the University of Virginia School of Medicine. Inspired by an early video on the New York Times VR app, shot in a buffalo field at Yellowstone National Park, Dr. Haskal quickly realized the potential. “It was clear that that kind of immersive experience was going to be the beginning of something dramatic, even at that simplest VR level,” he says. “It also makes people feel capable and removes barriers to adoption.”
Using funding from an annual innovation grant provided by JVIR publisher Elsevier, Dr. Haskal began to explore the possibilities of AR and VR for education. “I wanted to fire a heavy rocket, beyond the consumer-level camera, play with the ergonomics and the floating in of objects, and demonstrate the extent of the capabilities of these technologies,” he says. He determined to produce a series of educational videos using VR.
The shoot took months of planning and storyboarding, as the team experimented with placement of cameras and people, point-of-view perspective, where to position screens and many other considerations. “You must understand what the viewer wants to see and incorporate elements of filmmaking and production,” Dr. Haskal says. It was a professional shoot, using two cameras, one full- perspective and one point-of-view, as well as two additional sources of input from the inset screens. The resulting videos are extremely high-resolution, with 360-degree perspective. “They provide a training and educational experience that switches on a different aspect of availability and aspect in the viewer’s mind and causes them to become enveloped, resident in the space,” Dr. Haskal says. “They mimic apprenticeship training.”
The choice of procedure was an important consideration as well, he says. He decided on transjugular intrahepatic portosystemic shunt (TIPS). “We took a procedure that is well-established but difficult and anxiety-producing. We used the videos to teach it methodically, step by step. The VR brings extra value,” he says. The procedure took just under an hour; the video was divided into ten segments of approximately four minutes each. Although somewhat long for VR,
people do watch them in their entirety, Dr. Haskal says: “That means they are engaged with the content.”
He showed the videos for the first time during his “Extreme IR” session at SIR 2018, distributing to attendees JVIR- branded VR viewers. The full collection of videos can be viewed at
bit.ly/2KzvWH7 (see sidebar for viewing instructions).
Dr. Haskal believes VR videos also have potential for patient education. “Patients don’t really know what will happen once we roll them down the hallway into the room,” he says. “Such immersive videos could help considerably.”
Challenges There are major challenges to widespread adoption of AR and VR in interventional radiology. “High-quality headsets are very expensive, and that cost can hinder innovation,” says Dr. Gupta. Although the cost of Oculus headsets has come down in recent months, Microsoft HoloLens costs about $3,000. EchoPixel charges $25,000 per year for a subscription to its software.
The logistics of organizing his shoot were daunting, says Dr. Haskal, who reports experiencing tremendous personal stress around identifying suitable patients. (But the patient who eventually was filmed was very enthusiastic about participating, he adds.) Dr. Haskal also had to find a partner company for hardware and software, obtain the necessary approvals to use the IR suite for two days, arrange a high-definition feed with the fluoro units, conduct conversations and get approvals from anesthesia, as well as perform 20–25 hours of postproduction work.
Future Dr. Kothary believes that AR and VR will be combined with cone-beam CT images to keep making navigation simpler and easier, as well as to decrease radiation and contrast use.
The next step in Dr. Wood’s work is interfacing with fused images in a semi-AR environment via a “smart needle.” “This has potential for proving you have finished an ablation and gotten every last cell,” he says. He and Dr. Xu have developed an app that uses
a smartphone’s camera and gyroscope to optimize needle-insertion angle for planning and performing percutaneous CT-guided biopsies and ablations, which was described at SIR 2017.
Dr. Haskal has his sights on the future of medical education and has scripted more videos for a new 17K stereoscopic VR camera, which provides the highest possible quality. “Simulators are large, inefficient and impractical,” he says. “We can use VR to teach every medical student, who can demonstrate benchmarks for increased training confidence on a new, complex device at the time of need.” He has formed a small production group and will release future videos through the JVIR YouTube channel.
“We are excited for the future, where the use of AR in health care will be just as commonplace as use of a stethoscope,” says Dr. Murthi.
Viewing JVIR VR videos To view the JVIR VR videos using a Google Cardboard-style viewer:
1. If you have not already done so, download and install the YouTube app for your smartphone
2. Using your smartphone, download a JVIR VR video at bit. ly/2KzvWH7
3. Open video using the YouTube app
4. When video is playing, touch VR viewer icon
5. Insert phone into viewer, screen facing up, and close the back panel
6. View video through the lenses, gently repositioning phone within viewer to ensure proper viewing alignment
sirweb.org/irq | 31
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40
