Surgical procedure training system

Abstract

The present disclosure relates to a surgical procedure training system. The system comprises a patient body part simulator (2), such as a replica of a heart (5) or a part thereof, such as a mitral valve (6,7). Further, an image acquisition system (3) directed at the patient body part simulator is provided. The system also comprises an image processing system (700) configured to convert images from the image acquisition system (3) into emulation images corresponding with a specific imaging technique, from a group comprising echoscopy and / or echocardiography, as deployed during an actual surgical procedure on the patient body part; and an image display (4) presenting to a training surgeon images from the image acquisition system (3) and converted by the image processing system (700) into the images corresponding with the specific imaging technique.

Description

[0001] SURGICAL PROCEDURE TRAINING SYSTEM

[0002] FIELD

[0003] The present disclosure relates to a surgical procedure training system .

[0004] BACKGROUND

[0005] Surgical procedure training systems in general are known . However, these are not known to the inventors of the present disclosure to exhibit any sophistication other than in terms of materials and production of patient body part simulators , such as a heart , to allow training ( cardio- ) surgeons the opportunity to practice a surgical procedure on a simulator or simulated heart , ( to train for the surgical procedure ) , with a look and feel approximating a situation as they could encounter when performing an actual surgical ( or generally : medical ) procedure on an actual heart or another body part . Reference to training, in the following disclosure , also includes training for interventional physicians , and not only surgeons , as well as other practitioners .

[0006] However, relative to practice , such an isolated simulator or simulated heart would not represent actual circumstances during an actual surgical procedure . Consequently, available surgical procedure training systems fall short of providing a substantial lifelike situation for a training surgeon during training a surgical procedure .

[0007] A theoretical training system for surgeons is known from KR-10- 2 -282 413 , which allows training of - for example - cardio-vascular treatments that are during real surgical treatments monitored using X-ray transmission based imaging . To this end, this prior publication discloses that a simulator, which is a model of the human cardiovascular system, and a device for imaging the simulator are required . To avoid that the device for imaging needs to actually involve X-ray transmission based imaging, with potential detrimental effects for a trainee surgeon associated with exposure to radiation, this prior disclosure teaches the use of a camera to capture images of the simulator or model and process those images to resemble X-ray images as if taken during a real life medical procedure , to enhance the training experience . Although training for a surgical procedure that is in real life a medical treatment assisted by X-ray transmission based imaging , can reduce radiation effects by - during training - resembling X-ray images , detrimental radiation effects during real life operations are thereby not mitigated .

[0008] Moreover , where the present disclosure is directed at in particular a surgical procedure training system to prepare for real life situations of surgical procedures in which non-harmful- radiation based imaging techniques are deployed, in particular echoscopy or echocardiography or a similar technique may be used, the problem underlying the herein proposed solution resides in the complexity of a replica or model system . In principle , a replica, model or simulator of a patient body part may be imaged for training purposes by deploying the same imaging technique as that which would be used in real life medical procedures , as there would be no reason to abstain therefrom, as would be the case with the prior system of KR-102 282 413 that uses potentially detrimental radiation for imaging .

[0009] However, when using such in principle harmless techniques for imaging during training, sound and pressure and other types of waves used for imaging would require a medium to be conducted therethrough that would emulate tissue and also fluid like blood, that doesn' t even show up in X-ray imaging . Such in principle harmless imaging techniques during training for actual medical procedures , would then pose entirely different requirements on fluids and tissues simulating materials , and without proper medium to guide waves , no imaging would be possible at all , which together constitutes an entirely different set of challenges to the s killed person than the starting point of potentially harmful radiation, which was the incentive for the inventors that developed the training system of KR-102 282 413 , which arrives at a proposal to address a completely different problem in only a slightly similar way .

[0010] SUMMARY

[0011] The surgical procedure training system according to the present disclosure provides considerable improvements over the prior art . These and other improvements , effects and benefits of the present disclosure are provided in that the surgical procedure training system comprises : a patient body part simulator, such as a replica of a heart or a part thereof , such as a mitral valve ; an image acquisition system directed at the patient body part simulator; an image processing system configured to convert images from the image acquisition system into emulation images corresponding with a specific imaging technique , from a group at least comprising echoscopy and / or echocardiography, as deployed during an actual surgical procedure on the patient body part ; and an image display presenting to a training surgeon images from the image acquisition system and converted by the image processing system into the images corresponding with the specific imaging technique .

[0012] By converting acquired images before displaying converted images in a format or corresponding with the specific imaging technique , such as echoscopy and / or even echocardiography, as deployed during an actual surgical procedure on the patient body part , the training surgeon is able to train much more effectively any desired medical or surgical procedure in which imaging aids the surgeon when performing the actual procedure . Moreover, imaging during training then simulates views , in a same manner as these would be presented on a display as during an actual medical procedure , in a much more life-like fashion, while the replica or patient body part simulator may comprise only organs like a heart and blood vessels or arteries even without body fluids in or around the simulator, that would in real life be necessary to conduct sound or pressure or other waves used for imaging techniques of the type in the above mentioned groups .

[0013] The present disclosure , in a further aspect , relates to a method of surgical procedure training , comprising : providing a patient body part simulator , such as a replica of a heart or a part thereof , such as a mitral valve ; acquiring images with an image acquisition system directed at the patient body part simulator ; converting acquired images into emulation images corresponding with a specific technique of imaging as available during an actual surgical procedure on the patient body part ; and displaying converted acquired images to a training surgeon on a display, wherein the images correspond with the specific imaging technique as available during an actual surgical procedure on the patient body part .

[0014] Further, the disclosure comprises numerous possibilities , which may be defined in the appended dependent claims , and / or form part of the below embodiment description of preferred embodiments . In more detail , the following features are referred to here in more detail .

[0015] The surgical procedure training system may have the image acquisition system compris ing a plurality of camera' s .

[0016] The surgical procedure training system may then have the image acquisition system compris ing at least one pair or camera' s arranged to in combination acquire 3-dimensional images of at least a part of the patient body part simulator .

[0017] Additionally or alternatively the surgical training system may have the image acquisition system trained at the patient body part simulator from a perspective corresponding with medical imaging of the specific technique , in particular from the group comprising echoscopy and / or echocardiography, as deployed during an actual surgical procedure on the patient body part .

[0018] However, it should be noted that for example depending on an accuracy of the image acquisition system and image conversion by the image processing system, especially when deploying a 3-dimensional or depth imaging , the feature that the image acquisition system must be arranged to function from a perspective corresponding with medical imaging of a specific technique may be replaced and realized by image processing rather than camera positioning, especially when using stereoscopic camera .

[0019] Additionally or alternatively, the surgical procedure training system may have the patient body part simulator comprising a tissue simulating replica of the patient body part . Then, the tissue simulating replica of the patient body part may be a 3D printed replica, using soft printed material . Additionally or alternatively, the surgical procedure training system may further comprise a frame configured to support or suspend the patient body part simulator .

[0020] Additionally or alternatively, the surgical training system according may further comprise an actuator connected to the patient body part simulator to simulate patient body part motion, wherein the actuator comprises a component from a group at least comprising an electric motor, a pneumatic drive and a hydraulic drive . Then, the actuator can be selectable to drive only a body part simulator that is obj ect of the trained procedure and a portion in images acquired, converted and presented on the image display .

[0021] Additionally or alternatively, for imaging, motion of stationary portions of the body part simulator can be introduced by image processing into images acquired, converted and presented on the image display .

[0022] Additionally or alternatively, the surgical procedure training system may further comprise a line-of-sight barrier arranged between the image display at which a training surgeon is positioned, and the patient body part simulator .

[0023] Additionally or alternatively, the surgical procedure training system may have the image processing system being configured to convert images from the image acquisition system into at least one type of medical images from a group comprising echoscopy and / or perhaps even echocardiographic images . For example , the echocardiographic images may comprise transesophageal echocardiography 'TEE ' images . However , alternative types or techniques of medical imaging may be used as a template for converting the acquired images of the patient body part simulator during training . For example , the disclosure may involve converting live images of the patient body part simulator during training into emulation images correspond with specific techniques of imaging during an actual surgical procedure , such as MRI images and the like .

[0024] Additionally or alternatively, the surgical procedure training system may have the image processing system being configured to track and display actions by a training surgeon . Additionally or alternatively, the system can further comprise an illumination from a type comprising at least one of daylight and / or IR light .

[0025] Additionally or alternatively, actions by a training surgeon may comprise applying stitches using suture thread, and the image processing system may then be configured to measure characteristics of stitches set during training . It is noted that in particular the type of illumination and the suture thread are matched to provide emphasized display of sutures in presented images . For example , suture thread is relatively opaque when using IR cameras and / or IR illumination, to show up in a well discernable manner in images during training, which would allow a high degree of accuracy and reproducibility when assessing quality of applied stitches . Such coordinated or matching illumination and / or image capture and selection of suture materials used for training allows for the system to assess practices sutures for s kill , quality or other criteria . Measured characteristics of the stitches can comprise at least one characteristic from a group comprising : lengths of stitches , distance between stitches , distances of applied stitches to pre-defined zones of critical anatomy, tissue depths to which a stitching instrument is inserted into surrounding replica tissue , other 2-dimensionally measurable characteristics of stitches , and also other characteristics of stitches are derivable therefrom, among which a smoothness indicator of a stitching instrument' s traj ectory to minimize tissue trauma . Yet further , in this embodiment , the image processing system may be configured to compare measured characteristics of the stitches with a norm or threshold .

[0026] Additionally or alternatively, the image processing system may be configured to output on the display pointers for a training surgeon to perform the surgical procedure .

[0027] Moreover , according to the present disclosure in another aspect thereof , next to the system and the method, a computer program product may be provided for a data processing system, the computer program product comprising computer program code to perform the method according to the present disclosure , when the computer program product is run on a processing unit or processor of the image or date processing system. Thus, a system as described above and hereinafter may be controlled using the likewise identified method. The method may be executed, for example, by the data processing system described above and hereinafter. Moreover, a computer program for carrying out the methods described herein, as well as a non-transitory computer readable storage-medium storing the computer program may be provided. A computer program may, for example, be downloaded by or uploaded to an existing device or be stored upon manufacturing of these systems.

[0028] A non-transitory computer-readable storage medium stores at least one software code portion, the software code portion, when executed or processed by a computer, being configured to perform executable steps of the surgical procedure training method.

[0029] As will be appreciated by one skilled in the art, aspects of the present disclosure may be embodied as a system or constituent components thereof, a device, a method and / or a computer program product. Accordingly, aspects of the present disclosure may take the form of an entirely hardware embodiment, an entirely software embodiment (including firmware, resident software, micro-code, etc. ) or an embodiment combining software and hardware aspects that may all generally be referred to herein as a "circuit", "module" or "system. " Functions described in this disclosure may be implemented as an algorithm executed by a processor / microprocessor of a computer. Furthermore, aspects of the present disclosure may take the form of a computer program product embodied in one or more computer readable medium(s) having computer readable program code embodied, e.g. , stored, thereon.

[0030] Any combination of one or more computer readable medium(s) may be utilized. The computer readable medium may be a computer readable signal medium or a computer readable storage medium. A computer readable storage medium may be, for example, but not limited to, an electronic, magnetic, optical, electromagnetic, infrared, or semiconductor system, apparatus, or device, or any suitable combination of the foregoing. More specific examples of a computer readable storage medium may include, but are not limited to, the following: an electrical connection having one or more wires, a portable computer diskette, a hard disk, a random access memory (RAM) , a read-only memory (ROM) , an erasable programmable read-only memory (EPROM or Flash memory) , an optical fiber, a portable compact disc read-only memory (CD-ROM) , an optical storage device, a magnetic storage device, or any suitable combination of the foregoing. In the context of the present disclosure, a computer readable storage medium may be any tangible medium that can contain, or store, a program for use by or in connection with an instruction execution system, apparatus, or device.

[0031] A computer readable signal medium may include a propagated data signal with computer readable program code embodied therein, for example, in baseband or as part of a carrier wave. Such a propagated signal may take any of a variety of forms, including, but not limited to, electro-magnetic, optical, or any suitable combination thereof. A computer readable signal medium may be any computer readable medium that is not a computer readable storage medium and that can communicate, propagate, or transport a program for use by or in connection with an instruction execution system, apparatus, or device .

[0032] Program code embodied on a computer readable medium may be transmitted using any appropriate medium, including but not limited to wireless, wireline, optical fibre, cable, RF, etc. , or any suitable combination of the foregoing. Computer program code for carrying out operations for aspects of the present disclosure may be written in any combination of one or more programming languages, including an object oriented programming language such as Java(TM) , Smalltalk, C++ or the like and conventional procedural programming languages, such as the "C" programming language or similar programming languages . The program code may execute entirely on the user's computer, partly on the user's computer, as a stand-alone software package, partly on the user's computer and partly on a remote computer, or entirely on the remote computer or server. In the latter scenario, the remote computer may be connected to the user's computer through any type of network, including a local area network (LAN) or a wide area network (WAN) , or the connection may be made to an external computer (for example, through the Internet using an Internet Service Provider) . Aspects of the present disclosure are described below with reference to flowchart illustrations and / or block diagrams of methods , apparatus ( systems ) , and computer program products according to embodiments of the present disclosure . It will be understood that each block of the flowchart illustrations and / or block diagrams , and combinations of blocks in the flowchart illustrations and / or block diagrams , can be implemented by computer program instructions . These computer program instructions may be provided to a processor, in particular a microprocessor or a central processing unit (CPU) , of a general purpose computer, special purpose computer , or other programmable data processing apparatus to produce a machine , such that the instructions , which execute via the processor of the computer , other programmable data processing apparatus , or other devices create means for implementing the functions / acts specified in the flowchart and / or block diagram block or blocks .

[0033] These computer program instructions may also be stored in a computer readable medium that can direct a computer, other programmable data processing apparatus , or other devices to function in a particular manner , such that the instructions stored in the computer readable medium produce an article of manufacture including instructions which implement the function / act specified in the flowchart and / or block diagram block or blocks .

[0034] The computer program instructions may also be loaded onto a computer , other programmable data processing apparatus , or other devices to cause a series of operational steps to be performed on the computer , other programmable apparatus or other devices to produce a computer implemented process such that the instructions which execute on the computer or other programmable apparatus provide processes for implementing the functions / acts specified in the flowchart and / or block diagram block or blocks .

[0035] The flowchart and block diagrams in the figures illustrate the architecture , functionality, and operation of possible implementations of devices , methods and computer program products according to various embodiments of the present disclosure . In this regard, each block in the flowchart or block diagrams may represent a module , segment , or portion of code , which comprises one or more executable instructions for implementing the specified logical function ( s ) . It should also be noted that , in some alternative implementations , the functions noted in the blocks may occur out of the order noted in the figures . For example , two blocks shown in succession may, in fact , be executed substantially concurrently, or the blocks may sometimes be executed in the reverse order, depending upon the functionality involved . It will also be noted that each block of the block diagrams and / or flowchart illustrations , and combinations of blocks in the block diagrams and / or flowchart illustrations , can be implemented by special purpose hardware-based systems that perform the specified functions or acts , or combinations of special purpose hardware and computer instructions .

[0036] After the above identification of features of the disclosure in terms of the appended claims , below a description of at least one embodiment is provided with reference to the appended figures , where it is noted here , that the shown and below described embodiment ( s ) is or are not the exclusively singular embodiment ( s ) that fall within the scope of the disclosure defined in the independent claims , and consequently, the shown end below described embodiment ( s ) may comprise features that are not limiting on the defined scope according to the appended independent claims . Even features defined in the appended independent claims may be replaced, at least in or for some j urisdiction ( s ) with obvious alternatives that may differ only in a literal sense from the definitions employed in the appended independent claims .

[0037] BRIEF DESCRIPTION OF THE DRAWING

[0038] In the appended drawing , an embodiment of a surgical procedure training system and components thereof are shown in non-limiting embodiments , wherein the same or similar elements , components and functional aspects may be designated throughout the drawing with the same or similar reference signs and wherein :

[0039] FIG . 1 exhibits a schematic configuration of a possible surgical procedure training system;

[0040] FIG . 2 exhibits a perspective view of a heart , illustrating the a surgeon' s challenges when performing a medical procedure with or based on medical imaging ; FIG . 3 exhibits an acquired image of a part of a patient body part simulator , in particular mitral valve simulator of a heart simulator, in a stage of a simulated cycle of a heartbeat ;

[0041] FIG . 4 exhibits an image displayed on a display, after conversion from a photo or other real life type image into a medical image , here : an echo image for a training surgeon to follow image ;

[0042] FIG . 5 exhibits an exemplary displayed (partial ) image of a mitral valve ( forming part of a replica heart on the display, showing functionality attainable by the image processing system;

[0043] FIG . 6 exhibits a flow chart of a method according to the present disclosure ; and

[0044] FIG . 7 exhibits a block diagram of an exemplary data processing system for image data to perform the method according to the present disclosure .

[0045] DETAILED DESCRIPTION OF EMBODIMENTS

[0046] In FIG . 1 , a potential non-exclusive embodiment of a surgical procedure training system 1 is shown . Surgical procedure training system 1 is herein below referred to simply as ' system 1 ' .

[0047] The shown embodiment of system 1 comprises a patient body part simulator 2 . Patent body part simulator 2 comprises a frame 9 , in or on which a replica of a body part is supported or suspended . It is noted that the replica of the body part is neither intended not designed to be used as an artificial or replacement patient body part , but is intended and designed to function merely as a replica for training purposes to aid a surgeon with a desire of practicing a particular medical procedure or operation . For example , the replica patient body part may have the appearance and texture , and the like , of a heart 5 or a part thereof , such as a mitral valve 7 in a valve seat 6 and comprising mitral leaflets 8 .

[0048] System 1 further comprises an image acquisition system 3 directed at the patient body part simulator in the form of heart 5 or a portion thereof . Image acquisition system 3 comprises a number of camera' s 10 , here four, but may comprise a higher or lower number of camera' s 10 . Each camera 10 may be formed by and RGB camera , an infrared camera or a 3D camera , or any other readily available type of camera . Likewise , sets of camera' s may be used to acquire depth images , for example through cooperation of at least one pair of camera' s 10 . Acquired images may be regular RGB photographs , infrared images or the like , and may be 3D depth images or plane 2D images .

[0049] Image acquisition system 3 is connected by wire or wirelessly to an image processing system 700 , an example of which is represented in FIG . 7 , to supply images of the patient body part simulator acquired by image acquisition system 3 to image processing system 700 , of which an exemplary embodiment is exhibited in FIG . 7 ( as will be described in generic terms herein below ) .

[0050] Image processing system 700 is configured to convert images from the image acquisition system 3 into emulation images corresponding with a specific imaging technique , such as echoscopy and / or even echocardiography, as deployed during an actual surgical procedure on an actual patient body part , like a heart .

[0051] An image display 4 is connected to image processing system 700 for presenting or displaying images thereon . Displayed images are obtained from image acquisition system 3 and converted by image processing system 700 into images corresponding with the specific imaging technique . For example , images like the one in FIG . 3 of a replica mitral valve 7 in a replica valve seat 6 of a replica heart 5 in FIG . 1 and in FIG . 3 are converted by image processing system 700 to resemble ultrasound or echo-images , like the one in FIG . 4 . It is noted here that the represented image in FIG . 4 is in fact not an in-vivo echoscopy and / or even echocardiographic image of a live mitral heart valve , but an image of the patient body simulator 2 and in particular of a replica of a heart 5 from camera' s 10 of image acquisition system 3 converted into a format or specific imaging technique resembling a type of imaging ( often ) used during a medical procedure that the surgeon is trained or training for . More in detail , when training for a mitral valve 6 , 7 replacement or repair , imaging during the procedure is most often (but not exclusively) echoscopy and more in particular echocardiography to visualize to the surgeon what and where action is being performed, when placing a replacement valve 7 and suturing it to valve seat 6 in or of heart 5 . By converting images from ( regular ) camera' s into a format corresponding with an imaging technique used during a medical / surgical procedure , the training surgeon received a more lifelike training .

[0052] While training , the training surgeon may view the converted image on display 4 , using the schematically shown eye in FIG . 1 , while manipulating a medical instrument , which may have the form of a schematically represented suture needle 13 forming part of a medical / surgical instrument 13 . During training, actual circumstances during a real life medical / surgical procedure may be emulated to such a realistic degree , that training is optimised .

[0053] To render the training with system 1 according to the present disclosure even more lifelike , camera' s 10 of image acquisition system may be oriented on patient body part simulator 2 in much the same way as the perspective from an echocardiography probe ( not shown in system 1 ) . However , camera' s 10 may also be positioned for optimum information acquisition, which would allow image processing system 700 to convert acquired images from image acquisition system 3 into a most realistic representation on display 4 . The latter may require tilting, panning and any other image processing as may be required .

[0054] In FIG . 2 , ( somewhat exaggerated ) line of sight differences between imaging along arrow B , for example an orientation of echocardiography, and actual view along arrow A desired by a training surgeon are presented . Precisely such a difference in line- of sight or orientation necessitates rigorous training for the surgeon to be able to manipulate instrument 13 by hand ( schematically shown in FIG . 1 ) on the basis of images on display 4 , and achieve a desired result of the medical / surgical procedure .

[0055] Also , it is noted here that when training a medical / surgical procedure on patient body part simulator 2 , imaging the same as when performing the medical / surgical procedure for real is often times not possible . For example , during training, echocardiography is not available as the patient body part simulator 2 would normally not be surrounded by bodily fluids , like a real body part would be surrounded by bodily fluids , and without fluids with properties very akin to those of bodily fluids to guide image information gathering ultrasound waves , images obtained using ultrasound transducers would not render any usable information for training . Moreover , in particular in the case of a moving body part simulator , for example mimicking heart 5 , a number of actuators 12 in the embodiment of FIG . 1 would be necessary to emulate motion of entirety of a simulated heart 5 . Further , submerging simulated heart 5 in fluids , even if resembling body fluids like blood, to be able to use customary ultrasound transducers would considerably raise the complexity of any resulting surgical procedure training system, especially if an electrical motor were to be used as actuator 12 . However , actuator 12 may be connected to the patient body part simulator 2 to simulate patient body part motion, wherein actuator 12 could comprise an alternative component , other than an electric motor, such as a pneumatic drive and a hydraulic drive .

[0056] To present a training surgeon with a replica of a or simulated heart 5 , several options are available to achieve a training situation that is as lifelike as necessary to be useful for the intended training purposes . For instance , the patient body part simulator 2 may comprises a tissue simulating replica of the patient body part . For example , for the replica of heart 5 , to emulate muscular tissue thereof , 3D printed, cast or moulded plastics may be employed, such as silicone , polyurethane or latex or the like , which may preferably be as soft and tough but j ust as puncture resistant as actual heart tissue . For training purposes to replace a mitral valve 7 , replacement and / or repair valve leaflets 8 need to be sutured in place on valve seat 6 and it is beneficial when the replica of the heart 5 exhibits a similar resistance to suturing as real life muscle tissue of a real heart .

[0057] According to the present disclosure , a simple embodiment can be provided if an obj ect of the training is identified and only motion thereof is actually simulated in the replica . For example , heart replica 5 and the valve leaves 8 of mitral valve 7 can be made of appropriate material that approximates heart tissue in terms of an appearance thereof in images for viewing on display 4 . The mitral valve 7 and in particular valve leaflets 8 can be driven in a natural heart motion by actuator 12 . Other parts of heart replica 5 than the obj ect of the training can remain stationary in heart replica 5 on which the cameras 10 are trained . In this case , mitral valve 7 is the obj ect of the training , for instance replacement thereof , and only mitral valve 7 is made to move by actuator 12 in heart replica 5 . To emulate a true-to-lif e situation, image processing system 700 is preferably configured to simulate heart motion of other parts of replica heart 5 than mitral valve 7 , in particular leaflets 8 thereof , in converted images on display 4 .

[0058] In the configuration of system 1 in FIG . 1 , display 4 is positioned as close to patient body part simulator 2 as it would be in real life during a medical / surgical procedure being performed on a live patient . However, for training purposes it suffices to not provide a complete replica of a body of a patient , but only a replica of the heart 5 or only mitral valve 7 on valve seat 6 . For training purposes it suffices to only move selected portions of heart replica 5 , in particular in this case mitral valve 7 , which is connected to actuator 12 , while motion of other parts of heart replica 5 than mitral valve 7 can be introduced in displayed images by image processing system 700 , to create a more lifelike simulation on display 4 for training purposes , while complexity of the body simulator 2 or heart simulator 5 is minimized .

[0059] To provide an optimally versatile training system, several actuators much like actuator 12 can be provided to drive other parts of heart simulator 5 in a natural heart motion for training other medical procedures than mitral valve 7 replacement . Depending on an actual medical procedure to be trained for , selected ones of these actuators 12 can be driven or left motionless , while associated heart motions of parts not drive by an actuator 12 may be simulated in images converted by image processing system 700 and shown on display 4 . Consequently, in the embodiment of FIG . 1 , only a single actuator 12 is shown to be connected to mitral valve simulator 7 .

[0060] Likewise , in addition to or as an alternative for motion of other parts than mitral valve 7 in displayed images , anatomical elements surrounding the part of interest but not provided in patient body part simulator 2 may still be visualized on display 4 , for example using augmented reality, which may be added to converted images by image processing system 700 .

[0061] In the shown embodiment , a physical barrier 11 may be erected between the training surgeon and at least body part simulator 2 , to render the surgical procedure training as dependent on the imaging presented on display 4 as possible and avoid that an inadvertent glance along a line-of-sight at patient body part simulator 2 provides the training surgeon with any information that would in reality of the surgical procedure also not be available . Display 4 may form the entirety or a part of barrier 11 .

[0062] As noted above , image processing system 700 may be configured to convert images from image acquisition system 3 of patient body part simulator 2 into at least one type of medical images from a group comprising echocardiography images . More in particular , converted images may adhere to a format of transesophageal echocardiography (TEE ) images . Other imaging techniques may also be emulated, in as far as these might be employed in practice during a medical / surgical procedure , such as MRI images and the or other non-invasive technique . Likewise , converted images may exhibit a format of a specific imaging technique , that may be more internally performed, like echocardiography .

[0063] Image processing system 700 may be configured to track and display actions by a training surgeon, for example when manoeuvring instrument 13 by hand ( schematically shown in FIG . 1 ) . To this end, a portion of an acquired image may contain instrument 13 . Potentially, a portion of an acquired image , the portion corresponding with instrument 13 , may not need to be converted .

[0064] Even though the present disclosure relates to medical training simulators more generally, more in particular an example is referred to herein below which relies on generating ultrasound-like transesophageal echocardiography ( TEE ) imagery in real time from one or more of RGB cameras 10 observing a physical heart replica 5 during simulated minimally invasive cardiac procedures , for example mitral valve replacement . Illumination is providing in the form of LED' s 22 , which may generate one or more than one of daylight ( approximately) , IR light ( see below with respect to suture assessment ) or any other type of light dependent on the intended purpose . When sufficient ambient light of a desired or necessary type is available , LED' s 22 may be omitted .

[0065] Many minimally invasive mitral procedures are performed while viewing 2D TEE slices on display 4 . Trainees must learn to navigate 3D anatomy and tools on the basis of what is shown to trainees in such 2D views on display 4 . Building a simulator forming a training system 1 according to the present disclosure , that produces TEE appearance and motion in real time (while instruments 13 and a mechanically driven model valve 6 , 7 , 8 are moving, and optionally but mostly not the rest of replica 5 ) has proven to be a technical challenge .

[0066] Disclosed is a pipeline that renders TEE-style ( B-mode ) video from monocular RGB streams of a physical 3D heart replica 5 . Per- pixel depth is estimated from the RGB frame via a learned model ( e . g . , monocular depth) , cached, and then transformed into a dynamic , slice-like intensity field by evaluating peaked functions around a time-varying "virtual imaging plane" synchronized to a heart-beat signal .

[0067] Ultrasound-like speckle , far-field attenuation, and sector masking are added procedurally . The replica mitral valve 7 with leaflets 8 in valve seat 6 is mechanically actuated by actuator 12 in synchronisation with a simulated heart beat pattern . The result is a convincing real-time TEE-style feed shown on display 4 that remains in visual sync with the model ' s valve motion . Using a type of augmented reality, movement of other parts of heart replica 5 may be presented on display 4 , even if such other parts of the heart replica 5 are not mechanically actuated for the training .

[0068] One or more fixed RGB cameras 10 are provided . These cameras may be set to an IR receptive mode for the below described aspects of stitch quality assessment , or other cameras 10 may be added for this specific purpose . Cameras 10 view and image physical heart replica 5 with exposed regions for the mitral valve 7 and adj oining atrial septum. A disposable valve 7 is actuated via a controllable mechanism through actuator 12 . Even though, the rest of the heart replica 5 may be static, motion thereof may be simulated on display 4 by deploying appropriate image processing to be presented on image display 4 .

[0069] There may be provided a virtual heartbeat generator , for example formed by processor 702 , to provide time-varying amplitude signals for leaflet 8 positions , chamber volumes , electrocardiogram views or displays , etc . Those values can be used to control the mechanical valve 7 and also parameterize in-plane shift and axial position of the virtual imaging depth to mimic cardiac motion and valve 7 phases .

[0070] For an incoming RGB frame acquired by RGB camera 10 or multiple RGB cameras 10 , a depth estimator ( e . g . , a pretrained monocular model ) produces a per-pixel depth map . A local heartbeat amplitude is computed from the virtual heartbeat generator, to provide a context to the mitral valve 7 motion when shown on display 4 .

[0071] Each instantaneous slice depth is then computed as a predefined position-based 3D affine transform amplified by the current heartbeat amplitude , thus faithfully recreating the heart' s relative motion to the camera . A procedural Perlin field modulates background and far-field to emulate speckle and depth-dependent attenuation, to more genuinely approximate a view on display 4 that the trainee would encounter when performing the trained operation for real . This yields a bright , thin "slice" with speckled tissue texture and a softer noisy background .

[0072] Additionally, further visual filters can be used, for example to simulate the characteristic TEE style . Firstly, additive Gaussian noise is inj ected . The ultrasonic beam angular blur can be simulated using blur filter to add blur based on a point of origin from the acoustic center . Also as an example , a wedge-shaped mas k can be applied, matching the TEE ergonomics .

[0073] The system 1 thus provides a manner of producing convincing, controllable TEE-style imagery from inexpensive monocular cameras 10 without a physical ultrasound probe . The system remains visually synchronized with the mechanical valve 7 motion ( generated by actuator 5 ) and the heart replica 5 (mostly stationary in reality but simulated on display 4 to be moving using information from the virtual heartbeat generator, for example formed by processor 702 ) . Thereby it is possible to provide the trainee with physically accurate haptic feedback , and additional measures may be deployed to this end as well .

[0074] Image processing system 700 may further be configured to monitor progress of the training surgeon while training the surgical procedure . For example , a training surgeon may apply stitches or sutures 21 in FIG . 5 to fix leaflets 8 of a mitral valve 7 onto valve seat 6 . Then the image processing system 700 may measure characteristics of the stitches . In FIG . 5 , an example is shown, wherein image processing system 700 generates in display 4 representations of stitches or suture 21 and intermediate distances between neighbouring sutures 21 , indicated by double arrows . The distance between neighbouring sutures 21 may provide an indication of a quality of the performed and thereby trained surgical procedure . Any so measured characteristic may be compared with a norm or threshold to arrive at an indication of quality of the performed and thereby trained medical / surgical procedure . Other indicators may be measured and compared with norms or thresholds to arrive at such quality indicators .

[0075] During training , while a trainee is applying sutures 21 , image processing system 700 may include , for representation on display 4 , generating an indication of a number of sutures 21 yet to be applied by the training surgeon or even a pointer to a location where to apply a first-next suture 21 , for example in the form of pointer or arrow C . Other progress information may also or alternatively be made available on display 4 for the benefit of the training surgeon . When the trainee is busy with or done applying sutures 21 , an assessment of a quality of applied sutures 21 may be generated . For assessment of a trainee ' s results during training for example a mitral valve 7 replacement , and in particular a measure of quality of applied sutures 21 , the following is noted .

[0076] In the embodiment of FIG . 5 , cameras 10 of image acquisition system 3 are trained on ( directed at ) patient body part simulator 2 , as noted herein above in relation also to FIG . 1 .

[0077] Further, at least one IR light source 22 and preferably an array of IR light sources 22 is provided near the replica or mitral valve 7 . Cameras 10 are herein IR cameras 10 , that are sensitive to the illumination provides by the IR light source 22 or array of IR light sources 22 , or may be sensitive to both daylight as well as IR light .

[0078] Sutures or stitches 21 ( or at least , the suture threads used) are more opaque in IR light when registered by cameras 10 than the surrounding material of the replica heart 5 in which the replacement replica mitral valve 7 is to be sutured on or in replica valve seat 6 . This makes applied sutures 21 that have been practiced by a training surgeon better detectable and measurable for quality determining characteristics thereof . Other types of illumination that accentuate applied sutures 21 against surrounding replica material and associated camera sensitivities may be used, in stead of IR light . Quality determining characteristics may be any of a group comprising length of sutures 21 , distance between sutures 21 along double arrows D in FIG . 5 , or any other measurable characteristic , from which an assessment of a measure of quality of one or more than one applied suture 21 may be derived .

[0079] This portion of the present disclosure relates to surgical training and assessment systems , and more particularly to measuring attributes or characteristics of sutures 21 placed by a training surgeon into a silicone mitral valve model to fixate a replica mitral valve 7 comprising replica leaflets 8 on replica valve seat 6 . The same as in the configuration of FIG . 1 , a plurality of camera' s 10 is used to provide multi-camera imaging . Image processing system 700 is configured to generate a three-dimensional reconstruction in an image space , wherein the desired quality determining characteristics can be measured in terms of real world values , such as length and distance .

[0080] When training for endoscopically assisted mitral valve 7 repair or replacement , trainees must learn to place annular sutures with consistent width or length, depth into the material replicating heart tissue or mitral valve seat 6 and spacing along double arrows D . Moreover , it is imperative to maintain a smooth intracardiac needle traj ectory to minimize tissue trauma .

[0081] The mitral valve 7 annulus or valve seat 6 is a 3D structure , and as a consequence purely 2D-measurements can misestimate in particular suture depth but also suture geometry in many regions and against many viewing orientations , and are susceptible to lighting variability and visual artifacts . Therefore , 2D-imaging and measurements in 2D images to determine quality of sutures 21 applied by a trainee are not adequate and there ' s a need for a considerable improvement .

[0082] According to the present disclosure , in a particular exemplary embodiment , a system and / or method is configured such that : ( i ) multi-exposure , near-infrared ( IR) images are acquired using paired cameras 10 on each side of a mitral valve disposable or valve seat 6 made of transparent silicone with an anatomically realistic valve 7 moulded inside ;

[0083] ( ii ) the sutures 21 are identified and optionally isolated ( from surrounding replica heart 5 or valve seat 6 material ) in 3D space constructed from paired views acquired by IR cameras 10 ;

[0084] ( iii ) geometric metrics are calculated, including depth, width, spacing, and a smoothness indicator derived from the suture' s internal traj ectory; and

[0085] ( iv) distances from sutures 21 to pre-defined zones of critical anatomy are reported, enabling real-time warnings and obj ective skill assessment , both during training and also afterwards .

[0086] The image processing system 700 supports batch measurements , and is designed to be robust to external lighting , such as for example daylight illumination in addition to IR illumination from sources 22 .

[0087] The shown embodiment contains an IR-transparent silicone body forming heart replica 5 or more in particular valve seat 6 , with a moulded mitral valve 7 comprising mitral valve leaflets 8 . In FIG . 1 replica heart 5 with mitral valve seat 6 is observed from each of four sides by an IR camera 10 . Use can be made of at least one calibrated stereo pair of IR cameras 10 . Internally mounted IR LED arrays 22 can be used to provide controlled lighting . Cameras 10 can carry IR-pass filters to suppress ambient ( artificial or day) light . Per side , the arrays of IR sources 22 can be time-multiplexed to produce multiple exposures that emphasize different visual cues of sutures 21 . The CPU or processor 702 of system 700 controls and orchestrates exposure sequences by IR sources 22 , image capture by cameras 10 , calibration use , reconstruction, metric computation and visualization . These aspects make clear that image acquisition system 3 and image processing system 700 should not be viewed as strictly separate parts of training system 1 , and that these may be integrated or share particular elements or components , such as processor 702 .

[0088] Image acquisitions system 3 and / or image processing system 700 can require precise calibration of both the per-camera intrinsics , distortion correction, and camera-disposable relative pose . This may form part of initiation of the image

[0089] For each stereo pair of cameras 10 , system 1 can acquire a small set of IR exposures with controlled illumination patterns . This reveals sutures that may be subtle in any single exposure .

[0090] Per camera 10 , acquired images are lens-corrected and processed by system 700 using computer vision algorithms to emphasize structures that resemble or qualify as suture 21 , while suppressing non-suture artifacts . Appropriate training of an AT based system may yield desired results , in particular , though not exclusively for suture 21 detection and / or surrounding material suppression .

[0091] Candidate suture features observed from the two cameras 10 of a pair are associated and reconstructed into 3D using ray-casting . The traj ectory of those rays is non-linear due to one or more light refraction boundaries between the camera 10 and the measured suture 21 . Data from adj acent pairs can be merged, once the casted rays meet inside the virtual silicone mold, producing a continuous point cloud of each suture along the annulus or valve seat 6 .

[0092] The suture point clouds are positioned relative to an accurate 3D model of the disposable or replica valve seat 6 and its anatomical landmarks , enabling consistent measurement and training results across sessions and trainees / users .

[0093] For each suture 21 , the system determines entry / exit points , local width, height and depth based on the extracted 3D point cloud . The "height" serves as an indicator of smoothness that reflects the internal traj ectory, based on which system 700 may arrive at a result in terms of suture 21 quality .

[0094] Distances from each suture 21 to predefined critical anatomy points may also be taken into account and can be computed in addition or alternatively, depending on criteria applied to arrive at a result in terms of a quality of trained suturing . Then, threshold breaches or punctures trigger warning messages may be made visible on display 4 to aid the trainee or user during training , or later as a measure of quality attained .

[0095] Colored 3D overlays can be used to show sutures on display 4 relative to valve model . Per-suture 21 and aggregate scores can be generated and presented on display 4 , both during and after training .

[0096] In the above described manner , the present disclosure provides accurate 3D measurement of depth and traj ectory on complex annular geometry, while being robust to ambient light and internal artifacts . The system provides obj ective , repeatable scoring that directly correlates with surgical technique and tissue trauma risk .

[0097] FIG . 6 exemplifies some of the steps of a method according to the present disclosure .

[0098] Such an exemplary method of surgical procedure training comprises the following steps :

[0099] Step 601 : providing a patient body part simulator , such as a replica of a heart or a part thereof , such as a mitral valve .

[0100] Step 602 : acquiring images with an image acquisition system directed at the patient body part simulator .

[0101] Step 603 : converting acquired images into emulation images corresponding with a specific technique of imaging as available during an actual surgical procedure on the patient body part .

[0102] Step 604 : displaying converted acquired images to a training surgeon on a display, wherein the images correspond with the specific imaging technique as available during an actual surgical procedure on the patient body part .

[0103] To augment training , the method may further comprise : including a representation in displayed images of actions performed by the training surgeon .

[0104] To further enhance training, the method may further exhibit a feature that the image acquisition system is trained at the patient body part simulator from a perspective corresponding with imaging of the specific technique , such as echoscopy and / or perhaps even echocardiography, as deployed during an actual surgical procedure on the patient body part , such as the heart . As noted above , placement of the image acquisition system is performed in a manner that is optimal for information gathering , and allows the image processing system 700 to perform the necessary image processing to be able to display visual information best suited for training purposes . FIG . 7 depicts a block diagram illustrating an exemplary data processing system that may be at the core of the system and / or perform the method as described herein reference .

[0105] As shown in FIG . 7 , the data processing system 700 may include at least one processor 702 coupled to memory elements 704 through a system bus 706 . As such, the data processing system may store program code within memory elements 704 . Further, the processor 702 may execute the program code accessed from the memory elements 704 via a system bus 706 . In one aspect , the data processing system may be implemented as a computer that is suitable for storing and / or executing program code . It should be appreciated, however , that the data processing system 700 may be implemented in the form of any system including a processor and a memory that is capable of performing the functions described within this specification .

[0106] The memory elements 704 may include one or more physical memory devices such as , for example , local memory 708 and one or more bulk storage devices 710 . The local memory may refer to random access memory or other non-persistent memory device ( s ) generally used during actual execution of the program code . A bulk storage device may be implemented as a hard drive or other persistent data storage device . The processing system 700 may also include one or more cache memories ( not shown) that provide temporary storage of at least some program code in order to reduce the quantity of times program code must be retrieved from the bulk storage device 710 during execution . The processing system 700 may also be able to use memory elements of another processing system, e . g . if the processing system 700 is part of a cloud-computing platform.

[0107] Input / output ( I / O ) devices depicted as an input device 712 and an output device 714 optionally can be coupled to the data processing system. Examples of input devices may include , but are not limited to , a keyboard, a pointing device such as a mouse , a microphone ( e . g . for voice and / or speech recognition) , or the like . Examples of output devices may include , but are not limited to , a monitor or a display 4 , speakers , or the like . Input and / or output devices may be coupled to the data processing system either directly or through intervening I / O controllers . In an embodiment, the input and the output devices may be implemented as a combined input / output device (illustrated in FIG. 7 with a dashed line surrounding the input device 712 and the output device 714) . An example of such a combined device is a touch sensitive display 4, also sometimes referred to as a "touch screen display" or simply "touch screen". In such an embodiment, input to the device may be provided by a movement of a physical object, such as e.g. a stylus or a finger of a user, on or near the touch screen display 4.

[0108] A network adapter 716 may also be coupled to the data processing system to enable it to become coupled to other systems, computer systems, remote network devices, and / or remote storage devices through intervening private or public networks. The network adapter may comprise a data receiver for receiving data that is transmitted by said systems, devices and / or networks to the data processing system 700, and a data transmitter for transmitting data from the data processing system 700 to said systems, devices and / or networks. Modems, cable modems, and Ethernet cards are examples of different types of network adapter that may be used with the data processing system 700.

[0109] As pictured in FIG. 7, the memory elements 704 may store an application 718. In various embodiments, the application 718 may be stored in the local memory 708, the one or more bulk storage devices 710, or separate from the local memory and the bulk storage devices.

[0110] It should be appreciated that the data processing system 700 may further execute an operating system (not shown in FIG. 7) that can facilitate execution of the application 718. The application 718, being implemented in the form of executable program code, can be executed by the data processing system 700, e.g., by the processor 702. Responsive to executing the application, the data processing system 700 may be configured to perform one or more operations or method steps described herein.

[0111] Application 718 stored in or retrieved from memory may cause data processing system 700, when loaded in processor 702, to perform any of a number of image processing steps and techniques, of which some are exemplified in FIG. 6 and defined in the appended independent method claim, in cooperation with at least some of the system 1 components shown in FIG . 1 .

[0112] For the following portion of the description, it is assumed that system 1 of FIG . 1 comprises a soft , 3D-printed replica 5 of the heart featuring movable mitral valve leaflets 8 and possibly also other interchangeable or replaceable components or valves , critical for training particular types of heart surgery for example interventional cardiology with transcatheter techniques . Image acquisition system 1 comprises an array of RGB cameras 10 that allow surgeons to monitor the procedure from standard TEE ( transoesophageal echocardiogram) imaging angles ( see also FIG . 2 and the above explanation of the relevance thereof ) . Advanced image processing algorithms , utilizing neural networks and advanced image processing techniques , may be employed to simulate TEE images through real-time depth approximation and a series of filters to produce the final image .

[0113] A Linux system may be employed to process images from camera' s 10 , which may here be RGB cameras 10 , in real time . The images are processed in the following steps :

[0114] The system synchronously reads images from the cameras via a USB interface and stores them in a buffer to ensure minimal output latency . The system then still can be made to run in real time for training or other purposes .

[0115] A neural network forming part of or being associated with image processing system 700 is used to approximate the depth of the displayed views captured or acquired by camera' s 10 , generating a depth map that can be estimated using neural network algorithms . For each image frame , the depth map is normalized relative to previous frames with neural network algorithms . A series of filters based on computer vision algorithms is applied to the depth map , taking into consideration current settings of the simulated TEE depth, a current phase of the simulated cardiac cycle , and positions of camera' s 10 or a purposeful selection thereof . The output of this step is an approximation of the TEE imaging view with simulated heart 5 motion synchronized with the movement of the mitral valve 7 leaflets 8 . A view presented on display 4 will then mimick images acquired in a 1 real life procedure from echoscopy and perhaps even echocardiography, comparable with the representation in FIG . 4 .

[0116] The image processing system 700 and a program loaded in and run by processor 702 may be different from the imaging above and may be used to detect and potentially also assess stitches or sutures 21 , which may be achieved in a different manner from the above described method of imaging a replica 5 of a heart in motion to produce on display 4 a view to a training surgeon that is comparable with an echoscopy image as will be presented to the surgeon performing the procedure later on . To detect and visualise in images on display 4 applied stitches or sutures 21 , the image processing system 700 may perform in the following manner .

[0117] It is assumed here that replica heart 5 is made of 3D printed or cast or moulded silicone and a replica replacement leaflet 8 of or for a mitral valve 7 is a silicone cast shaped like a mitral valve . For contrast and visibility, or even for the benefit of image processing, the replica leaflet 8 may be provided with at least one coloured or painted side or wall .

[0118] Stitches or sutures 21 placed by training surgeons are measured by image processing system 700 when using a series of infrared cameras 10 surrounding all but preferably at least a representative number of sides of the replica leaflet 8 of replica mitral valve 7 . When performing this function, image processing system 700 may employ advanced image processing algorithms and precise calibration to enable 3D spatial representation . The output is a 3D representation of the surgeon ' s training stitches or sutures 21 , which can be further analysed— for example , to determine their dimensions , evaluate errors and potential improvements for the surgeon, and monitor the training surgeon ' s accuracy over time .

[0119] For evaluation of ( a quality of ) sutures 21 applied by the training surgeon, the application 718 run on processor 702 of image processing system 700 may thus comprise a measurement or other factor determining module to determine lengths of sutures 21 and distances therebetween (with FIG . 5 only indicating the distances between sutures 21 using double arrows ) or other quality determining factors . For example , regarding other quality determining factors , suture placement along an edge of a replacement leaflet 8 of a mitral valve 7 and in valve seat 6 may be included in an evaluation of the quality of the training performance by the training surgeon, for example by defining a range from and edge of replica leaflet 8 and another range from an edge of valve seat 6 , and comparing results of training with such norms or thresholds . For simplicity of the present portion of the description, quality assessment (which may be embodied as complex as desired) is limited here to length and distance measurement of applied sutures 21 . It is assumed that the skilled person in image processing of or for medical images is familiar with modules able to perform at least length and distance measurements , and a further detailed description is omitted here , other than to mention here that quality factors may be determined by comparing lengths and distances between applied stitches or sutures 21 with norms or thresholds . Purely as an example , the following is noted .

[0120] To convert stitches or sutures 21 applied by a training surgeon into a 3D mapping, image processing system 700 may employ pairs of stereo infrared cameras 10 on four sides ( e . g . walls defined by or alongside frame 9 ) of the replica heart 5 or the at least oriented on the replica mitral valve 7 , which may be a silicone mold, as noted above . Images from the cameras 10 are processed through a series of computer vision filters designed to detect stitches or sutures 21 in the camera views while filtering out noise . The detected stitches or sutures 21 in images from or acquired by stereo IR cameras 10 are matched using linear sum assignment via the Hungarian algorithm based on determined mutual similarity scores thereof . These detected pairs are proj ected into space using ray casting, originating at the camera ' s focal point and passing through the silicone ' s refractive barrier . The intersection of the proj ected rays represents the stitch or suture 21 points in 3D space . By merging the same determined points from all the stereo IR cameras 10 , complete information is obtained about stitches or sutures 21 within the mold .

[0121] Individual steps of a computer vision pipeline of processes on images from a single IR camera 10 may comprise :

[0122] 1 ) Background subtraction using images lit from different angles ; 2) 2D convolutional filter with Gabor kernel (Gaussian function standard deviation tuned for suture detection) ;

[0123] 3) Coherence filter utilizing Sobel edge detection with Morphological operations and region of interest (ROI) mask;

[0124] 4) Grabcut probability-based segmentation filter with adaptive thresholding algorithm; and

[0125] 5) a rule-based binary image filter.

[0126] Additionally or alternatively, image processing may comprise or involve steps of linearising a 2D or 3D image portion comprising sutures, and combining result from images obtained from different camera's 10, by bringing lengths in of such image portions in correspondence. Also, image processing may comprise or involve steps of approximating

[0127] It is noted here that suture detection, proposed and described herein above, is presented in the framework of surgeon training. However, the features and steps required for suture detection may even be implemented for the same purpose, but under different circumstances than surgeon training. For example, suture detection and assessment of quality or viability thereof while in reality an actual procedure (e.g. for replacement of a mitral valve) is being performed. In this sense, suture detection, assessment and / or viability detection / prediction may be considered a separate invention in its own right.

[0128] Various embodiments of the disclosure may be implemented as a program product for use with a computer system, where the program(s) of the program product define functions of the embodiments (including the methods described herein) . In one embodiment, the program(s) can be contained on a variety of non-transitory computer- readable storage media, where, as used herein, the expression "non- transitory computer readable storage media" comprises all computer- readable media, with the sole exception being a transitory, propagating signal. In another embodiment, the program (s) can be contained on a variety of transitory computer-readable storage media. Illustrative computer-readable storage media include, but are not limited to: (i) non-writable storage media (e.g. , read-only memory devices within a computer such as CD-ROM disks readable by a CD-ROM drive, ROM chips or any type of solid-state non-volatile semiconductor memory) on which information is permanently stored; and ( ii ) writable storage media ( e . g . , flash memory, floppy dis ks within a diskette drive or hard-dis k drive or any type of solid- state random-access semiconductor memory) on which alterable information is stored . The computer program may be run on the processor 702 described herein .

[0129] The terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting of the disclosure . As used herein, the singular forms "a, " "an, " and "the" are intended to include the plural forms as well , unless the context clearly indicates otherwise . It will be further understood that the terms "comprises" and / or "comprising , " when used in this specification, specify the presence of stated features , integers , steps , operations , elements , and / or components , but do not preclude the presence or addition of one or more other features , integers , steps , operations , elements , components , and / or groups thereof .

[0130] The corresponding structures , materials , acts , and equivalents of all means or step plus function elements in the appended claims are intended to include any structure , material , or act for performing the function in combination with other claimed elements as specifically claimed . The description of embodiments of the present disclosure has been presented for purposes of illustration, but is not intended to be exhaustive or limited to the implementations in the form disclosed for determining or restricting the scope of the appended claims . Many modifications and variations relative to the shown and described embodiments will be apparent to those of ordinary s kill in the art without departing from the scope of the present disclosure as defined in the appended claims , and includes , at least for or in some j urisdictions , also obvious alternatives for claimed features . The embodiments were chosen, shown and described herein serve to explain the principles and some practical applications of the present disclosure , and to enable others of ordinary skill in the art to understand the present disclosure for various embodiments with various modifications as are suited to the particular use contemplated .

Claims

CLAIMS1. A surgical procedure training system (1) , comprising: a patient body part simulator (2) , such as a replica of a heart (5) or a part thereof, such as a mitral valve (6,7) ; an image acquisition system (3) directed at the patient body part simulator; an image processing system (700) configured to convert images from the image acquisition system (3) into emulation images corresponding with a specific imaging technique from a group at least comprising echoscopy or echocardiography, as deployed during an actual surgical procedure on the patient body part; and an image display (4) presenting to a training surgeon images from the image acquisition system (3) and converted by the image processing system (700) into the images corresponding with the specific imaging technique.

2. The surgical procedure training system according to claim1, wherein the image acquisition system (3) comprises a plurality of camera' s ( 10 ) .

3. The surgical procedure training system according to claim2, wherein the image acquisition system (3) comprises at least one pair of camera's (10) arranged to in combination acquire 3- dimensional images of at least a part of the patient body part simulator ( 2 ) .

4. The surgical procedure training system according to claim 1, 2 or 3, wherein the image acquisition system (3) is trained at the patient body part simulator from a perspective corresponding with medical imaging of the specific technique, in particular from the group comprising echoscopy or echocardiography, as deployed during an actual surgical procedure on the patient body part.

5. The surgical procedure training system according to any of the preceding claims, wherein the patient body part simulator (2) comprises a tissue simulating replica of the patient body part.

6. The surgical procedure training system according to claim 5, wherein the tissue simulating replica of the patient body part is a 3D printed replica, using soft printed material.

7. The surgical procedure training system according to any of the preceding claims, further comprising a frame (9) configured to support or suspend the patient body part simulator (2) .

8. The surgical procedure training system according to any of the preceding claims, further comprising an actuator (12) connected to the patient body part simulator to simulate patient body part motion, wherein the actuator comprises a component from a group at least comprising an electric motor, a pneumatic drive and a hydraulic drive.

9. The surgical procedure training system according to claim 8, wherein the actuator is selectable to drive only a body part simulator that is object of the trained procedure and a portion in images acquired, converted and presented on the image display (4) .

10. The surgical procedure training system according to any of the preceding claims, wherein, for imaging, motion of stationary portions of the body part simulator is introduced by image processing into images acquired, converted and presented on the image display (4) .

11. The surgical procedure training system according to any of the preceding claims, further comprising a line-of-sight barrier (11) arranged between the image display (4) at which a training surgeon is positioned, and the patient body part simulator (2) .

12. The surgical procedure training system according to any of the preceding claims, wherein the image processing system (700) is configured to convert images from the image acquisition system (3) into at least one type of medical images from a group comprising echoscopic or echocardiographic images.

13. The surgical procedure training system according to claim 12, wherein the echoscopic or echocardiographic images comprise transesophageal echocardiography 'TEE' images.

14. The surgical procedure training system according to any of the preceding claims, wherein the image processing system (700) is configured to track and display actions by a training surgeon.

15. The surgical procedure training system according to any of the preceding claims, further comprising an illumination (22) from a type comprising at least one of daylight and / or IR light.

16. The surgical procedure training system according to any of the preceding claims, wherein actions by a training surgeon comprise applying stitches using suture thread, and the image processing system (700) is configured to measure characteristics of the stitches.

17. The surgical procedure training system according to claims 15 and 16, wherein the type of illumination and the suture thread are matched to provide emphasized display of sutures in presented images.

18. The surgical procedure training system according to claim 16 or 17, wherein measured characteristics of the stitches comprise at least one characteristic from a group comprising: lengths of stitches (21) , distance between stitches (21) , distances of applied stitches (21) to pre-defined zones of critical anatomy, tissue depths to which a stitching instrument (13) is inserted into surrounding replica tissue, other 2-dimensionally measurable characteristics of stitches (21) , and also other characteristics of stitches are derivable therefrom, among which a smoothness indicator of a stitching instrument's trajectory to minimize tissue trauma.

19. The surgical procedure training system according to claim 16, 17 or 18, wherein the image processing system (700) is configured to compare measured characteristics of the stitches with a norm or threshold.

20. The surgical procedure training system according to any of the preceding claims, wherein the image processing system (700) is configured to output on the display (4) pointers for a training surgeon to perform the procedure.

21. A method of surgical procedure training, comprising: providing a patient body part simulator, such as a replica of a heart or a part thereof, such as a mitral valve; acquiring images with an image acquisition system directed at the patient body part simulator; converting acquired images into emulation images corresponding with a specific technique of imaging as available during an actual surgical procedure on the patient body part; and displaying converted acquired images to a training surgeon on a display, wherein the images correspond with the specific imagingtechnique as available during an actual surgical procedure on the patient body part.

22. The method according to claim 21, further comprising: including a representation in displayed images of actions performed by the training surgeon.

23. The method according to claim 21 or 22, wherein the image acquisition system is trained at the patient body part simulator from a perspective corresponding with imaging of the specific technique, such as echoscopy or echocardiography, as deployed during an actual surgical procedure on the patient body part.

24. A computer program product for a data processing system (700) , the computer program product comprising computer program code to perform the method of any of claims 20 - 228, when the computer program product is run on a processing unit (702) of the data processing system (700) .

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