Raphael Thys
Augmented Reality (AR) and Virtual reality (VR) are two of the masterpieces in contemporary technology. Eight out of top ten tech companies are invested in and committed to these technologies including Apple, Microsoft, Google, Samsung, Intel, IBM, Foxconn and HP. AR & VR, both elicit an immediate connection with gaming and entertainment. The recent success of Pokémon Go has demonstrated the potential of Augmented Reality (AR) becoming mainstream. Occulus Rift, on the other hand, has become the holy grail of VR gaming owing to its very affordable price point, superior performance and light form factor. Further, with Oculus Rift walking the red carpet to accept an Emmy award for the emotive and immersing short film “Henry”, the Hollywood is compelled to consider VR more than a trifling. Evidently, these technologies have much wider applicability.
VR has progressed relatively faster in comparison with AR in practically every field of application. The numerous VR related research publications in PubMed underscores that this technology is not new to healthcare practioners. In fact, the no. of such publications has increased from 204 in 2004 to 720 in 2014. In this article, I shall take you through a brief history and evolution of these technologies in healthcare.
- Mental Health Treatments: Virtual Reality Therapy is an age old exposure therapy dating back to early 90s. This exposure therapy finds roots in the cognitive behavioural therapy (CBT), which essentially means repeated, direct confrontation with an anxiety-provoking stimulus or situation. The basic objective of exposure is habituation to the feared stimulus. In other words, by way of frequent, systematic exposure, the patient becomes acclimated to the feared stimulus and to the experience of anxiety itself. Imagine a patient with an apoplectic fear of heights or flying. In such a situation, an in vivo exposure would be too expensive and impractical. Here’s where VR comes to rescue. Overtime, Virtual Reality exposure Therapy has become the gold-standard for most anxiety disorders and is particularly successful in such treatments as corroborated by published results. Understandably, the more real the simulation, the better the result. Psychologists and scientists are excited about Oculus Rift with its latest HMD as it offers a superior and affordable solution in this therapy segment.
Further, VR therapy has been used, for over 20 years, in clinical healthcare including management of phantom limb pain, pain management in burn patients, brain damage assessment and rehabilitation, social cognition training for young adults with autism, meditation for treatment of anxiety and depression, stroke rehabilitation, Alzheimer’s, and management of ADHD in children.
Companies such as Virtually Better, FirstHand Technology, Psious and Akli offer patented VR solutions and usage training to their clients. These companies continue to develop new apps to extend the use case and provide an ever immersive, patient-centric content.
Aid in Healthcare Training & Education: Who would want to be a surgeon’s first? Surgery simulators have been a vital tool in surgical training. Hospitals have invested hefty sums in avant-garde simulators such as those developed by ImmersiveTouch and Medical Realities. These VR platforms allow surgeons to see, feel and experience minimally invasive surgical pathways to improve surgical precision and improve patient outcomes. Haptic force feedback and 3D visualization help to simulate real world situation with a sense of touch for surgical practice. These VR simulator platforms are becoming even better employing the latest HMD gear and technical improvements in AR/VR technologies. Apart from surgery, VR has been a cost effective, safe and engaging method for clinical education and training of nurses, general physicians, counsellors, dentists, paramedics and even patients. VR allows for training on procedures, techniques, equipment, and patient interactions to be imparted in a far more immersive and realistic environment.
3D Visualization: Companies such as zSpace and VR HealthNet offer anatomical representation to procedural planning and help in medical learning by way of visualization. Earlier this month, Greg Hannon, lead researcher at Cambridge University raised £40 million funding to create Virtual Reality journey through a tumour. His team intends to create an interactive, faithful, 3D map of tumours that can be studied in virtual reality and provide much deeper insights about it. 3D scans of tumours and other cancerous growths already exist, but VR would provide much greater detail and interactivity. To quote Greg Hannon, “this sort of VR simulated visualization will allow the researcher to fly inside the tumour, point at every cell, know exactly what kind of cell it is, know what it’s doing, know who it’s talking to and know what it’s saying to them.” This will provide an opportunity to understand not only cancer but also organismal development. Watch this video to know more:
- Outpatient Treatments & Consumer Healthcare: Vivid Vision offers an alternative to traditional patching for treatment of amblyopia (lazy eye), strabismus (crossed eyes), and convergence disorders. This clinical pathway is meant to be undertaken in medical supervision of an ophthalmologist. The platform supports headsets like the Oculus Rift, HTC Vive, Samsung GearVR, and Google Daydream. Similarly, Next Galaxy and Miami Children’s Hospital are collaborating to develop an immersive Virtual Reality (VR) Instructional content on cardiopulmonary resuscitation (CPR) and other lifesaving procedures for patients and medical professional education. This content will be released as an application for smartphones. The medical VR models will be viewable through smartphone and desktop as 3D and through VR devices such as Google Cardboard, VRONE and Oculus Rift.
The market is rife with ‘fitness’ apps such as Runtastic and ‘wellness & entertainment’ VR content providers like Widerun, Activetainment and VirZoom. Serious healthcare apps, content and technological usage in this direction requires FDA approval, which implies gathering safety and clinical efficacy evidence.
Aforementioned examples are not an indication of widespread clinical usage. We are still in early stages in terms of breakthrough treatment paradigms facilitated by AR/VR.
The Future of AR and VR is Mixed Reality: The first and only of its kind device, created by Microsoft offers a mixed reality experience. Christened the Microsoft HoloLense, it blurs the boundaries between AR & VR. Its ability to alter realities between people, places and objects is one of the greatest improvements in AR/VR world, IMHO. Microsoft describes HoloLense as “the first self-contained, holographic computer, enabling you to engage with your digital content and interact with holograms in the world around you.” Watch this video from MS to get a sense of what this truly is.
For the scope of this article, I shall focus on HoloLense’s applicability in healthcare.
Though in its developmental stages, HoloLense has been adopted for 3D visualization DURING a spinal surgery. Spinal surgery is one of the most complicated procedures. In the video below, see how Dr Henrique Lampert of Santa Catarina, Brazil, performed the life altering procedure in a safe and affordable manner.
(Warning: The video contains visuals of spinal surgery.)
In the coming months, Dr Lampert and his colleague will author a medical paper to showcase just how effective the technique is compared to more traditional medical hardware, and what measurable difference it can make to patients. He also plans to create a new course for surgeons to help them learn how best to use holographic technology in the operating theatre.
- HoloLense and New Paradigm in Healthcare Education: MS HoloLense can potentially change the 100 years old medical education practice by allowing students to practice on hologram modelling of human organs and body. Dr Mark Griswold of the Case Western Reserve University observes that with HoloLense type of technology medical students can interact with a 3D rendering of the human body, instead of using cadavers.
This video shows how the device enables people to see a fully-animated 3D heart from any angle. The HoloLense offers a detailed view of the human body and gives users the ability to navigate through muscle tissue to internal organs. With HoloLens, students can not only receive remote instructions on what to do and what not to do, but also learn by performing each step of surgery on the holographic model.
Potential Uses of HoloLense
Create better understanding of diseases & symptoms: The device can help patients create an environment that they are going through. Doctors can enter this Mixed Reality and guide the patients better. Perhaps, some HoloLense app developers can create some sort of bridge that eliminates the gap between patients and doctors. The application will find usage in not just psychiatric patients, but also in general medicine.
Use in Prosthesis: Today, prosthetic limbs are designed using techniques like casting and moulding. However, HoloLense app developers can develop apps for visualising the patient’s anatomy and thus, create a customised prosthetic that can fit the patient’s anatomy perfectly.
Application in Telemedicine: HoloLense can aid the patient in sharing the images of burn, or lesion or an allergic area with the doctor so that the HCP can advise better when supported by a visual representation.
Medical Imaging: If apps are designed to help HCPs view the MRI, X-Ray, PET Scans as 3D mixed reality/AR visuals, the diagnosis will be a lot more simplified. Chances of errors will be decimated.
Distant Mentoring: Even experts need advice. Imagine, a team of surgeons performing a complex procedure in India, getting some expert advice from colleagues in US of A. In a small way, this has been achieved. Virtual Interactive Presence and Augmented Reality, using Google glasses successfully superimpose a real-time projection of the mentor’s hands into the surgeon’s field of sight. HoloLense can take it even further, making it way more real.
While I say HoloLense, there are other companies that are also working on similar technology. It would be exciting to see this year unfold with new players introducing Mixed Reality solutions and plenty innovative applications embellishing the ecosystem.