Evaluation of Virtual Reality for Detection of Lung Nodules on Computed Tomography

Abstract

Virtual reality (VR) systems can offer benefits of improved ergonomics, but their resolution may currently be limited for the detection of small features. For detection of lung nodules, we compared the performance of VR versus standard picture archiving and communication system (PACS) monitor. Four radiologists and 1 novice radiologist reviewed axial computed tomography (CTs) of the thorax using standard PACS monitors (SM) and a VR system (HTC Vive, HTC). In this study, 3 radiologists evaluated axial lung-window CT images of a Lungman phantom. One radiologist and the novice radiologist reviewed axial lung-window patient CT thoracic images (32 patients). This HIPAA-compliant study was approved by the institutional review board. Detection of 227 lung nodules on patient CTs did not result in different sensitivity with SM compared with VR. Detection of 23 simulated Lungman phantom lung nodules on CT with SM resulted in statistically greater sensitivity (78.3%) than with VR (52.2%, P = .041) for 1 of 3 radiologists. The trend was similar but not significant for the other radiologists. There was no significant difference in the time spent by readers reviewing CT images with VR versus SM. These findings indicate that performance of a commercially available VR system for detection of lung nodules may be similar to traditional radiology monitors for assessment of small lung nodules on CTs of the thorax for most radiologists. These results, along with the potential of improving ergonomics for radiologists, are promising for the future development of VR in diagnostic radiology.

Visual Search Performance and Strategy for Three-Dimensional Visualization Systems: Impact of Radiologist Experience

“…The rendering of two-dimensional images is discussed as a possible solution to this issue [1,13]. Namely, cross-sectional images can be fused into a three-dimensional representation of data, for instance, in virtual reality (VR) [14,15], augmented reality (AR) [15,16], on stereoscopic displays [17,18], or on volumetric displays [19,20].…”

“…Recently, the possible implementation of mobile stereoscopic systems (VR and AR) was discussed for education and training in diagnostic and interventional radiology [15], however, further confirmatory studies are required to prove the efficiency of the proposed methods. The first experimental assessment of VR's implementation in diagnostic radiology was conducted by Nguen et al [14]. As no significant differences were demonstrated in lung nodule detection sensitivity, the findings indicated that the VR system might be as suitable as a traditional radiology monitor in the case of the detection of lung nodules.…”

“…The prolonged use of stereoscopic displays provokes discomfort, which occurs due to the mismatch between accommodation and vergence [21]. It is believed that the symptoms related to stereoscopic viewing can be eliminated in the foreseeable future by improving the resolution and sampling rate of the visualization system [14] or by utilizing a multifocal architecture for the optical element, which has originally been applied in volumetric displays within a wearable display [22]. With improvements in viewing conditions, stereoscopic visualization is expected to become acceptable for long-term use on a daily basis for the purpose of medical image reading.…”

“…Further investigation of image manipulation techniques is required to maximize the usability of new three-dimensional displays for specific users. It should be noted that the image manipulations and search strategies were not assessed in recent studies where radiologists with different amounts of professional experience inspected three-dimensional images [14,18]. Thus, it remains unclear what image manipulation strategies radiologists implement when searching through real three-dimensional images in practice.…”

“…The detection of small spherical lung nodules is considered to be one of the most challenging and important tasks frequently performed by radiologists [14]. Inspired by the appearance of lung nodules, which are frequently missed due to their physical similarity when compared with pulmonary blood vessels in a cross-section, we designed a visual search array consisting of bright circles of a constant angular size on a dark background.…”