16th June 2016

Virtual reality innovations in healthcare

Virtual reality (VR) is the current disruptive technology striving to prove its case as more than just a gimmick. The latest head-mounted displays released in the past 2 years have brought VR to more people and enabled rapid experiments and research with less investment. While it looks already to have a strong future in gaming and entertainment, its impact on other industries is still in the early stages.

There are several encouraging areas of research and forays into VR use in healthcare that look to offer exciting developments for the industry and patients. The latest of these is the world's first surgery to be livestreamed in 360° VR. Dr Shafi Ahmed is a Consultant General, Colorectal and Laparoscopic Surgeon at Barts Health NHS Trust, whose Medical Realities company — specialists in VR for the healthcare industry — have collaborated with Barts Health and livestreaming service, Mativision, to showcase this new experience.

On April 14th 2016, Dr Ahmed performed surgery on a British man in his 70s with colon cancer at the Royal London Hospital. While the successful surgery was routine, the awareness of the cameras and audience brought a new dimension to it, with the patient saying he was excited about the experience prior to surgery and being described as very supportive of how we are trying to teach medicine around the world. BBC Click's Spencer Kelly attended the event in person.

The experience was filmed on two 360° cameras with multiple lenses, and was watched by thousands of medical students and the public through the VR in OR app on iOS and Android, and on the Medical Realities' website. The livestream was given a delay of about 1 minute, Dr Ahmed said, in case any unforeseen complications occurred: The operation isn't very risky, but if there's a major complication I'll stop immediately, but it's also important that people who are training in medicine see problems. There is no perfect operation, ever. If we have some complications, you have to see how to deal with them.

This isn’t the first time Dr Ahmed has broken new ground in the use of technology during surgery. After pestering Google for months for a pair of Google Glass, on May 22 2014 he performed surgery while wearing them, with 13,000 medical trainees and clinicians watching as he did so. During the surgery he also responded to questions sent by the audience which appeared on the Google Glass screen.

Dr Ahmed hopes to continue his innovation in this area to improve medical training and to address the global inequalities in surgical health through remote training. His vision of the future involves fully computer-rendered simulations of surgical operations, eventually with haptic feedback, ultimately leading to robots with artificial intelligence performing surgery better than humans.

VR use for treatment is also being researched in multiple areas:

VR is used in overcoming phobias and anxieties through exposure therapy. These help patients develop coping strategies and break patterns of avoidance in safe and controlled circumstances.

In cases of ongoing pain from wounds and physical therapy, VR can be used as pain management by distracting patients and overwhelming the pain pathways in the brain with inputs from other senses. A military study from 2011 has shown that a VR game used for this type of treatment worked better than morphine for soldiers with burn injuries from improvised explosive device blasts. It has also been used in the treatment of phantom limb pain, by allowing patients to see a VR limb in a relaxed state as if it was their own, sometimes linking its state to nerve inputs from the brain.

VR is being used for both assessing and treating brain function impairments such as those due to stroke and Alzheimer’s disease. Virtual reality situations can be created, based on concepts from existing tests, to assess the areas that require treatment. One study concluded that their test measures the same cognitive functions as the Wisconsin Card Sorting Task and may prove to be more ecologically valid. Once brain areas are identified, virtual reality allows for the selection and tailoring of tasks for treatment in that area.

For those with autism, VR allows them to practice their social skills by reading social cues and behaviours from virtual avatars in various situations, with brain activity monitoring measuring their development.

VR has been used in treating post-traumatic stress disorder from as far back as 1997. It is used to help veterans who are reliving the traumatic events they experienced, by learning to deal with triggers to behaviour that could otherwise be destructive to themselves or others. Psychology Professor Skip Rizzo of the University of Southern California, who directs the Medical Virtual Reality lab, has been treating patients remotely who served in the Middle East. His lab has created multiple different virtual worlds with settings similar to those war veterans would have experienced, to treat over 2000 veterans in hospital sites around the country. We put them in a world most similar to the kind of experiences that they had when they were in combat, in their traumatic moments, where they saw a person die, or if they killed someone, or got blown up in a vehicle explained Prof Rizzo.

Disabled and homebound patients are able to experience situations and environments they otherwise would not have access to and improve their quality of life.

What is clear is that the horizon for the application of VR in medicine is expanding rapidly, so hang on to your virtual hats and let’s see where it takes us. Virtually anything is possible!