Virtual Reality in clinical teaching and diagnostics for liver surgery: a prospective cohort study (Preprint)

BACKGROUND Learning and application of anatomy is essential but is studied and used in hospitals mostly through two-dimensional tools and imaging techniques. Therefore, the objective of this study is to verify the usefulness of an additional 3D technique and ensure a significant improvement in the visualization of anatomical structures and pathological findings. OBJECTIVE Examine the usefulness of virtual reality technology (VR) as an additional tool in medical diagnostics. Groups of students, residents and specialist in general and visceral surgery, radiology and internal medicine had to evaluate MRI (Magnetic resonance imaging) images by answering a multiple-choice (MC) based questionnaire. Subsequently, a virtual 3D display was used for processing. The questionnaire focused on the topographical conditions and the transfer of academic knowledge into clinical application. The main objectives were to determine the anatomical understanding in comparison between a 2D presentation and an additional VR (3D) presentation, measured by the error rate and response time based on the MC questions. The system usability scale was integrated as another criterion for usability of VR. METHODS 63 participants (students, residents, specialists) were assessed with regards to their knowledge on patient-specific liver anatomy and pathologies based on an interindividual comparison. Participants answered 25 multiple-choice questions first using 2D imaging (MRI) and afterwards with the respective segmented 3D model of the liver converted from MRI-data and visualized in a VR-simulation. Main criteria were “error rate” and “processing time”. RESULTS The error rate improved significantly by the additional use of VR (p=0.001). Using MRI, a significant difference between students and residents (p=0.042), as well as between students and specialists (p= <0.001) was shown. In the VR condition no significant differences between groups were found. In MRI condition significant differences in processing time between students and specialists (p=0.02) and between residents and specialists (p=0.047) were shown. No differences existed between students and residents. With VR the processing time decreased significantly in all groups (p=0.001). Significant differences between students and specialists (p=0.02) and between students and residents (p=0.004) remained, but there were no notable differences between residents and specialists (p=0.72). CONCLUSIONS The additional use of VR showed in all groups a significant improvement regarding error rate and general processing time. Transferred to clinical practice, this may lead to improvement in diagnostics and interventions. Using VR enables students and residents to participate in diagnostics and to create treatment plans at a very early stage. CLINICALTRIAL Our study, although randomized, could not be officially registered as a clinical trial due to its non-clinical nature. We submitted the study to the medical ethics committee of the Carl von Ossietzky University, which approved the study. Ethics approval statement: The medical ethics committee of Carl von Ossietzky University accepted this study (application number 2021-162). The study was registered with the German Register of Clinical Studies (DRKS). Informed consent statement: All participants gave their written informed consent.