World's first virtual heart brings breakthrough in education for cardiothoracic anaesthetists

17 July 2009

The world’s first virtual heart has been developed to improve teaching of peri-operative transoesophageal echocardiography (TOE) 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 four-year project driven by a team of three London-based cardiac anaesthetists.

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 TOE training by university teaching hospitals worldwide.

A demonstration of HeartWorks
A demonstration of HeartWorks

Defining the challenge of teaching TOE

The role of TOE in the management of life-threatening haemodynamic instability is well established. However, proficiency in performing a TOE examination requires significant training and expertise.

As the founder and clinical leader of TOE courses at UCLH, Dr Sue Wright MBBS FRCA was acutely aware that the opportunities to practise and observe peri-operative TOE 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 TOE, 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 TOE 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 TOE 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 synchronised to an ECG 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 TOE image simulation from the 3D virtual heart. The on-screen introduction of a virtual TOE probe down the path of the oesophagus 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 TOE 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

Dr Nick Fletcher, Consultant in Cardiothoracic Anaesthesia and Intensive Care and Honorary Senior Lecturer at St Georges Hospital and Medical School, London runs TOE 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," he said.

"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 TOE skills and probe manipulations or develop appreciation of ‘normal’ outside the OR to decrease the initial TOE learning curve.

"Using HeartWorks in trans-oesophageal echo mode, the heart appears as an actual dynamic image as observed on a real TOE machine. This powerful learning tool has greatly simplified the understanding of TOE anatomy and image orientation and has the potential to literally change the landscape of TOE training. It is a revolutionary advancement in the field of echocardiography with an enormous potential."

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