Validation of virtual reality orbitometry bridges digital and physical worlds

Abstract

Clinical science and medical imaging technology are traditionally displayed in two dimensions (2D) on a computer monitor. In contrast, three-dimensional (3D) virtual reality (VR) expands the realm of 2D image visualization, enabling an immersive VR experience with unhindered spatial interaction by the user. Thus far, analysis of data extracted from VR applications was mainly qualitative. In this study, we enhance VR and provide evidence for quantitative VR research by validating digital VR display of computed tomography (CT) data of the orbit. Volumetric CT data were transferred and rendered into a VR environment. Subsequently, seven graders performed repeated and blinded diameter measurements. the intergrader variability of the measurements in VR was much lower compared to measurements in the physical world and measurements were reasonably consistent with their corresponding elements in the real context. The overall VR measurements were 5.49% higher. As such, this study attests the ability of VR to provide similar quantitative data alongside the added benefit of VR interfaces. VR entails a lot of potential for the future research in ophthalmology and beyond in any scientific field that uses three-dimensional data. Orbital tumors can either be primary, arising from structures within the orbit, or secondary, due to metastatic spread of a primary tumor elsewhere 1-3. A myriad of clinical findings suggest the presence of an orbital mass, namely proptosis, diplopia, pain, conjunctival congestion and varying degrees of visual loss 4,5. Diagnosis relies on adequate clinical examination and orbital imaging like magnetic resonance imaging (MRI) and/or computed tomography (CT) 6. Despite the great progress in medical imaging, the diagnosis of orbital lesions based on neuroimaging features may lack characteristic imaging features. Often, the diagnosis of specific orbital disorders such as Graves' disease associated orbitopathy, orbital inflammation, orbital lymphoma, lacrimal gland epithelial tumor, metastatic carcinoma, and vascular orbital lesions is ambiguous 7-10. Confirmation of the diagnosis frequently relies on a biopsy which can be technically challenging and prone to complications due to the dense arrangement of tissue or inaccessibility of many of these lesions 11. Visualization of orbital lesions is still based on pre-surgery image assessment of two-dimensional (2D) data visualization on a computer monitor or on intraoperative exploration 12,13. There are increasing possibilities for presentation and interaction with virtual reality 14. In this context, virtual reality (VR) has recently been optimized as an enhanced medical image display method and showed to safeguard visual comfort 15,16. The main objective of this study was to extend current medical image display and validate the level of spatial precision in orbitometry of CT data, representing the physical world, compared to precision in three-dimensional (3D) virtual reality for the first time. This is especially important when new ways are explored to use ...

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