Virtual Reality in Medicine - many evolving uses and advantages

Virtual reality techniques, involving three-dimensional imaging and surround sound, are increasingly being used in diagnosis, treatment, and medical education. Initial applications of virtual reality in medicine involved visualization of the complex data sets generated by computed tomography (CT) and magnetic resonance imaging (MRI) scans. A recent application of these techniques for diagnostic purposes has been the “virtual colonoscopy,” in which data from a contrast-enhanced abdominal CT scan is used to make a “fly-through” of the colon. Radiologists then use this fly-through for colon cancer screening. Recent improvements in methodology have brought the sensitivity and specificity of this technique closer to the levels of optical colonoscopy, and patients prefer the technique to the traditional method.

Virtual reality has also been used extensively to treat phobias (such as a fear of heights, flying and spiders) and post-traumatic stress disorder. This type of therapy has been shown to be effective in the academic setting, and several commercial entities now offer it to patients. In one of my projects using the multi-user virtual reality environment offered by Second Life, one of several easily available online virtual reality environments, we have used a virtual psychosis environment to teach medical students about the auditory and visual hallucinations suffered by patients with schizophrenia.

Virtual reality has been used to provide medical education about healthcare responses to emergencies such as earthquakes, plane crashes and fires. While the primary advantage in phobia treatment is a “safe environment” which patients can explore, the primary advantage in emergency preparedness is simulation of events that are either too rare or too dangerous for effective real-world training. The immersive nature of the virtual reality experience helps to recreate the sense of urgency or panic associated with these events.

Virtual reality programs have also been used for a variety of medical emergency, mass casualty, and disaster response training sessions for medical and public health professionals. One study developed a protocol for training physicians to treat victims of chemical-origin mass casualties as well as victims of biological agents using simulated patients. Although it was found that using standardized patients for such training was more realistic, the computer-based simulations afforded a number of advantages over the live training. These included increased cost effectiveness, the opportunity to conduct the same training sessions over and over to improve skills, and the ability to use “just-in-time” learning techniques and experience the training session at any time and location, while adjusting the type and level of expertise required to use the training for various emergency response professionals. Others have explored the potential for training emergency responders for major health emergencies using virtual reality. Their objective was to increase exposure to life-like emergency situations to improve decision-making and performance and reduce psychological distress in a real health emergency.

Experience with recent natural disasters and terrorist acts has shown that good communication and coordination between responders is vital to an effective response. In my work using Second Life to develop a virtual mass disaster emergency clinic to hand out antibiotics to the population following a massive anthrax bioterrorism attack, we have found a number of important advantages of the virtual world, over the real world, for training first responders.

Responders to such events come from many different organizations, including fire, police, military, and hospital personnel. There are three major difficulties in training and evaluating these first responders in the real world:
They have little or no chance to train together before the event occurs and hence lack teamwork skills.
What training they may have had comes at great cost, in large part due to the effort and need to transport so many people to a specific training site at a specific time.
The training sites frequently cannot be the most common targets – for example, one cannot shut down the Golden Gate Bridge during rush hour to train for an earthquake or terror scenario.

Virtual reality offers some intriguing advantages over the real world for these aspects of first responder training, as all of the above difficulties can be overcome. Virtual reality systems can support multiple simultaneous users, each connecting to the system using standard office personal computers and broadband Internet access. Lifelike models of buildings, roads, bridges, and other natural and man-made structures where the users can interact can be constructed. Finally, the whole scenario can be digitally preserved and a full workflow analysis can be performed retrospectively. Public health officials and first-responders can work through the scenarios as many times as they like to familiarize themselves with the workflow and emergency protocols, without encumbering the time and expense of organizing a mock emergency in real life.

Virtual Reality treatments are rapidly becoming more available. They are currently being used to treat post-traumatic stress disorders caused by wartime experiences, and US servicemen are now increasingly being offered such programs. Rather than the traditional method of confronting old nightmares, online technology is able to deliver treatment in a far more therapeutic and humane way. Patients are “transported” to the battlefront and fears and traumas are resolved in virtual place and real time. Virtual Reality is here to stay, and will increasingly be used widely in a number of areas of healthcare.

Peter Yellowlees MD blogs at http://informationagehealth.blogspot.com and has recently published “Your Health in the Information Age – how you and your doctor can use the Internet to work together”. It is available at www.InformationAgeHealth.com and most online bookstores.