Advancing Cardiac Surgery Case Planning and Case Review Conferences Using Virtual Reality in Medical Libraries: Evaluation of the Usability of Two Virtual Reality Apps

Abstract

BackgroundCare providers and surgeons prepare for cardiac surgery using case conferences to review, discuss, and run through the surgical procedure. Surgeons visualize a patient’s anatomy to decide the right surgical approach using magnetic resonance imaging and echocardiograms in a presurgical case planning session. Previous studies have shown that surgical errors can be reduced through the effective use of immersive virtual reality (VR) to visualize patient anatomy. However, inconsistent user interfaces, delegation of view control, and insufficient depth information cause user disorientation and interaction difficulties in using VR apps for case planning.ObjectiveThe objective of the study was to evaluate and compare the usability of 2 commercially available VR apps—Bosc (Pyrus Medical systems) and Medical Holodeck (Nooon Web & IT GmbH)—using the Vive VR headset (HTC Corporation) to evaluate ease of use, physician attitudes toward VR technology, and viability for presurgical case planning. The role of medical libraries in advancing case planning is also explored.MethodsAfter screening a convenience sample of surgeons, fellows, and residents, ethnographic interviews were conducted to understand physician attitudes and experience with VR. Gaps in current case planning methods were also examined. We ran a usability study, employing a concurrent think-aloud protocol. To evaluate user satisfaction, we used the system usability scale (SUS) and the National Aeronautics and Space Administration-Task Load Index (NASA-TLX). A poststudy questionnaire was used to evaluate the VR experience and explore the role of medical libraries in advancing presurgical case planning. Semistructured interview data were analyzed using content analysis with feedback categorization.ResultsParticipants were residents, fellows, and surgeons from the University of Washington with a mean age of 41.5 (SD 11.67) years. A total of 8 surgeons participated in the usability study, 3 of whom had prior exposure to VR. Users found Medical Holodeck easier to use than Bosc. Mean adjusted NASA-TLX score for Medical Holodeck was 62.71 (SD 18.25) versus Bosc’s 40.87 (SD 13.90). Neither app passed the mean SUS score of 68 for an app to be considered usable, though Medical Holodeck (66.25 [SD 12.87]) scored a higher mean SUS than Bosc (37.19 [SD 22.41]). One user rated the Bosc usable, whereas 3 users rated Medical Holodeck usable.ConclusionsInterviews highlighted the importance of precise anatomical conceptualization in presurgical case planning and teaching, identifying it as the top reason for modifying a surgical procedure. The importance of standardized user interaction features such as labeling is justified. The study also sheds light on the new roles medical librarians can play in curating VR content and promoting interdisciplinary collaboration.

A Virtual Reality System for Improved Image-Based Planning of Complex Cardiac Procedures

“…Medical Holodeck https://www.medicalholodeck.com (accessed on 30 May 2021) provides a general-purpose VR app that can be used for immersive interrogation of 3D medical images. Medical Holodeck and Bosc (Pyrus Medical systems) have been applied to VR-based surgery planning with positive results [15].…”

“…Immersive Extended Reality (XR) technology, which includes Augmented Reality (AR), Virtual Reality and Mixed Reality (MR), has been proposed [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ] to improve the visualisation of, and interaction with, anatomical models of the heart for educational and medical applications.…”

A Virtual Reality System for Improved Image-based Planning of Complex Cardiac Procedures

“…Immersive Extended Reality (XR) technology, which includes Augmented Reality (AR), Virtual Reality and Mixed Reality (MR) has been proposed [4][5][6][7][8][9][10][11][12][13][14][15] to improve visualisation of, and interaction with, anatomical models of the heart for educational and medical applications.…”

“…Medical Holodeck 6 provides a general purpose VR app that can be used for immersive interrogation of 3D medical images. Medical Holodeck and Bosc (Pyrus Medical systems) have been applied to VR based surgery planning with positive results [15].…”

Evaluation of a Virtual Reality (VR) Learning Tool for Fundamental Turbine Engineering Concepts

“…SUS was created by John Brooke in 1986 to measure the usability of electronic office systems, but it's now applied to a wide variety of web or technology-based applications to measure how easy or difficult they are to use in order to improve [14,16]. SUS has also been used in various virtual reality application usability evaluation such as in the medical field [19], automotive [20] and locomotive industry.…”