臨床上使用心導管手術搭配閉合器來治療第二型心房中隔缺損已是首選方式，術中併用心臟內超音波觀察心房結構，具有不需全身麻醉之優勢。然而二維心臟內超音波影像不易評估心房立體結構與中隔缺損狀況，對於新進臨床醫師具有一定的困難度。傳統的臨床教學多以術中一對一方式進行教學，此種方式容易造成新進臨床人員缺乏反覆練習的機會，且對手術安全具有爭議與顧慮。本研究將發展一套利用虛擬實境技術模擬心導管手術的訓練系統，此系統不但能提供執行此類手術醫生不斷練習的平台，讓其熟悉手術的各個程序，並對各類突發狀況有正確的處置方式。另外，更有幾項操作時參數的記錄，例如：完成手術的時間、執行氣球擴張術時錯誤的次數與錯誤處理…等等。在完成系統建構同時，我們設計一套完整的心房中隔缺損關閉術的心導管手術實驗，其中，包括導絲、導管、氣球導管的操作以及安普拉茲閉合器的放置。最後，邀請三位具備執行心房中隔缺損關閉術知識但沒有實際臨床手術經驗的人員參與實驗。過程中，先觀察受測者於操作流程的順序是否正確，接著是執行氣球導管擴張術的測試，最後記錄完成模擬手術的時間。根據實驗結果數據顯示，在操作順序的正確率與完成模擬手術的時間都有所提升。未來更可以與現今台灣醫學教育做一結合，成為一套完善的教學平台與示範工具。

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.

[1] 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.
[2] 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.
[3] “http://my.clevelandclinic.org/disorders/atrial_septal_defect/hic_atrial_septal_defect_asd.aspx,” Cleveland Clinic.
[4] “ http://www.americanheart.org/,” American Heart Association.
[5] 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.
[6] “http://www.csmc.edu/,” Heart Center – Echocardiography.
[7] 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.
[8] 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.
[9] “http://www.jysls.com/thread-183538-1-1.html”
[10] “http://gizmodo.com/5285690/ultra+hd-military-f+16-flight-simulator-runs-on-120-pc-graphic-cards, “ GIZMODO.
[11] “http://www.our-picks.com/archives/2007/01/01/how-interactive-can-a-video-game-get/,” News, Articles and Reviews.
[12] 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.
[13] 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.
[14] 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.
[15] 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.
[16] 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.
[17] 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.
[18] 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.
[19] 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.
[20] D. A. Millam and L. C. Hadaway, “On the Road to Successful I.V. Starts,” Nursing, Vol. 30, No. 4, pp. 34-48, 2000.
[21] 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.
[22] 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.
[23] 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.
[24] 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.
[25] “http://www.sensable.com/products/premium.htm,” SensAble Technologies: PHANTOM Premium.
[26] “http://www.immersion.com/medical/products/vascular_access/,” Immersion Corporation – Medical Products Vascular Access.
[27] “http://www.immersion.com/medical/products/endoscopy/,” Immersion Corporation – Medical Products Endoscopy.
[28] “http://www.immersion.com/medical/products/endovascular,” Immersion Corporation – Medical Products Endovascular.
[29] 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.
[30] 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.
[31] 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.
[32] 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.
[33] 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.
[34] “http://www.mentice.com/default.asp,” Mentice.
[35] 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.
[36] “http://en.wikipedia.org/wiki/Strain_gauge, “ Wikipeaia.
[37] “http://www.transducertechniques.com/mdb-load-cell.cfm, “ Transducer Techniques.