Validation of virtual reality orbitometry bridges digital and physical worlds

Use of a Novel Beyeonics One Three-dimensional Head-mounted Digital Visualization Platform in Vitreoretinal surgeries

BACKGROUND

Ophthalmic microscopes have been crucial in visualizing surgical fields, but their limitations in enhancing the surgical view through digital image processing have prompted the development of digital surgical microscopes. The Beyeonics One microscope, a novel digital microscope, offers ophthalmic surgeons a 3D visualization platform and an augmented reality (AR) surgical headset, potentially improving surgical decision-making and outcomes. While its initial use has been described in cataract and corneal surgeries, its application in vitreoretinal surgery remains relatively unexplored.

METHODS

In this interventional case series, we collected data from the medical records of patients who underwent vitreoretinal surgery using the Beyeonics One 3D visualization platform at the Tel Aviv Medical Center. A total of 36 eyes from 36 subjects were included. Surgical techniques included retinal detachment surgeries and macular surgeries, performed by experienced surgeons. The surgical visualization was facilitated by the Beyeonics One 3D head-mounted display (HMD) platform.

RESULTS

The procedures were uneventful, and none intra- or postoperative complications were reported, and surgeons did not experience any signal delay in the real-time video.

DISCUSSION

The Beyeonics One microscope offers several potential advantages in vitreoretinal surgery, including digital image processing, enhanced depth perception through the 3D HMD platform, and hands-free image control using head gestures. While this study demonstrates the feasibility and safety of the Beyeonics One microscope, addressing limitations related to hazy views and optimizing image quality are crucial for consistent visualization.

Assessment of resectability of pancreatic cancer using novel immersive high-performance virtual reality rendering of abdominal computed tomography and magnetic resonance imaging

PURPOSE

Virtual reality (VR) allows for an immersive and interactive analysis of imaging data such as computed tomography (CT) and magnetic resonance imaging (MRI). The aim of this study is to assess the comprehensibility of VR anatomy and its value in assessing resectability of pancreatic ductal adenocarcinoma (PDAC).

METHODS

This study assesses exposure to VR anatomy and evaluates the potential role of VR in assessing resectability of PDAC. Firstly, volumetric abdominal CT and MRI data were displayed in an immersive VR environment. Volunteering physicians were asked to identify anatomical landmarks in VR. In the second stage, experienced clinicians were asked to identify vascular involvement in a total of 12 CT and MRI scans displaying PDAC (2 resectable, 2 borderline resectable, and 2 locally advanced tumours per modality). Results were compared to 2D standard PACS viewing.

RESULTS

In VR visualisation of CT and MRI, the abdominal anatomical landmarks were recognised by all participants except the pancreas (30/34) in VR CT and the splenic (31/34) and common hepatic artery (18/34) in VR MRI, respectively. In VR CT, resectable, borderline resectable, and locally advanced PDAC were correctly identified in 22/24, 20/24 and 19/24 scans, respectively. Whereas, in VR MRI, resectable, borderline resectable, and locally advanced PDAC were correctly identified in 19/24, 19/24 and 21/24 scans, respectively. Interobserver agreement as measured by Fleiss κ was 0.7 for CT and 0.4 for MRI, respectively (p < 0.001). Scans were significantly assessed more accurately in VR CT than standard 2D PACS CT, with a median of 5.5 (IQR 4.75-6) and a median of 3 (IQR 2-3) correctly assessed out of 6 scans (p < 0.001).

CONCLUSION

VR enhanced visualisation of abdominal CT and MRI scan data provides intuitive handling and understanding of anatomy and might allow for more accurate staging of PDAC and could thus become a valuable adjunct in PDAC resectability assessment in the future.

Validation of collaborative cyberspace virtual reality oculometry enhanced with near real-time spatial audio

Currently, most medical image data, such as optical coherence tomography (OCT) images, are displayed in two dimensions on a computer screen. Advances in computer information technology have contributed to the growing storage of these data in electronic form. However, the data are usually processed only locally on site. To overcome such hurdles, a cyberspace virtual reality (csVR) application was validated, in which interactive OCT data were presented simultaneously to geographically distant sites (Lucerne, London, and Barcelona) where three graders independently measured the ocular csVR OCT diameters. A total of 109 objects were measured, each three times, resulting in a total of 327 csVR measurements. A minor mean absolute difference of 5.3 µm was found among the 3 measurements of an object (standard deviation 4.2 µm, coefficient of variation 0.3% with respect to the mean object size). Despite the 5 h of online work, csVR was well tolerated and safe. Digital high-resolution OCT data can be remotely and collaboratively processed in csVR. With csVR, measurements and actions enhanced with spatial audio communication can be made consistently in near real time, even if the users are situated geographically far apart. The proposed visuo-auditory framework has the potential to further boost the convenience of digital medicine toward csVR precision and collaborative medicine.

"Snap on" or Not? A Validation on the Measurement Tool in a Virtual Reality Application

This multi-rater comparison study aims to validate the measurement tool with a "snap" feature option (SNAP ON vs. SNAP OFF), in a virtual reality (VR) application, ImmersiveView v. 2.1, against a conventional software Mimics Innovation Suite v.22 (MIS). It is hypothesized that these measurement tools are equivalent between SNAP ON, and SNAP OFF, and when compared to MIS, in terms of basic linear and angular measurements. Six (6) raters conducted a set of 40 linear and 15 angular measurements using CT scan data of three objects (L-block, hand model, and dry skull) with fiducial markers. Inter-rater repeatability and intra-rater reproducibility were assessed via inter-class coefficient (ICC). Equivalency between each pair of modules (SNAP ON, SNAP OFF, and MIS) was analyzed via Bland-Altman plots and two one-sided t-tests (TOST) procedure. The ICC for intra-rater repeatability yielded 0.999 to 1.000, and inter-rater reproducibility yielded 0.998 to 1.000, which suggests high degree of intra- and inter-rater reliability. The Bland-Altman plots demonstrated that measurements acquired from SNAP ON, SNAP OFF, and MIS were equivalent. The TOST procedure yielded that the measurements through all three modules are equivalent within ± 0.2 mm interval for distance, and ± 0.3° interval for angular measurements. The measurement tool with the "snap" feature in a newly developed VR application (ImmersiveView v.2.1) has been validated through a multi-rater comparison study. In terms of linear and angular measurements, this VR application, whether the "snap" feature was on or off, was equivalent to each other and to the control software (MIS) under the condition of this study. A strong reliability, both intra-rater repeatability and inter-rater reproducibility, has been found.

Randomized study comparing 3D virtual reality and conventional 2D on-screen teaching of cerebrovascular anatomy

OBJECTIVE

Performing aneurysmal clipping requires years of training to successfully understand the 3D neurovascular anatomy. This training has traditionally been obtained by learning through observation. Currently, with fewer operative aneurysm clippings, stricter work-hour regulations, and increased patient safety concerns, novel teaching methods are required for young neurosurgeons. Virtual-reality (VR) models offer the opportunity to either train a specific surgical skill or prepare for an individual surgery. With this study, the authors aimed to compare the spatial orientation between traditional 2D images and 3D VR models in neurosurgical residents or medical students.

METHODS

Residents and students were each randomly assigned to describe 4 aneurysm cases, which could be either 2D images or 3D VR models. The time to aneurysm detection as well as a spatial anatomical description was assessed via an online questionnaire and compared between the groups. The aneurysm cases were 10 selected patient cases treated at the authors' institution.

RESULTS

Overall, the time to aneurysm detection was shorter in the 3D VR model compared to 2D images, with a trend toward statistical significance (25.77 ± 37.26 vs 45.70 ± 51.94 seconds, p = 0.052). No significant difference was observed for residents (3D VR 24.47 ± 40.16 vs 2D 33.52 ± 56.06 seconds, p = 0.564), while in students a significantly shorter time to aneurysm detection was measured using 3D VR models (26.95 ± 35.39 vs 59.16 ± 44.60 seconds, p = 0.015). No significant differences between the modalities for anatomical and descriptive spatial mistakes were observed. Most participants (90%) preferred the 3D VR models for aneurysm detection and description, and only 1 participant (5%) described VR-related side effects such as dizziness or nausea.

CONCLUSIONS

VR platforms facilitate aneurysm recognition and understanding of its spatial anatomy, which could make them the preferred method compared to 2D images in the years to come.