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

Surgical planning in virtual reality: a systematic review

Purpose

Virtual reality (VR) technology has emerged as a promising tool for physicians, offering the ability to assess anatomical data in 3D with visuospatial interaction qualities. The last decade has witnessed a remarkable increase in the number of studies focusing on the application of VR to assess patient-specific image data. This systematic review aims to provide an up-to-date overview of the latest research on VR in the field of surgical planning.

Approach

A comprehensive literature search was conducted based on the preferred reporting items for systematic reviews and meta-analyses covering the period from April 1, 2021 to May 10, 2023. It includes research articles reporting on preoperative surgical planning using patient-specific medical images in virtual reality using head-mounted displays. The review summarizes the current state of research in this field, identifying key findings, technologies, study designs, methods, and potential directions for future research.

Results

The selected studies show a positive impact on surgical decision-making and anatomy understanding compared to other visualization modalities. A substantial number of studies are reporting anecdotal evidence and case-specific outcomes. Notably, surgical planning using VR led to more frequent changes in surgical plans compared to planning with other visualization methods when surgeons reassessed their initial plans. VR demonstrated benefits in reducing planning time and improving spatial localization of pathologies.

Conclusions

Results show that the application of VR for surgical planning is still in an experimental stage but is gradually advancing toward clinical use. The diverse study designs, methodologies, and varying reporting hinder a comprehensive analysis. Some findings lack statistical evidence and rely on subjective assumptions. To strengthen evaluation, future research should focus on refining study designs, improving technical reporting, defining visual and technical proficiency requirements, and enhancing VR software usability and design. Addressing these areas could pave the way for an effective implementation of VR in clinical settings.

Use of Virtual Reality and 3D Models in Contemporary Practice of Cardiology

PURPOSE OF REVIEW

To provide an overview of the impact of virtual and augmented reality in contemporary cardiovascular medical practice.

RECENT FINDINGS

The utilization of virtual and augmented reality has emerged as an innovative technique in various cardiovascular subspecialties, including interventional adult, pediatric, and adult congenital as well as structural heart disease and heart failure. In particular, electrophysiology has proven valuable for both diagnostic and therapeutic procedures. The incorporation of 3D reconstruction modeling has significantly enhanced our understanding of patient anatomy and morphology, thereby improving diagnostic accuracy and patient outcomes. The interactive modeling of cardiac structure and function within the virtual realm plays a pivotal role in comprehending complex congenital, structural, and coronary pathology. This, in turn, contributes to safer interventions and surgical procedures. Noteworthy applications include septal defect device closure, transcatheter valvular interventions, and left atrial occlusion device implantation. The implementation of virtual reality has been shown to yield cost savings in healthcare, reduce procedure time, minimize radiation exposure, lower intravenous contrast usage, and decrease the extent of anesthesia required. These benefits collectively result in a more efficient and effective approach to patient care.

Virtual Reality-based Methods for Training Novice Electrophysiology Trainees-A Pilot Study

Developing an accurate and detailed 3-dimensional (3D) mental model of cardiac anatomy is critical for electrophysiology (EP) trainees. Due to its immersive nature, virtual reality (VR) may provide a better learning environment than traditional teaching methods for assimilating 3D cardiac anatomy. The purpose of this pilot study was to evaluate the technical feasibility of an interactive, remote VR-based method for teaching cardiac anatomy to novice EP trainees. We created a shared, remote VR environment that allows the shared viewing of high-resolution 3D cardiac models. Eighteen trainees accepted for pediatric and adult EP fellowships were recruited. We performed a cohort study comparing the traditional teaching methods with the VR learning environment. Participants completed a demographic questionnaire and a satisfaction survey. The adult EP trainees were given a multiple-choice pre- and post-test exam to assess their anatomical knowledge. Both the adult and pediatric EP trainee cohorts rated the VR experience positively and preferred the VR environment to the more traditional teaching method. All the participants expressed interest in incorporating the VR learning environment into the EP fellowship curriculum. The usability of the system was relatively low, with approximately one-third of participants rating the system as hard to use. The impact of the VR session on exam performance was mixed among the adult cohort. We demonstrated the feasibility of gathering geographically dispersed EP fellows in training with a shared VR-based environment to teach cardiac anatomy. Although we were not able to demonstrate a learning benefit over the traditional lecture format in the adult cohort, the training environment was favorably received by all the participants.

An immersive virtual reality learning environment with CFD simulations: Unveiling the Virtual Garage concept

Virtual reality has become a significant asset to diversify the existing toolkit supporting engineering education and training. The cognitive and behavioral advantages of virtual reality (VR) can help lecturers reduce entry barriers to concepts that students struggle with. Computational fluid dynamics (CFD) simulations are imperative tools intensively utilized in the design and analysis of chemical engineering problems. Although CFD simulation tools can be directly applied in engineering education, they bring several challenges in the implementation and operation for both students and lecturers. In this study, we develop the "Virtual Garage" as a task-centered educational VR application with CFD simulations to tackle these challenges. The Virtual Garage is composed of a holistic immersive virtual reality experience to educate students with a real-life engineering problem solved by CFD simulation data. The prototype is tested by graduate students (n = 24) assessing usability, user experience, task load and simulator sickness via standardized questionnaires together with self-reported metrics and a semi-structured interview. Results show that the Virtual Garage is well-received by participants. We identify features that can further leverage the quality of the VR experience with CFD simulations. Implications are incorporated throughout the study to provide practical guidance for developers and practitioners.

Evaluation of a Linear Measurement Tool in Virtual Reality for Assessment of Multimodality Imaging Data-A Phantom Study

This study aimed to evaluate the accuracy and reliability of a virtual reality (VR) system line measurement tool using phantom data across three cardiac imaging modalities: three-dimensional echocardiography (3DE), computed tomography (CT) and magnetic resonance imaging (MRI). The same phantoms were also measured using industry-standard image visualisation software packages. Two participants performed blinded measurements on volume-rendered images of standard phantoms both in VR and on an industry-standard image visualisation platform. The intra- and interrater reliability of the VR measurement method was evaluated by intraclass correlation coefficient (ICC) and coefficient of variance (CV). Measurement accuracy was analysed using Bland−Altman and mean absolute percentage error (MAPE). VR measurements showed good intra- and interobserver reliability (ICC ≥ 0.99, p < 0.05; CV < 10%) across all imaging modalities. MAPE for VR measurements compared to ground truth were 1.6%, 1.6% and 7.7% in MRI, CT and 3DE datasets, respectively. Bland−Altman analysis demonstrated no systematic measurement bias in CT or MRI data in VR compared to ground truth. A small bias toward smaller measurements in 3DE data was seen in both VR (mean −0.52 mm [−0.16 to −0.88]) and the standard platform (mean −0.22 mm [−0.03 to −0.40]) when compared to ground truth. Limits of agreement for measurements across all modalities were similar in VR and standard software. This study has shown good measurement accuracy and reliability of VR in CT and MRI data with a higher MAPE for 3DE data. This may relate to the overall smaller measurement dimensions within the 3DE phantom. Further evaluation is required of all modalities for assessment of measurements <10 mm.

A High-Fidelity Three-Dimensional Computational Model of a Patient with Hypertrophic Cardiomyopathy

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Echocardiography and CMR are used for diagnosis of HCM.

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Learning echocardiography requires advanced and repetitive training.

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A 3D model can enhance understanding of cardiac anatomy and pathophysiology.