Kardiol Pol. 2010 Mar;68(3):374-9.
Echocardiography is one of the most important diagnostic tools in cardiology. The two most widespread modes of echocardiography are transthoracic (TTE) and transoesophageal (TEE) echocardiography, both requiring extensive training. In TEE the manual skills seem to be less important, but it is more challenging for the trainee to imagine the orientation of the cutting planes in space. This becomes more complicated, even for an experienced echocardiographer, in patients with congenital heart disease. There is a growing interest in TEE simulators. All of them are, however, manikin based and their use is limited to only a few medical centres.
To develop an internet-based TEE simulator offering interactive training in cases with and without congenital heart disease.
Because of high spatial resolution we use data from ECG-triggered heart computed tomography (CT) to build the 3D heart model. On every CT image the oesophagus has to be marked and the greyscale values converted in order to mimic the tissue greyscales seen in TEE. After such preparations the 3D set created from CT data can be cut in any plane. The trainee can use the slider buttons in the simulator interface to freely steer the virtual TEE probe. While setting the desired TEE plane the application conducts calculations in order to simulate the typical sonographic artefacts.
We were able to construct an application allowing a TEE simulation based on CT data. There are two versions of the simulator. The first one has to be downloaded to a personal computer together with the CT data. The second one is internet based and freely accessible on the project's web page (www.ct2tee.agh.edu.pl). It doesn't offer real time simulation, but is sufficient to obtain all possible views in the TEE. There are currently three data sets, two with congenital heart disease, and further development of the database and simulator is planned.
The CT2TEE simulator, described in this paper, is the first fully interactive, internet-based TEE simulator. It can be a training tool both in learning TEE basics and in congenital heart disease.
超声心动图是心脏病学中最重要的诊断工具之一。超声心动图最广泛的两种模式是经胸（TTE）和经食管（TEE）超声心动图，这两种模式都需要广泛的培训。在 TEE 中，手动技能似乎不太重要，但对于学员来说，想象空间中切割平面的方向更具挑战性。对于患有先天性心脏病的患者，即使对于有经验的超声心动图医师来说，这也变得更加复杂。人们对 TEE 模拟器越来越感兴趣。然而，所有这些模拟器都是基于人体模型的，并且它们的使用仅限于少数医疗中心。
开发一种基于互联网的 TEE 模拟器，提供具有和不具有先天性心脏病病例的交互式培训。
由于高空间分辨率，我们使用来自心电图触发的心脏计算机断层扫描（CT）的数据来构建 3D 心脏模型。在每幅 CT 图像上，都必须标记食管，并转换灰度值，以模拟 TEE 中看到的组织灰度。经过这样的准备，从 CT 数据创建的 3D 数据集可以在任何平面上切割。学员可以使用模拟器界面中的滑块按钮自由引导虚拟 TEE 探头。在设置所需的 TEE 平面时，应用程序会进行计算，以模拟典型的超声伪影。
我们能够构建一个允许基于 CT 数据进行 TEE 模拟的应用程序。该模拟器有两个版本。第一个版本必须与 CT 数据一起下载到个人计算机上。第二个版本是基于互联网的，可以在项目的网页（www.ct2tee.agh.edu.pl）上免费访问。它不提供实时模拟，但足以获得 TEE 中的所有可能视图。目前有三个数据集，其中两个具有先天性心脏病，并且计划进一步开发数据库和模拟器。
本文描述的 CT2TEE 模拟器是第一个完全交互式的基于互联网的 TEE 模拟器。它既可以作为学习 TEE 基础知识的培训工具，也可以作为先天性心脏病的培训工具。
