Echocardiography is the most important imaging technology to examine the neonatal heart. It is central in diagnosing congenital heart disease, one of the leading causes of neonatal mortality and morbidity in the developed world. Beyond that, examining the neonatal heart by echocardiography has emerged as essential in the management of sick neonates and preterm babies. One of the drawbacks of echocardiography is its user-dependency and its necessary high level of expertise. This expertise can only be achieved with considerable hands-on training. The delicate nature of neonates prohibits the acquisition of the necessary skills on sick patients. Simulation technology has increasingly become a standard in medical training. EchoCom|Neo now offers the opportunity to train echocardiography in neonates without putting patients at risk.
Echocom|Neo is the first ultrasound simulator worldwide dedicated to train echocardiography in infants and newborns. It is the result of 20 years of experience in simulation in echocardiography. The EchoCom simulator is based on real 3D ultrasound data. We believe that realistic data provide better acquisition of skills and knowledge than virtual models.
However, virtual models can help understand the 3D anatomy of the heart and its spatial relationship to the scan plane. We have therefore applied the concept of augmented reality that couples real and virtual data. A virtual probe and scan plane demonstrates this relationship through side-by-side presentation of the virtual and echocardiographic image. Echocom|Neo is designed to impart the two core skills needed by beginners: spatial sense and hand-eye-coordination.
For the beginner in echocardiography data sets of normal hearts allow users to understand the complex anatomy of the heart, its visual presentation by echocardiography and to practice the movements required to obtain standard planes. The more advanced trainee can scan the database for typical neonatal cardiac problems and congenital heart diseases.
Echocom|Neo is used by leading neonatal and cardiac medical centers, among others SickKids in Toronto, Canada (Dr. Patrick Mc Namara), Weill Cornell University, New York, USA (Dr. Alan Groves), the Rotunda Hospital, Dublin, Ireland (Dr. Afif Al-Kuffash), the Royal Brompton Hospital, London, UK (Dr. Nitha Naqvi) and Radboud University Medical Center, Nijmegen, The Netherlands (Dr. Willem-Pieter de Boode).
We believe that this is a fantastic way to increase the exposure of neonatal and cardiology trainees to the whole range of structural abnormalities that newborn babies can have. For novice scanners in the NICU we think the simple act of getting your hands on the echo probe, getting used to seeing what a heart should look like, how the images change as you tilt and rotate the probe, will be a key foundation step in learning to perform echocardiography"
Dr. Alan Groves, Division of Neonatology, Weill Cornell University, New York
Echocom|Neo consists of a dummy manikin and a dummy probe, a 3D tracking device and a computer with pre-installed software. The simulator fits in a custom made case to allow easy transport. On a split screen a virtual scene is presented side-by-side with a 2D echocardiograhic image derived from a 3D data set based on the tracked position of the dummy probe. Due to the use of real 3D data, the derived 2D image is highly realistic.
The images can be manipulated to adjust brightness, contrast, view standard planes or alter the heart rate. The virtual scene consists of a 3D heart that can be rendered transparent to see the valves, the thorax and a virtual ultrasound probe.
The absence of high quality 3D Color Doppler technology so far forbids the application of Color Doppler in Echocom|Neo. To implement Color Doppler and Spectral Doppler we have enriched the volume data with prerecorded 2D films. These films and images are integrated in PowerPoint slides and will be accessible via the applications interface soon.
The manikin is a custom made life-sized newborn. The abdomen and neck are soft to allow indentation, while the thorax is made of less compressible material. The transmitter that is used for the tracking is incorporated into the manikin. A special silicon composition provides a highly realistic skin feel.
The use of real 3D data enables us to build up a data base with a large number of case studies with all types of cardiac diseases. Our library encompasses data sets with the most common congenital cardiac defects and acquired heart diseases. Therefore it is suitable for physicians and technicians working in the field of pediatric cardiology and neonatologists performing echocardiography, so called targeted or functional neonatel echocardiography.
Training could also be augmented by use of simulators in neonatal echocardiography that are increasingly used for teaching on echocardiography courses. This could help in developing skills in acquiring standard echocardiographic views and recognizing common congenital heart conditions.”
Expert consensus statement ‘Neonatologist-performed Echocardiography (NoPE)’—training and accreditation in UK. Singh-Y et al. EurJPediatr(2016)175:281–287
The use of simulators for training in neonatologist performed echocardiography is now endorsed by the European Society for Neonatology.
Michael Weidenbach, MD, PhD. Michael has worked in several projects dealing with simulation in echocardiography. He is board certified pediatric cardiologist, neonatologist and pediatric intensivist, currently working in the Department of Pediatric Cardiology at the Heart Center Leipzig, Germany. He has published several scientific articles, among others the first publications about simulation in transthoracic and transesophageal echocardiography. He is involved in echocardiography workshops around the world.
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