Clinical application of immersive, patient-specific three-dimensional virtual reality in neurosurgery

Gary Steinberg cerebral@stanford.edu

Abstract

The introduction and advancement of medical imaging and imaging analysis has allowed physicians to better diagnose, monitor, and treat patients by viewing the body with a level of detail previously unavailable. In addition to CT, MRI, and PET scans, higher resolution MRI imaging has given rise to MRI-based Diffusion Tensor Imaging (DTI), which allows the visualization of the brain’s various white matter tracts. This proposal for a Technology Hub Exhibit examines a novel FDA-approved technology currently in use at Stanford Hospital designed to provide digitally rendering patient-specific, three-dimensional virtual reality (VR) models based on multiple imaging modalities that are fused together (Fig. 1). This technology integrates with various VR hardware platforms to allow physicians, residents, students, and patients to become fully immersed within the anatomy to gain a unique perspective of the human body.

360VR is applied across the continuum of the patient’s health care from the initial consultation, to preoperative surgical planning, to intraoperative surgical navigation, to increased education for particular surgical approaches and pathologies. The technology is currently used in, but not limited to, neurosurgery and can import and fuse any DICOM files with volumetric data. The novel use of 360VR in the clinic involves fusing patient-specific two-dimensional DICOM images from multiple imaging modalities (CT, MRI, DTI, angiography) to create volumetric models in VR. The surgeon then shows the patients these models during consultation, where they can manipulate the anatomy themselves via touchscreen controls. It is hypothesized that utilizing this new technology in the clinic setting will enhance patient engagement, understanding, and satisfaction and, ultimately, create a more meaningful shared decision making process.

Preoperatively, these immersive 360VR models are used by the surgeon to review and rehearse the planned surgery. This can be as simple as reviewing the planned craniotomy and trajectory to rehearsing the application of interventional devices such as aneurysm clips. The 360VR device is also used in the operating room during the actual surgical procedure. Surgical Theater’s 360VR technology connects to standard intraoperative navigation systems that display tools in 2D DICOM slices and significantly enhances this visualization by displaying 3D representations of the surgical tools within the VR environment of the anatomy and pathology. After surgery, postoperative scans can be fused into the pre-operative model to assess the amount of tumor resected or the progression of recurrence postoperatively.
Whether presented to the patient, the patient’s family, the surgeon, trainees, philanthropists or collaborating colleagues, 360VR seems to be a universal language adept at quickly conveying complex, context-specific spatial information, bridging the gaps between technology, patient, and physician. 
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