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Virtual reality for preoperative planning in large ventricular septal defects
... Conclusions: MixR represents a promising tool for preoperative planning and 3-dimensional visualization in patients with complex congenital heart defects; however, its systematic adoption in intraoperative settings requires further implementation of current hardware technology and software versatility. (J Thorac Cardiovasc Surg 2025;-: [1][2][3][4][5][6][7][8][9] Mixed reality in congenital heart surgery. ...
... [5][6][7] Virtual reality (VR) creates a fully immersive digital environment, isolating users from the real world and allowing interaction only with virtual objects. Although promising for medical education and preoperative planning, [8][9][10][11][12] VR's lack of real-world interaction limits its practicality for direct intraoperative use. The isolation required by VR further restricts its application in surgical settings, where interaction with the physical environment is crucial. ...
... In recent years, three-dimensional (3D) technologies such as 3D printing, virtual reality (VR), and mixed reality (MR) technologies have developed rapidly and have become more available. Since they all can provide an intuitive understanding of the anatomy, they have been used in the surgical treatment of some structural heart diseases and are considered effective (8)(9)(10)(11)(12)(13)(14)(15)(16). In our center, since January 2018, these 3D technologies were routinely used in the surgical treatment for patients with PA/VSD/MAPCAs as reported earlier (17), which we named the 3D visualized operative procedure. ...
... Different from only using the 3D printed model reported by Ryan et al. (19), our 3D visualized operative procedure is to introduce 3D printing, VR, and MR models into different treatment processes of PA/VSD/MAPCAs according to their technical characteristics. To be more specific, the VR model can intuitively display all the anatomical structures with full depth perception (8). The VR platform developed by our center allowed rotation, movement, scaling, section, and notes drawing of the VR model, which took little time and effort to be converted from the 3D digital model. ...
Objectives
Pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries (PA/VSD/MAPCAs) is a relatively rare, complex, and heterogeneous congenital heart disease. As one of the effective treatments, the midline unifocalization strategy still remains complicated and challenging due to the diverse forms of MAPCAs and pulmonary arteries. The purpose of this study is to summarize our experience of a novel three-dimensional (3D) visualized operative procedure in the single-stage complete repair with unifocalization and to clarify the benefits it may bring to us.
Methods
We described our experience of the 3D visualized operative procedure such as 3D printing, virtual reality (VR), and mixed reality (MR) technology in patients with PA/VSD/MAPCAs who underwent a single-stage complete repair with unifocalization. The data from the patients who underwent this procedure (3D group) and those who underwent the conventional procedure (conventional group) were compared.
Results
The conventional and 3D groups included 11 patients from September 2011 to December 2017 and 9 from January 2018 to March 2021, respectively. The baseline characteristics such as age, body weight, preoperative saturation, the anatomy of the pulmonary arteries and MAPCAs, the Nakata index, and TNPAI had no statistical significance. All 9 patients in the 3D group were operated only through a median sternotomy, while 8 cases (72.7%) in the conventional group needed another posterolateral thoracotomy ( p = 0.001). In the 3D group, the CPB time was shorter (93.2 ± 63.8 vs. 145.1 ± 68.4 min, p = 0.099), and the median pre-CPB time per MAPCAs was significantly shorter [25.7 (14.0, 46.3) vs. 65 (41.3, 75.0) min, p = 0.031]. There was no early death in the 3D group, while there were 3 in the conventional group (0 vs. 27.3%, p = 0.218).
Conclusion
The novel 3D visualized operative procedure may help improve the performance of the single-stage complete repair with the midline unifocalization of PA/VSD/MAPCAs and help shorten the dissecting time of the MAPCAs. It may promote the routine and successful application of this strategy in more centers.
... This echoes the finding from a recent meta-analysis, which found preoperative planning being the most relevant application of 3DPHM [24]. VR has also been reported in the current literature for its ability to provide an immersive, interactive, and free-form visualization experience, despite it not being tactile like 3DPHM [12,14,[25][26][27]. Unlike 3DPHM, being static and unable to show cardiac functional information, the VR project can be "programmed" to show dynamic cardiac models [28,29], to allow users to scale, rotate, crop the cardiac models, and change the viewing planes according to their needs [12]. ...
... However, the users were not able to change the viewing planes or crop the cardiac models, which is one of the limitations of the presented VR project. The simplicity of this VR project makes it quite different from other studies in which the users are able to change the clipping plane [12,14,25,26], or view the models intraluminally [27]. In fact, there is no standardized way for creating a VR project [25]. ...
Both three-dimensional (3D) printing and virtual reality (VR) are reported as being superior to the current visualization techniques in conveying more comprehensive visualization of congenital heart disease (CHD). However, little is known in terms of their clinical value in diagnostic assessment, medical education, and preoperative planning of CHD. This cross-sectional study aims to address these by involving 35 medical practitioners to subjectively evaluate VR visualization of four selected CHD cases in comparison with the corresponding 3D printed heart models (3DPHM). Six questionnaires were excluded due to incomplete sections, hence a total of 29 records were included for the analysis. The results showed both VR and 3D printed heart models were comparable in terms of the degree of realism. VR was perceived as more useful in medical education and preoperative planning compared to 3D printed heart models, although there was no significant difference in the ratings (p = 0.54 and 0.35, respectively). Twenty-one participants (72%) indicated both the VR and 3DPHM provided additional benefits compared to the conventional medical imaging visualizations. This study concludes the similar clinical value of both VR and 3DPHM in CHD, although further research is needed to involve more cardiac specialists for their views on the usefulness of these tools.
... virtual and augmented reality (AR)] have enabled the application of more state-of-the-art XR equipment to render 3D volumetric, CT-or ultrasound-derived images of anatomy to support patient selection, preoperative procedural planning, and intraoperative guidance. [6][7][8] By using head mounted displays (HMD's), dedicated medical software, and powerful computers, the user is able to review images and environments in a totally virtual reality (VR). On the other hand, in AR, the user is able to project virtual 3D images onto the real world. ...
... So far, several groups have reported on the utilization of various XR modalities to create patient-specific 3D models of cardiac pathology for diagnostic and interventional application. 7,8,20 However, most articles do not elaborate on the necessities and requirements to implement such an XR platform in clinical practice. In our experience, the performance and clinical implementation of a VR platform mainly depends on the availability of some essential elements such as: (i) the initiation and maintenance of a dedicated and multidisciplinary 3D-surgery team (consisting of at least a surgeon, a technician, a software engineer or information technology specialist, and when available a (cardiovascular) radiologist), (ii) a VR platform (e.g. ...
Aims
Increased complexity in cardiac surgery over the last decades necessitates more precise preoperative planning to minimize operating time, to limit the risk of complications during surgery and to aim for the best possible patient outcome. Novel, more realistic, and more immersive techniques, such as three-dimensional (3D) virtual reality (VR) could potentially contribute to the preoperative planning phase. This study shows our initial experience on the implementation of immersive VR technology as a complementary research-based imaging tool for preoperative planning in cardiothoracic surgery. In addition, essentials to set up and implement a VR platform are described.
Methods
Six patients who underwent cardiac surgery at the Erasmus Medical Center, Rotterdam, The Netherlands, between March 2020 and August 2020, were included, based on request by the surgeon and availability of computed tomography images. After 3D VR rendering and 3D segmentation of specific structures, the reconstruction was analysed via a head mount display. All participating surgeons (n = 5) filled out a questionnaire to evaluate the use of VR as preoperative planning tool for surgery.
Conclusion
Our study demonstrates that immersive 3D VR visualization of anatomy might be beneficial as a supplementary preoperative planning tool for cardiothoracic surgery, and further research on this topic may be considered to implement this innovative tool in daily clinical practice.
Lay summary
Over the past decades, surgery on the heart and vessels is becoming more and more complex, necessitating more precise and accurate preoperative planning. Nowadays, operative planning is feasible on flat, two-dimensional computer screens, however, requiring a lot of spatial and three-dimensional (3D) thinking of the surgeon. Since immersive 3D virtual reality (VR) is an upcoming imaging technique with promising results in other fields of surgery, we aimed in this study to explore the additional value of this technique in heart surgery. Our surgeons planned six different heart operations by visualizing computed tomography scans with a dedicated VR headset, enabling them to visualize the patient’s anatomy in an immersive and 3D environment. The outcomes of this preliminary study are positive, with a much more reality-like simulation for the surgeon. In such, VR could potentially be beneficial as a preoperative planning tool for complex heart surgery.
... The feasibility of extended reality or 3D print applications for pre-operative simulation has been demonstrated for the closure of various VSD types. [17][18][19] Contrary to these studies, the present study is the first to report a real-time interactive patch design performed entirely in mixed-reality with a direct comparison to intraoperative findings, as represented by DRP. Mixed-reality technology enables the evaluation of anatomy with a different depth perception compared to other modalities, such as desktop application volume rendering or traditional tomographic slices. ...
Aims
Structural heart defects, including congenital ventricular septal defect closure or intracardiac rerouting, frequently require surgical reconstruction using hand-cut patch materials. Digitally modelled patch templates may improve patch fit and reduce outflow tract obstruction, residual defect risk, and conduction system damage. In this study, we benchmarked mixed reality and a desktop application against a digitalised model of a real implanted patch.
Methods and Results
Ten patients scheduled for the repair of various defects consented to prospective inclusion in the study. After surgery, a digital model of the implanted patch was created from the residual material. Five clinical experts created ten digital patches, one per patient, both in mixed reality and desktop application, for comparison with the reference measurements, including the digitalised model of the real patch used during the surgery. Subjective residual shunt risk prediction was performed using both modalities.
Digital patches created in mixed reality closely matched the surgical material, whereas those created using desktop applications were significantly smaller. Different evaluators showed varying preferences for the application of the residual shunt risk and area.
Conclusion
Digitally created patches can assist surgeons in preoperatively sizing of patch implants, potentially reducing postoperative complications.
... Our literature search identified a scoping review by Bakhuis et al. [39], which demonstrated that the number of case studies involving the use of VR in surgical planning for congenital heart disorders is lower than what is seen for education in training, with a total of ten studies, conotruncal anomalies, VSD open surgical closure, AV valve repair and pulmonary sequestration were the main field of the published reports (18%) (Figure 2) [40][41][42][43][44][45][46][47][48][49][50]. Another aspect worth noting was the imaging modality used for 3D modelling, CT accounted for 60% of the reported studies, while CMR for 30%, and only one case report was performed using 3D echocardiography. ...
Several medical graduates, avoid surgical specialties especially those with complex and delicate anatomy due to their doubt in their visual spatial abilities. Many patients are deemed inoperable, particularly in the field of pediatric cardiology, due to the complexity of the anatomy. On a similar note, stratification of risk of cardiac interventions, and decision making, is a room of significant person-based and center-based bias. Two inter-related technologies, namely immersive virtual reality (VR) and artificial intelligence have made impossible things possible and can help to standardize decision making strategies. This review aimed at reviewing the main anatomical and lesion-based scopes of these advancements in the field of cardiac care, with a special focus on pediatric cardiology.
... Користуючись відповідними приладами, кардіологи, аритмологи і хірурги, отримують можливість стереоскопічно розглянути моделі серця та оцінити деталі будови клапанів, камер, перегородок, магістральних та коронарних судин. Нові засоби оцінки патологічно зміненої анатомії серця виявились більш прецензійним способом вибору тактики лікування, ніж традиційний огляд ехокардіограм чи томографій, дозволили точніше описати анатомічні зміни, створити повноцінне тривимірне розуміння вади і на цій підставі скласти план хірургічного втручання, а саму операцію виконати швидше [19][20][21][22]. ...
Introduction. It is difficult to display the heart structure with traditional drawings due to its complex three-dimensional structure. Therefore, to depict the heart anatomy, it became necessary to use three-dimensional models, and appropriate digital technologies for the latter became available in the recent decades. Material and methods. Manuscripts reflecting the key stages of the emergence of three-dimensional digital technologies for the heart anatomy visualization and fields of their medical implementation were selected from the MEDLINE database. Results. Three-dimensional reconstructions of the heart are created by the method of segmentation from the results of radiological examinations (computed tomography, magnetic resonance imaging, ultrasound diagnostics). The created models reproduce the anatomy of the cardiovascular system in vivo. Digital models are interactive and allow the user to explore the external form and internal structure. The images can be viewed on a computer screen or stereoscopically using a virtual reality headset and smart glasses, the models can be rotated at any angle, “immersed” into or divided into parts. Repeated manipulations that are impossible with real organs can be performed on the reconstructions (virtual autopsy). The new tools are used in education and teaching anatomy, fundamental research of the structure of the normal and diseased heart, they supplement diagnostic cardiology reports, are used in planning or performing endovascular and surgical interventions. Digital models can be imported into mixed reality devices and thus used for navigation during surgical and endovascular interventions. Conclusion. Novel three-dimensional technologies have made progress in education, teaching, scientific study of heart anatomy, as well as diagnosis and treatment of a wide range of diseases of the cardiovascular system. Digital images, as opposed to traditional drawings, are interactive and can be viewed both on a computer and with extended reality devices. The use of the novel heart imaging modalities deepens the understanding of the fundamental anatomy, facilitates basic education, makes the diagnostic conclusions more descriptive, and contributes to the more accurate performance of interventions. The positive results of the implementations of these technologies justify and stipulate their further utilization.
... We consider MixR may offer several advantages compared to virtual reality (Mendez et al. 2019;Tandon et al. 2019). Virtual reality is a fully immersive digital environment, but there is no interaction with the real world. ...
To assess the potential of mixed reality holograms (MixR) based on CT images to improve percutaneous lead extraction (PLE) planning and intraoperative assistance. This was a prospective, controlled, single-centre study. Five patients with CIED infection for PLE were included in the study. Conventional imaging (chest radiograph and CT) and MixR holograms were evaluated for preoperative planning to identify common complications such as vascular thrombosis, broken leads, loops, kinking, fibrosis along the wires, and perforation of cardiovascular structures. The degree of difficulty of the procedure was estimated based on potential complications. After the PLE procedure, the level of concordance between conventional imaging and MixR holograms with intraoperative findings was evaluated. The utility of MixR intraoperative guidance was also assessed. MixR holograms demonstrated a very high correlation in predicting the presence of loops, kinking, and fibrosis compared to conventional imaging, which showed a low-to-high correlation. MixR also showed a high correlation in estimating the degree of difficulty of the procedure compared to conventional imaging, which tended to underestimate it. The surgeon who performed the PLE agreed that MixR was helpful during intraoperative assistance. MixR holograms based on CT images are an effective tool for understanding cardiovascular anatomy and detecting potential areas of complications. MixR may be used as a complementary tool for both preoperative planning and intraoperative assistance in PLE procedures.
Graphical abstract
Mixed reality holograms for intraprocedural intervention assistance.
... Останнім часом все більша кількість спеціалізованих центрів вдаються до планування операцій шляхом доопераційного дослідження будови клапанів, перегородок, камер серця, коронарних артерій, магістральних судин у ВР, що дозволяє більш прецизійно оцінити анатомічні особливості і на їх підставі обрати тактику хірургічного втручання [2,13,14,15,16]. Pisowodzka et al. (2020) розглянули 3D-ЕхоКГ картини недостатності мітрального клапана спочатку з екрана ультразвукового апарата, а потім в стереоскопічному вигляді, і виявили, що в двох з дев'яти випадків ВР суттєво доповнила розуміння клапанних вад та вплинула на тактику операційного лікування [15]. ...
Extended reality combines the real and digital worlds. This technology has found applications in all fields of medicine, including cardiac surgery and interventional cardiology. The paper describes the application of three types of extended reality, namely virtual, augmented and mixed realities. The aim. To explain the principles of operation of various types of extended reality using non-medical and medical applications as examples; to analyze the data from specialized publications in the field of cardiac interventions. Materials. Articles from the Pubmed database. Results. The article highlights important details of the heart and blood vessels image creation technique with which users operate. Primary data is obtained from imaging modalities like tomography or ultrasound, then it is segmented and processed for the virtual viewing. In virtual reality, three-dimensional (3D) images of the heart defects are analyzed in depth, and virtual manipulations can be performed that simulate the course of the operation. Virtual reality includes printing the heart on a 3D printer with subsequent executions on physical models, both diagnostic dissections and therapeutic surgical or endovascular simulations. In augmented reality, the created image of the internal anatomy of the defect is present near the surgeon, without interfering medical manipulations. In mixed reality, a virtual image is superimposed on the patient’s body, creating a detailed navigation map. Conclusions. Extended reality application deepens the understanding of anatomy due to stereoscopic visualization of the structure of the heart and blood vessels. Creating a model of a patient’s heart defect and simulating an operation on it shortens the “learning curve”, improves the professional skills of surgeons and cardiologists, and also allows for surgical and endovascular interventions individualization. Planning interventions in cardiac surgery and interventional cardiology with extended reality technologies influences decision-making and reduces the duration of operations.
... An increasing number of centers have adopted this kind of technology for pre-procedural planning. 32 In Supplementary data online, Video S3, we demonstrate an example of our XR approach to TAVR implantation. XR implementation in congenital heart disease is rapidly maturing. ...
Technological advancement and the COVID-19 pandemic have brought virtual learning and working into our daily lives. Extended realities (XR), an umbrella term for all the immersive technologies that merge virtual and physical experiences, will undoubtedly be an indispensable part of future clinical practice. The intuitive and three-dimensional nature of XR has great potential to benefit healthcare providers and empower patients and physicians. In the past decade, the implementation of XR into cardiovascular medicine has flourished such that it is now integrated into medical training, patient education, pre-procedural planning, intra-procedural visualization, and post-procedural care. This review article discussed how XR could provide innovative care and complement traditional practice, as well as addressing its limitations and considering its future perspectives.
... [2,3] Many heart centers have now started to use three-dimensional (3D) heart models, with VR and AR, to assist catheter-based interventions and surgical planning including ventricular assist device fit testing, and education. [4][5][6][7] There is limited literature, however, about the use of advanced imaging and VR to image preserved specimens. ...
Introduction : Preserved congenital heart specimens are an important component of training professionals working with children and adults with congenital heart disease. They are curated in few institutions worldwide and not freely accessible. This was a proof-of-concept project to explore the use of advanced cardiac imaging modalities (computed tomography [CT] and magnetic resonance imaging [MRI]) and virtual reality (VR) simulation to assess the feasibility and identify the best method of imaging curated cardiac pathology specimens.
Methods : Seven specimens in glass jars with formalin, with varied anatomic lesions, from a curated collection were imaged using MRI and high-dose CT to compare the fidelity of models created via each modality. Three-dimensional (3D) models were created and loaded into a VR headset and viewed in virtual space. Two independent physicians performed a “virtual dissection” and scored the resultant models.
Results : The highest fidelity and tissue characterization of more delicate structures was achieved with T2 spoiled gradient-echo sequences on MRI (median score of 4 out of 5). CT (median score of 3), while excellent for external anatomy, lost some fidelity with delicate internal anatomy, even at high-radiation doses. No specimens were damaged.
Conclusions : We believe that in vitro heart specimens can be easily scanned with high fidelity at a relatively low cost, without causing damage, using high-dose CT and MRI. The ability to “walk through” different chambers of the heart makes the understanding of anatomy easy and intuitive. VR and 3D printing are technologies that could be easily adapted to digitize preserved heart specimens, making it globally accessible for teaching and training purposes.
... Although in an earlier phase of development and application in the biomedical field, there already exist proof-of-concept studies of using VR technologies for cardiac devices such as the pre-operative planning of transcatheter closure of cardiac deficiencies, such as ventricular septal [20] or sinus venous defects [21,22] . Nam et al. [23] used new functionalities of the 3D-Slicer open-source software (i.e., link with VR headsets) to develop a tool for the virtual testing, selection, and placement of transcatheter device closures of atrial and ventricular septal defects. ...
Advanced visual computing solutions and three-dimensional (3D) printing are moving from engineering to clinical pipelines for training, planning, and guidance of complex interventions. 3D imaging and rendering, virtual reality (VR), and in-silico simulations, as well as 3D printing technologies provide complementary information to better understand the structure and function of the organs, thereby improving and personalizing clinical decisions. In this study, we evaluated several advanced visual computing solutions, such as web-based 3D imaging visualization, VR, and computational fluid simulations, together with 3D printing, for the planning of the left atrial appendage occluder (LAAO) device implantations. Six cardiologists tested different technologies in pre-operative data of five patients to identify the usability, limitations, and requirements for the clinical translation of each technology through a qualitative questionnaire. The obtained results demonstrate the potential impact of advanced visual computing solutions and 3D printing to improve the planning of LAAO interventions as well as the need for their integration into a single workflow to be used in a clinical environment.
... Although in an earlier phase of development and application in the biomedical field, there already exist proof-ofconcept studies of using VR technologies for cardiac devices such as the pre-operative planning of trans-catheter closure of cardiac deficiencies such as ventricular septal Mendez et al. (2018) or sinus venous defects Tandon et al. (2019);Southworth et al. (2020). Nam et al. ...
Advanced visual computing solutions and 3D printing are starting to move from the engineering and development stage to being integrated into clinical pipelines for training, planning and guidance of complex interventions. Commonly, clinicians make decisions based on the exploration of patient-specific medical images in 2D flat monitors using specialised software with standard multi-planar reconstruction (MPR) visualisation. The new generation of visual computing technologies such as 3D imaging, 3D printing, 3D advanced rendering, Virtual Reality and in-silico simulations from Virtual Physiological Human models, provide complementary ways to better understand the structure and function of the organs under study and improve and personalise clinical decisions. Cardiology is a medical field where new visual computing solutions are already having an impact in decisions such as the selection of the optimal therapy for a given patient. A good example is the role of emerging visualisation technologies to choose the most appropriate settings of a left atrial appendage occluder (LAAO) device that needs to be implanted in some patients with atrial fibrillation having contraindications to drug therapies. Clinicians need to select the type and size of the LAAO device to implant, as well as the location to be deployed. Usually, interventional cardiologists make these decisions after the analysis of patient-specific medical images in 2D flat monitors with MPR visualisation, before and during the procedure, obtain manual measurements characterising the cardiac anatomy of the patient to avoid adverse events after the implantation. In this paper we evaluate several advanced visual computing solutions such as web-based 3D imaging visualisation (VIDAA platform), Virtual Reality (VRIDAA platform) and computational fluid simulations and 3D printing for the planning of LAAO device implantations. Six physicians including three interventional and three imaging cardiologists, with different level of experience in LAAO, tested the different technologies in preoperative data of 5 patients to identify the usability, friendliness, limitations and requirements for clinical translation of each technology through a qualitative questionnaire. The obtained results demonstrate the potential impact of advanced visual computing solutions to improve the planning of LAAO interventions but also a need of unification of them in order to be able to be uses in a clinical environment.
... Of note, in case of expecting the unexpected, in 25% of examinations in this study (15 of 60), findings obtained with 4D MUSIC MRI were additive to other available imaging data with additional value for the presurgical planning. In addition to diagnostic accuracy, imaging quality is getting increasingly important in patients with complex CHD because these imaging studies are the essential starting point for more advanced pre-interventional planning using 3D printing (8) and augmented and virtual reality (9). For instance, in the case of a double outlet right ventricle, MRI-based 3D printing proved to be an important addition in the treatment and presurgical planning of these patients (10). ...
... Near-eye displays (NEDs) are the newest entrants to the medical industry, typically in the form of a head-mounted display. They are quickly finding applications in surgery planning [29,30], minimally invasive procedures and surgery [31][32][33][34][35]63], 3D image segmentation [36], therapy [37][38][39], and training [40,41]. This is an emergent field where the terminology, critical performance parameters, and measurement methodologies have yet to be fully developed [42]. ...
Visual information is a critical component in the evaluation and communication of patient medical information. As display technologies have evolved, the medical community has sought to take advantage of advances in wider color gamuts, greater display portability, and more immersive imagery. These image quality enhancements have shown improvements in the quality of healthcare through greater efficiency, higher diagnostic accuracy, added functionality, enhanced training, and better health records. However, the display technology advances typically introduce greater complexity in the image workflow and display evaluation. This paper highlights some of the optical measurement challenges created by these new display technologies and offers possible pathways to address them.
... Volumetric representation in virtual reality (VR) was first applied to interactive real-time visualization of cardiac anatomy in 2001, 4 and it proved to be a promising 3D rendering technique that may answer some clinical needs in the management of patients with complex congenital heart disease (CHD). [5][6][7] However, VR rendering in this context was based on manual segmentation of 3D data derived from medical imaging, consequently leading to operator variability and relevant time-consumption limitations. ...
Background and Aim of the Study
We sought to evaluate the appropriateness of cardiac anatomy renderings by a new virtual reality (VR) technology, entitled DIVA, directly applicable to raw magnetic resonance imaging (MRI) data without intermediate segmentation steps in comparison to standard three‐dimensional (3D) rendering techniques (3D PDF and 3D printing). Differences in post‐processing times were also evaluated.
Methods
We reconstructed 3D (STL, 3D‐PDF, and 3D printed ones) and VR models of three patients with different types of complex congenital heart disease (CHD). We then asked a senior pediatric heart surgeon to compare and grade the results obtained.
Results
All anatomical structures were well visualized in both VR and 3D PDF/printed models. Ventricular‐arterial connections and their relationship with the great vessels were better visualized with the VR model (Case 2); aortic arch anatomy and details were also better visualized by the VR model (Case 3). The median post‐processing time to get VR models using DIVA was 5 min in comparison to 8 h (range 8–12 h including printing time) for 3D models (PDF/printed).
Conclusions
VR directly applied to non‐segmented 3D‐MRI data set is a promising technique for 3D advanced modeling in CHD. It is systematically more consistent and faster when compared to standard 3D‐modeling techniques.
... The dynamic development of technology enables more effective applications in medicine [33]. Mendez et al. [34] was show the VR advantages in the visualization of the major septal defect whilst comparison to traditional imaging. The holographic heart and vascular anatomy models were develop based on MRI. ...
Immersive technologies, like Virtual Reality (VR), Augmented Reality (AR) and Mixed Reality (MR) have undergone technical evolutions over the last few decades. Their rapid development and dynamic changes enable their effective applications in medicine, in fields like imaging, preprocedural planning, treatment, operations planning, medical students training, and active support during therapeutic and rehabilitation procedures. Within this paper, a comprehensive analysis of VR/AR/MR application in the medical industry and education is presented. We overview and discuss our previous experience with AR/MR and 3D visual environment and MR-based imaging systems in cardiology and interventional cardiology. Our research shows that using immersive technologies users can not only visualize the heart and its structure but also obtain quantitative feedback on their location. The MR-based imaging system proposed offers better visualization to interventionists and potentially helps users understand complex operational cases. The results obtained suggest that technology using VR/AR/MR can be successfully used in the teaching process of future doctors, both in aspects related to anatomy and clinical classes. Moreover, the system proposed provides a unique opportunity to break the boundaries, interact in the learning process, and exchange experiences inside the medical community.
... While the majority of these efforts have focused on consumer applications and entertainment, these technologies have considerable potential in medicine and are being explored for surgical [3][4][5][6][7][8][9][10][11][12][13][14][15][16], training [15,[17][18][19], and therapeutic applications [15,20]. The continued advancements in 3D medical imaging technologies present an additional application for visualizing 3D data sets, which has been demonstrated for displaying magnetic resonance imaging (MRI) segmentation [21] and for surgical planning [22,23]. ...
We demonstrate a method for measuring the transverse chromatic aberration (TCA) in a virtual reality head-mounted display. The method relies on acquiring images of a digital bar pattern and measuring the displacement of different color bars. This procedure was used to characterize the TCAs in the Oculus Go, Oculus Rift, Samsung Gear, and HTC Vive. The results show noticeable TCAs for the Oculus devices for angles larger than 5° from the center of the field of view. TCA is less noticeable in the Vive in part due to off-axis monochromatic aberrations. Finally, user measurements were conducted, which were in excellent agreement with the laboratory results.
The use of virtual and augmented reality has grown in popularity in recent years, particularly as the technology has become more accessible to the masses; however, regardless of its mainstream use in video games, it has great potential for use in medicine. This article explores how virtual and augmented reality can be meaningfully used in medicine, whether for medical training purposes or as an aid to surgical planning and how these tools can influence cardiac surgery in the future.
Infections in cardiac implantable electronic devices (CIED) are increasing over time and associated with substantially mortality and healthcare costs. The best approach is the complete removal of the system by transvenous lead extraction (TLE). However, when leads are more than 10 years old, this technique requires considerable expertise and failures with the result of abandoned leads or serious complications may occur.
The aim of this study is to describe our experience using virtual and mixed reality in the preoperative planning of complex cases.
Consecutive patients from a referral centre with CIED infections in which TLE was judged difficult. Synchronized computed tomography (CT) scan images were processed and transferred to a fully immersive virtual reality room and also to the operative room (mixed reality) for better guidance during the extracting procedure.
Ten patients (seven with local and three with systemic infections) were preoperative evaluated. Processed images and virtual reality showed intense adherences of the leads to the veins, right ventricle, and right atrium endocardium and between them that preclude a difficult extraction and required a carefully planning and sometimes a different technical approach. The anticipated difficulty was confirmed by the higher times of fluoroscopy. All leads were extracted and no complications were registered.
Preoperative planning is essential for evaluation of TLE difficulty and prevention of unexpected situations. Virtual reality seems an estimable aid for operators in planning difficult cases and also an excellent tool for teaching.
Aims
We aim to determine any additional benefit of virtual reality (VR) experience if compared to conventional cross-sectional imaging and standard 3D modelling when deciding on surgical strategy in patients with complex double outlet right ventricle (DORV).
Methods and results
We retrospectively selected ten consecutive patients with DORV and complex interventricular communications, who underwent biventricular repair. An arterial switch operation (ASO) was part of the repair in three of those. CT or cardiac MRI images were used to reconstruct patient-specific 3D anatomies, which were then presented using different visualisation modalities: 3D pdf, 3D printed models, and VR models. Two experienced paediatric cardiac surgeons, blinded to repair performed, reviewed each case evaluating the suitability of repair following assessment of each visualization modalities. In addition, they had to identify those who had ASO as part of the procedure. Answers of the two surgeons were compared to the actual operations performed. There was no mortality during the follow-up (mean = 2.5 years). Two patients required reoperations. After review of CT/CMR images, the evaluators identified the surgical strategy in accordance with the actual surgical plan in 75% of the cases. When using 3D pdf this reached only 70%. Accordance improved to 85% after revision of 3D printed models and to 95% after VR. Use of 3D printed models and VR facilitated the identification of patients who required ASO.
Conclusion
VR can enhance understanding of suitability for biventricular repair in patients with complex DORV if compared to cross-sectional images and other 3D modelling techniques.
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 Virtual reality 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 & development. This study also identifies ten 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 analyse 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 preoperatively 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 heart surgery and development in cardiovascular treatment to improve patient outcome.
Background
This review aims to examine the existing literature to address currently used virtual, augmented, and mixed reality modalities in the areas of preoperative surgical planning, intraoperative guidance, and postoperative management in the field of cardiothoracic surgery. In addition, this innovative technology provides future perspectives and potential benefits for cardiothoracic surgeons, trainees, and patients.
Methods
A targeted, non-systematic literature assessment was performed within the Medline and Google Scholar databases to help identify current trends and to provide better understanding of the current state-of-the-art extended reality (XR) modalities in cardiothoracic surgery. Related articles published up to July 2020, are included in the review.
Results
XR is a novel technique gaining increasing application in cardiothoracic surgery. It provides a three-dimensional (3D) and realistic view of structures and environments and offers the user the ability to interact with digital projections of surgical targets. Recent studies showed the validity and benefits of XR applications in cardiothoracic surgery. Examples include XR-guided pre-operative planning, intraoperative guidance and navigation, post-operative pain and rehabilitation management, surgical simulation, and patient education.
Conclusions
XR is gaining interest in the field of cardiothoracic surgery. In particular, there are promising roles for XR applications in televirtuality, surgical planning, surgical simulation, and perioperative management. However, future refinement and research is needed to further implement XR in the aforementioned settings within cardiothoracic surgery.
To address the expanding needs to acquire the necessary skill sets for managing a wide array of transcatheter interventions, a 3D visualization system that integrates into the training platform would significantly enhance the trainee's capacity to comprehend the spatial relationships of various cardiac structures and facilitate the learning process. In addition to procedural training, the same technology may potentially help formulate treatment strategies in preprocedural planning especially in complex anatomy. Herein, a hybrid simulator for structural heart disease interventions is demonstrated by using the combination of a mixed reality (MR) display and 3D printing. The system consists of a 3D printed phantom heart model, a catheter with real‐time tracking using electromagnetic sensors, and the stand‐alone MR display for rendering 3D positions of the catheter within the heart model, along with quantitative feedback. The phantom heart model is generated by 3D printing technology using a segmented geometry from a human cardiac computed tomography (CT) scan. The catheter is coupled with electromagnetic sensors that allow real‐time tracking of their 3D positions and orientations. Custom software and algorithms to coregister and display the catheter's position relative to the phantom heart model are developed to interface with commercial software provided with the tracking sensors and MR display such that updates occur seamlessly in real time. Prespecified target crossings in the fossa ovalis during a transcatheter septal puncture procedure are demonstrated in the training scene. This hybrid training system will be used for training and educating transcatheter septal puncture procedure and other structural heart interventions.
Technological progress in medicine is constantly garnering pace, requiring that physicians constantly update their knowledge. The new wave of technologies breaking through into clinical practice includes the following: a) mHealth, which allows constant monitoring of biological parameters, anytime, anyplace, of hundreds of patients at the same time; b) artificial intelligence, which, powered by new deep learning techniques, are starting to beat human experts at their own game: diagnosis by imaging or electrocardiography; c) 3-dimensional printing, which may lead to patient-specific prostheses; d) systems medicine, which has arisen from big data, and which will open the way to personalized medicine by bringing together genetic, epigenetic, environmental, clinical and social data into complex integral mathematical models to design highly personalized therapies. This state-of-the-art review aims to summarize in a single document the most recent and most important technological trends that are being applied to cardiology, and to provide and overall view that will allow readers to discern at a glance the direction of cardiology in the next few years.
Virtual reality (VR) uptake and adoption is becoming increasingly popular, and its impact is more realized. VR is defined as the immersion of a user in a computer-generated environment. This concept was first popularized in the late nineteenth century and has since been adopted across all industries, including healthcare. This chapter explores VR as an emerging education strategy and a surgical support tool. In surgical education, VR offers the potential to standardize and improve both cognitive and technical skills, free of the demands of traditional clinical environments. In clinical practice, VR facilitates manipulation of patient-specific data to optimize preoperative planning and intraoperative support. The application of VR technology to healthcare is an endeavor uniquely positioned to succeed, and its impact, once realized, will be nothing short of revolutionary.
Resumen
La continua progresión tecnológica que experimenta la medicina se produce cada vez a mayor velocidad, lo que exige una actualización constante del profesional de la salud. La nueva ola de tecnologías que está abriéndose camino en la práctica clínica incluye: a) salud asistida por el móvil (mHealth) o dispositivos miniaturizados que permiten la detección constante de parámetros biológicos, a cualquier hora y en cualquier lugar, de cientos de miles de pacientes a la vez; b) inteligencia artificial impulsada por nuevas técnicas de aprendizaje profundo que están batiendo a médicos expertos en su propio campo (pruebas de imagen o electrocardiografía); c) impresión tridimensional que permite vislumbrar un mundo de prótesis cardiovasculares adaptadas a cada paciente; d) medicina de sistemas, que apoyándose en el big data abrirá las puertas a la medicina personalizada, aunando en modelos matemáticos de gran complejidad datos genéticos, epigenéticos, ambientales, clínicos y sociales para diseñar tratamientos de precisión. Esta revisión pretende resumir la evidencia sobre los últimos avances tecnológicos basados en tecnologías de la información y ciencias de la computación aplicados a la cardiología y esbozar un mapa que de un solo vistazo permita tener una impresión general del horizonte hacia el que va a progresar la cardiología en los próximos años.
We demonstrate a method for measuring the transverse chromatic aberration (TCA) in a virtual reality head‐mounted display (VR HMD). This procedure was used to characterize the Oculus Go VR HMD. Results show a measurable TCA for angles larger than approximately 5o from the center of the field of view.
Recent miniaturization of electronic components and advances in image processing software have facilitated the entry of extended reality technology into clinical practice. In the last several years, the number of applications in cardiology has multiplied, with many promising to become standard of care. We review many of these applications in the areas of patient and physician education, cardiac rehabilitation, pre-procedural planning and intraprocedural use. The rapid integration of these approaches into the many facets of cardiology suggests that they will one day become an every-day part of physician practice.
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