Augmented reality projects images onto the eyewear of providers helping them with ultrasound-guided procedures. (Lloyd Fox, Baltimore Sun video)
With a futuristic headset wrapped around her head, Dr. Sarah Murthi looks as if she is ready to play a video game.
But the surgeon at Maryland Shock Trauma Center, dressed in pink scrubs, is instead examining the heart of a volunteer patient as she demonstrates one way she hopes virtual reality will soon be used in the operating room.
On the table is Eric Lee, a college student who agreed to be her guinea pig. Murthi slathers gel across his chest then performs an ultrasound. Instead of images of his heart appearing on a nearby computer screen as in regular ultrasounds, they appear to her to float in midair before her eyes. The headset gives her an up-close, multidimensional view of Lee's heart, like something out of a science fiction film.
Shock Trauma is one of the many medical facilities around the country testing, and in some cases already using, virtual reality technology in the treatment of patients.
Virtual reality is being used to distract patients during painful procedures, such as treatment for severe burns, so they feel less pain. Soldiers and veterans suffering from depression and post-traumatic stress disorder are getting treated with virtual reality videos that recreate traumatic events to help patients face them head-on and learn, over time, to cope with the mental effects of their combat experiences. Doctors also are using the techniques for surgery simulations and robotic surgery.
"It is an exciting technique that is more than just gaming," said Dr. Neil Martin, director of the Neuroscience Institute and chief quality officer at Geisinger Health Systems in Pennsylvania, at a recent forum on the topic at the Newseum in Washington.
Martin uses the technology to examine patients' brains before surgery.
The market for virtual reality in health care is expected to reach $3.8 billion worldwide by 2020, according to research firm Global Industry Analysts. Consulting firm Deloitte recently listed virtual reality as one of its top 10 health care innovations. The firm said that the simulated environments could "accelerate behavior change in patients in a way that is safer, more convenient, and more accessible."
Virtual reality has been around since the 1990s but has become more more affordable, portable and user-friendly, those familiar with it say. While some devices remain expensive, many cost just several hundred dollars.
"It is becoming much more mainstream, and the reason is that the price of the tools has come down where it is really affordable," said Dr. Mark Wiederhold with the Virtual Reality Medical Center in San Diego.
The center uses virtual reality exposure therapy to treat patients with panic and anxiety disorders, including phobias such as fear of flying, driving, public speaking and thunderstorms.
Researchers at Cedars-Sinai Medical Center in Los Angeles reviewed several studies that looked at the medical efficacy of the technology in inpatient settings in the past decade and found that it is still relatively novel but also promising. Most of the studies found virtual reality to be "efficacious, easy to use, safe and contributing to high patient satisfaction," the researchers wrote in a paper that appeared in January in the journal Innovations in Clinical Neuroscience.
The use of virtual reality is still in the investigative stages at Shock Trauma, but Murthi and others hope to use it on real patients in the near future.
By having the image directly in front of her, Murthi said she can keep her eyes on the patient, rather than having to keep looking away at a computer screen, which could cause her to miss significant changes in vital signs.
"I could be so focused on the ultrasound that I don't notice that the patient's heart rate has gone up significantly," said Murthi, who's also a clinical associate professor at the University of Maryland School of Medicine. "You want to look away from the patient as little as possible."
At the University of Southern California's Institute for Creative Technologies, clinicians are using virtual reality to treat soldiers with post-traumatic stress disorder through a program dubbed Bravemind. When the soldiers put on the headgear they are transported virtually back to their days in Iraq, Afghanistan or Kuwait, in desert environments where bombs are detonating around them and a dead enemy soldier may lay nearby.
Clinicians expose the soldiers to scenes gradually, allowing them to relive the traumatic events that have caused them to difficulties in real life. Research has shown many PTSD patients tend to avoid reminders of the past. Exposure helps them learn to confront those past experiences rather than let the experiences cripple them. Without virtual reality, they have to rely on their memories, which may not be as vivid or may be hard to recall if the patients are suppressing them.
"It gives the traumatic event a place in their life so that they can live life," said Arno Hartholt, a computer scientist with the USC institute who recently demonstrated the technology at the Newseum.
At the University of Washington Harborview Regional Burn Center in Seattle, doctors use a virtual reality system called SnowWorld to distract burn victims' from intensive treatments that can involve painful skin stretching, wound care and scrubbing away of dead skin.
To help with the pain, patients wear headsets that puts them in an icy canyon with snowmen, igloos and penguins. They play a game where they toss snowballs at the objects by clicking a mouse. The game was created by Dr. David Patterson and Dr. Hunter Hoffman, University of Washington psychologists who say that distracting the mind can help people deal with pain.
Hoffman has looked at brain scans of his patients and said parts of the brain that indicate pain light up when virtual reality is not used with a patient being treated.
Oftentimes, hospitals and other medical facilities partner with engineers and computer scientists to develop the software to make their virtual techniques work. The headgear and other technology is often already available.
the department of orthopedic surgery at Johns Hopkins Hospital and the Laboratory for Computational Sensing and Robotics at the Johns Hopkins University are looking at various ways to improve treatment of patients, including using augmented reality for the treatment of pelvic fractures.
Shock Trauma is collaborating with the University of Maryland Institute for Advanced Computer Studies. The researchers are using HoloLens headgear developed by Microsoft; the units cost $3,000 apiece.
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"Virtual reality is not just for gaming and finding Pokeman," said Amitabh Varshney, director of the Augmentarium, a virtual- and augmented-reality lab at the University of Maryland institute. "This can be used in the medical field to help doctors treat patients."
Virtual reality is also a good educational tool. Varshney is working on a project with doctors to re-create the chaotic environment at Shock Trauma so that medical students can learn from it.
When a gunshot victim is brought to the trauma center, a small army of nurses, doctors and other medical staff work simultaneously to treat the patient, making it hard for a resident to observe everything taking place. Shock Trauma is using immersive cameras to capture all the scenes, so they can be replayed later on a big wall, allowing residents can put themselves in the shoes of the surgeon.
"It happens so fast in the moment," Murthi said, "but we can re-create it to improve the learning environment."