A simulator and a simulator-based training method for adrenal vein blood sampling

Abstract

This invention relates to the field of simulation training, specifically a simulator and a simulator-based training method for adrenal vein blood sampling. The method includes adjusting the simulator and simulated surgical instruments to an initial preparation state; training personnel performing simulated surgical procedures in the simulator in this initial preparation state; recording the simulated surgical procedures to obtain a training personnel simulation process record; acquiring an expert simulation process record; and analyzing the training performance of the training personnel corresponding to the expert simulation process record based on the expert simulation process record. This invention can improve the efficiency of training for adrenal vein blood sampling using simulated DSA-guided vascular imaging technology.

Description

Technical Field

[0001] This invention belongs to the field of simulation training technology, and in particular relates to a simulator and a training method for adrenal vein blood collection based on the simulator. Background Technology

[0002] Primary aldosteronism (PA) is one of the most common causes of secondary hypertension, with a prevalence of approximately 5%–10% in the general hypertensive population. Treatment for PA depends primarily on whether aldosterone secretion is dominant, thus determining whether surgical or pharmacological treatment is necessary. Compared to pharmacological treatment, surgical treatment not only improves blood pressure biochemical indicators better but also significantly reduces the long-term risk of cardiovascular and cerebrovascular events. Therefore, determining whether there is a significant dominance in aldosterone secretion by the adrenal glands is crucial. Adrenal venous sampling (AVS) is an interventional technique where, under CT (computed tomography) guidance, catheters are inserted into both adrenal veins. Angiography visualizes the vascular morphology, confirms correct placement, and blood samples are collected to measure aldosterone and cortisol concentrations, determining the success of the AVS and the presence of dominant aldosterone secretion. AVS is the gold standard recommended by domestic and international PA diagnosis and treatment guidelines or expert consensus for determining the presence of a significant dominance in aldosterone secretion by the adrenal glands.

[0003] AVS is a challenging invasive procedure, and beginners often struggle with precise positioning, which affects the success rate of AVS cannulation and significantly limits its widespread clinical application.

[0004] The right adrenal vein usually originates from the right posterolateral wall of the inferior vena cava, while the left adrenal vein usually merges with the left inferior phrenic vein and then flows downward and medially into the left renal vein. The right adrenal vein is not only short but also has a smaller diameter. In addition, there are small veins such as accessory hepatic veins, renal capsule veins, and intercostal veins around the right adrenal vein, which often cause confusion during cannulation. Therefore, correctly identifying the angiographic morphology of the right adrenal vein is crucial to ensuring successful blood collection.

[0005] Currently, AVS (Adrenal Vein Surgery) training primarily combines theoretical learning with clinical practice. Due to the high difficulty of blood collection, extensive experience in adrenal vein blood collection is required to perform the procedure proficiently, quickly, and effectively. However, due to considerations of surgical volume and patient safety, training often includes limited clinical practice, resulting in a slow improvement in the success rate. This also increases the learning difficulty and hinders the widespread application of adrenal vein blood collection. According to Lin Yueli et al.'s analysis of the learning curve for adrenal vein blood collection, a significant improvement in the success rate only occurs after approximately 30 AVS procedures performed by the same surgeon.

[0006] Currently, many clinical training programs utilize 3D-printed models or VR surgical operating systems to improve beginners' operational skills and shorten the learning curve. However, these training systems involve peripheral blood vessels or the coronary system, and there is currently no dedicated adrenal vein simulation system. Patent application number CN202221947506 discloses a venous interventional surgery training simulation system, including a three-dimensional reconstructed venous system area, a fluid tank, dual shut-off valves, a catheter, a circulation pump, a support-type macro wide-angle lens, and a display. The three-dimensional reconstructed venous system area includes the superior vena cava, heart, inferior vena cava, right kidney and right renal vein, right adrenal gland and right adrenal vein, left kidney and left renal vein, left adrenal gland and left adrenal vein, lumbar vein, right spermatic vein, left spermatic vein, right femoral vein, and left femoral vein. This patent provides a relatively complete view of abdominal veins, but it is mainly used for training vascular interventional embolization surgery. It lacks training in adrenal vein blood sampling procedures such as catheterization and angiography, angiography morphology recognition, and interference vein identification, thus failing to effectively train clinical operation of adrenal vein embolization (AVS). Patent application CN202411757567 discloses an adrenal vein blood sampling auxiliary system based on three-dimensional reconstruction, including an image acquisition module, an image preprocessing module, a contour recognition module, a three-dimensional reconstruction module, a model correction module, a rendering module, and a positioning assistance module. The main purpose of this system is to address complex vascular circuits, improve the accuracy of three-dimensional reconstruction, provide accurate guidance for adrenal vein blood sampling, and assist clinical decision-making. However, this system primarily involves secondary processing and development of medical CT data for virtual imaging, providing preoperative guidance to doctors, but its effect on improving the operational proficiency of beginners is not significant. Virtual technology can provide different training modules based on different patient conditions, but it is expensive. Furthermore, due to the lack of a realistic fluid environment, virtual technology cannot simulate the impact and resistance of blood flow on interventional devices (such as catheters and guidewires), resulting in an inability to reproduce the differentiated force feedback of different devices under real hemodynamic conditions, leading to a significant gap between virtual technology and actual clinical operation. On the other hand, physical simulation systems (such as 3D printed models) can highly replicate the human vascular system and can simulate parameters such as pressure and flow rate in human blood vessels when connected to the circulatory system. However, physical simulation systems have a long production cycle and cannot switch training modules for different patients in real time. They also cannot be operated under the guidance of DSA (digital subtraction angiography), which is inconsistent with the clinical operation of adrenal vein blood sampling, which mainly observes the status of the instruments under DSA to identify the catheter insertion status.

[0007] Therefore, there is an urgent need for a simulator and a simulator-based training method for adrenal vein blood sampling to improve the efficiency of adrenal vein blood sampling training. Summary of the Invention

[0008] This invention provides a simulator and a simulator-based training method for adrenal vein blood sampling, which can improve the efficiency of adrenal vein blood sampling training using simulated DSA vascular imaging technology.

[0009] To achieve the above objectives, the present invention provides a simulator, which includes a human simulation system 1 for simulating the human vascular operating environment; and a simulated DSA angiography system 2 for providing simulated DSA image guidance and virtual angiography morphology recognition in a radiation-free environment.

[0010] To address the aforementioned problems, this invention also provides a training method for adrenal vein blood sampling simulating DSA-guided vascular imaging technology, comprising:

[0011] The simulator and surgical instruments are adjusted to the initial preparation state. The trainees perform surgical simulation operations in the simulator in the initial preparation state, and the surgical simulation operation process is recorded to obtain the trainee simulation process record.

[0012] The trainees perform simulated surgical procedures in a simulator in an initial preparation state, including:

[0013] The trainees disinfected the puncture area set in the simulated vascular network in the initial preparation state, and performed a simulated femoral vein puncture operation in the puncture area under the guidance of the preset medical ultrasound equipment. After successful puncture, the puncture sheath was inserted in the simulator.

[0014] The simulated surgical instruments are inserted into the simulator through a puncture sheath. Guided by the virtual fluoroscopic image of the human body displayed in the preset simulated DSA angiography system, the catheter and guidewire in the simulated surgical instruments are delivered to the virtual spine. The system also identifies whether the catheter has been inserted into the target blood vessel and injects the simulated contrast agent into the target blood vessel.

[0015] Based on the virtual angiography pattern displayed by the simulator in the preset simulated DSA angiography system after the injection of the simulated contrast agent, it is determined whether the catheter has entered the target blood vessel. When the catheter enters the target blood vessel, the sequential operation of adrenal vein blood sampling and inferior vena cava blood sampling is performed in the simulator to complete the surgical simulation process.

[0016] Obtain expert simulation process records and analyze the training performance of trainees corresponding to the expert simulation process records based on these records.

[0017] This invention adjusts the simulator and simulated surgical instruments to their initial preparation state, ensuring the standardization and repeatability of the training environment. Each training session is conducted under consistent conditions, avoiding training deviations caused by differences in equipment status and improving the usability and safety of the training. Furthermore, trainees disinfect the puncture area set in the simulated vascular network in the initial preparation state and perform a simulated femoral vein puncture in the puncture area under the guidance of a preset medical ultrasound device. After a successful puncture, a puncture sheath is inserted into the simulator. By simulating real clinical procedures, trainees can master the basic skills of adrenal vein blood sampling. In addition, the simulated surgical instruments enter the simulator through the puncture sheath, and under the guidance of a virtual fluoroscopic image of the human body displayed in a preset simulated DSA angiography system, the catheter and guidewire in the simulated surgical instruments are advanced to the virtual spine. The system identifies whether the catheter has been inserted into the target blood vessel and injects simulated contrast agent into the target blood vessel, enhancing the trainees' ability to navigate and identify target blood vessels under image guidance. Through virtual fluoroscopic images, trainees can learn to operate catheters and guidewires in complex vascular structures, avoiding accidental entry into interfering vessels such as accessory hepatic veins and renal capsule veins. Furthermore, based on the virtual angiography morphology displayed by the simulator in a preset simulated DSA angiography system after the injection of the simulated contrast agent, it can be determined whether the catheter has entered the target vessel. When the catheter enters the target vessel, the sequential operation of adrenal vein blood sampling and inferior vena cava blood sampling is performed in the simulator to complete the surgical simulation process, which can enhance the trainees' accuracy in angiography morphology recognition and blood sampling sequence operation. Finally, by acquiring expert simulation process records and analyzing the training performance of trainees based on these records, the efficiency of adrenal vein blood sampling training can be improved. Attached Figure Description

[0018] Figure 1 This is a flowchart illustrating a training method for adrenal vein blood sampling using simulated DSA-guided vascular imaging technology, provided in an embodiment of the present invention.

[0019] Figure 2 This is a schematic diagram of a simulator structure provided in an embodiment of the present invention;

[0020] Figure 3 This is a structural framework diagram of a human simulation system in a simulator provided in an embodiment of the present invention;

[0021] Figure 4 This is a system framework diagram of a simulator for simulating a DSA angiography system according to an embodiment of the present invention.

[0022] The attached figures are labeled as follows: 1. Simulated human system; 2. Simulated DSA angiography system; 11. Simulated venous circulation system; 12. 3D printed blood vessel system; 21. Simulated DSA device; 22. Image acquisition device; 23. Sensor; 24. Processor; 111. Liquid tank; 112. Circulation pump; 113. Flow control valve; 121. Femoral vein puncture module; 122. Basilic vein approach; 123. Median cubital vein; 124. Brachial vein; 125. Basilic vein; 126. Cephalic vein; 127. Right subclavian vein; 128. Right external jugular vein; 129. Right internal jugular vein; 1210. Left subclavian vein; 1211. Right heart chamber 1212. Left inferior diaphragmatic vein; 1213. Left adrenal vein; 1214. Left renal vein; 1215. Left common iliac vein; 1216. Left internal iliac vein; 1217. Left femoral vein; 1218. Right femoral vein; 1219. Right internal iliac vein; 1220. Right common iliac vein; 1221. Right renal vein; 1222. Right adrenal vein; 1223. Accessory hepatic vein; 1224. Inferior vena cava; 1225. Superior vena cava; 1226. Base; 211. DSA-like software; 212. Monitor; 2111. Angiography morphology image group module; 2112. Virtual perspective image module for human skeletal tissue.

[0023] The realization of the objective, functional features and advantages of the present invention will be further explained in conjunction with the embodiments and with reference to the accompanying drawings. Detailed Implementation

[0024] It should be understood that the specific embodiments described herein are merely illustrative of the invention and are not intended to limit the invention.

[0025] Reference Figure 2 The diagram shown is a schematic diagram of a simulator structure provided in an embodiment of the present invention.

[0026] It is understood that the simulator includes:

[0027] Human Simulation System 1, used to simulate the operating environment of human blood vessels;

[0028] The simulated DSA imaging system 2 is used to provide simulated DSA image guidance and virtual imaging morphology recognition in a radiation-free environment.

[0029] Reference Figure 3 The diagram shown is a structural framework diagram of a human simulation system in a simulator provided in an embodiment of the present invention.

[0030] Understandably, the simulated human system 1 includes:

[0031] 3D printed vascular system 12, used to simulate the structure of human veins;

[0032] The simulated venous circulation system 11 is used to provide a simulated blood circulation environment for the 3D printed vascular system 12.

[0033] Understandably, the 3D printed blood vessel system 12 includes: a base 1226; a simulated blood vessel network disposed on the base 1226; and a femoral vein puncture module 121 for puncturing the puncture area set in the simulated blood vessel network.

[0034] Understandably, 3D-printed vascular systems use the entire human blood vessel system as a basis, which can form a continuous blood supply pathway. This makes the training more representative and further increases the efficiency and accuracy of the training.

[0035] Furthermore, the simulated vascular network includes a superior vena cava network, an inferior vena cava network, a confluence of the superior vena cava network and the inferior vena cava network, and a right heart ventricle 1211; a virtual spine is marked in the simulated vascular network.

[0036] Furthermore, the simulated venous circulation system 11 includes a circulation pipeline, and a liquid tank 111, a circulation pump 112, and a flow regulating valve 113 disposed in the circulation pipeline; the simulated vascular network is connected in series in the circulation pipeline; wherein, the liquid in the circulation pipeline flows into the simulated vascular network from the superior vena cava network and the inferior vena cava network respectively, and flows back into the circulation pipeline from the right heart chamber 1211.

[0037] The circulation pump 112 delivers the liquid in the liquid tank 111 to the manifold within the base of the 3D-printed vascular system 12. The manifold has 21 channels. One channel connects to the water pipe output by the circulation pump via a flexible hose and rigid connector. Eight other channels connect via hoses and rigid connectors to the left subclavian vein 1210, the median cubital vein 123, the cephalic vein 125, the cephalic vein 126, the brachial vein 124, the right subclavian vein 127, the right internal jugular vein 129, and the right external jugular vein 128, respectively. The median cubital vein 123, the cephalic vein 126, and the brachial vein 124 serve as the fluid conduits for these veins. The fluid flows to the right subclavian vein 127, then merges with the fluids from the right internal jugular vein 129, right external jugular vein 128, and left subclavian vein 1210 into the superior vena cava 1225; the other 12 channels, via flexible tubes and rigid connectors, connect to the right adrenal vein 1222, accessory hepatic vein 1223, right renal vein 1221, left renal vein 1214, left adrenal vein 1213, left inferior phrenic vein 1212, left common iliac vein 1215, left internal iliac vein 1216, and right... The lateral common iliac vein 1220, the right internal iliac vein 1219, the left femoral vein 1217, and the right femoral vein 1218 are connected. The fluid from the left femoral vein 1217 and the left internal iliac vein 1216 flows into the left common iliac vein 1215; the fluid from the right femoral vein 1218 and the right internal iliac vein 1219 flows into the right common iliac vein 1220; and the fluid from the left common iliac vein 1215 and the right common iliac vein 1220 flows into the inferior vena cava 1224. Additionally, the left adrenal vein 1213... The fluid in the left inferior diaphragmatic vein 1212 flows into the left renal vein 1214, and then the fluid in the right adrenal vein 1222, accessory hepatic vein 1223, right renal vein 1221, and left renal vein 1214 flows into the inferior vena cava 1224. Finally, the fluid in the superior vena cava 1225 and the inferior vena cava 1224 flows into the right heart ventricle 1211, and is connected to the fluid tank 111 through a flexible tube and a rigid connector. Finally, the fluid in the vascular model flows into the fluid tank 111, forming a simulated venous circulation system loop.

[0038] It is understood that a junction box is installed inside the base 1226.

[0039] Understandably, a manifold is a liquid collection point in a circulation pipeline.

[0040] Understandably, the liquids in the liquid tank include, but are not limited to, purified water, tissue fluids used for experiments, and saline.

[0041] Furthermore, the 3D-printed vascular system 12 includes a cephalic vein access 122, a median cubital vein 123, a brachial vein 124, a cephalic vein 125, a cephalic vein 126, a right subclavian vein 127, a right external jugular vein 128, a right internal jugular vein 129, a left subclavian vein 1210, a right heart ventricle 1211, a left inferior diaphragmatic vein 1212, a left adrenal vein 1213, a left renal vein 1214, a left common iliac vein 1215, a left internal iliac vein 1216, a left femoral vein 1217, a right femoral vein 1218, a right internal iliac vein 1219, a right common iliac vein 1220, a right renal vein 1221, a right adrenal vein 1222, an accessory hepatic vein 1223, an inferior vena cava 1224, a superior vena cava 1225, a base 1226, and a femoral vein puncture module 121.

[0042] Furthermore, the simulated venous circulation system 11 includes a liquid tank 111, a circulation pump 112, a flow regulating valve 113, and a hollow flexible tube. The circulation pump 112 delivers simulated blood from the liquid tank 111 to the manifold within the base 1226 of the 3D-printed vascular system 12, flowing into the superior vena cava network and the inferior vena cava network. Specifically, the fluid flowing through the median cubital vein 123, basilic vein 125, cephalic vein 126, brachial vein 124, right subclavian vein 127, right internal jugular vein 129, and right external jugular vein 128 in the superior vena cava network converges into the superior vena cava 122. 5. The fluid flowing through the inferior vena cava network, including the right adrenal vein 1222, accessory hepatic vein 1223, right renal vein 1221, left renal vein 1214, left adrenal vein 1213, left inferior diaphragmatic vein 1212, left common iliac vein 1215, left internal iliac vein 1216, right common iliac vein 1220, right internal iliac vein 1219, left femoral vein 1217, and right femoral vein 1218, converges into the inferior vena cava 1224, then flows into the right heart ventricle 1211, and finally returns to the fluid tank 111, forming a simulated venous circulation system loop.

[0043] Understandably, the simulated blood vessels in the 3D printed blood vessel system are all hollow tubes.

[0044] Reference Figure 4 The figure shown is a system framework diagram of a simulator for simulating a DSA angiography system provided in an embodiment of the present invention.

[0045] It is understood that the analog DSA imaging system 2 includes an analog DSA device 21, an image acquisition device 22, a sensor 23, and a processor 24. The sensor 23 is electrically connected to the processor 24, and the processor 24 and the image acquisition device 22 are both electrically connected to the analog DSA device 21.

[0046] Understandably, sensor 23 is a pressure sensor installed in the simulated adrenal vein and the simulated accessory hepatic vein. When the trainee observes the catheter insertion point under the simulated DSA device 21, the simulated contrast agent is pushed in. The sensor in the simulated blood vessel detects the pressure change and transmits the electrical signal to the processor 24. The processor 24 transmits the instruction to the simulated DSA device 21, retrieves the corresponding adrenal vein or accessory hepatic vein angiography morphology image module, and displays it on the simulated DSA angiography software for the trainee to identify. The angiography morphology image group module 2111 consists of common angiography morphologies in clinical practice. After the image acquisition device 22 acquires the image, it is input into the human skeletal tissue virtual perspective image module 2112. The human skeletal tissue virtual perspective image module 2112 generates perspective images of bones and organs, providing spatial reference for catheter positioning and operation guidance. Both the angiography morphology image group module 2111 and the human skeletal tissue virtual perspective image module 2112 are connected to the display 212, which is responsible for displaying the images in the angiography morphology image group module 2111 and the human skeletal tissue virtual perspective image module 2112.

[0047] Furthermore, the image acquisition device 22 is a movable support lens, which transmits the virtual angiographic morphology of the 3D printed vascular system 12 to the analog DSA device 21 in real time.

[0048] Reference Figure 1 The diagram shown is a flowchart illustrating a training method for adrenal vein blood sampling using simulated DSA-guided vascular imaging technology according to an embodiment of the present invention. In this embodiment, the training method for adrenal vein blood sampling using simulated DSA-guided vascular imaging technology includes:

[0049] S1. Adjust the simulator and surgical instruments to the initial preparation state. The trainee performs a surgical simulation operation in the simulator in the initial preparation state and records the surgical simulation operation process to obtain the trainee simulation process record.

[0050] Understandably, simulated surgical instruments refer to the simulated instruments used during training, including puncture needles, puncture sheaths, guidewires, and catheters, and other simulated instruments, for trainees to perform simulated surgical operations within the simulator.

[0051] Understandably, the initial preparation state refers to the standardized setup of the simulator and surgical instruments before the start of training, including but not limited to turning on the equipment, simulating blood injection, and returning the instruments to their positions, to ensure that the trainees' training begins under uniform conditions.

[0052] Understandably, trainees refer to participants in simulated surgical training who perform adrenal vein blood sampling procedures in a simulator and undergo performance evaluation.

[0053] Understandably, the training process record refers to the data and trajectory of the entire surgical simulation operation collected and saved when the trainee performs the simulated adrenal vein blood sampling operation in the simulator.

[0054] Specifically, step S1 includes S101-S103:

[0055] S101. The trainee performs a surgical simulation operation in the simulator in the initial preparation state, including: the trainee disinfects the puncture area set in the simulated vascular network in the initial preparation state, and performs a femoral vein puncture simulation operation in the puncture area under the prompt of the preset medical ultrasound equipment, and inserts the puncture sheath in the simulator after successful puncture.

[0056] Understandably, the puncture area set in the simulated vascular network refers to the femoral vein puncture module in the simulator, which is made of ultrasonic material and can display the skin, muscle, femoral vein, and femoral artery under ultrasound equipment, for training personnel to practice puncture.

[0057] Understandably, disinfection refers to the disinfection of the puncture area, such as wiping with iodine solution, during surgical simulation to simulate the preoperative disinfection steps in real clinical practice.

[0058] Understandably, the preset medical ultrasound equipment refers to the ultrasound imaging device that is pre-configured and set in the surgical simulation operating system. It is used to provide real-time ultrasound images in the puncture area set in the simulated vascular network to guide trainees in performing femoral vein puncture and catheterization. Before performing real-time ultrasound imaging, coupling agent needs to be applied to the femoral vein puncture module.

[0059] Understandably, the femoral vein is a large vein in the lower limbs of the human body and is a commonly used access vessel for interventional procedures. In the simulator, it is replaced by a femoral vein module for trainees to practice puncture and catheter placement.

[0060] Understandably, a puncture sheath is a short tubular instrument inserted into the femoral vein as a vascular access point, facilitating the repeated entry and exit of guidewires, catheters, etc., without the need for repeated punctures.

[0061] S102. The simulated surgical instruments are inserted into the simulator through a puncture sheath. Under the guidance of the virtual fluoroscopic image of the human body displayed in the preset simulated DSA angiography system, the catheter and guidewire in the simulated surgical instruments are delivered to the virtual spine. The system identifies whether the catheter is inserted into the target blood vessel and injects the simulated contrast agent into the target blood vessel.

[0062] Understandably, virtual fluoroscopic images of the human body refer to virtual images generated by fusing the real-time status of instruments in a simulated DSA angiography system with three-dimensional images of human bones, organs, and tissues through digital processing technology. This simulates the fluoroscopic effect under clinical DSA (digital subtraction angiography) without the need for real X-ray radiation.

[0063] Understandably, a guidewire is a metal wire that establishes a path within a blood vessel to guide a catheter into the target blood vessel. In this embodiment of the invention, it can be delivered to the virtual spinal position in a simulator.

[0064] Understandably, a catheter is a tubular instrument inserted into a blood vessel through a sheath and guidewire for insertion, injection of contrast agents, or blood sampling.

[0065] Understandably, the virtual spine refers to the positioning reference point used to locate the duct, usually the spatial location of the 11th thoracic vertebra (T11 vertebral body) to help trainees operate in a virtual perspective environment.

[0066] Understandably, the target vessel refers to the vessel that needs to be cannulated during the surgical simulation, namely the adrenal vein. Trainees need to identify and insert a cannula into this vessel in the simulator.

[0067] Understandably, simulated contrast agents refer to liquids injected into a simulator to simulate the imaging effect of clinical contrast agents in blood vessels.

[0068] S103. Based on the virtual angiography pattern displayed by the simulator in the preset simulated DSA angiography system after the injection of the simulated contrast agent, determine whether the catheter has entered the target blood vessel. When the catheter enters the target blood vessel, perform the sequential operation of adrenal vein blood sampling and inferior vena cava blood sampling in the simulator to complete the surgical simulation process.

[0069] Understandably, the pre-configured simulated DSA angiography system refers to a pre-configured digital subtraction angiography (DSA) simulation module, which is used to provide fluoroscopic images and operational interactions similar to clinical DSA in a radiation-free environment.

[0070] Specifically, the virtual angiography pattern displayed by the simulator in a preset simulated DSA angiography system after the injection of the simulated contrast agent includes the adrenal vein angiography pattern and the accessory hepatic vein angiography pattern, wherein the accessory hepatic vein angiography pattern is an interfering angiography pattern.

[0071] Understandably, virtual angiography morphology refers to the angiography images displayed by a simulated DSA system, which are divided into adrenal vein angiography morphology (Group A) and accessory hepatic vein angiography morphology (Group B), for trainees to identify whether the target blood vessel has been entered.

[0072] For example, to determine whether the catheter has entered the target blood vessel based on the virtual angiography pattern displayed by the simulator in a preset simulated DSA angiography system after the injection of the simulated contrast agent, the following implementation steps can be used:

[0073] Group A consists of adrenal vein angiography morphology images, while Group B consists of interfering angiography morphology images. In clinical practice, accessory hepatic veins are easily confused with the right adrenal vein; therefore, accessory hepatic veins are included as an interfering element. Group A comprises five subgroups, each with two angiography morphology images: A1 shows a glandular angiography morphology, A2 a "Δ (Delta)" angiography morphology, A3 a triangular angiography morphology, A4 a spider angiography morphology, and A5 an irregular angiography morphology. Group B contains five accessory hepatic vein angiography images. The vascular model in the simulator is equipped with sensors; the adrenal vein has an adrenal vein sensor, and the accessory hepatic vein has an accessory hepatic vein sensor. After the catheter is inserted into the vascular model and the simulated contrast agent is injected, if the adrenal vein sensor receives a signal, the processor in the simulator retrieves one angiography morphology image from Group A for the trainee to identify; if the accessory hepatic vein sensor receives a signal, the processor in the simulator retrieves one angiography morphology image from Group B for the trainee to identify.

[0074] Understandably, sequential operation refers to the continuous procedure of performing blood sampling from the adrenal vein and the inferior vena cava in a surgical simulation, simulating real clinical steps.

[0075] Understandably, after the virtual angiography pattern is displayed in the preset simulated DSA angiography system based on the injected simulated contrast agent, the preset simulated DSA angiography system will also pop up two options, "Yes" or "No," for the trainee to choose whether it is the target angiography pattern. After the trainee selects one of the options, the system will prompt whether the selection is correct and prompt the next operation procedure.

[0076] S2. Obtain the expert simulation process record, and analyze the training performance of the trainees corresponding to the expert simulation process record based on the expert simulation process record.

[0077] Understandably, the expert simulation process refers to the standard operating procedure performed by senior doctors on the simulator, which serves as a reference record for comparison with the trainees' operating procedures and for evaluating training performance.

[0078] Specifically, the analysis of training performance based on expert simulation process records includes:

[0079] The training scores of trainees are analyzed based on the preset training score calculation formula and the corresponding training scores recorded during the training simulation process. The preset formula for calculating training results is as follows:

[0080]

[0081] in, To train personnel on the duration of sheath insertion, The training period for successful right adrenal vein catheterization. The training session focused on the successful duration of left adrenal vein catheterization. To train personnel to simulate DSA exposure time, Weighting of the training personnel's sheath insertion time score. Weighting of the score for successful right adrenal vein cannulation time for trainees. Weighting of the score for successful left adrenal vein cannulation. To simulate the DSA exposure duration score weighting for trainees, For the duration of sheath placement by experts, The duration of successful right adrenal vein catheterization by the expert. The duration of successful left adrenal vein catheterization by the expert. To simulate DSA exposure time for experts.

[0082] Understandably, the standard surgical sequence in adrenal gland surgery is: catheter placement, locating and drawing blood from the right adrenal vein, locating and drawing blood from the left adrenal vein, and the time required to locate the left and right veins under DSA. In this embodiment of the invention... , , , The results are based on a scientific quantification of the anatomical characteristics, operational difficulty, and clinical radiation protection guidelines of adrenal vein sampling (AVS) surgery, specifically as follows:

[0083] Understandably, The training time for sheath placement is assigned a weight to the score. Sheath placement is a fundamental step in establishing vascular access during interventional surgery. This step does not involve complex catheter selection or delicate manipulation and usually does not require DSA fluoroscopic guidance. Because it has the lowest operational difficulty and is not the core training objective of this simulator, it is assigned the lowest weight, i.e., the fourth level weight. The right adrenal vein cannulation time is weighted in the training program to account for the training participants' scores. The right adrenal vein is characterized by its short, thin structure and direct draining into the inferior vena cava network, making it easily confused with the adjacent accessory hepatic veins, a major cause of clinical AVS (Adrenal Vascular Surgery) failure. To address this challenge, this simulator specifically designs three right adrenal vein cannulation models with different opening directions, along with an accessory hepatic vein for interference, requiring trainees to accurately identify them. Due to its significant anatomical variations and the highest cannulation difficulty, it is the decisive factor in surgical success or failure and is therefore assigned the highest weight, i.e., the first-level weight. The score weights for the successful cannulation time of the left adrenal vein are calculated. The left adrenal vein usually drains above the left renal vein, and its anatomical location is relatively fixed. A standard model is designed for this simulator. Compared to the right side, the difficulty of locating and cannulating the left side is moderate, therefore it is assigned a moderate weight, i.e., a third-level weight. To assign weight to the DSA exposure duration for trainees, and considering that AVS surgery relies entirely on DSA guidance, radiation protection is a key indicator for evaluating the operator's professional competence. This indicator assesses the trainee's ability to protect themselves and others from excessive radiation damage. Skillful operation of DSA while protecting oneself from radiation is crucial. Furthermore, considering the importance of protecting both medical staff and patients from unnecessary radiation exposure, its weight is set second only to the most difficult operation, i.e., a second-level weight. Therefore, typical values ​​for each weight coefficient can be [value missing]. , , , .

[0084] This invention provides student scoring and result determination. Specifically, , , , These four items are in seconds (s), when + + + A score of ≥3600 seconds, meaning a total time exceeding 1 hour, will be automatically deemed unsatisfactory by the system. Total Score The maximum score is 100 points. The total score is calculated according to the scoring formula. Then, according to the judgment criteria shown in the table below, give a result such as "qualified" or "good".

[0085]

[0086] When the expert operates on the simulator, the system training number is "1", and the timings for the four sub-items of their operation are as follows: =60s, =180s, =180s, =30s, which the system uses as the evaluation benchmark; taking the first trainee (number 1001) as an example, the time for the four sub-items of the operation on the simulator was as follows: =100s, =260s, =220s, =60s, calculate the total score according to the scoring formula. for:

[0087]

[0088] The calculation and judgment of other trainees' scores are shown in the table below.

[0089]

[0090] This invention adjusts the simulator and simulated surgical instruments to their initial preparation state, ensuring the standardization and repeatability of the training environment. Each training session is conducted under consistent conditions, avoiding training deviations caused by differences in equipment status and improving the usability and safety of the training. Furthermore, trainees disinfect the puncture area set in the simulated vascular network in the initial preparation state and perform a simulated femoral vein puncture in the puncture area under the guidance of a preset medical ultrasound device. After a successful puncture, a puncture sheath is inserted into the simulator. By simulating real clinical procedures, trainees can master the basic skills of adrenal vein blood sampling. In addition, the simulated surgical instruments enter the simulator through the puncture sheath, and under the guidance of a virtual fluoroscopic image of the human body displayed in a preset simulated DSA angiography system, the catheter and guidewire in the simulated surgical instruments are advanced to the virtual spine. The system identifies whether the catheter has been inserted into the target blood vessel and injects simulated contrast agent into the target blood vessel, enhancing the trainees' ability to navigate and identify target blood vessels under image guidance. Through virtual fluoroscopic images, trainees can learn to operate catheters and guidewires in complex vascular structures, avoiding accidental entry into interfering vessels such as accessory hepatic veins and renal capsule veins. Furthermore, based on the virtual angiography morphology displayed by the simulator in a preset simulated DSA angiography system after the injection of the simulated contrast agent, it can be determined whether the catheter has entered the target vessel. When the catheter enters the target vessel, the sequential operation of adrenal vein blood sampling and inferior vena cava blood sampling is performed in the simulator to complete the surgical simulation process, which can enhance the trainees' accuracy in angiography morphology recognition and blood sampling sequence operation. Finally, by acquiring expert simulation process records and analyzing the training performance of trainees based on these records, the efficiency of adrenal vein blood sampling training can be improved.

[0091] It will be apparent to those skilled in the art that the present invention is not limited to the details of the exemplary embodiments described above, and that the present invention can be implemented in other specific forms without departing from the spirit or essential characteristics of the present invention.

[0092] Therefore, the embodiments should be considered exemplary and non-limiting in all respects, and the scope of the invention is defined by the appended claims rather than the foregoing description. Thus, all variations falling within the meaning and scope of equivalents of the claims are intended to be embraced within the invention. No appended diagram markings in the claims should be construed as limiting the scope of the claims.

[0093] The embodiments of this application can acquire and process relevant data based on artificial intelligence technology. Artificial intelligence (AI) refers to the theories, methods, technologies, and application systems that use digital computers or machines controlled by digital computers to simulate, extend, and expand human intelligence, perceive the environment, acquire knowledge, and use that knowledge to obtain optimal results.

[0094] Furthermore, it is clear that the word "comprising" does not exclude other units or steps, and the singular does not exclude the plural. Multiple units or devices recited in a system claim may also be implemented by a single unit or device through software or hardware. The terms "first," "second," etc., are used to indicate names and do not indicate any specific order.

[0095] Finally, it should be noted that the above embodiments are only used to illustrate the technical solutions of the present invention and are not intended to limit it. Although the present invention has been described in detail with reference to preferred embodiments, those skilled in the art should understand that modifications or equivalent substitutions can be made to the technical solutions of the present invention without departing from the spirit and scope of the technical solutions of the present invention.

Claims

1. A simulator, characterized by The simulator includes: A human simulation system (1) is used to simulate the operating environment of human blood vessels, wherein the human simulation system (1) includes: A 3D-printed vascular system (12) is used to simulate the structure of human veins. The 3D-printed vascular system (12) includes: a base (1226); a simulated vascular network disposed on the base (1226); a femoral vein puncture module (121) for puncturing a puncture area set in the simulated vascular network. The simulated vascular network includes a superior vena cava network, an inferior vena cava network, a right heart ventricle (1211) that drains from the superior vena cava network and the inferior vena cava network; and a virtual spine is marked in the simulated vascular network. A simulated venous circulation system (11) is used to provide a simulated blood circulation environment for a 3D printed vascular system (12). The simulated venous circulation system (11) includes a circulation pipeline, a liquid tank (111), a circulation pump (112), and a flow regulating valve (113) disposed in the circulation pipeline. The simulated vascular network is connected in series in the circulation pipeline. Liquid in the circulation pipeline flows into the simulated vascular network from the superior vena cava network and the inferior vena cava network, and flows back into the circulation pipeline from the right heart chamber (1211). A simulated DSA angiography system (2) is used to provide simulated DSA image guidance and virtual angiography morphology recognition in a radiation-free environment. The simulated DSA angiography system (2) includes a simulated DSA device (21), an image acquisition device (22), a sensor (23), and a processor (24). The sensor (23) is electrically connected to the processor (24), and the processor (24) and the image acquisition device (22) are electrically connected to the simulated DSA device (21). The sensor (23) is a pressure sensor installed in the simulated adrenal vein and the simulated accessory hepatic vein. When the trainee observes the catheter hanging point under the simulated DSA device (21), the simulated contrast agent is pushed. The sensor (23) in the simulated blood vessel detects the pressure change and transmits the electrical signal to the processor (24). The processor (24) transmits the instruction to the simulated DSA device (21) to retrieve the corresponding adrenal vein or accessory hepatic vein angiography morphology image module and display it on the simulated DSA device. The simulated DSA imaging software is provided for trainees to identify the angiography. Among them, the angiography morphology image group module (2111) is composed of common clinical angiography morphologies. After the image acquisition device (22) acquires the image, it is input into the human bone tissue virtual perspective image module (2112). The human bone tissue virtual perspective image module (2112) generates perspective images of bones and organs, providing spatial reference for catheter positioning and operation guidance. The angiography morphology image group module (2111) and the human bone tissue virtual perspective image module (2112) are both connected to the display (212). The display (212) is responsible for displaying the images in the angiography morphology image group module (2111) and the human bone tissue virtual perspective image module (2112). The image acquisition device (22) is a movable support lens. The image acquisition device (22) transmits the virtual angiography morphology of the 3D printed blood vessel system (12) to the simulated DSA device (21) in real time.

2. A method for training adrenal vein blood removal using a simulation of a blood vessel imaging technique under DSA, based on the simulator as claimed in claim 1, characterized in that, The method includes: The simulator and surgical instruments are adjusted to the initial preparation state. The trainees perform surgical simulation operations in the simulator in the initial preparation state, and the surgical simulation operation process is recorded to obtain the trainee simulation process record. The trainees perform simulated surgical procedures in a simulator in an initial preparation state, including: The trainees disinfected the puncture area set in the simulated vascular network in the initial preparation state, and performed a simulated femoral vein puncture operation in the puncture area under the guidance of the preset medical ultrasound equipment. After successful puncture, the puncture sheath was inserted in the simulator. The simulated surgical instruments are inserted into the simulator through a puncture sheath. Guided by the virtual fluoroscopic image of the human body displayed in the preset simulated DSA angiography system, the catheter and guidewire in the simulated surgical instruments are delivered to the virtual spine. The system also identifies whether the catheter has been inserted into the target blood vessel and injects the simulated contrast agent into the target blood vessel. Based on the virtual angiography pattern displayed by the simulator in the preset simulated DSA angiography system after the injection of the simulated contrast agent, it is determined whether the catheter has entered the target blood vessel. When the catheter enters the target blood vessel, the sequential operation of adrenal vein blood sampling and inferior vena cava blood sampling is performed in the simulator to complete the surgical simulation process. Obtain expert simulation process records and analyze the training performance of trainees corresponding to the expert simulation process records based on these records.

3. The adrenal vein blood sampling training method under the technique of simulating DSA angiography of blood vessels, as claimed in claim 2, wherein The virtual angiography pattern is displayed by the simulator in a preset simulated DSA angiography system after the injection of the simulated contrast agent. The virtual angiography pattern includes adrenal vein angiography pattern and accessory hepatic vein angiography pattern, wherein the accessory hepatic vein angiography pattern is an interfering angiography pattern.

4. The training method for adrenal vein blood sampling under simulated DSA vascular imaging technology as described in claim 3, characterized in that, The analysis of training performance based on expert simulation process records includes: The training scores of trainees are analyzed based on the preset training score calculation formula and the corresponding training scores recorded during the training simulation process. The preset formula for calculating training results is as follows: in, To train personnel on the duration of sheath insertion, The training period for successful right adrenal vein catheterization. The training session focused on the successful duration of left adrenal vein catheterization. To train personnel to simulate DSA exposure time, Weighting of the training personnel's sheath insertion time score. Weighting of the score for successful right adrenal vein cannulation time for trainees. Weighting of the score for successful left adrenal vein cannulation. To simulate the DSA exposure duration score weighting for trainees, For the duration of sheath placement by experts, The duration of successful right adrenal vein catheterization by the expert. The duration of successful left adrenal vein catheterization by the expert. To simulate DSA exposure time for experts.

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