Randomized study comparing 3D virtual reality and conventional 2D on-screen teaching of cerebrovascular anatomy

Abstract

OBJECTIVE Performing aneurysmal clipping requires years of training to successfully understand the 3D neurovascular anatomy. This training has traditionally been obtained by learning through observation. Currently, with fewer operative aneurysm clippings, stricter work-hour regulations, and increased patient safety concerns, novel teaching methods are required for young neurosurgeons. Virtual-reality (VR) models offer the opportunity to either train a specific surgical skill or prepare for an individual surgery. With this study, the authors aimed to compare the spatial orientation between traditional 2D images and 3D VR models in neurosurgical residents or medical students. METHODS Residents and students were each randomly assigned to describe 4 aneurysm cases, which could be either 2D images or 3D VR models. The time to aneurysm detection as well as a spatial anatomical description was assessed via an online questionnaire and compared between the groups. The aneurysm cases were 10 selected patient cases treated at the authors’ institution. RESULTS Overall, the time to aneurysm detection was shorter in the 3D VR model compared to 2D images, with a trend toward statistical significance (25.77 ± 37.26 vs 45.70 ± 51.94 seconds, p = 0.052). No significant difference was observed for residents (3D VR 24.47 ± 40.16 vs 2D 33.52 ± 56.06 seconds, p = 0.564), while in students a significantly shorter time to aneurysm detection was measured using 3D VR models (26.95 ± 35.39 vs 59.16 ± 44.60 seconds, p = 0.015). No significant differences between the modalities for anatomical and descriptive spatial mistakes were observed. Most participants (90%) preferred the 3D VR models for aneurysm detection and description, and only 1 participant (5%) described VR-related side effects such as dizziness or nausea. CONCLUSIONS VR platforms facilitate aneurysm recognition and understanding of its spatial anatomy, which could make them the preferred method compared to 2D images in the years to come.

Virtual Simulation in Undergraduate Medical Education: A Scoping Review of Recent Practice

“…Despite the diversification of virtual simulators/platforms/systems used in undergraduate medical education, we found that 48 (52%) studies ( 18 , 22 , 23 , 27 – 31 , 33 – 35 , 37 – 39 , 42 , 44 – 48 , 50 , 52 , 54 , 57 – 67 , 71 , 72 , 75 , 78 , 81 – 84 , 93 , 96 , 99 , 101 , 103 , 105 ) reported the immersive VR application, which is characterized by the use of VR equipment consisting of head-mounted displays (headsets or goggles) and/or hand controllers. This finding suggested that VR might be a typical and popular representative of modern VS technology used in medical education.…”

“…This finding suggested that VR might be a typical and popular representative of modern VS technology used in medical education. Moreover, only one third of (31) articles ( 15 , 16 , 22 , 26 , 31 – 33 , 38 , 47 , 48 , 52 , 53 , 56 , 58 , 60 – 62 , 64 , 65 , 67 , 71 , 73 , 75 , 76 , 78 – 80 , 95 , 96 , 101 , 105 ) included in this review were based on the commercially available or free VS softwares/platforms, the rest used the self-developed ones.…”

“…Of the included 92 papers, 38% (35 paper) reported the integration of VS in surgical training for medical undergraduates, among which 12 studies focused on the instructional application of virtual endoscopic [including laparoscopic ( 31 , 36 , 37 , 56 , 73 , 76 , 78 , 98 ), arthroscopic ( 26 , 47 , 48 ), and otoscopic ( 53 )] simulators; 7 studies were for learning procedures or concepts of orthopedic and bone surgery ( 32 , 33 , 35 , 45 , 57 , 66 , 70 ); 5 studies were based on VS system or platform as a primary mode of teaching neurosurgical procedures, neuroanatomy and pathologies ( 22 , 28 , 71 , 80 , 81 ); 4 papers ( 38 , 61 , 75 , 84 ) reported the exposure of medical undergraduates as novice surgeons to the robotic surgery simulators; 2 studies conducted by the same team ( 64 , 65 ) explored the VR simulation-based training in Cochlear Implant surgery; the other 2 were for learning basic motor skills in liver surgery ( 50 , 52 ); 1 in minimally invasive surgery ( 97 ), and 1 in vitreoretinal surgery ( 67 ). In addition, Fukuta et al ( 46 ) generated a virtual operating theater orientation to improve knowledge and confidence of medical undergraduates.…”

The Use of Virtual Reality in Teaching Three-Dimensional Anatomy and Pathology on CT

“…Compared to preexisting virtual reality software programs, our software has a greater emphasis on anatomy as it relates to imaging and focuses on diagnosis rather than on anatomy visualization for treatment alone [ 8 , 10 , 11 ]. Additionally, unlike most surgical-focused virtual reality studies [ 24 ], our study includes both normal virtual angiography for educational intervention and normal CT angiography exams for assessment as well as virtual aneurysms and CT angiography with aneurysms. The presence of normal exams is more relevant for radiologists who interact with normal exams far more often than aneurysms and need to understand normal anatomy to correctly diagnose pathologic lesions.…”

Use of 3-Dimensional Modeling and Augmented/Virtual Reality Applications in Microsurgical Neuroanatomy Training

“…21 VR platforms facilitate the learning and understanding of the brain's spatial anatomy, and this is the preferred method compared with 2D images. 22,23 Furthermore, some studies have shown that neurosurgical simulation with photographic 3D models is a helpful, enjoyable, and attractive learning tool for neurosurgery residents and that further development of resources can aid the education of neurosurgeons. 14,[24][25][26] Initially, VR was found to accelerate the learning curve of novices, but more traditional and supervised training was required later on.…”