||Development of a Cardiac Catheterization Simulator for ASD Procedures
||Institute of Biomedical Engineering
Atrial Septal Defect (ASD)
intracardiac echocardiography (ICE)
Virtual Reality (VR)
Transcatheter device closure is one of the treatments for secundum type atrial septal defect (ASD) in clinical operation currently. The advantage of transcatheter device closure with intracardiac echocardiography (ICE) guidance can avoid general anesthesia. However, clinicians need to image the 3D structure and ASD of the heart during the operation, and there may be higher risk during the procedure. Thus it is rather difficult for inexperienced clinicians to learn the operation procedure. Usually, new physicians don’t have adequate opportunities for practicing ASD surgery, because the most common mode of teaching is a manner of one-to-one during the procedure of operation. It’s controversial and scrupulous for surgery safety. For the purpose of clinical training, this study developed a simulation system of cardiac catheterization and ASD closure procedure with the Virtual Reality (VR) technique. With this system, clinicians can repetitively practice the procedure of the cardiac catheterization and ASD closure. Steps of the procedure will be learned and potential risks could be avoided before treatment. Finally, we invite three subjects to participate the experiments in this study and the results indicate that the performances of proposed system demonstrated greater efficiency and higher accuracy in clinical training for cardiac catheterization in ASD.
Chapter 1 Introduction 1
1.1 Motivations and the aims of this study 1
1.1.1 Introduction to ASD 2
1.1.2 The characteristic of VR technology 3
1.1.3 Introduction to ICE 6
1.2 Literature review 6
Chapter 2 Methodology 12
2.1 System design 12
2.1.1 Encoder 13
2.1.2 Load cell 15
2.2 Hardware design 16
2.3 User interface 19
2.4 The program flowchart 19
2.5 Calibration of displacement and rotation measurement 20
Chapter 3 Results and Discussions 23
3.1 Catheter movement simulation 24
3.2 Catheter rotation simulation 24
3.3 Perturbation of blood simulation 25
3.4 Balloon inflation simulation 25
3.5 Amplatzer implementing 26
3.6 User interface 26
3.7 Operation sequence flowchart 30
Chapter 4 Conclusions 33
 S. Betsou, E.P. Efstathopoulos, D. Katritsis, K. Faulkner, and G. Panayiotakis, “Patient radiation doses during cardiac catheterization procedures,” The British Journal of Radiology, Vol. 71, No. 846, pp. 634-639, 1998.
 H. C. Lue, T. C. Sung, S. H. Hou, M. H. Wu, S. J. Cheng, S. H. Chu, and C. R. Hung, “Ventricular Septal Defect in Chinese with Aortic Valve Prolapse and Aortic Regurgitation,” Heart and Vessels, Vol.2, No. 2, pp. 111-116, 1986.
 “http://my.clevelandclinic.org/disorders/atrial_septal_defect/hic_atrial_septal_defect_asd.aspx,” Cleveland Clinic.
 “ http://www.americanheart.org/,” American Heart Association.
 T. D. King, S. L. Thompson, C. Steiner, and N. L. Mills, “Secundum atrial septal defect. Nonoperative closure during cardiac catheterization,” JAMA, Vol. 235, No. 23, pp. 2506-2509, 1976.
 “http://www.csmc.edu/,” Heart Center – Echocardiography.
 H. P. Kühl, R. Hoffmann, M. W. Merx, A. Franke, C. Klotzsch, W. Lepper, T. Reineke, J. Noth and P. Hanrath, “Transthoracic echocardiography using second harmonic imaging: diagnostic alternative to transesophageal echocardiography for the detection of atrial right to left shunt in patients with cerebral embolic events,” Journal of American College of Cardiology, Vol. 34, No. 6, pp. 1823-1830, 1999.
 R. E. Kardon, M. C. Sokoloski, D. S. Levi, J. S. Perry II, D. J. Schneider, V. Allada and J. W. Moore, “Transthoracic echocardiographic guidance of transcatheter atrial septal defect closure,” American Journal Cardiology, Vol. 94, No. 2, pp. 256-260, 2004.
 “http://gizmodo.com/5285690/ultra+hd-military-f+16-flight-simulator-runs-on-120-pc-graphic-cards, “ GIZMODO.
 “http://www.our-picks.com/archives/2007/01/01/how-interactive-can-a-video-game-get/,” News, Articles and Reviews.
 S. F. F. Gibson, J. Samosky, A. Mor, C. Fyock, W. E. L. Grimson, K. Takeo, R. Kikinis, H. C. Lauer, N. McKenzie, S. Nakajima, T. Ohkami, R. Osborne, and A. Sawada, “Simulating arthroscopic knee surgery using volumetric object representations, real-time volume rendering and haptic feedback,” Proceedings of the First Joint Conference on Computer Vision, Virtual Reality and Robotics in Medicine and Medial Robotics and Computer-Assisted Surgery, Vol. 1205, pp. 367-378, 1997.
 E. Ulrich, K. Ludger, M. Wolfgang, Z. Rolf, and M. Wolf, “Virtual reality: Preparation and execution of sinus surgery,” Computer Aided Surgery, Vol. 3, No. 1, pp. 45-50, 1998.
 U. G. Kühnapfel, B. Neisius, H. G. Krumm, C. Kuhn, and M. Hübner, “CAD-Based Simulation and Modeling for Endoscopic Surgery,” Proceedings SMIT’94, 1994.
 U. G. Kühnapfel, H. Krumm, C. Kuhn, M. Hübner, and B. Neisius, “Endosurgery Simulations with KISMET: A Flexible Tool for Surgical Instrument Design, Operation Room Planning and VR Technology Based Abdominal Surgery Training,” Proceedings VR’95 WORLD Conference, 1995.
 S. Gillner, M. O. Schnur, B. Mentges, U. Kuhnapfel, and G. F. Buess, “VR simulation of a laparoscopic gall bladder removal: Evaluation for surgical training,” Proceedings CAR’97, pp. 565-568, 1998.
 H. K. Çakmak and U. Kühnapfel, “Animation and Simulation Techniques for VR-Training Systems in Endoscopic Surgery,” Proceedings of the Eleventh Eurographics Workshop, pp. 173-185, 2000.
 U. Kühnapfel, H. K. Cakmak, and H. MaaB, “Endoscopic surgery training using virtual reality and deformable tissue simulation,” Computers & Graphics, Vol. 24, pp. 671-682, 2000.
 K. B. Frame and C. Chrystal, “Faculty and clinicians collaborate to teach basic intravenous skills to senior baccalaureate nursing students,” Journal of Intravenous Nursing, Vol. 22, No. 5, pp. 253-256, 1999.
 D. A. Millam and L. C. Hadaway, “On the Road to Successful I.V. Starts,” Nursing, Vol. 30, No. 4, pp. 34-48, 2000.
 H. A. Schwid, G. Rooke, B. K. Ross, and M. Sivarajan, “Use of a Computerized Advanced Cardiac Life Support Guidelines Better than a Textbook Review,” Critical Care Medicine, Vol. 27, No. 4, pp. 821-824, 1999.
 J. B. Prystowsky, G. Regehr, D. A. Rogers, J. P. Loan, L. L. Hiemenz, and K. M. Smith, “A Virtual Reality Module for Intravenous Catheter Placement,” The American Journal of Surgery, Vol. 177, No. 2, pp. 171-175, 1999.
 D. Steven, C. Stephane, M. Dwight, W. S. David, and A. F. Margaret, “Designing a computer-based simulator for interventional cardiology training,” Catheterization and Cardiovascular Interventions, Vol. 51, No. 4, pp. 522-527, 2000.
 Y. Cai, C. Chui, X. Ye, Y. Wang, and J. H. Anderson, “VR simulated training for less invasive vascular intervention,” Computers & Graphics, Vol. 27, pp. 215-221, 2003.
 “http://www.sensable.com/products/premium.htm,” SensAble Technologies: PHANTOM Premium.
 “http://www.immersion.com/medical/products/vascular_access/,” Immersion Corporation – Medical Products Vascular Access.
 “http://www.immersion.com/medical/products/endoscopy/,” Immersion Corporation – Medical Products Endoscopy.
 “http://www.immersion.com/medical/products/endovascular,” Immersion Corporation – Medical Products Endovascular.
 A. G. Gallagher, E. M. Ritter, H. Champion, G. Higgins, M. P. Fried, G. Moses, C. D. Smith, and R. M. Satava, “Virtual reality simulation for the operating room: proficiency-based training as a paradigm shift in surgical skills training,” Annals of Surgery, Vol.241, No. 2, pp. 364-372, 2005.
 J. S. Tsang, P. A. Naughton, S. Leong, A. D. K. Hill, C. J. Kelly, A. L. Leahy, “Virtual reality simulation in endovascular surgical training,” The Surgeon, Vol. 6, No. 4, pp. 214-220, 2009.
 R. A. Chaer, B. G. DeRubertis, S. C. Lin, H. L. Bush, J. K. Karwowski, D. Birk, N. J. Morrissey, P. L. Faries, J. F. McKinsey, and K. C. Kent, “Simulation Improves Resident Performance in Catheter-Based Intervention,” Annals of Surgery, Vol. 244, No. 3, pp. 343-352, 2006.
 R. Aggarwal, S. A. Black, J. R. Hance, A. Darzi, and N. J. W. Cheshire, “Virtual Reality Simulation Training can Improve Inexperienced Surgeons’ Endovascular Skills,” European Journal of Vascular and Endovascular Surgery, Vol. 31, No. 6, pp. 588-593, 2006.
 D. A. Gould, J. A. Reekers, D. O. Kessel, N. C. Chalmers, M. Sapoval, A. A. Patel, G. J. Becker, M. J. Lee, and L. Stockx, “Simulation devices in interventional radiology: validation pending,” Journal of Vascular and Interventional Radiology, Vol. 17, pp. 215-216, 2006.
 “http://www.mentice.com/default.asp,” Mentice.
 G. L. Hicks, J. Gangemi, R. E. Angona, P. S. Ramphal, R. H. Feins and J. I. Fann, “Cardiopulmonary bypass simulation at the Boot Camp,” The Journal of Thoracic and Cardiovascular Surgery, Vol. 141, No. 1, pp. 284-292, 2011.
 “http://en.wikipedia.org/wiki/Strain_gauge, “ Wikipeaia.
 “http://www.transducertechniques.com/mdb-load-cell.cfm, “ Transducer Techniques.