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Calé R. "Observe, simulate, execute and mentor": A contemporary approach to learning in Interventional Cardiology. Rev Port Cardiol 2024; 43:397-398. [PMID: 38759914 DOI: 10.1016/j.repc.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024] Open
Affiliation(s)
- Rita Calé
- Hospital Garcia de Orta, Almada, Portugal.
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Sequeira C, Oliveira-Santos M, Borges Rosa J, Silva Marques J, Oliveira Santos E, Norte G, Gonçalves L. Three-dimensional simulation for interventional cardiology procedures: Face and content validity. Rev Port Cardiol 2024; 43:389-396. [PMID: 38401705 DOI: 10.1016/j.repc.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/29/2023] [Indexed: 02/26/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES Three-dimensional (3D) model simulation provides the opportunity to manipulate real devices and learn intervention skills in a realistic, controlled, and safe environment. To ensure that simulators provide a realistic surrogate to real procedures they must undergo scientific validation. We aimed to evaluate the 3D-printed simulator SimulHeart® for face and content validity to demonstrate its value as a training tool in interventional cardiology (IC). METHODS Health professionals were recruited from sixteen Portuguese IC units. All participants received a 30-minute theoretical introduction, 10-minute demonstration of each task and then performed the intervention on a 3D-printed simulator (SimulHeart®). Finally, a post-training questionnaire focusing on the appearance of the simulation, simulation content, and satisfaction/self-efficacy was administered. RESULTS We included 56 participants: 16 "experts" (general and interventional cardiologists), 26 "novices" (cardiology residents), and 14 nurses and allied professionals. On a five-point Likert scale, the overall mean score of face validity was 4.38±0.35 and the overall mean score of content validity was 4.69±0.32. There was no statistically significant difference in the scores provided by "experts" and "novices". Participants reported a high level of satisfaction/self-efficacy with 60.7% considering it strongly improved their skills. The majority (82.1%) "agreed" or "strongly agreed" that after the simulation they felt confident to perform the procedure on a patient. CONCLUSION The 3D-printed simulator (SimulHeart®) showed excellent face and content validity. 3D simulation may play an important role in future IC training programs. Further research is required to correlate simulator performance with clinical performance in real patients.
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Affiliation(s)
| | - Manuel Oliveira-Santos
- Faculty of Medicine, University of Coimbra, Portugal; Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; 3D CardioSolutions, Coimbra, Portugal
| | - João Borges Rosa
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - João Silva Marques
- 3D CardioSolutions, Coimbra, Portugal; Serviço de Cardiologia, CHULN Hospital de Santa Maria, Lisboa, Portugal; Structural and Coronary Heart Disease Unit, Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | | | - Gustavo Norte
- Centro Hospitalar de Trás-Os-Montes e Alto Douro, Vila Real, Portugal
| | - Lino Gonçalves
- Faculty of Medicine, University of Coimbra, Portugal; Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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3
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Chetan D, Valverde I, Yoo SJ. 3D Printed Models in Cardiology Training. JACC. ADVANCES 2024; 3:100893. [PMID: 38939682 PMCID: PMC11198327 DOI: 10.1016/j.jacadv.2024.100893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
- Devin Chetan
- Division of Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Israel Valverde
- Division of Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Shi-Joon Yoo
- Division of Cardiac Imaging, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
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Mohanadas HP, Nair V, Doctor AA, Faudzi AAM, Tucker N, Ismail AF, Ramakrishna S, Saidin S, Jaganathan SK. A Systematic Analysis of Additive Manufacturing Techniques in the Bioengineering of In Vitro Cardiovascular Models. Ann Biomed Eng 2023; 51:2365-2383. [PMID: 37466879 PMCID: PMC10598155 DOI: 10.1007/s10439-023-03322-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 07/13/2023] [Indexed: 07/20/2023]
Abstract
Additive Manufacturing is noted for ease of product customization and short production run cost-effectiveness. As our global population approaches 8 billion, additive manufacturing has a future in maintaining and improving average human life expectancy for the same reasons that it has advantaged general manufacturing. In recent years, additive manufacturing has been applied to tissue engineering, regenerative medicine, and drug delivery. Additive Manufacturing combined with tissue engineering and biocompatibility studies offers future opportunities for various complex cardiovascular implants and surgeries. This paper is a comprehensive overview of current technological advancements in additive manufacturing with potential for cardiovascular application. The current limitations and prospects of the technology for cardiovascular applications are explored and evaluated.
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Affiliation(s)
| | - Vivek Nair
- Computational Fluid Dynamics (CFD) Lab, Mechanical and Aerospace Engineering, University of Texas Arlington, Arlington, TX, 76010, USA
| | | | - Ahmad Athif Mohd Faudzi
- Faculty of Engineering, School of Electrical Engineering, Universiti Teknologi Malaysia, Johor Bahru, Malaysia
- Centre for Artificial Intelligence and Robotics, Universiti Teknologi Malaysia, Kuala Lumpur, Malaysia
| | - Nick Tucker
- School of Engineering, College of Science, Brayford Pool, Lincoln, LN6 7TS, UK
| | - Ahmad Fauzi Ismail
- School of Chemical and Energy Engineering, Advanced Membrane Technology Research Centre (AMTEC), Universiti Teknologi Malaysia, Skudai, Malaysia
| | - Seeram Ramakrishna
- Department of Mechanical Engineering, Center for Nanofibers & Nanotechnology Initiative, National University of Singapore, Singapore, Singapore
| | - Syafiqah Saidin
- IJNUTM Cardiovascular Engineering Centre, Universiti Teknologi Malaysia, Johor Bahru, Malaysia
| | - Saravana Kumar Jaganathan
- Faculty of Engineering, School of Electrical Engineering, Universiti Teknologi Malaysia, Johor Bahru, Malaysia.
- Centre for Artificial Intelligence and Robotics, Universiti Teknologi Malaysia, Kuala Lumpur, Malaysia.
- School of Engineering, College of Science, Brayford Pool, Lincoln, LN6 7TS, UK.
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5
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Lee KS, Natarajan B, Wong WX, Yousman W, Koester S, Nyotowidjojo I, Lee JZ, Kern KB, Acharya D, Fortuin D, Hung O, Voelker W, Indik JH. A randomized controlled trial of simulation training in teaching coronary angiographic views. BMC MEDICAL EDUCATION 2022; 22:644. [PMID: 36028807 PMCID: PMC9414435 DOI: 10.1186/s12909-022-03705-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 08/17/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Simulation technology has an established role in teaching technical skills to cardiology fellows, but its impact on teaching trainees to interpret coronary angiographic (CA) images has not been systematically studied. The aim of this randomized controlled study was to test whether structured simulation training, in addition to traditional methods would improve CA image interpretation skills in a heterogeneous group of medical trainees. METHODS We prospectively randomized a convenience sample of 105 subjects comprising of medical students (N = 20), residents (N = 68) and fellows (N = 17) from the University of Arizona. Subjects were randomized in a stratified fashion into a simulation training group which received simulation training in addition to didactic teaching (n = 53) and a control training group which received didactic teaching alone (n = 52). The change in pre and post-test score (delta score) was analyzed by a two-way ANOVA for education status and training arm. RESULTS Subjects improved in their post-test scores with a mean change of 4.6 ± 4.0 points. Subjects in the simulation training arm had a higher delta score compared to control (5.4 ± 4.2 versus 3.8 ± 3.7, p = 0.04), with greatest impact for residents (6.6 ± 4.0 versus 3.5 ± 3.4) with a p = 0.02 for interaction of training arm and education status. CONCLUSIONS Simulation training complements traditional methods to improve CA interpretation skill, with greatest impact on residents. This highlights the importance of incorporating high-fidelity simulation training early in cardiovascular fellowship curricula.
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Affiliation(s)
- Kwan S Lee
- Sarver Heart Center, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - Balaji Natarajan
- University of California Riverside School of Medicine, Riverside, CA, USA
| | - Wei X Wong
- Sarver Heart Center, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - Wina Yousman
- Sarver Heart Center, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - Stefan Koester
- Sarver Heart Center, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - Iwan Nyotowidjojo
- Sarver Heart Center, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | | | - Karl B Kern
- Sarver Heart Center, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - Deepak Acharya
- Sarver Heart Center, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | | | - Olivia Hung
- Sarver Heart Center, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | | | - Julia H Indik
- Sarver Heart Center, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA.
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Popovic B, Varlot J, Girard-Bertrand B, Basile JL, Thouvenot C, Fay R, Villani N, Tran N, Camenzind E. Impact of Simulation-Based Training on Radiation Exposure of Young Interventional Cardiologists. Am J Cardiol 2022; 181:25-31. [PMID: 35973834 DOI: 10.1016/j.amjcard.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/26/2022] [Accepted: 07/05/2022] [Indexed: 11/01/2022]
Abstract
Reducing radiation exposure during cardiovascular catheterization is of paramount importance to ensure patient and staff safety. Our study aimed to assess the transferability of acquired skills from virtual reality to the real world, including radioprotection measures during mentored simulation training (ST) in coronary angiography. A total of 10 cardiology residents were evaluated during real-life cases in the catheterization laboratory before (group A) and after mentored ST. The educational effect of mentored simulator training on real-life case performance was evaluated at 2 different time points: within the first week (group B) and after 12 weeks (group C). Compared with group A, the total dose area product (DAP) (µGy•m2) and total air kerma (mGy) were lower after ST: group A: 2,633 (1,723 to 3,617) versus group B: 1,618 (1,032 to 2,562), p <0.05 and 214 (136 to 297) versus 135 (84 to 222), p <0.05, respectively. Concerning operator radiation exposure (µSv), left finger dose: 1,090 (820 to 1,460) versus 635 (300 to 900), p = 0.028; left leg dose 80 (0 to 110) versus 0 (0 to 0), p = 0.027; left eye lens dose: 39 (24 to 69) versus 11 (8 to 20), p <0.0001; and chest dose outside the lead apron: 50 (34 to 88) versus 29 (21 to 50), p <0.003 were significantly lower in the group B than group A. A total of 12 weeks after ST, the total DAP and total air kerma remained stable along with operator exposure except left eye lens dose (µSv): group B: 11 (8 to 20) versus group C: 16 (12 to 27), p = 0.02. In addition, left eye lens dose, left wrist dose, and chest dose outside the lead apron were significantly correlated with total DAP (rs = 0.635, rs = 0.729, and rs = 0, 629, respectively) and total air kerma (rs = 0.488, rs = 0.514, and rs = 0.548, respectively) at 12 weeks. In conclusion, ST for coronary angiography may improve radioprotection learning and should be incorporated into training curricula.
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Affiliation(s)
- Batric Popovic
- Department of Cardiology, University of Lorraine, University Hospital of Nancy, Nancy, France.
| | - Jeanne Varlot
- Department of Cardiology, University of Lorraine, University Hospital of Nancy, Nancy, France
| | - Barbara Girard-Bertrand
- Radiation Protection Unit, University of Lorraine, University hospital of Nancy, Nancy, France
| | - Jean Louis Basile
- Radiation Protection Unit, University of Lorraine, University hospital of Nancy, Nancy, France
| | - Christophe Thouvenot
- Radiation Protection Unit, University of Lorraine, University hospital of Nancy, Nancy, France
| | - Renaud Fay
- Department of Cardiology, University of Lorraine, University Hospital of Nancy, Nancy, France
| | - Nicolas Villani
- Radiation Protection Unit, University of Lorraine, University hospital of Nancy, Nancy, France
| | - Nguyen Tran
- Nancy's School of Surgery, University of Lorraine, Nancy, France
| | - Edoardo Camenzind
- Department of Cardiology, University of Lorraine, University Hospital of Nancy, Nancy, France
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Petri N, Weber C, Maniuc O, Oder D, Lengenfelder B, Voelker W. A Skill Trainer for Balloon/Stent Exchange in Percutaneous Coronary Intervention-Concept and Evaluation. Simul Healthc 2022; 17:249-255. [PMID: 35044355 DOI: 10.1097/sih.0000000000000630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND To prevent complications, uncontrolled movement of the guidewire during a coronary intervention should be avoided. Unintentional withdrawal of the wire can result in the inability to recross a lesion with the risk of myocardial infarction. On the other hand, unintended forward pushing can lead to a coronary perforation. Thus, interventionalists in training should practice keeping the coronary guidewire in a stable position to prevent complications. For this purpose, a skill trainer has been developed, which provides the possibility of unlimited practice outside of the cath lab.The purpose of this study was to assess the effectiveness and the validity of this skills trainer. METHODS Ten novices and 10 participants with experience in diagnostic catheterization underwent training on the skills trainer consisting of 25 procedures. To assess the efficacy of the training module, the mean score of the first 3 procedures was compared with the final 3 procedures in the novice and the advanced group. To determine the construct validity of the simulator, a group of experts (E; performed >1000 percutaneous coronary interventions) also underwent evaluation on the skills trainer. For each procedure, the change in position of the guidewire as well as the time was determined and combined into a skills score with a maximum of 15 points. RESULTS The novice and the advanced group improved significantly throughout the training on the simulator (N: 7.1 ± 2.6 to 12.2 ± 2.0, P = 0.007; A: 8.3 ± 2.0 to 13.2 ± 1.0, P = 0.005, Wilcoxon).The experts scored significantly higher than novices or the advanced participants during their first 3 procedures (E: 12.9 ± 1.0; N: 7.1 ± 2.6, P = 0.001; A: 8.3 ± 2.0, P = 0.001; Mann-Whitney U ). CONCLUSIONS This low-cost task trainer is a valid and effective tool to train adequate balloon/stent exchange while keeping the guidewire in a stable position. Whether the skills acquired on the task trainer can be transferred to procedures performed on patients needs further investigation.
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Affiliation(s)
- Nils Petri
- From the Department of Internal Medicine I, University Hospital Wuerzburg, Wuerzburg, Germany
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8
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CT-Derived 3D Printing for Coronary Artery Cannulation Simulator Design Manufacturing. Bioengineering (Basel) 2022; 9:bioengineering9080338. [PMID: 35892751 PMCID: PMC9330152 DOI: 10.3390/bioengineering9080338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/06/2022] [Accepted: 07/13/2022] [Indexed: 11/17/2022] Open
Abstract
Mastering coronary angiography requires practice. Cadavers and animals do not accurately represent the human anatomical body, and practicing with actual patients has medical safety issues. Simulation offers safe and realistic conditions for cardiology intervention training. In this study, we propose a novel 3D printed simulator that contains physically realistic anatomy and has four access points. It increases safety for patients and students, and production is low-cost. We aimed to make and validate this simulator design as a prototype for coronary cannulation training. It was designed using computed tomography (CT) scan data of aorta, coronary, and heart models, and was printed by 3D printing with resin materials consisting of 75% or 85% clear resin and 25% or 15% flexible resin additive. The simulator was constructed with a camera above the simulator with a degree of LAO of 30°/0°, a display table, and an acrylic box. Twelve validators were interviewed for their expert opinions and analyzed by a qualitative method. They scored the simulator’s suitability on a four-point Likert scale questionnaire. They described the simulator as having admirable values for all aspects (85.8%), curriculum suitability (92%), educational importance (94%), accuracy (83%), efficiency (78%), safety (87.5%), endurance (81.2%), aesthetics (80.7%), storage (85.4%), and affordability (85.8%).
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9
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Lange RA, Mukherjee D. Linking the right education to right heart catheterization. Catheter Cardiovasc Interv 2021. [DOI: 10.1002/ccd.29534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Richard A. Lange
- Division of Cardiovascular Medicine Texas Tech University Health Sciences Center El Paso Texas
| | - Debabrata Mukherjee
- Division of Cardiovascular Medicine Texas Tech University Health Sciences Center El Paso Texas
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Review of the use of simulators in learning revascularization techniques. Gen Thorac Cardiovasc Surg 2021; 69:415-424. [PMID: 33428083 DOI: 10.1007/s11748-020-01577-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE OF REVIEW The apprentice model has been traditionally used to train cardiac surgery and cardiology learners the techniques for revascularization with the use of simulators recently becoming more prevalent in these training programs. This review aims to summarize research conducted on the use of simulation-based teaching (SBT) for trainees learning percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), and off-pump CABG (OPCAB). RECENT FINDINGS Prior literature evaluating the utility of SBT has demonstrated remarkable results including reduced procedural times, use of fluoroscopy, incidence of mistakes, improved stent placement, and confidence with PCI simulators. Similarly, the use of CABG and OPCAB simulators demonstrated improvement in forceps use, needle angles, Objective Structured Assessment of Technical Skill, and reduced completion times. The apprentice model has undoubtedly been successful as the most successful cardiac surgeons and cardiologists have been produced through this training model. Even so, many shortcomings have been identified including insufficient time to teach all relevant technical skills, inadequate exposure to rare adverse events, high-cost, and often unstructured format while being time-consuming and resource-intensive with little objective assessment of proficiency. SBT has been pursued as a potential adjunct to fill the gaps left by the traditional apprentice model. While simulations have been demonstrated to be successful in teaching both experienced and inexperienced learners complex techniques, it is unlikely that training will ever solely rely on simulations. The most efficient method of training learners for revascularization in the future will likely involve a combination of hands-on learning and SBT.
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Czerwińska-Jelonkiewicz K, Montero S, Bañeras J, Wood A, Zeid A, De Rosa S, Guerra F, Tica O, Serrano F, Bohm A, Ahrens I, Gierlotka M, Masip J, Bonnefoy E, Lettino M, Kirchhof P, Sionis A. Current status and needs for changes in critical care training: the voice of the young cardiologists. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2021; 10:94-101. [PMID: 33580774 DOI: 10.1093/ehjacc/zuaa027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/03/2020] [Accepted: 09/22/2020] [Indexed: 01/22/2023]
Abstract
AIMS The implementation of the 2013 European Society of Cardiology (ESC) Core Curriculum guidelines for acute cardiovascular care (acc) training among European countries is unknown. We aimed to evaluate the current status of acc training among cardiology trainees and young cardiologists (<40 years) from ESC countries. METHODS AND RESULTS The survey (March-July 2019) asked about details of cardiology training, self-confidence in acc technical and non-technical skills, access to training opportunities, and needs for further training in the field. Overall 614 young doctors, 31 (26-43) years old, 55% males were surveyed. Place and duration of acc training differed between countries and between centres in the same country. Although the majority of the respondents (91%) had completed their acc training, the average self-confidence to perform invasive procedures and to manage acc clinical scenarios was low-44% (27.3-70.4). The opportunities for simulation-based learning were scarce-18% (5.8-51.3), as it was previous leadership training (32%) and knowledge about key teamwork principles was poor (48%). The need for further acc training was high-81% (61.9-94.3). Male gender, higher level of training centres, professional qualifications of respondents, longer duration of acc/intensive care training, debriefings, and previous leadership training as well as knowledge about teamwork were related to higher self-confidence in all investigated aspects. CONCLUSIONS The current cardiology training program is burdened by deficits in acc technical/non-technical skills, substantial variability in programs across ESC countries, and a clear gender-related disparity in outcomes. The forthcoming ESC Core Curriculum for General Cardiology is expected to address these deficiencies.
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Affiliation(s)
- Katarzyna Czerwińska-Jelonkiewicz
- Andrzej Frycz Modrzewski Krakow University, Gustawa Herlinga-Grudzinskiego 1, 30-705 Krakow, Poland.,Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, Hill End Road, UB9 6JH, London, UK
| | - Santiago Montero
- Department of Internal Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia.,Departament de Medicina, Universitat Autònoma de Barcelona, Plaça Cívica 08193 Bellaterra, Barcelona, Spain
| | - J Bañeras
- Acute Cardiovascular Care Unit, Department of Cardiology, Centre de Simulació Clínica Avançada VHISCA, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, 119, 08035 Barcelona, Spain
| | - A Wood
- University Hospital of Leicester, Leicester, LE3 9QP, UK
| | - A Zeid
- El Maamoura Chest Hospital-Cardiology Department, Alexandria, Egypt
| | - S De Rosa
- Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, 88100 Calabria, Italy
| | - F Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti Umberto I - Lancisi - Salesi", 60121 Ancona Italy
| | - O Tica
- Faculty of Medicine and Pharmacy, Medical Discipline, University of Oradea, 1st of December Square, no 10, Oradea, Bihor County, Romania
| | - F Serrano
- The European Society of Cardiology, Sophia Antipolis, CS 80179 Biot, France
| | - A Bohm
- Department of Acute Cardiology, National Institute of Cardiovascular Diseases, 833 48 Bratislava 37, Slovakia
| | - I Ahrens
- Cardiology and Medical Intensive Care, Augustinerinnen Hospital, 50678 Cologne, Germany
| | - M Gierlotka
- Department of Cardiology, University Hospital, Institute of Medical Sciences, University of Opole, pl. Kopernika 11a 45-040 Opole, Poland
| | - J Masip
- Intensive Care Department, Consorci Sanitari Integral University of Barcelona, Barcelona, AVENIDA JOSEP MOLINS, 29 - 41 08906, Spain
| | - E Bonnefoy
- Intensive Cardiac Care Unit, Cardiologic Hospital Louis Pradel, Hospices Civils de Lyon, Université Lyon 1, 69002 Lyon, France
| | - M Lettino
- Cardiovascular Department, San Gerardo Hospital, ASST-Monza, Via Pegolesi 33 20900 Monza, Italy
| | - P Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, B15 2TT Birmingham, UK.,University Heart and Vascular Center, UKE Hamburg, Martinistraße 52 20246, Hamburg, Germany
| | - A Sionis
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Carrer de Sant Quintí, 89, 08041, Barcelona, Spain
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Utility of Three-Dimensional (3D) Modeling for Planning Structural Heart Interventions (with an Emphasis on Valvular Heart Disease). Curr Cardiol Rep 2020; 22:125. [PMID: 32789652 DOI: 10.1007/s11886-020-01354-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW Advanced imaging has played a vital role in the contemporary, rapid rise of structural heart interventions. 3D modeling and printing has emerged as one of the most recent imaging tools and the implementation of 3D modeling is expected to increase with further advances in imaging, print hardware, and materials. RECENT FINDINGS 3D modeling can be used to educate patients and clinical teams, provide ex vivo procedural simulation, and improve outcomes. Intra-procedural success rates may be improved, and post-procedural complications can be predicted more robustly with appropriate application of 3D modeling. Recent advances in technology have increased the availability of this tool, such that there can be more ready adoption into a routine clinical workflow. Familiarity with 3D modeling and its current utilization and role in structural interventions will help inform how to approach and adapt this exciting new technology.
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Ospel JM, Kashani N, Mayank A, Liebig T, Kaesmacher J, Holtmannspötter M, Shankar J, Almekhlafi MA, Mitha AP, Wong JH, Goyal M. Current and future usefulness and potential of virtual simulation in improving outcomes and reducing complications in endovascular treatment of unruptured intracranial aneurysms. J Neurointerv Surg 2020; 13:251-254. [PMID: 32669397 DOI: 10.1136/neurintsurg-2020-016343] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/08/2020] [Accepted: 06/11/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Simulation training has been used in the aviation industry and surgical specialties for many years, but integration into neurointerventional practice is lagging behind. OBJECTIVE To investigate how neurointerventionalists perceive the usefulness and limitations of simulation tools for the treatment of unruptured intracranial aneurysms (UIAs), and to identify simulation applications that were perceived to be most valuable for endovascular UIA treatment. METHODS A web-based international multidisciplinary survey was conducted among neurointerventionalists. Participants were asked for their perceptions on the usefulness of current simulation tools and the potential impact of future simulation tools in endovascular UIA treatment. They identified simulation applications that could add most value to endovascular UIA treatment and help to specifically reduce endovascular UIA treatment complications. RESULTS 233 neurointerventionalists from 38 countries completed the survey, most of whom (157/233 (67.4%)) had access to a simulator as a trainee, but only 15.3% used it frequently. Most participants (117/233 (50.2%)) considered currently available simulation tools relatively useful for endovascular UIA treatment, with greater value for trainees than for staff. Simulation of new devices (147/233 (63.1%)) and virtual practice runs in individual patient anatomy (119/233 (51.1%)) were considered most valuable for reducing endovascular UIA treatment complications. CONCLUSION Although neurointerventionalists perceived currently available simulation tools relatively useful, they did not use them regularly during their training. A priori testing of new devices and practice runs in individual patient anatomy in a virtual environment were thought to have the greatest potential for reducing endovascular UIA treatment complications.
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Affiliation(s)
- Johanna Maria Ospel
- Department of Radiology, Universitatsspital Basel, Basel, Switzerland.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Nima Kashani
- Department of Radiology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Arnuv Mayank
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Thomas Liebig
- Department of Neuroradiology, LMU Munich, Munich, Germany
| | | | | | - Jai Shankar
- Department of Radiology, University of Manitoba, Winnipeg, Nova Scotia, Canada
| | - Mohammed A Almekhlafi
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Alim P Mitha
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.,Department of Neurosurgery, University of Calgary, Calgary, Alberta, Canada
| | - John H Wong
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.,Department of Neurosurgery, University of Calgary, Calgary, Alberta, Canada
| | - Mayank Goyal
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada .,Department of Radiology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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Pezel T, Coisne A, Picard F, Gueret P. How simulation teaching is revolutionizing our relationship with cardiology. Arch Cardiovasc Dis 2020; 113:297-302. [PMID: 32291188 DOI: 10.1016/j.acvd.2020.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 03/10/2020] [Accepted: 03/11/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Théo Pezel
- Inserm UMRS 942, Department of Cardiology, University of Paris, Lariboisière Hospital, Centre Hospitalo-Universitaire Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France; Division of Cardiology, Johns Hopkins University, 21287-0409 Baltimore, MD, USA; French Commission of Simulation Teaching (Commission d'enseignement par simulation [COMSI]) of the French Society of Cardiology, 75012 Paris, France.
| | - Augustin Coisne
- French Commission of Simulation Teaching (Commission d'enseignement par simulation [COMSI]) of the French Society of Cardiology, 75012 Paris, France; Department of Cardiovascular Explorations and Echocardiography, Heart Valve Clinic, CHU de Lille, 59000 Lille, France; Inserm UMR 1011, 59019 Lille, France; Institut Pasteur de Lille, 59000 Lille, France
| | - Fabien Picard
- French Commission of Simulation Teaching (Commission d'enseignement par simulation [COMSI]) of the French Society of Cardiology, 75012 Paris, France; Department of Cardiology, Cochin Hospital, hôpitaux universitaires Paris Centre, AP-HP, 75014 Paris, France; Inserm U970, Paris Cardiovascular Research Center (PARCC), Georges Pompidou European Hospital, 75015 Paris, France
| | - Pascal Gueret
- French Commission of Simulation Teaching (Commission d'enseignement par simulation [COMSI]) of the French Society of Cardiology, 75012 Paris, France; Department of Cardiology, Foch Hospital, 92150 Suresnes, France
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- Inserm UMRS 942, Department of Cardiology, University of Paris, Lariboisière Hospital, Centre Hospitalo-Universitaire Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France; Division of Cardiology, Johns Hopkins University, 21287-0409 Baltimore, MD, USA; French Commission of Simulation Teaching (Commission d'enseignement par simulation [COMSI]) of the French Society of Cardiology, 75012 Paris, France; Department of Cardiovascular Explorations and Echocardiography, Heart Valve Clinic, CHU de Lille, 59000 Lille, France; Inserm UMR 1011, 59019 Lille, France; Institut Pasteur de Lille, 59000 Lille, France; Department of Cardiology, Cochin Hospital, hôpitaux universitaires Paris Centre, AP-HP, 75014 Paris, France; Inserm U970, Paris Cardiovascular Research Center (PARCC), Georges Pompidou European Hospital, 75015 Paris, France; Department of Cardiology, Foch Hospital, 92150 Suresnes, France
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15
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Dreyfus J, Donal E, Pezel T. Moving Into a New Era for Echocardiography Education With Simulation and Workshop-Based Training. JACC Case Rep 2020; 2:505-507. [PMID: 34317277 PMCID: PMC8311600 DOI: 10.1016/j.jaccas.2019.12.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Julien Dreyfus
- Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France
| | - Erwan Donal
- University of Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, Rennes, France
| | - Théo Pezel
- University of Paris, CHU Lariboisière, Inserm, UMRS 942, Paris, France
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16
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17
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Polymers for additive manufacturing and 4D-printing: Materials, methodologies, and biomedical applications. Prog Polym Sci 2019. [DOI: 10.1016/j.progpolymsci.2019.03.001] [Citation(s) in RCA: 243] [Impact Index Per Article: 48.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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18
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Abstract
Advances in biomedical engineering have led to three-dimensional (3D)-printed models being used for a broad range of different applications. Teaching medical personnel, communicating with patients and relatives, planning complex heart surgery, or designing new techniques for repair of CHD via cardiac catheterisation are now options available using patient-specific 3D-printed models. The management of CHD can be challenging owing to the wide spectrum of morphological conditions and the differences between patients. Direct visualisation and manipulation of the patients' individual anatomy has opened new horizons in personalised treatment, providing the possibility of performing the whole procedure in vitro beforehand, thus anticipating complications and possible outcomes. In this review, we discuss the workflow to implement 3D printing in clinical practice, the imaging modalities used for anatomical segmentation, the applications of this emerging technique in patients with structural heart disease, and its limitations and future directions.
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19
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Oliveira-Santos MD, Oliveira-Santos E, Gonçalves L, Silva Marques J. Cardiovascular Three-Dimensional Printing in Non-Congenital Percutaneous Interventions. Heart Lung Circ 2019; 28:1525-1534. [PMID: 31176626 DOI: 10.1016/j.hlc.2019.04.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 03/01/2019] [Accepted: 04/22/2019] [Indexed: 01/22/2023]
Abstract
Three-dimensional (3D) printing technology is emerging as a potential new tool for the planning of medical interventions. In the last few years, increasing data have accumulated on its ability to guide interventional cardiology procedures, going beyond initial reports in congenital heart disease settings. In fact, there is compelling evidence on the advantages of a 3D-printed guided strategy for left atrial appendage closure, suggesting a high success rate with optimal device selection and lower radiation load. Furthermore, there is emerging experience in aortic root printing, which may improve the success rate and safety of transcatheter aortic valve replacement and may be of particular interest for targeting low-risk populations. Additionally, there are stimulating reports in mitral valve intervention, setting the tone for this new field in cardiovascular percutaneous intervention. In this clinically oriented paper, we will review current 3D printing use in interventional cardiology and we will address future directions, with a focus on procedural planning and medical simulation.
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Affiliation(s)
- Manuel de Oliveira-Santos
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal.
| | | | - Lino Gonçalves
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
| | - João Silva Marques
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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20
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Popovic B, Pinelli S, Albuisson E, Metzdorf PA, Mourer B, Tran N, Camenzind E. The Simulation Training in Coronary Angiography and Its Impact on Real Life Conduct in the Catheterization Laboratory. Am J Cardiol 2019; 123:1208-1213. [PMID: 30732853 DOI: 10.1016/j.amjcard.2019.01.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 01/05/2019] [Accepted: 01/09/2019] [Indexed: 11/15/2022]
Abstract
Our study aimed to evaluate the effectiveness of mentored simulation training (ST) in coronary angiography and to assess the transferability of acquired skills from virtual reality to the real world. Twenty cardiology residents were randomized to ST or control before performing real-life cases in the catheterization laboratory. The control group underwent secondary ST and reperformed real-life cases in the catheterization laboratory. Skill metrics were compared between the ST and the control group, and within the control group between before and after ST. In real-life cases, the procedure time was shorter (p = 0.002), the radiation dose lower (p = 0.001), and the global procedure skill score was higher (p = 0.0001) in the ST group as compared with the control (before ST) group. During virtual ST procedural time (p <0.001), fluoroscopic time (p <0.001), training contrast amount (p <0.001), and global training score (p <0.001) significantly decreased. In the control group, all monitoring procedure parameters were significantly improved after ST, as well as, the global procedure flow score (p <0.0001). In conclusion, simulator-based training in coronary angiography improved operator skills compared with traditional in catheterization laboratory mentor-based training. ST should be incorporated in the curriculum of the interventionalist to improve learning in coronary angiography.
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Affiliation(s)
- Batric Popovic
- Université de Lorraine, 54000, Nancy, France; Département de Cardiologie, Centre Hospitalier Universitaire Brabois, Nancy, France.
| | - Samuel Pinelli
- Université de Lorraine, 54000, Nancy, France; Département de Cardiologie, Centre Hospitalier Universitaire Brabois, Nancy, France
| | - Eliane Albuisson
- Université de Lorraine, 54000, Nancy, France; Plateforme d'aide à la recherche clinique (PARC-UMDS), Centre Hospitalier Universitaire Brabois, Nancy, France
| | - Pierre Adrien Metzdorf
- Université de Lorraine, 54000, Nancy, France; Département de Cardiologie, Centre Hospitalier Universitaire Brabois, Nancy, France
| | - Brice Mourer
- Université de Lorraine, 54000, Nancy, France; Plateforme d'aide à la recherche clinique (PARC-UMDS), Centre Hospitalier Universitaire Brabois, Nancy, France
| | - Nguyen Tran
- Université de Lorraine, 54000, Nancy, France; Ecole de Chirurgie, Faculté de médecine, Nancy, France
| | - Edoardo Camenzind
- Université de Lorraine, 54000, Nancy, France; Département de Cardiologie, Centre Hospitalier Universitaire Brabois, Nancy, France
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21
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22
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Haleem A, Javaid M, Saxena A. Additive manufacturing applications in cardiology: A review. Egypt Heart J 2018; 70:433-441. [PMID: 30591768 PMCID: PMC6303383 DOI: 10.1016/j.ehj.2018.09.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 09/28/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Additive manufacturing (AM) has emerged as a serious planning, strategy, and education tool in cardiovascular medicine. This review describes and illustrates the application, development and associated limitation of additive manufacturing in the field of cardiology by studying research papers on AM in medicine/cardiology. METHODS Relevant research papers till August 2018 were identified through Scopus and examined for strength, benefits, limitation, contribution and future potential of AM. With the help of the existing literature & bibliometric analysis, different applications of AM in cardiology are investigated. RESULTS AM creates an accurate three-dimensional anatomical model to explain, understand and prepare for complex medical procedures. A prior study of patient's 3D heart model can help doctors understand the anatomy of the individual patient, which may also be used create training modules for institutions and surgeons for medical training. CONCLUSION AM has the potential to be of immense help to the cardiologists and cardiac surgeons for intervention and surgical planning, monitoring and analysis. Additive manufacturing creates a 3D model of the heart of a specific patient in lesser time and cost. This technology is used to create and analyse 3D model before starting actual surgery on the patient. It can improve the treatment outcomes for patients, besides saving their lives. Paper summarised additive manufacturing applications particularly in the area of cardiology, especially manufacturing of a patient-specific artificial heart or its component. Model printed by this technology reduces risk, improves the quality of diagnosis and preoperative planning and also enhanced team communication. In cardiology, patient data of heart varies from patient to patient, so AM technologies efficiently produce 3D models, through converting the predesigned virtual model into a tangible object. Companies explore additive manufacturing for commercial medical applications.
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Affiliation(s)
- Abid Haleem
- Department of Mechanical Engineering, Jamia Millia Islamia, New Delhi, India
| | - Mohd Javaid
- Department of Mechanical Engineering, Jamia Millia Islamia, New Delhi, India
| | - Anil Saxena
- Cardiac Pacing & Electrophysiology, Fortis Escorts, New Delhi, India
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23
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Fischer Q, Sbissa Y, Nhan P, Adjedj J, Picard F, Mignon A, Varenne O. Use of Simulator-Based Teaching to Improve Medical Students' Knowledge and Competencies: Randomized Controlled Trial. J Med Internet Res 2018; 20:e261. [PMID: 30249587 PMCID: PMC6231746 DOI: 10.2196/jmir.9634] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 04/10/2018] [Accepted: 06/18/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Simulator-based teaching for coronary angiography (CA) is an attractive educational tool for medical students to improve their knowledge and skills. Its pedagogical impact has not been fully evaluated yet. OBJECTIVE The aim of this study was to compare traditional face-to-face teaching with a simulator-based teaching for the acquisition of coronary anatomy knowledge and CAs interpretation. METHODS A total of 118 medical school students in their fourth to sixth year were prospectively randomized in 2 groups: (1) a control teaching group (n=59, CONT group) and (2) a simulator group (using the Mentice VIST-Lab CA simulator; n=59, SIM group). The CONT group received a PowerPoint-based course, whereas the SIM group received a simulator-based course including the same information. After the course, all students were evaluated by 40 multiple choice questions (maximum of 100 points), including questions on coronary anatomy (part 1), angiographic projections (part 2), and real CAs interpretation (part 3). Satisfaction of the students was also evaluated by a simple questionnaire. RESULTS Student characteristics were identical in both the groups: 62/118 (52.5%) were female and age was 22.6 (SD 1.4) years. Moreover, 35.6% (42/118) were in their fourth year, 35.6% (42/118) were in the fifth year, and 28.8% (34/118) in the sixth year. During the evaluation, SIM students had higher global scores compared with CONT students, irrespective of their year of medical school (59.5 [SD 10.8] points vs 43.7 [SD 11.3] points, P<.001). The same observations were noted for each part of the test (36.9 [SD 6.6] points vs 29.6 [SD 6.9] points, P<.001; 5.9 [SD 3.0] points vs 3.1 [SD 2.8] points, P<.001; and 16.8 [SD 6.9] points vs 10.9 [SD 6.5] points, P<.001; for parts 1, 2, and 3, respectively). Student satisfaction was higher in the SIM group compared with the CONT group (98% vs 75%, P<.001). CONCLUSIONS This study suggests that simulator-based teaching could potentially improve students' knowledge of coronary anatomy, angiography projections, and interpretation of real clinical cases, suggesting better clinical skills. These results should encourage further evaluation of simulator-based teaching in other medical specialties and how they can translate into clinical practice.
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Affiliation(s)
- Quentin Fischer
- Department of Cardiology, Cochin Hospital (Assistance Publique-Hôpitaux de Paris), Paris Descartes University, Paris, France
| | - Yannis Sbissa
- Department of Cardiology, Cochin Hospital (Assistance Publique-Hôpitaux de Paris), Paris Descartes University, Paris, France
| | - Pascal Nhan
- Department of Cardiology, Cochin Hospital (Assistance Publique-Hôpitaux de Paris), Paris Descartes University, Paris, France
| | - Julien Adjedj
- Department of Cardiology, Cochin Hospital (Assistance Publique-Hôpitaux de Paris), Paris Descartes University, Paris, France
| | - Fabien Picard
- Department of Cardiology, Cochin Hospital (Assistance Publique-Hôpitaux de Paris), Paris Descartes University, Paris, France.,Faculty of Medicine, Paris Descartes University, Paris, France
| | - Alexandre Mignon
- Faculty of Medicine, Paris Descartes University, Paris, France.,Surgical Intensive Care Unit, Cochin Hospital (Assistance Publique-Hôpitaux de Paris), Paris Descartes University, Paris, France.,iLumens, Department of Medical Simulation, Paris Descartes University, Paris, France
| | - Olivier Varenne
- Department of Cardiology, Cochin Hospital (Assistance Publique-Hôpitaux de Paris), Paris Descartes University, Paris, France.,Faculty of Medicine, Paris Descartes University, Paris, France.,iLumens, Department of Medical Simulation, Paris Descartes University, Paris, France
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24
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Yip E, Andalam S, Roop PS, Malik A, Trew ML, Ai W, Patel N. Towards the Emulation of the Cardiac Conduction System for Pacemaker Validation. ACM TRANSACTIONS ON CYBER-PHYSICAL SYSTEMS 2018. [DOI: 10.1145/3134845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The heart is a vital organ that relies on the orchestrated propagation of electrical stimuli to coordinate each heartbeat. Abnormalities in the heart’s electrical behaviour can be managed with a cardiac pacemaker. Recently, the closed-loop testing of pacemakers with an emulation (real-time simulation) of the heart has been proposed. This enables developers to interrogate their pacemaker design without having to engage in costly or lengthy clinical trials. Many high-fidelity heart models have been developed, but are too computationally intensive to be simulated in real-time. Heart models, designed specifically for the closed-loop testing of pacemaker logic, are too abstract to be useful for the testing of pacemaker implementations.
In the context of pacemaker testing, compared to high-fidelity heart models, this article presents a more computationally efficient heart model that generates realistic piecewise continuous electrical signals. The heart model is composed of cardiac cells that are connected by paths. Our heart model is based on the Stony Brook cardiac cell model and the UPenn path model, and improves them by stabilising the activation behaviour of the cells and by capturing the piecewise continuous behaviour of electrical propagation. We provide simulation results that show our ability to faithfully model a range of arrhythmias, such as VA conduction, heart blocks, and long Q-T syndrome. Moreover, re-entrant circuits (that cause arrhythmia) can be faithfully modelled, which only the discrete-event UPenn heart model is also able to achieve.
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Affiliation(s)
| | | | | | | | | | - Weiwei Ai
- The University of Auckland, New Zealand
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25
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El Sabbagh A, Eleid MF, Al-Hijji M, Anavekar NS, Holmes DR, Nkomo VT, Oderich GS, Cassivi SD, Said SM, Rihal CS, Matsumoto JM, Foley TA. The Various Applications of 3D Printing in Cardiovascular Diseases. Curr Cardiol Rep 2018; 20:47. [PMID: 29749577 DOI: 10.1007/s11886-018-0992-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW To highlight the various applications of 3D printing in cardiovascular disease and discuss its limitations and future direction. RECENT FINDINGS Use of handheld 3D printed models of cardiovascular structures has emerged as a facile modality in procedural and surgical planning as well as education and communication. Three-dimensional (3D) printing is a novel imaging modality which involves creating patient-specific models of cardiovascular structures. As percutaneous and surgical therapies evolve, spatial recognition of complex cardiovascular anatomic relationships by cardiologists and cardiovascular surgeons is imperative. Handheld 3D printed models of cardiovascular structures provide a facile and intuitive road map for procedural and surgical planning, complementing conventional imaging modalities. Moreover, 3D printed models are efficacious educational and communication tools. This review highlights the various applications of 3D printing in cardiovascular diseases and discusses its limitations and future directions.
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Affiliation(s)
- Abdallah El Sabbagh
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Mackram F Eleid
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Mohammed Al-Hijji
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Nandan S Anavekar
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - David R Holmes
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | | | - Sameh M Said
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Charanjit S Rihal
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | - Thomas A Foley
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.
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26
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Seslar SP, Patton KK. Initial experience with a novel electrophysiology mapping simulator. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:197-202. [PMID: 29266257 DOI: 10.1111/pace.13262] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 11/05/2017] [Accepted: 11/26/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite data supporting the use of simulation training in procedural specialties and accreditation requirements, few options exist for electrophysiology (EP) training. We aimed to develop a low-cost, accessible simulator for training in EP mapping, and to test the simulator in a group of novice users. METHODS Our mapping simulator is composed of three components: an acrylic case representing torso and thigh; three-dimensional (3D) printed cardiac models; and a commercially available mapping system. Using a proprietary flexible material that mimics the consistency of human heart tissue, we created an anatomically accurate model of a normal right atrium (RA) from computed tomography data. We developed a test protocol consisting of two activities: creation of a RA shell and timed navigation to specific locations within the RA shell. Seventeen participants were randomized to either practice versus no practice on the simulator, and repeated simulator and self-assessment tests were performed after 1 week. We measured volume of the RA map and time taken and distance from the target sites for each target location. RESULTS Both groups showed improvement in generation of geometry, volume, time to target, and self-assessed comfort level after initial exposure to the simulator. Compared with no-practice, the practice group demonstrated an improved sense of confidence in mapping. CONCLUSIONS Focused training in EP mapping using a novel simulator created with 3D printed heart models and a standard mapping system is feasible for use in the training environment. Exposure to the simulator is associated with improved mapping skills and trainee comfort level.
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Affiliation(s)
- Stephen P Seslar
- Division of Pediatric Cardiology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Kristen K Patton
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
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27
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Young MN, Markley R, Leo T, Coffin S, Davidson MA, Salloum J, Mendes LA, Damp JB. Effects of Advanced Cardiac Procedure Simulator Training on Learning and Performance in Cardiovascular Medicine Fellows. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2018; 5:2382120518803118. [PMID: 30302396 PMCID: PMC6172931 DOI: 10.1177/2382120518803118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 08/09/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Simulation-based training has been used in medical training environments to facilitate the learning of surgical and minimally invasive techniques. We hypothesized that integration of a procedural simulation curriculum into a cardiology fellowship program may be educationally beneficial. METHODS We conducted an 18-month prospective study of cardiology trainees at Vanderbilt University Medical Center. Two consecutive classes of first-year fellows (n = 17) underwent a teaching protocol facilitated by simulated cases and equipment. We performed knowledge and skills evaluations for 3 procedures (transvenous pacing [TVP] wire, intra-aortic balloon pump [IABP], and pericardiocentesis [PC]). The index class of fellows was reevaluated at 18 months postintervention to measure retention. Using nonparametric statistical tests, we compared assessments of the intervention group, at the time of intervention and 18 months, with those of third-year fellows (n = 7) who did not receive simulator-based training. RESULTS Compared with controls, the intervention cohort had higher scores on the postsimulator written assessment, TVP skills assessment, and IABP skills assessment (P = .04, .007, and .02, respectively). However, there was no statistically significant difference in scores on the PC skills assessment between intervention and control groups (P = .08). Skills assessment scores for the intervention group remained higher than the controls at 18 months (P = .01, .004, and .002 for TVP, IABP, and PC, respectively). Participation rate was 100% (24/24). CONCLUSIONS Procedural simulation training may be an effective tool to enhance the acquisition of knowledge and technical skills for cardiology trainees. Future studies may address methods to improve performance retention over time.
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Affiliation(s)
- Michael N Young
- Cardiology Division, Massachusetts
General Hospital, Boston, MA, USA
| | - Roshanak Markley
- Division of Cardiovascular Medicine,
Virginia Commonwealth University, Richmond, VA, USA
| | - Troy Leo
- Sanger Heart & Vascular Institute,
Carolinas HealthCare System, Charlotte, NC, USA
| | - Samuel Coffin
- MaineHealth Cardiology, Maine Medical
Center, Portland, ME, USA
| | - Mario A Davidson
- Department of Biostatistics, School of
Medicine, Vanderbilt University, Nashville, TN, USA
| | - Joseph Salloum
- Division of Cardiovascular Medicine,
Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lisa A Mendes
- Division of Cardiovascular Medicine,
Vanderbilt University Medical Center, Nashville, TN, USA
| | - Julie B Damp
- Division of Cardiovascular Medicine,
Vanderbilt University Medical Center, Nashville, TN, USA
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28
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Prenner SB, Wayne DB, Sweis RN, Cohen ER, Feinglass JM, Schimmel DR. Simulation-based education leads to decreased use of fluoroscopy in diagnostic coronary angiography. Catheter Cardiovasc Interv 2017; 91:1054-1059. [DOI: 10.1002/ccd.27203] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 06/15/2017] [Indexed: 12/23/2022]
Affiliation(s)
- Stuart B. Prenner
- Division of Cardiology; Bluhm Cardiovascular Institute, Northwestern Memorial Hospital; Chicago Illinois
| | - Diane B. Wayne
- Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago Illinois
| | - Ranya N. Sweis
- Division of Cardiology; Bluhm Cardiovascular Institute, Northwestern Memorial Hospital; Chicago Illinois
| | - Elaine R. Cohen
- Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago Illinois
| | - Joe M. Feinglass
- Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago Illinois
| | - Daniel R. Schimmel
- Division of Cardiology; Bluhm Cardiovascular Institute, Northwestern Memorial Hospital; Chicago Illinois
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29
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Foley TA, El Sabbagh A, Anavekar NS, Williamson EE, Matsumoto JM. 3D-Printing: Applications in Cardiovascular Imaging. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0239-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Sakakushev BE, Marinov BI, Stefanova PP, Kostianev SS, Georgiou EK. Striving for Better Medical Education: the Simulation Approach. Folia Med (Plovdiv) 2017; 59:123-131. [DOI: 10.1515/folmed-2017-0039] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 04/18/2017] [Indexed: 12/15/2022] Open
Abstract
AbstractMedical simulation is a rapidly expanding area within medical education due to advances in technology, significant reduction in training hours and increased procedural complexity. Simulation training aims to enhance patient safety through improved technical competency and eliminating human factors in a risk free environment. It is particularly applicable to a practical, procedure-orientated specialties.Simulation can be useful for novice trainees, experienced clinicians (e.g. for revalidation) and team building. It has become a cornerstone in the delivery of medical education, being a paradigm shift in how doctors are educated and trained. Simulation must take a proactive position in the development of metric-based simulation curriculum, adoption of proficiency benchmarking definitions, and should not depend on the simulation platforms used.Conversely, ingraining of poor practice may occur in the absence of adequate supervision, and equipment malfunction during the simulation can break the immersion and disrupt any learning that has occurred. Despite the presence of high technology, there is a substantial learning curve for both learners and facilitators.The technology of simulation continues to advance, offering devices capable of improved fidelity in virtual reality simulation, more sophisticated procedural practice and advanced patient simulators. Simulation-based training has also brought about paradigm shifts in the medical and surgical education arenas and ensured that the scope and impact of simulation will continue to broaden.
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Harris TH, Adler M, Unti SM, McBride ME. Pediatric heart disease simulation curriculum: Educating the pediatrician. CONGENIT HEART DIS 2017; 12:546-553. [PMID: 28547923 DOI: 10.1111/chd.12483] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/19/2017] [Accepted: 05/06/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Training guidelines state that pediatricians should be able to diagnose, manage, and triage patients with heart disease. Acutely ill cardiac patients present infrequently and with high acuity, yet residents receive less exposure to acute cardiac conditions than previous generations. Trainees must learn to manage these situations despite this gap. Simulation has been used successfully to train learners to provide acute care. We hypothesized that a simulation-based cardiac curriculum would improve residents' ability to manage cardiac patients. METHODS Pediatric residents completed 4 simulation cases followed by debriefing and a computer presentation reviewing the learning objectives. Subjects returned at 1 month for postintervention cases and again at 4-6 months to measure knowledge retention. Cases were scored by 2 raters using a dichotomous checklist. We used repeated measure ANOVA and effect size to compare groups and intra-class correlation (ICC) to assess inter-rater reliability. RESULTS Twenty-five participants were enrolled. Scores were low on pretesting but showed significant improvement (P < .05) in all 4 cases. No decay was noted on late testing. Pre-post effect sizes ranged from 1.1 to 2.1, demonstrating meaningful improvement. Inter-rater reliability (ICC) ranged from 0.61 to 0.93 across cases. CONCLUSIONS This novel simulation-based curriculum targets a gap in pediatric training and offers an effective way to train pediatricians. We plan to expand this curriculum to new populations of participants and have integrated it into our resident cardiology rotation.
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Affiliation(s)
- Tyler H Harris
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh Medical School, Pittsburgh, Pennsylvania, USA
| | - Mark Adler
- Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sharon M Unti
- Division of Academic General Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mary E McBride
- Divisions of Cardiology and Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Harrison CM, Gosai JN. Simulation-based training for cardiology procedures: Are we any further forward in evidencing real-world benefits? Trends Cardiovasc Med 2017; 27:163-170. [DOI: 10.1016/j.tcm.2016.08.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 08/17/2016] [Accepted: 08/22/2016] [Indexed: 12/18/2022]
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Valverde I. Impresión tridimensional de modelos cardiacos: aplicaciones en el campo de la educación médica, la cirugía cardiaca y el intervencionismo estructural. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.09.043] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Aggarwal S, Choudhury E, Ladha S, Kapoor PM, Kiran U. Simulation in cardiac catheterization laboratory: Need of the hour to improve the clinical skills. Ann Card Anaesth 2017; 19:521-6. [PMID: 27397459 PMCID: PMC4971983 DOI: 10.4103/0971-9784.185548] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Simulation is an effective teaching tool to decrease the learning curve for novices without compromising patient safety. Simulation helps interventionalist in mentally translating a two dimentional, black and white image into a usable three dimentional model. It also bridges the gap in training diverse team members on new procedures and products. All simulators have collision detection, i.e., virtual contact forces generated from collision which updates haptic output with new calculations.
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Affiliation(s)
| | - Erin Choudhury
- Department of Cardiac Anaesthesia, CTC, AIIMS, New Delhi, India
| | - Suruchi Ladha
- Department of Cardiac Anaesthesia, CTC, AIIMS, New Delhi, India
| | | | - Usha Kiran
- Department of Cardiac Anaesthesia, CTC, AIIMS, New Delhi, India
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Valverde I. Three-dimensional Printed Cardiac Models: Applications in the Field of Medical Education, Cardiovascular Surgery, and Structural Heart Interventions. ACTA ACUST UNITED AC 2017; 70:282-291. [PMID: 28189544 DOI: 10.1016/j.rec.2017.01.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 09/29/2016] [Indexed: 01/17/2023]
Abstract
In recent years, three-dimensional (3D) printed models have been incorporated into cardiology because of their potential usefulness in enhancing understanding of congenital heart disease, surgical planning, and simulation of structural percutaneous interventions. This review provides an introduction to 3D printing technology and identifies the elements needed to construct a 3D model: the types of imaging modalities that can be used, their minimum quality requirements, and the kinds of 3D printers available. The review also assesses the usefulness of 3D printed models in medical education, specialist physician training, and patient communication. We also review the most recent applications of 3D models in surgical planning and simulation of percutaneous structural heart interventions. Finally, the current limitations of 3D printing and its future directions are discussed to explore potential new applications in this exciting medical field.
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Affiliation(s)
- Israel Valverde
- Sección de Cardiología y Hemodinámica Pediátrica, Servicio de Pediatría, Hospital Virgen del Rocío, Sevilla, Spain; Grupo de Fisiopatología Cardiovascular, Instituto de Biomedicina de Sevilla, IBIS, Hospital Virgen de Rocío/CSIC/Universidad de Sevilla, Seville, Spain; Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, St. Thomas' Hospital, London, United Kingdom; Paediatric Cardiology, Evelina London Children's Hospital at Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
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Validation of a High-Fidelity Electrophysiology Simulator and Development of a Proficiency-Based Simulator Training Program. ACTA ACUST UNITED AC 2017; 12:41-46. [DOI: 10.1097/sih.0000000000000197] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Brunette V, Thibodeau-Jarry N. Simulation as a Tool to Ensure Competency and Quality of Care in the Cardiac Critical Care Unit. Can J Cardiol 2016; 33:119-127. [PMID: 28024550 DOI: 10.1016/j.cjca.2016.10.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/17/2016] [Accepted: 10/19/2016] [Indexed: 02/03/2023] Open
Abstract
Cardiac critical care units are high-risk clinical environments. Medical emergencies are frequent and require the intervention of a cohesive, efficient, and well trained interprofessional team. In modern clinical practice there is increased emphasis on safety but also increased lack of acceptance of medical errors and as a consequence, increased litigation. In the past decade, simulation-based learning has arisen as an effective and safe means to learn and practice acute care setting skills. It has been used and studied in different contexts including procedural skills training, crisis resource management and team training, patient and family member communication skills, and health care system quality improvement. Simulation-based education is a relatively recent teaching strategy and evidence of its efficacy continues to grow. Nevertheless, many influential medical societies are now promoting a simulation-based approach for cardiovascular training and continuing medical education. In this article we review the simulation literature in the intensive care unit and evaluate its integration in coronary care units and postoperative cardiovascular intensive care units. We also provide resources for educators and clinicians who wish to implement simulation workshops in these settings.
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Affiliation(s)
- Véronique Brunette
- Critical Care Department, Hôpital du Sacré-Cœur de Montréal, University de Montréal, Montreal, Québec, Canada; Surgical Department, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada.
| | - Nicolas Thibodeau-Jarry
- Masters of Medical Sciences in Medical Education Program, Harvard Medical School, Boston, Massachusetts, USA
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Editorial Commentary: Bringing precision medicine to intervention: Virtually a reality. Trends Cardiovasc Med 2016; 26:474-6. [DOI: 10.1016/j.tcm.2016.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 03/03/2016] [Indexed: 11/19/2022]
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Westerdahl DE, Henry TD. "More may mean less... " the role for simulation-based medical education in the cardiac catheterization laboratory. Catheter Cardiovasc Interv 2016; 87:389-90. [PMID: 26919338 DOI: 10.1002/ccd.26445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 01/09/2016] [Indexed: 11/12/2022]
Abstract
Implementation of simulation-based medical education (SBME) can improve cardiovascular fellows' angiography skills and knowledge SBME focused on performing coronary angiography shortened procedure times and decreased the use of cine-fluoroscopy The ACGME mandate and SCAI's Simulation Committee recommendations suggest SBME will play an expanding and integral role in the field of cardiovascular medicine.
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Affiliation(s)
- Daniel E Westerdahl
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California
| | - Timothy D Henry
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California
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Diagnostic coronary angiography: initial results of a simulation program. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2015; 17:102-5. [PMID: 26811001 DOI: 10.1016/j.carrev.2015.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 11/25/2015] [Accepted: 12/02/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND The use of simulator-based teaching in cardiology has unfortunately lagged behind other procedural specialties. This study investigates the utility of a simulator-based training program for fellows in cardiovascular disease with no prior experience in diagnostic coronary angiography. METHODS First-year cardiology fellows at University of Illinois-Chicago (UIC) using AngioMentor™ simulators completed benchmark cases requiring basic coronary engagement. Subsequently, benchmark cases were completed one day later and at 9months following 2-3months of training in the cardiac catheterization lab. In addition, 1st year cardiology fellows were compared to 3rd year fellows. Objective measures assessed from benchmark cases were total procedural time, total contrast used, and total fluoroscopy time. RESULTS All 1st year fellows improved their total time to complete the benchmark case from initial to second attempt one day later (14:56 on Day 1, 8:30 on Day 2, P=0.03). Total contrast used (60mL on Day 1, 39mL on Day 2, P=0.11) and total fluoroscopic time (6:30 on Day 1 and 4:26 on Day 2, P=0.16) also both decreased. Overall procedure time and contrast use were similar among 1st and 3rd year fellows after simulation training. Decreases in procedure and fluoroscopy time were maintained in 1st year fellows after 2-3months of training. CONCLUSION Fellows displayed technical and procedural improvement at diagnostic coronary angiography in a short period of time and in a safe, patient free environment. In this study, a computer-based simulator was successfully incorporated into a first year cardiovascular fellowship curriculum and represents a contemporary means to provide the fellow increased procedural training without added risk to the patient. SENTENCE SUMMARY The use of simulator-based teaching in cardiology has unfortunately lagged behind other procedural specialties. In this study, a computer-based simulator was successfully incorporated into a first year cardiovascular fellowship curriculum. A firm teaching curriculum is the next step towards implementing this modality in an organized fashion.
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Voelker W, Petri N, Tönissen C, Störk S, Birkemeyer R, Kaiser E, Oberhoff M. Does Simulation-Based Training Improve Procedural Skills of Beginners in Interventional Cardiology?-A Stratified Randomized Study. J Interv Cardiol 2015; 29:75-82. [DOI: 10.1111/joic.12257] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Wolfram Voelker
- Department of Internal Medicine I-Cardiology; Würzburg University; Germany
| | - Nils Petri
- Department of Internal Medicine I-Cardiology; Würzburg University; Germany
| | | | - Stefan Störk
- Department of Internal Medicine I-Cardiology; Würzburg University; Germany
- Comprehensive Heart Failure Center Würzburg; Würzburg University; Germany
| | | | | | - Martin Oberhoff
- Clinic for Internal Medicine and Cardiology Calw; Calw District Hospital; Germany
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Gómez-Ciriza G, Hussain T, Gómez-Cía T, Valverde I. Potential of 3D-printed models in planning structural interventional procedures. Interv Cardiol 2015. [DOI: 10.2217/ica.15.25] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Schimmel DR, Sweis R, Cohen ER, Davidson C, Wayne DB. Targeting clinical outcomes: Endovascular simulation improves diagnostic coronary angiography skills. Catheter Cardiovasc Interv 2015. [PMID: 26198625 DOI: 10.1002/ccd.26089] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The purpose of this study is to determine the effects of simulation-based medical education (SBME) on the skills required to perform coronary angiography in the cardiac catheterization laboratory. BACKGROUND Cardiovascular fellows commonly learn invasive procedures on patients. Because this approach is not standardized, it can result in inconsistent skill acquisition through exclusion of concepts and skills. Also, the learning curve varies between trainees yielding variability in skill acquisition. Therefore, coronary angiography skills are an excellent target for SBME in an environment in which direct patient care is not jeopardized. METHODS From January 2013 to June 2013, 14 cardiovascular fellows entering the cardiac catheterization laboratory at a tertiary care teaching hospital were tested on an endovascular simulator to assess baseline skills. All fellows subsequently underwent didactic teaching and preceptor-lead training on the endovascular simulator. Topics included basic catheterization skills and a review of catheterization laboratory systems. Following training, all fellows underwent a post-training assessment on the endovascular simulator. Paired t tests were used to compare items on the skills checklist and simulator defined variables. RESULTS Cardiovascular fellows scored significantly higher on a diagnostic coronary angiography skills checklist following SBME using an endovascular simulator. The mean pretest score was 66.6% (SD = 9.7%) compared to 86.0% (SD = 6.3%) following simulator training (P < 0.001). Additional findings include significant reduction in procedure time and use of cine-fluoroscopy at posttest. CONCLUSIONS SBME significantly improved cardiovascular fellows' performance of simulated coronary angiography skills. Standardized simulation-based education is a valuable adjunct to traditional clinical education for cardiovascular fellows.
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Affiliation(s)
- Daniel R Schimmel
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ranya Sweis
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elaine R Cohen
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Charles Davidson
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Diane B Wayne
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Blankenship JC, Rosenfield K, Jennings HS. Privileging and credentialing for interventional cardiology procedures. Catheter Cardiovasc Interv 2015; 86:655-63. [PMID: 25534235 DOI: 10.1002/ccd.25793] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 12/14/2014] [Indexed: 01/28/2023]
Abstract
Local institutional-specific credentialing and privileging for procedures is an important process for ensuring the quality of care provided by interventional cardiologists. Recently revised standards for coronary intervention and the blossoming of structural heart disease programs have generated controversy over these processes. How standards are set for credentialing and privileging is poorly understood by most interventional cardiologists, including those responsible for credentialing and privileging. Requirements from The Joint Commission dictate how credentialing and privileging is performed at hospitals they accredit. Physicians must be recredentialed every 2 years at each hospital, with privileges renewed at that time. Hospitals must review quality of physicians even more frequently using Ongoing Professional Practice Evaluations. Hospitals must also evaluate the performance of physicians when they join a hospital staff or when they begin performing new procedures using Focused Professional Practice Evaluations. Cardiology department directors and catheterization laboratory directors are responsible for recredentialing and reprivileging members of their departments. Individual physicians are responsible for cooperating with these processes, and for periodic recertification with specialty boards and governmental agencies. We provide specific guidance to help physicians navigate these processes.
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Affiliation(s)
| | - Kenneth Rosenfield
- Department of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Henry S Jennings
- Vanderbilt Heart and Vascular Institute, Vanderbilt University School of Medicine, Nashville, Tennessee
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Valverde I, Gomez G, Coserria JF, Suarez-Mejias C, Uribe S, Sotelo J, Velasco MN, Santos De Soto J, Hosseinpour AR, Gomez-Cia T. 3D printed models for planning endovascular stenting in transverse aortic arch hypoplasia. Catheter Cardiovasc Interv 2015; 85:1006-12. [PMID: 25557983 DOI: 10.1002/ccd.25810] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 12/19/2014] [Accepted: 12/25/2014] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To evaluate whether three-dimensional (3D) printed models can be used to improve interventional simulation and planning in patients with aortic arch hypoplasia. BACKGROUND Stenting of a hypoplastic transverse arch is technically challenging, and complications such as stent migration and partial obstruction of the origin of the head and neck vessels are highly dependent on operator skills and expertise. METHODS Using magnetic resonance imaging (MRI) data, a 3D model of a repaired aortic coarctation of a 15-year-old boy with hypoplastic aortic arch was printed. Simulation of the endovascular stenting of the hypoplastic arch was carried out under fluoroscopic guidance in the 3D printed model, and subsequently in the patient. A Bland-Altman analysis was used to evaluate the agreement between measurements of aortic diameter in the 3D printed model and the patient's MRI and X-ray angiography. RESULTS The 3D printed model proved to be radio-opaque and allowed simulation of the stenting intervention. The assessment of optimal stent position, size, and length was found to be useful for the actual intervention in the patient. There was excellent agreement between the 3D printed model and both MRI and X-ray angiographic images (mean bias and standard deviation of 0.36 ± 0.45 mm). CONCLUSIONS 3D printed models accurately replicate patients' anatomy and are helpful in planning endovascular stenting in transverse arch hypoplasia. This opens a door for potential simulation applications of 3D models in the field of catheterization and cardiovascular interventions.
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Affiliation(s)
- Israel Valverde
- Paediatric Cardiology Unit, Hospital Virgen Del Rocio, Seville, Spain; Cardiovascular Pathology Unit, Institute of Biomedicine of Seville, IBIS, Hospital Virgen De Rocio/CSIC/University of Seville, Seville, Spain
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Gosai J, Purva M, Gunn J. Simulation in cardiology: state of the art. Eur Heart J 2015; 36:777-83. [DOI: 10.1093/eurheartj/ehu527] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 12/27/2014] [Indexed: 01/01/2023] Open
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