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Virtual Reality as an All-In-One Solution for Anatomical Simulation

By Justin Sutherland Co-founder & CEO, Realize Medical Inc.
Medical images can be segmented directly in virtual reality (VR) using a purpose-built VR stylus pen and the aid of a drawing surface. Users apply 2D or 3D operations on the image, in combination of other semi-automatic segmentation processes such as image thresholding. The segmented volume of interest is converted into a print-ready mesh in real time and (optionally) displayed to the user. (All images provided by Realize Medical)

It is without question that medical additive manufacturing provides immense value, as it shapes everything from how physicians make diagnoses, plan complex surgeries, design and fabricate patient-specific implants, and educate their patients and trainees. The demand for 3D printing will continue to grow in the coming years, limited only by the capacity of healthcare providers to meet it.

But in our view the medical additive manufacturing industry faces a crisis of access.

As additive manufacturing processes trend toward the standard of care for many conditions, health care organizations will be forced to confront two main challenges with establishing and/or scaling their programs, particularly as it relates to anatomical studies: image segmentation and printing time.

Virtual Reality Helps Meet Challenges

Fortunately, these challenges can be addressed by considering fresh approaches. When it comes to image segmentation, practitioners may be surprised to discover that it makes more sense to perform this work in virtual reality (VR), rather than on a conventional computer workstation. In VR, the full potential of 2D and 3D views are unlocked, and users are better able to assess model accuracy using novel means of referring to the images from which they were derived. As an example, in the integrated medical VR platform, Elucis, a wide array of print-ready 3D anatomical models can be created with only a few basic modeling operations. Medical images are first imported into a VR environment via the companion desktop interface, after which they can be immediately viewed in one of a number of compatible VR headsets. From there, a virtual stylus tied to a VR controller is used to rapidly segment volumes of interest which are converted to fully formatted models compatible with 3D printers and appear before users in real-time. It’s important to note that no knowledge of traditional segmentation processes or CAD terminology is required, as this particular platform is geared toward clinicians.

It’s also important to note that the entire process of going from model creation to visualization with a true 3D perspective is all done within a single, integrated VR platform. We’ve enhanced this platform further by including AI-based auto-segmentation tools, but users retain full control over the final results as they have the means to quickly make edits. All models can be exported in STL (or other) format for 3D printing, if desired, with no additional image processing steps.

Physical Models Alone are Limiting

For 3D visualization, hospitals have primarily relied on additive (or subtractive) manufacturing processes to bring the digital 3D anatomical models to life, and there are many good reasons for this. However, this alone may limit the volume of 3D studies depending on the available printing capacity. Even today, printing times for some of the more intricate, multi-colored models can take several days to complete. There’s also a per-print cost that needs to be considered. This is a primary reason why VR will be so important in the coming years. When properly implemented, VR is an ideal substitute for visualizing and interacting with printed models. In Elucis, for example, multi-color models with fidelity can be viewed and interacted even as they are being created.

Examples of anatomical models created in virtual reality (VR) showing a variety of available visualization options, including color, transparency, and medical imaging.

There are other advantages to using VR. Users have full, flexible control over the color and transparency assigned to anatomical structures, providing visualization not available with physical prints. In a virtual environment, transparency can also be more effective since it is not inextricably linked with refractive distortion of internal structures as with physical materials. Also, since users are not limited by the availability or constraints of 3D printers, 3D models viewed in VR can be more inclusive of surrounding anatomy and these additional structures can be selectively used to provide clinical context as required. Flexibility is needed to meet the range of needs amongst practitioners, patients, and trainees.

VR is also naturally scalable. Digital models can be easily duplicated and shared within the circle of care on secure networks. At the same time, VR workstations consume less physical space and supporting infrastructure than 3D printers and provide consistent failure-free output while avoiding many quality assurance requirements. If environmental impact is a consideration, it is worth noting that VR nominally doesn’t involve consumable (and occasionally costly) materials. And if your VR platform has advanced modeling capabilities, it eliminates the need to source and maintain separate image segmentation software.

The implications of a VR platform capable of anatomical modeling stretch beyond anatomical studies and into the realm of surgical planning and simulation. Here, again, VR plays a role as it facilitates pre-surgical planning and surgical simulation activities, including the simulation of cuts or the removal of tissue. When using VR for these activities, users have the option of reverting back to the original models to test different approaches.

The virtual nature of digital models is aligned with the increasingly remotely-connected world. Digital models are freely and instantaneously transmitted or can even be created and engaged with simultaneously across any distance.  Consequently, VR can enable urban centers of excellence to share 3D content, modeling judgment, or clinical experience with smaller, remote communities.

No matter what the needs are for any anatomical studies, creating and visualizing 3D anatomical models needs to be easier and more accessible. As such, medical VR systems that integrate advanced modeling capabilities will play a large role in anatomical studies going forward, even if 3D printing is the intended endpoint. By consolidating model creation (segmentation), visualization, and other activities into one platform, these studies become more accessible to a wider number of clinical users. It increases the reach of 3D planning. It also boosts efficiency of technical support personnel in charge of model creation and quality oversight, reduces errors, and lowers the barrier to entry for institutions by cutting down start-up and operating costs. Virtual reality is the perfect complement to any hospital-based additive manufacturing program, and forward-looking institutions would be served well by integrating an all-in-one VR solution.

(Editor’s note: The Elucis software package provided by Realize Medical based in Ottawa, Canada is in the process of gaining regulatory approval as of January 2021.)

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