The Development And Clinical Application Of Transesophageal Echocardiography Simulation System

Background:Transesophageal echocardiography (TEE) is a ultrasonic imaging method withultrasonic probe in esophagus, which can detect the structrures and functional changes inheart and vessels from back of them. The scanning mode of TEE have changed from asingle plane, double planes to multiple planes. And now, multiple planes TEE is widelyused in diagnosis of cardiac diseases and monitoring of open thoracotomy andinterventional operation. However, there are at most180slices in each depth of TEE. Itseriously impact the popularizing of TEE because of lack of Uniform standards andcorresponding Thin layer section anatomy materials to standardize too much and complexslices. Besides, The complexity of the operation and diversity of Image of TEE also affectaccuracy rate of clinical diagnosis. Therefore, it’s urged to establish a Virtual SimulationSystem adapted to TEE to train doctors and Auxiliary clinical diagnosis. In recent years,Medical virtual system is keep developing. It’s based on the datas of human sectionalanatomy and medical imaging. It’s a virtual simulation system creating medical virtualenvironment with computer technique and simulating medical operation. It contains real2-dimentional and3-dimentional anatomic information, and also supplies emulationalapplication environment and platform for clinical medcine(Medical Imaging, surgery, etc.).For these reasons, our reaserch is going to develop a Transesophageal echocardiographysimulation system based on chinese visible human datasets and cardiac duel-sourcecomputered tomography(DSCT) angiography. The aim of our reaserch are preferablyclosing to the leading edges of our subjects, conquering thelimits of TEE examination,assisting clinician to diagnose diseases and providing a virtual training platform.Objectives:To establish high-quality3D visible heart and coronary models based on chinesevisible human datasets and DSCT coronary angiography datasets, discuss and compare the characteristic of the models, complete databank of virtual heart models. Combining thevisible heart models established before and standard slices of TEE together to provideaccurate and precise anatomic contrast. Design Transesophageal echocardiographysimulation system to apply2D and3D anatomical platform for cardiac TEE diagnosis.Methords:1.Using consecutive thin sectional cardiac images of the First Chinese VisibleHuman datasets and DSCT coronary angiography images with no cardiac diseases toestablish three-dimensional visible heart models in volume rendering and surface renderingwith AMIRA software. Studing the characteristics and comparewith each other. Usingsemi-automatic segmentation to rebuild3D coronary visible models, refining to2-3levelbranches.2.Collecting TEE images with healthy crowd to build normal TEE databank.3.Simulating0°-180°TEE images from back of esophagus in3D visible heartsestablished before, and making contrastive reaserch to provide anatomical basis for anyangle image of TEE4.segmenting and naming the anatomic structures of cardiac thin sectional slices inCHV and DSCTA datasets with Amira5.2.1software and Photoshop CS7.0software.5.Selecting TEE images, importing databank of3D visible heart models and3D visiblecoronary models，coding procedure to import the name of anatomical structrues, designingsoftware to establish the Transesophageal echocardiography simulation systemResults:1.Our reaserch successfully established six3D visible heart models with two kindsbased on CVH and DSCTA datasets. The two kinds models are established with elaboratetechnology of image segmentation and visual softwares. The two kinds can clearly display3D anatomical structures of heart and great vessels. They are typical, can virtual cut, rotatewith any angel. But the two kinds also have different merits and demerits because ofdifferent picture quality and anatomical information. Therefore, combining the two kinds ofheart models together, covering the shortages of each other.2.The detailing completed3D visible coronary artery models databank based on heartmodels can fully represent most anatomical structures of coronary artery. It also clearlydisplay the main parts and branches of left and right normal coronary artery. It’s more meticulous based on DSCTA than CVH.3.Cutting virtually in CVH and DSCTA databanks by simulating0°-180°TEE imageswith Amira5.2.1software’s “obliqueslice-rotate” function, and co-display CVH andDSCTA datasets with TEE images in the same angel. It provides contrast in anatomy andimageology for TEE and the data foundation for establishing Transesophagealechocardiography simulation system with high quality.4.Have designed and completed the Transesophageal echocardiography simulationsystem. The system can fully make full use of the advantages of visible models. It displaysdynamically and real-time0°-180°TEE images and the simulated CVH and DSCTAimages with the same angels of TEE. The system can clearly display the name ofanatomical structures and contiguity in the cardiac anatomical slices with pickup mode. Italso can provide anatomical contrast for TEEConclusions:1.By putting all models which established based on CVH and DSCTA together, aaboundant and comprehensive platform of virtual heart is completed and would apply asolid basement of virtual echocardiography system.2.As a significant tool and bridge, the3D visible models of coronary artery serves as a2D and3D anatomical control for TTE and new technique base on it, such as mycardialcontrast echocardiogrphy and Myocardial quantitative analysis diagnosis of coronary heartdisease (CHD), and it helps clinicians identify coronary artery segments that correspond tomyocardial segments as shown in conventional TTE sectional images, thus increasing theaccuracy of TTE diagnosis of CHD.3.DSCT visible hearts can provide the fine control with multiple TEE, they also lay thefoundation for futher establish of TEE simulation system4.Transesophageal echocardiography simulation system can provide a virtual platformfor medical students and clinicians to master the operation of TEE and diagnosis of images.