Advancing Cardiac Surgery Case Planning and Case Review Conferences Using Virtual Reality in Medical Libraries: Evaluation of the Usability of Two Virtual Reality Apps

ChatGPT-3.5 System Usability Scale early assessment among Healthcare Workers: Horizons of adoption in medical practice

Artificial intelligence (AI) chatbots, such as ChatGPT, have widely invaded all domains of human life. They have the potential to transform healthcare future. However, their effective implementation hinges on healthcare workers' (HCWs) adoption and perceptions. This study aimed to evaluate HCWs usability of ChatGPT three months post-launch in Saudi Arabia using the System Usability Scale (SUS). A total of 194 HCWs participated in the survey. Forty-seven percent were satisfied with their usage, 57 % expressed moderate to high trust in its ability to generate medical decisions. 58 % expected ChatGPT would improve patients' outcomes, even though 84 % were optimistic of its potential to improve the future of healthcare practice. They expressed possible concerns like recommending harmful medical decisions and medicolegal implications. The overall mean SUS score was 64.52, equivalent to 50 % percentile rank, indicating high marginal acceptability of the system. The strongest positive predictors of high SUS scores were participants' belief in AI chatbot's benefits in medical research, self-rated familiarity with ChatGPT and self-rated computer skills proficiency. Participants' learnability and ease of use score correlated positively but weakly. On the other hand, medical students and interns had significantly high learnability scores compared to others, while ease of use scores correlated very strongly with participants' perception of positive impact of ChatGPT on the future of healthcare practice. Our findings highlight the HCWs' perceived marginal acceptance of ChatGPT at the current stage and their optimism of its potential in supporting them in future practice, especially in the research domain, in addition to humble ambition of its potential to improve patients' outcomes particularly in regard of medical decisions. On the other end, it underscores the need for ongoing efforts to build trust and address ethical and legal concerns of AI implications in healthcare. The study contributes to the growing body of literature on AI chatbots in healthcare, especially addressing its future improvement strategies and provides insights for policymakers and healthcare providers about the potential benefits and challenges of implementing them in their practice.

Presence and simulator sickness predict the usability of a virtual reality attention task

Attention is the ability to actively process specific information within one's environment over longer periods of time while disregarding other details. Attention is an important process that contributes to overall cognitive performance from performing every day basic tasks to complex work activities. The use of virtual reality (VR) allows study of the attention processes in realistic environments using ecological tasks. To date, research has focused on the efficacy of VR attention tasks in detecting attention impairment, while the impact of the combination of variables such as mental workload, presence and simulator sickness on both self-reported usability and objective attention task performance in immersive VR has not been examined. The current study tested 87 participants on an attention task in a virtual aquarium using a cross-sectional design. The VR task followed the continuous performance test paradigm where participants had to respond to correct targets and ignore non-targets over 18 min. Performance was measured using three outcomes: omission (failing to respond to correct targets), commission errors (incorrect responses to targets) and reaction time to correct targets. Measures of self-reported usability, mental workload, presence and simulator sickness were collected. The results showed that only presence and simulator sickness had a significant impact on usability. For performance outcomes, simulator sickness was significantly and weakly associated with omission errors, but not with reaction time and commission errors. Mental workload and presence did not significantly predict performance. Our results suggest that usability is more likely to be negatively impacted by simulator sickness and lack of presence than performance and that usability and attention performance are linked. They highlight the importance of considering factors such as presence and simulator sickness in attention tasks as these variables can impact usability.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10055-023-00782-3.

HEARTBEAT4D: An Open-source Toolbox for Turning 4D Cardiac CT into VR/AR

Four-dimensional data sets are increasingly common in MRI and CT. While clinical visualization often focuses on individual temporal phases capturing the tissue(s) of interest, it may be possible to gain additional insight through exploring animated 3D reconstructions of physiological motion made possible by augmented or virtual reality representations of 4D patient imaging. Cardiac CT acquisitions can provide sufficient spatial resolution and temporal data to support advanced visualization, however, there are no open-source tools readily available to facilitate the transformation from raw medical images to dynamic and interactive augmented or virtual reality representations. To address this gap, we developed a workflow using free and open-source tools to process 4D cardiac CT imaging starting from raw DICOM data and ending with dynamic AR representations viewable on a phone, tablet, or computer. In addition to assembling the workflow using existing platforms (3D Slicer and Unity), we also contribute two new features: 1. custom software which can propagate a segmentation created for one cardiac phase to all others and export to surface files in a fully automated fashion, and 2. a user interface and linked code for the animation and interactive review of the surfaces in augmented reality. Validation of the surface-based areas demonstrated excellent correlation with radiologists' image-based areas (R > 0.99). While our tools were developed specifically for 4D cardiac CT, the open framework will allow it to serve as a blueprint for similar applications applied to 4D imaging of other tissues and using other modalities. We anticipate this and related workflows will be useful both clinically and for educational purposes.

Virtual Reality in the Preoperative Planning of Adult Aortic Surgery: A Feasibility Study

Background: Complex aortic anatomy needs careful preoperative planning in which a patient-tailored approach with novel immersive techniques could serve as a valuable addition to current preoperative imaging. This pilot study aimed to investigate the technical feasibility of virtual reality (VR) as an additional imaging tool for preoperative planning in ascending aortic surgery. Methods: Ten cardiothoracic surgeons were presented with six patients who had each undergone a recent repair of the ascending aorta. Two-dimensional computed tomography images of each patient were assessed prior to the VR session. After three-dimensional (3D) VR rendering and 3D segmentation of the ascending aorta and aortic arch, the reconstructions were analyzed by each surgeon in VR via a head-mounted display. Each cardiothoracic surgeon completed a questionnaire after each planning procedure. The results of their assessments were compared to the performed operations. The primary endpoint of the present study was a change of surgical approach from open to clamped distal anastomosis, and vice versa. Results: Compared with conventional imaging, 80% of surgeons found that VR prepared them better for surgery. In 33% of cases (two out of six), the preoperative decision was adjusted due to the 3D VR-based evaluation of the anatomy. Surgeons rated CardioVR usefulness, user-friendliness, and satisfaction with median scores of 3.8 (IQR: 3.5-4.1), 4.2 (IQR: 3.8-4.6,) and 4.1 (IQR: 3.8-4.7) on a five-point Likert scale, respectively. Conclusions: Three-dimensional VR imaging was associated with improved anatomical understanding among surgeons and could be helpful in the future preoperative planning of ascending aortic surgery.

A Virtual Reality System for Improved Image-Based Planning of Complex Cardiac Procedures

The intricate nature of congenital heart disease requires understanding of the complex, patient-specific three-dimensional dynamic anatomy of the heart, from imaging data such as three-dimensional echocardiography for successful outcomes from surgical and interventional procedures. Conventional clinical systems use flat screens, and therefore, display remains two-dimensional, which undermines the full understanding of the three-dimensional dynamic data. Additionally, the control of three-dimensional visualisation with two-dimensional tools is often difficult, so used only by imaging specialists. In this paper, we describe a virtual reality system for immersive surgery planning using dynamic three-dimensional echocardiography, which enables fast prototyping for visualisation such as volume rendering, multiplanar reformatting, flow visualisation and advanced interaction such as three-dimensional cropping, windowing, measurement, haptic feedback, automatic image orientation and multiuser interactions. The available features were evaluated by imaging and nonimaging clinicians, showing that the virtual reality system can help improve the understanding and communication of three-dimensional echocardiography imaging and potentially benefit congenital heart disease treatment.

Virtual reality three-dimensional echocardiographic imaging for planning surgical atrioventricular valve repair

OBJECTIVES

To investigate how virtual reality (VR) imaging impacts decision-making in atrioventricular valve surgery.

METHODS

This was a single-center retrospective study involving 15 children and adolescents, median age 6 years (range, 0.33-16) requiring surgical repair of the atrioventricular valves between the years 2016 and 2019. The patients' preoperative 3-dimesnional (3D) echocardiographic data were used to create 3D visualization in a VR application. Five pediatric cardiothoracic surgeons completed a questionnaire formulated to compare their surgical decisions regarding the cases after reviewing conventionally presented 2-dimesnional and 3D echocardiographic images and again after visualization of 3D echocardiograms using the VR platform. Finally, intraoperative findings were shared with surgeons to confirm assessment of the pathology.

RESULTS

In 67% of cases presented with VR, surgeons reported having "more" or "much more" confidence in their understanding of each patient's pathology and their surgical approach. In all but one case, surgeons were at least as confident after reviewing the VR compared with standard imaging. The case where surgeons reported to be least confident on VR had the worst technical quality of data used. After viewing patient cases on VR, surgeons reported that they would have made minor modifications to surgical approach in 53% and major modifications in 7% of cases.

CONCLUSIONS

The main impact of viewing imaging on VR is the improved clarity of the anatomical structures. Surgeons reported that this would have impacted the surgical approach in the majority of cases. Poor-quality 3D echocardiographic data were associated with a negative impact of VR visualization; thus. quality assessment of imaging is necessary before projecting in a VR format.

Applications of Head-Mounted Displays and Smart Glasses in Vascular Surgery

OBJECTIVES

Advances in virtual, augmented and mixed reality have led to the development of wearable technologies including head mounted displays (HMD) and smart glasses. While there is a growing interest on their potential applications in health, only a few studies have addressed so far their use in vascular surgery. The aim of this review was to summarize the fundamental notions associated with these technologies and to discuss potential applications and current limits for their use in vascular surgery.

METHODS

A comprehensive literature review was performed to introduce the fundamental concepts and provide an overview of applications of HMD and smart glasses in surgery.

RESULTS

HMD and smart glasses demonstrated a potential interest for the education of surgeons including anatomical teaching, surgical training, teaching and telementoring. Applications for pre-surgical planning have been developed in general and cardiac surgery and could be transposed for a use in vascular surgery. The use of wearable technologies in the operating room has also been investigated in both general and cardiovascular surgery and demonstrated its potential interest for image-guided surgery and data collection.

CONCLUSION

Studies performed so far represent a proof of concept of the interest of HMD and smart glasses in vascular surgery for education of surgeons and for surgical practice. Although these technologies exhibited encouraging results for applications in vascular surgery, technical improvements and further clinical research in large series are required before hoping using them in daily clinical practice.

Virtual Reality (VR) Applications in Cardiology: A Review

Virtual reality (VR) has applications in cardiology to create enhancement, thereby improving the quality of associated planning, treatment and surgery. The need is to study different applications of this technology in the field of cardiology. We have studied research papers on VR and its applications in cardiology through a detailed bibliometric analysis. The study identified five significant steps for proper implementation of this technology in cardiology. Some challenges are to be undertaken by using this technology, and they can provide some benefits; thus, authors contemplate extensive research and development. This study also identifies 10 major VR technology applications in cardiology and provided a brief description. This innovative technology helps a heart surgeon to perform complex heart surgery effectively. Thus, VR applications have the potential for improving decision-making, which helps save human life. VR plays a significant role in the development of a surgical procedure. This technology undertakes 3D heart model information in full colour, which helps to analyze the overall heart vane, blockage and blood flow. With the help of this digital technology, a surgeon can improve the accuracy of heart surgery, and he can simulate the surgery. A surgeon can undertake surgery in a virtual environment on a virtual patient. The unique purpose of this technology is to practice pre-operatively on the specific circumstance. A cardiologist can also check the proper status of inner and outer heart wall layer. Thus, by using this 3D information, the surgeon can now interact with heart data/information without any physical touch. This technology opens a new opportunity to improve the heart surgery and development in cardiovascular treatment to improve patient outcome.