Computer-based training in two-dimensional echocardiography using an echocardiography simulator.

Two-dimensional (2D) echocardiography is a user-dependent technique that poses some inherent problems to the beginner. The first problem for beginners is spatial orientation, especially the orientation of the scan plane in reference to the 3-dimensional (3D) geometry of the heart. The second problem for beginners is steering of the ultrasound probe. We have designed a simulator to teach these skills. On a computer screen a side-by-side presentation of a 3D virtual reality scene on the right side and a 2D echocardiographic view on the left side is given. The virtual scene consists of a 3D heart and an ultrasound probe with scan plane. The 2D echocardiographic image is calculated from 3D echocardiographic data sets that are registered with the heart model to achieve spatial and temporal congruency. The displayed 2D echocardiographic image is defined and controlled by the orientation of the virtual scan plane. To teach hand-eye coordination we equipped a dummy transducer with a 3D tracking system and placed it on a dummy torso. We have evaluated the usability of the simulator in an introductory course for final-year medical students. The simulator was graded realistic and easy to use. According to a subjective self-assessment by a standardized questionnaire the aforementioned skills were imparted effectively.

[1]  J Z Ayanian,et al.  American College of Cardiology/American Heart Association Clinical Competence Statement on Stress Testing. A Report of the American College of Cardiology/American Heart Association/American College of Physicians-American Society of Internal Medicine Task Force on Clinical Competence. , 2000, Circulation.

[2]  C Sohn,et al.  [New ultrasound simulation system: a method for training and improved quality management in ultrasound examination]. , 2001, Zeitschrift fur Geburtshilfe und Neonatologie.

[3]  Richard Wise,et al.  Science, medicine, and the future , 1998 .

[4]  A. Collins,et al.  Situated Cognition and the Culture of Learning , 1989 .

[5]  M. Yacoub,et al.  Three-dimensional echocardiography can simulate intraoperative visualization of congenitally malformed hearts. , 1995, The Annals of thoracic surgery.

[6]  F J Ten Cate,et al.  Accurate measurement of left ventricular ejection fraction by three-dimensional echocardiography. A comparison with radionuclide angiography. , 1996, Circulation.

[7]  J Spierdijk,et al.  Does training on an anaesthesia simulator lead to improvement in performance? , 1994, British journal of anaesthesia.

[8]  J. Weller,et al.  Simulation in undergraduate medical education: bridging the gap between theory and practice , 2004, Medical education.

[9]  J. Seward,et al.  ACC/AHA clinical competence statement on echocardiography: a report of the American College of Cardiology/American Heart Association/American College of Physicians-American Society of Internal Medicine Task Force on Clinical Competence. , 2003, Journal of the American College of Cardiology.

[10]  Doreen Cleave-Hogg,et al.  A worldwide survey of the use of simulation in anesthesia , 2002, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[11]  R M Harden,et al.  Adoption and integration of simulation‐based learning technologies into the curriculum of a UK Undergraduate Education Programme , 2003, Medical education.

[12]  Thomas Berlage,et al.  Intelligent training system integrated in an echocardiography simulator , 2004, Comput. Biol. Medicine.

[13]  A M DiGioia,et al.  Augmented reality and its future in orthopaedics. , 1998, Clinical orthopaedics and related research.

[14]  M. Abu-Yousef,et al.  Teaching physical examination of the adult liver with use of real-time sonography. , 1998, Academic radiology.

[15]  U. Teichgräber,et al.  Ultrasound anatomy: a practical teaching system in human gross anatomy , 1996, Medical education.

[16]  Christoph Wick,et al.  Augmented Reality Simulator for Training in Two-Dimensional Echocardiography , 2000, Comput. Biomed. Res..

[17]  Clarence D. Kreiter,et al.  Medical students' use of information resources: is the digital age dawning? , 2004 .

[18]  R. Schoefl,et al.  Evaluation of a virtual endoscopy simulator for training in gastrointestinal endoscopy. , 2002, Endoscopy.

[19]  H Reindell,et al.  Simulation of abdomen sonography. Evaluation of a new ultrasound simulator. , 2003, Ultraschall in der Medizin.

[20]  R McCloy,et al.  Virtual reality in surgery , 2001, BMJ : British Medical Journal.

[21]  Robert E Sedlack,et al.  Computer Simulator Training Enhances the Competency of Gastroenterology Fellows at Colonoscopy: Results of a Pilot Study , 2004, American Journal of Gastroenterology.

[22]  Amitai Ziv,et al.  Using a sonographic simulator to assess residents before overnight call. , 2002, AJR. American journal of roentgenology.

[23]  G. Bashein,et al.  A miniature position and orientation locator for three dimensional echocardiography , 1993, Proceedings of Computers in Cardiology Conference.

[24]  Ng Wan Sing,et al.  Augmented reality systems for medical applications. , 1998, IEEE engineering in medicine and biology magazine : the quarterly magazine of the Engineering in Medicine & Biology Society.

[25]  R. Evans,et al.  Reliability of the "Draw-a-Man" test. , 1975 .

[26]  M.E. Legget,et al.  System for quantitative three-dimensional echocardiography of the left ventricle based on a magnetic-field position and orientation sensing system , 1998, IEEE Transactions on Biomedical Engineering.

[27]  E A Geiser,et al.  Guidelines for cardiac sonographer education: recommendations of the American Society of Echocardiography Sonographer Training and Education Committee. , 2001, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.