How Can Virtual Reality in Medicine Enhance the Patient Experience?

Virtual reality, already established in brain surgery, is starting to prove its value as a patient-education tool in the spine setting. Here’s how VR in medicine can enhance the patient experience.

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Virtual reality in medicine can change the game for surgeons. Any neurosurgeon who has slipped on virtual reality (VR) goggles and “flown” through an interactive, immersive three-dimensional (3-D) visualization of a patient’s brain aneurysm or meningioma can instantly grasp how useful the technology can be for patient education, surgical planning, and as a teaching tool for trainees.

VR patient experienceVirtual reality: Coming to an (operating) theater near you?

But until recently spine surgeons haven’t been able to reap the benefits of this state-of-the-art technology. Now Jeremy Steinberger, MD, director of minimally invasive spine surgery for Mount Sinai Health System’s Department of Neurosurgery in New York City, is working to change that. Since mid-2019, Dr. Steinberger has been applying what he’s learned about using VR in brain surgery to the spine setting.

In VR, the computer-generated simulation of a three-dimensional image or environment that can be interacted with in a seemingly physical way by a person wearing a special headset, the user seems to enter into that world. Anatomical landmarks and the interrelationship of key physical structures can be visualized and understood in ways that two-dimensional views can’t convey.

What’s more, the viewer doesn’t need to have medical knowledge to grasp the risks and benefits of their surgeon’s proposed treatment.

Worth a Thousand Words

Dr. Steinberger’s standard workflow for new patient consultations now involves having his team prepare a model of the patient’s pathology using the Surgical Theater system before the patient arrives at the clinic.

VR systems like Surgical Theater fuse the patient’s MRI and CT imaging, then process the information to create patient-specific, 3-D VR reconstructions. A human operator then “paints” the reconstruction to smooth out and finalize that patient’s unique visualization.

VR patient experience - visualizationDetailed 3-D renderings of patient anatomy are a possibility with VR

Dr. Steinberger begins by discussing the pathology with the patient, then reviewing the 2-D imaging slice by slice just as he’s always done. He then discusses treatment recommendations and answers questions before inviting the patient to view their own VR reconstruction.

“They put on the VR headset and literally experience what it’s like to go inside their own body to look at the disc pushing on the nerve or the tumor pushing on the spinal cord,” Dr. Steinberger says. “You can show them their MRI for an hour, but then show them the VR model for 10 seconds and they get it instantly. It’s a real a-ha moment for most people.”

The stakes are even higher when it comes to obtaining a patient’s consent for surgery. “No matter how patiently and thoroughly we explain the risks of surgery, most patients get overwhelmed and can’t retain much of what they hear,” Dr. Steinberger says. “But showing them their VR model gives them clarity on how we’re going to operate and what the risks are. They leave my office with a much deeper understanding of their clinical situation and their surgical risks.”

VR in Medicine: Benefits and Drawbacks

As an early adopter, it’s no surprise that Dr. Steinberger prefers to focus on the positives of using VR as a patient-education tool. For example, one could see how adding the VR reconstruction to patient consults could make the workflow more cumbersome.

But Dr. Steinberger has found that adding VR has not increased his consultation time. “I’m already very thorough with my explanations so using VR doesn’t add time,” he says. “On the other hand, using VR doesn’t really reduce my time spent, either…yet.”

VR patient experience - educationVR may help with patient education

Of course, creating each patient-specific simulation takes time, and being able to do so comes with a very real learning curve. Dr. Steinberger, who completed his training in both neurosurgery at the Icahn School of Medicine at Mount Sinai and Orthopedic Spine Surgery at Hospital for Special Surgery, considers the time spent training staff to create VR reconstructions to be well-spent.

“During my neurosurgery training, it used to take us at least 30 minutes to model each brain simulation, but we’ve gotten that down to three minutes with experience,” he says. “Doing a spine [reconstruction] is nowhere near that fast but it’s getting faster as we gain experience.”

Dr. Steinberger also notes that today’s VR systems tend to be easy and intuitive to use, so that a variety of staff members, from residents to physician assistants to technicians, can successfully create a reconstruction.

The most obvious drawback of integrating VR into clinical practice is the cost of the system, which includes both hardware and software components. “Quantifying the patient benefits of this technology is difficult, and I didn’t have to do it because Mount Sinai had already invested in the technology,” Dr. Steinberger admits. “But, like any other technology, the price is dropping rapidly as it matures and competition intensifies.”

Research May Quantify Patients’ Improved Understanding

In hopes of speeding VR’s acceptance within the spine community, Dr. Steinberger is researching two different aspects of VR’s effects on the patient experience.

In one project, he is trying to assess VR’s potential for increasing patient retention within the practice. Currently all patient consultations include viewing the patient’s VR reconstruction, even those who are not surgical candidates. Following each new-patient consultation, patients complete a survey about their reactions to the technology.

“We want to know if offering VR technology so that they can experience their own anatomy and pathology makes them want to stay with our practice,” Dr. Steinberger says. “It’s possible that patients may be less inclined to seek second opinions or leave the practice because we’ve been able to build trust right from their first encounter.”

In another project, Dr. Steinberger administered a questionnaire to two groups of patients: those who received VR demonstrations at their consults and those who did not. The purpose is to assess patients’ understanding of their condition, their treatment plan, and their surgical risks.

Once one or both of these studies are published, Dr. Steinberger hopes the results—coupled with declining VR equipment costs—will encourage neurosurgeons and spine surgeons to accept VR as a valuable addition to clinical spine care.

“Just because the patient benefits are not easy to quantify doesn’t mean they’re not real,” he says. “Patients very much benefit from a better understanding of their condition, just as they benefit from increased safety when their surgeon uses VR to help with surgical planning. We just need to convince our colleagues.”

Updated on: 07/09/20
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