Technology has been driving health care since the past two decades or more and its use — the applications of artificial intelligence in particular — in improving quality, safety and accuracy in medicine has been under intense focus.
Training next-generation cardiologists is another crucial area where technology has taken over, with simulation-based catheter training emerging as a valuable tool to enhance procedural skills in interventional cardiology
Over 150 young cardiologists and cardiologists-in-training from across the country participated in ‘Back to Basics’, a two-day short course on the basics of cardiac interventions, with hands-on simulator-based training sessions, organised by the Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, on January 20-21.
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Key areas
The key areas of training included various aspects of diagnostic and interventional procedures in patients with narrowing of blood vessels supplying the heart (coronary artery disease), valvular heart diseases and heart diseases affecting newborn and paediatric age group. Another area of focus was the implantation of artificial pacemakers and other devices for patients with disorders of heart rhythm and conduction.
The Fractional Flow Reserve (FFR ) simulator session was done for the first time in India at the workshop. FFR is a procedure done using a catheter at the time of a coronary angiogram to accurately measure blood pressure and flow through a specific part of the coronary artery, so as to decide whether or not an angioplasty (re-vascularisation of a blockage) is necessary.
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“The actual FFR machine is connected to an artificial pump that mimics the heart pumping at the normal artery pressure and a model of the coronary artery circuit. FFR measurement can be done as we do in the Cath lab on a patient and the real-time simulator can simulate all possible situations that a patient might undergo, ” said S. Harikrishnan, Professor of Cardiology and the organiser of the workshop.
The coronary simulator can mimic a patient with a blocked artery and a trainee doctor can do all procedures , including ballooning, stenting etc.
The Optical Cohorence Tomography is intra-coronary artery imaging using a catheter which has a tiny camera attached to its end. It gives three dimensional images from inside the artery so that the cardiologist can determine the composition of a vblockage (fat or calcium) or determine if a stent position is right.
“The simulation-based training is a good opportunity for young doctors to get hands-on training on how to insert a catheter and guide wire, how to do stenting or the right amount of pressure to be exerted to expand the balloon, etc. What is better, they can afford to make mistakes and learn from it because the machine gives a clear report on their performance and where they went wrong,” points out Dr. Harikrishnan
Some of the important simulator sessions included those on femoral and radial coronary angioplasty, wet model rotablation (a catheter-based technique to remove hard plaque from coronary arteries) simulation, percutaneous aortic valve replacement, advanced intracoronary imaging and physiology assessment.
“Simulator-based training has brought in a major change in the way cardiology is taught because the machines can replicate complex physiological changes and enact pre-programmed patient scenarios, which a trainee doctor might never actually get to handle in a Cath lab,” said V.K. Ajithkumar, Head of Cardiology, SCTIMST.
This is the seventh year that the SCTIMST is organising the training programme and it has been growing in popularity across the country. Simulators are very expensive and the workshop is an opportunity for biomedical firms to introduce new technology and for doctors to get trained.