World's first virtual heart brings breakthrough in education for
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
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
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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