A Free-Access Online Interactive Simulator to Enhance Perioperative Transesophageal Echocardiography Training Using a High-Fidelity Human Heart 3D Model.

The clinical uses of perioperative transesophageal echocardiography have grown exponentially in recent years for both cardiac and noncardiac surgical patients. Yet, echocardiography is a complex skill that also requires an advanced understanding of human cardiac anatomy. Although simulation has changed the way echocardiography is taught, most available systems are still limited by investment costs, accessibility, and qualities of the input cardiac 3-dimensional models. In this report, the authors discuss the development of an online simulator using a high-resolution human heart scan that accurately represents real cardiac anatomies, and that should be accessible to a wide range of learners without space or time limitations.

Virtual Reality-based Methods for Training Novice Electrophysiology Trainees-A Pilot Study.

Developing an accurate and detailed 3-dimensional (3D) mental model of cardiac anatomy is critical for electrophysiology (EP) trainees. Due to its immersive nature, virtual reality (VR) may provide a better learning environment than traditional teaching methods for assimilating 3D cardiac anatomy. The purpose of this pilot study was to evaluate the technical feasibility of an interactive, remote VR-based method for teaching cardiac anatomy to novice EP trainees. We created a shared, remote VR environment that allows the shared viewing of high-resolution 3D cardiac models. Eighteen trainees accepted for pediatric and adult EP fellowships were recruited. We performed a cohort study comparing the traditional teaching methods with the VR learning environment. Participants completed a demographic questionnaire and a satisfaction survey. The adult EP trainees were given a multiple-choice pre- and post-test exam to assess their anatomical knowledge. Both the adult and pediatric EP trainee cohorts rated the VR experience positively and preferred the VR environment to the more traditional teaching method. All the participants expressed interest in incorporating the VR learning environment into the EP fellowship curriculum. The usability of the system was relatively low, with approximately one-third of participants rating the system as hard to use. The impact of the VR session on exam performance was mixed among the adult cohort. We demonstrated the feasibility of gathering geographically dispersed EP fellows in training with a shared VR-based environment to teach cardiac anatomy. Although we were not able to demonstrate a learning benefit over the traditional lecture format in the adult cohort, the training environment was favorably received by all the participants.

The Application of 3D Landmark-Based Geometric Morphometrics towards Refinement of the Piglet Grimace Scale.

Proper methods of assessment to objectively identify pain are essential for welfare improvements of piglets undergoing surgical castration on commercial farms. The Piglet Grimace Scale (PGS) is used to identify changes in facial expressions caused by acute pain in piglets undergoing tail docking and castration. However, subjective scoring methods are a concern for the validation of the PGS. The objectives of this study were to evaluate and refine the PGS through 3D landmark geometric morphometrics. Male piglets (n = 88) were randomly allocated to one of two treatments: castration and sham-castration. Piglet facial images were taken at four time points (before treatment, immediately post-treatment, 1 h post-treatment, and 4 h post-treatment) using a photogrammetry rig. Images were scored by four raters using five facial action units (FAUs): orbital tightening, ear position, temporal tension, lip contraction, and nose bulge/cheek tension. Three-dimensional facial models were generated and landmarked denoting 3 FAUs (orbital tightening, lip contraction, and nose bulge/cheek tension). Results suggest that orbital tightening and ear position may be reliable FAUs for the PGS. However, neither the PGS nor 3D landmark-based geometric morphometrics were able (both p > 0.10) to reliably identify facial indicators of pain in piglets undergoing castration.