title: CT2TEE--a novel, internet-based simulator of transoesophageal echocardiography in congenital heart disease.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  To develop an internet-based TEE simulator offering interactive training in cases with and without congenital heart disease.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.forename: Aleksander
authors.initials: A
authors.lastname: Kempny
authors.forename: Adam
authors.initials: A
authors.lastname: Piórkowski
mesh_terms: D003198:Computer Simulation; D003194:Computer-Assisted Instruction; D017548:Echocardiography, Transesophageal / Q000379:methods*; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging*; D006801:Humans; D020407:Internet; D008953:Models, Anatomic; D008955:Models, Cardiovascular