IT matters: Virtual and augmented reality in medicine

May 15, 2017
By Alaa Beydoun, Vikash Gupta and Eliot Siegel

Virtual reality and augmented reality are “disruptive” technologies that will soon redefine the ways in which people interact with their environment. Due to recent breakthroughs in optical head mounted displays (OHMDs), the market for VR and AR is expected to exceed $100 billion in 2020 with these technologies finding applications in nearly every industry, including health care. Currently available OHMDs function on a spectrum of VR and AR. VR devices (e.g. Oculus Rift) on the one hand are used to create a simulated environment, supplanting the user’s surroundings with a computer-generated one.

These devices provide great immersive potential, allowing users to experience a myriad of simulated environments such as a beach, amusement park or even the surface of Mars. AR devices (e.g. Microsoft HoloLens) supplement the user’s own environment, mixing the user’s surroundings with computer-generated images. These devices can consequently display holograms that appear to exist in the user’s location such as an office or backyard. The general availability of this disruptive technology provides the potential for many use cases in health care that can positively impact value-based care. The following are several of these applications.

Simulated education
VR and AR devices are already proving to be important innovations for medical education. Multiple research studies have cited their use as low-cost and accurate simulation environments for developing procedural skills. In laparoscopy, randomized controlled studies have shown VR instruction is effective at reducing procedure time and improving technical performance. Although they may not be ready to replace traditional simulation centers just yet, these devices increase accessibility for procedural training. Similarly, VR and AR are being used as innovative platforms for medical education, providing interactive 3-D models that can teach anatomy and physiology in an intuitive format, to be utilized by trainees and patients.

Patient immersion
Recent technical advances in VR create breathtaking immersive environments and simulated atmospheres. Pioneered by the entertainment and gaming industries, genres include virtual tourism, guided meditation and music immersion. When applied to patient care, these applications have the potential to improve the patient experience such as relaxation therapy for patients too ill to visit therapeutic gardens. This application also has the potential to improve patient satisfaction, an important metric recently factored into Medicare reimbursements. VR and AR devices have also proven to be effective tools for rehabilitation medicine. When combined with patient feedback, prior studies have reported improved outcomes when used for stroke rehabilitation and in PTSD therapy.

Minimally invasive augmented Procedures
The modern era of health care delivery is increasingly focused on development and refinement of minimally invasive procedures to decrease patient recovery times and peri-procedural morbidity. Early adoption of AR navigational systems by surgical specialties has enabled improved interventions with smaller incisions. In laparoscopy, for example, AR navigational systems can be used to project computer-generated images on the patient to enhance the intra-operative perspective. Similar applications have also been developed for abdominal, neurosurgical, facial and orthopedic procedures.

The democratization of AR with consumer grade OHMD systems will facilitate the adoption of this technology beyond operating rooms and interventional suites. By combining three-dimensional holograms derived from a patient’s diagnostic imaging with advanced co-registration technology, there is tremendous potential to use diagnostic imaging to augment clinic or bedside procedures. These solutions will result in improved technical success rates while decreasing procedure times and complication rates for complex as well as routine procedures.

Imaging in 3-D
From ultrasound to CT or MRI, perception of three-dimensional relationships from two-dimensional images remains an ever-present challenge in diagnostic imaging. VR and AR devices can help to address this by displaying these data as 3-D projections. This allows physicians to approach imaging in an intuitive manner as if they were looking at a virtual patient. For surgeons, the perspective can be manipulated to simulate what is seen intra-operatively.

Recent strong interest in 3-D printing has reaffirmed the value of pre-procedural planning. With the use of VR and AR devices, such planning can be performed in a faster, more cost-effective manner while also providing a more dynamic representation of spatial relationships and detail. This dynamic imaging would not be constrained to static overlays, but could include streaming, functional information such as cardiac or brain blood flow data or articular motion of the knee joint. Additionally, through the use of teleconferencing, this technology can facilitate virtual consultations, allowing a diagnostician to be virtually ”present” during key portions of a surgical procedure.

About the authors: Alaa Beydoun is an interventional radiology-bound radiology resident at the University of Maryland Medical Center and cofounder of the departmental Innovation Committee. Vikash Gupta is a radiology resident at the University of Maryland Medical Center and has a lifelong interest in advancing health care through technology. Eliot Siegel is a professor and vice chair of research information systems for the University of Maryland Department of Diagnostic Radiology and Nuclear Medicine.