Kim Byeol, Loke Yue-Hin, Mass Paige, Irwin Matthew R, Capeland Conrad, Olivieri Laura, Krieger Axel
University of Maryland, College Park, MD, United States.
Children's National Hospital, Washington, DC, United States.
JMIR Cardio. 2020 Dec 8;4(1):e20633. doi: 10.2196/20633.
The complex 3-dimensional (3D) nature of anatomical abnormalities in congenital heart disease (CHD) necessitates multidisciplinary group discussions centered around the review of medical images such as magnetic resonance imaging. Currently, group viewings of medical images are constrained to 2-dimensional (2D) cross-sectional displays of 3D scans. However, 2D display methods could introduce additional challenges since they require physicians to accurately reconstruct the images mentally into 3D anatomies for diagnosis, staging, and planning of surgery or other therapies. Virtual reality (VR) software may enhance diagnosis and care of CHD via 3D visualization of medical images. Yet, present-day VR developments for medicine lack the emphasis on multiuser collaborative environments, and the effect of displays and level of immersion for diagnosing CHDs have not been studied.
The objective of the study was to evaluate and compare the diagnostic accuracies and preferences of various display systems, including the conventional 2D display and a novel group VR software, in group discussions of CHD.
A total of 22 medical trainees consisting of 1 first-year, 10 second-year, 4 third-year, and 1 fourth-year residents and 6 medical students, who volunteered for the study, were formed into groups of 4 to 5 participants. Each group discussed three diagnostic cases of CHD with varying structural complexity using conventional 2D display and group VR software. A group VR software, Cardiac Review 3D, was developed by our team using the Unity engine. By using different display hardware, VR was classified into nonimmersive and full-immersive settings. The discussion time, diagnostic accuracy score, and peer assessment were collected to capture the group and individual diagnostic performances. The diagnostic accuracies for each participant were scored by two experienced cardiologists following a predetermined answer rubric. At the end of the study, all participants were provided a survey to rank their preferences of the display systems for performing group medical discussions.
Diagnostic accuracies were highest when groups used the full-immersive VR compared with the conventional and nonimmersive VR (χ=9.0, P=.01) displays. Differences between the display systems were more prominent with increasing case complexity (χ=14.1, P<.001) where full-immersive VR had accuracy scores that were 54.49% and 146.82% higher than conventional and nonimmersive VR, respectively. The diagnostic accuracies provided by the two cardiologists for each participant did not statistically differ from each other (t=-1.01, P=.31). The full-immersive VR was ranked as the most preferred display for performing group CHD discussions by 68% of the participants.
The most preferred display system among medical trainees for visualizing medical images during group diagnostic discussions is full-immersive VR, with a trend toward improved diagnostic accuracy in complex anatomical abnormalities. Immersion is a crucial feature of displays of medical images for diagnostic accuracy in collaborative discussions.
先天性心脏病（CHD）解剖异常的复杂三维（3D）特性使得有必要围绕磁共振成像等医学图像的审查展开多学科小组讨论。目前，医学图像的小组查看仅限于3D扫描的二维（2D）横截面显示。然而，2D显示方法可能会带来额外挑战，因为它们要求医生在脑海中准确地将图像重建为3D解剖结构，以便进行诊断、分期以及手术或其他治疗的规划。虚拟现实（VR）软件可通过医学图像的3D可视化来增强CHD的诊断和护理。然而，当前医学领域的VR发展缺乏对多用户协作环境的重视，并且尚未研究显示方式和沉浸程度对CHD诊断的影响。
本研究的目的是评估和比较各种显示系统，包括传统的2D显示和一种新型的小组VR软件，在CHD小组讨论中的诊断准确性和偏好。
共有22名医学实习生参与了本研究，其中包括1名一年级、10名二年级、4名三年级和1名四年级住院医师以及6名医学生，他们自愿组成4至5人一组。每个小组使用传统的2D显示和小组VR软件讨论了三个结构复杂程度不同的CHD诊断病例。我们的团队使用Unity引擎开发了一款小组VR软件Cardiac Review 3D。通过使用不同的显示硬件，VR被分为非沉浸式和全沉浸式设置。收集讨论时间、诊断准确性得分和同伴评估，以了解小组和个人的诊断表现。两名经验丰富的心脏病专家根据预先确定的答案评分标准对每个参与者的诊断准确性进行评分。在研究结束时，向所有参与者提供了一项调查，以对他们在进行小组医学讨论时对显示系统的偏好进行排名。
与传统和非沉浸式VR（χ=9.0，P=.01）显示相比，当小组使用全沉浸式VR时，诊断准确性最高。随着病例复杂性的增加，显示系统之间的差异更为显著（χ=14.1，P<.001），其中全沉浸式VR的准确性得分分别比传统和非沉浸式VR高54.49%和146.82%。两位心脏病专家对每个参与者的诊断准确性在统计学上没有差异（t=-1.01，P=.31）。68%的参与者将全沉浸式VR列为进行小组CHD讨论时最受欢迎的显示方式。
在小组诊断讨论中，医学实习生最青睐的医学图像可视化显示系统是全沉浸式VR，对于复杂解剖异常的诊断准确性有提高的趋势。在协作讨论中，沉浸是医学图像显示对于诊断准确性的关键特征。
