion, with a variable heart rate that is synchronized to an EKG trace. It can be viewed from any angle both internally and externally, through a range of zoom, can be rotated freely around any axis, and sliced in any plane."
"The addition of an ultrasound simulation package introduces the facility for real time TEE image simulation from the 3D virtual heart. The on-screen introduction of a virtual TEE probe down the path of the esophagus generates simulated ultrasound images that are derived directly and continuously from the 3D model. The mannequin package supplements the ultrasound simulation package and allows the operator to perform a true-to-life TEE examination. The use of this complete simulator package allows the novice sonographer to gain valuable early experience before examining patients."
Hands-on education with overarching realism - now available in the UK and the US
Dr Nick Fletcher, Consultant in Cardiothoracic Anesthesia and Intensive Care and Honorary Senior Lecturer at St Georges Hospital and Medical School, London runs TEE courses that are attended by cardiothoracic and intensive care specialists from all around the world. Having just purchased the HeartWorks suite, Dr Fletcher is enthusiastic about the integration of the virtual training in his curriculum. "There is enormous demand for this type of skill in the field of intensive care, from cardiac physiology students to clinical practitioners. The inclusion of the HeartWorks simulation experience in our course will enable delegates to observe and safely practice skills for a day in a typical scenario before they go on to hone their skills in the perioperative setting. I anticipate that it will be an extremely valuable addition and we are looking forward to its imminent implementation."
Dr Feroze Mahmood, Director of Vascular Anesthesia from Beth Israel Deaconess Medical Centre, Boston, which is part of the Harvard Medical School, agreed, "Up until the introduction of HeartWorks, even for residents and fellows there has been no such facility or equipment to learn basic TEE skills and probe manipulations or develop appreciation of 'normal' outside the OR to decrease the initial TEE learning curve. Using HeartWorks in trans-esophageal echo mode, the heart appears as an actual dynamic image as observed on a real TEE machine. This powerful learning tool has greatly simplified the understanding of TEE anatomy and image orientation and has the potential to literally change the landscape of TEE training. It is a revolutionary advancement in the field of echocardiography with an enormous potential."
Inventive Medical Ltd
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