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VheaRts – VR revolutionising traditional heart surgery

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Through the virtual modelling of patients’ hearts using Virtual Reality (VR) technology, heart surgery is being revolutionised for clinicians, patients and students alike. Health Tech World learns more about the pioneering project from Dr Claudio Capelli 

 

In a wholly unique project, for the past two years, digital modelling technology has been in use at Great Ormond Street Hospital in London, and has redefined what is possible in understanding and predicting hugely complex heart surgery of patients born with congenital defects. 

Not only does the introduction of VR enable surgeons to view a digital version of the heart they will operate on ahead of surgery, allowing them to understand in a more innovative way than ever before what they are about to encounter, but for young patients and their families, the impact has been equally significant. 

Through the introduction of a VR headset, something more and more familiar to children and young people from its use in gaming, the patient can explore their own heart and understand what their life-changing surgery will involve, in an accessible way that helps to remove a lot of the fear and anxiety from something that may previously have felt unknown. 

The creation of the VheaRts project – a partnership between the cardiovascular engineering team at UCL Institute of Cardiovascular Science and Great Ormond Street Hospital – is also rejuvenating traditional ways of learning for students, whose studies can now also benefit from the innovation of VR, and have been allowed to continue virtually during the COVID-19 pandemic wherever they are in the world. 

And the technology – which also played a role in the separation of conjoined twins Safa and Marwa Ullah at GOSH in 2019 – is now set to be rolled out within the next year. The second phase of validation currently underway at key institutions across Europe, paving the way for more clinicians, patients and students to benefit in the very near future. 

The potential for expansion into other fields of expertise – such as brain and liver surgery – is a likely further development in future years. 

For Dr Claudio Capelli, a biomedical engineer and senior research fellow at UCL, the project is the latest phase of his 15-year dedication to using computational modelling in cardiology, translating technology into greater understanding of heart surgery. 

“There was natural evolution in terms of technology available to us, but the same constant in terms of our ambitions,” says Dr Capelli. 

“We can enhance the diagnostic tools, and help things to be seen that aren’t as visible in medical images. The simulation of future scenarios and possible treatments are now a concrete possibility.

“We stood shoulder to shoulder with clinicians to understand their needs and turn the technology into what was needed in a hospital environment. 

“We designed our own software. There was nothing like this on the market, nothing with all the features a clinician would need, especially in a hospital setting. 

“Through the adoption of technology, we have our own defined pathway. There are some very complex cases where clinicians ask to test the platform and go into the operating theatres more confident of understanding the situation better.” 

The use of VR came as a successor to Dr Capelli’s previous innovation in understanding heart surgery, through the use of 3D printed hearts. At that time, the hugely complex and detailed physical models gave a new level of insight – although was not without limitations.  

“3D printing had been in use for 20 years already, so was not new, but we used it to help clinicians with new devices and ideas, such as making a 3D model of a specific heart of a specific patient,” says Dr Capelli. 

“The use of 3D printing had a lot of positives, but was not perfect – the costs, the limited choice of materials, they were restrictions, but did add positive impacts to treatments. 

“But then through the use of VR, we were able to make something that was much more accessible. Some of the limitations around 3D printing were now being solved through the freedom given by VR. It allowed you to change perspectives easily, and it was very, very cheap. 

“When you print a 3D model of a heart, you have to define the view you want before you print it. But when you have it in your hands, you realise it would be good to have another perspective. This takes time and money to do, but with VR it is virtual and low cost.

“While VR had been around for 20 years if not more, the headsets had become more affordable, through its use in the gaming industry it had become widely available. 

“There had been some huge steps forward in VR and we saw the fantastic possibilities of being in an immersive environment like this, it gave unprecedented access. 

“From our biomedical engineering point of view, the challenge was to look at what had been developed and then to translate that to improve medical care.”

Dr Claudio Capellithat to improve medical care.”

The technology first came to international prominence at an early stage in its development, through its role in the separation of the conjoined sisters, featuring in a BBC documentary about the inspirational story. 

“It played a very small part, but it was very important experience for us to understand the potential, as we were in Proof of Concept and prototype stage at that point – this gave us huge motivation,” recalls Dr Capelli. 

And from there, the VheaRts project has developed significantly, supporting clinicians in their work, but also delivering benefits to patients and supporting the next generation of heart surgeons and medical teams. 

“We built on the experience of our 3D printing to facilitate the understanding of a complex problem, both for kids and their families,” says Dr Capelli. 

“It’s not a generic heart they’re looking at, it’s a replica of their own heart. They can have fun with it. It helps to distract them a bit and to forget some of the stress.

“In the majority of cases, it is something very interesting to teenagers in particular, because of its links to gaming. We try to speak their own language through this tool and they find it interesting. 

“We participated to initiatives of public and patients engagement to communicate our research and  find out what they like, what they don’t like, what benefits they find. Their involvement and input is very important and we’re holding  a dedicated focus group in a couple of months. 

“We are in process of collecting more solid data, but from the feedback we have collected so far, it is going beyond any of our expectations.”

While its benefits to education and training were recognised from the outset of the project, its role came to the fore during the COVID-19 pandemic in enabling studies to continue remotely, with access to both digital models and library all through the headset. 

“From the very first moment, we realised the potential in education, it could give a much wider perspective,” says Dr Capelli. 

“It had been taught so far to students like ours from books, with diagrams and images. There are anatomical reference books that have been around for the last 60 years, which are a fantastic source of information and access to resources, but when COVID came, access to this and to the lab became more complication. 

“It was a natural evolution that we should test what we had been developed on our students. Through using VR, and the digital models of the heart, that enabled them to access this information without going to the lab. 

“They could be completely immersed in these models of the heart, they can navigate inside and out and learn about structures. When COVID came, it was possible to remotely have students all in one virtual room for a class, forgetting they were separately in places around the UK or abroad. They were all in the same room, and being shown in the same enriched way. 

“It was a crucial opportunity to test our assumptions. The Institute fully supported us and invested to purchase 20 headsets for use in our teaching programs in Cardiovascular Science. We have seen the motivation from using VR, it’s really stimulating.”

Now established in its use at GOSH and UCL, and set to be launched more widely within the next year – ideally the next six to nine months – attentions are now turning to its potential, and how it can benefit other areas of medical work. 

“It can go far beyond cardiovascular application, beyond this specific niche, and from a technology point of view, we could also apply it to the brain, liver, bones,” says Dr Capelli. 

“That’s what we are working towards. Our effort is now focused on translating such technology to the widest group of beneficiaries. The translation takes always a lot of effort but it’s very achievable and the first version is in the pipeline.”

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