JMIR Publications

ABSTRACT

Background:

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 MRI. 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 multi-user collaborative environments and the effect of displays and level of immersion for diagnosing CHDs have not been studied.

Objective:

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.

Methods:

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 utilizing different display hardware, VR was classified into a non-immersive and a full-immersive setting. 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 was 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.

Results:

Diagnostic accuracies was highest when groups utilized the full-immersive VR compared to the conventional and the non-immersive VR (χ2(2)=9.008, p=0.011) displays. Differences between the display systems were more prominent with increasing case complexity (χ2(2)=14.110, p<0.001) where full-immersive VR had 54.49% and 146.82% higher accuracy scores than the conventional and non-immersive VR, respectively. The diagnostic accuracies provided by the two cardiologists for each participant did not statistically differ from each other (t=-1.012, p=0.313). The full-immersive VR was ranked as the most preferred display for performing group CHD discussions by 68% of the participants.

Conclusions:

The most preferred display system amongst medical trainees for visualizing medical images during group diagnostic discussions is full-immersive VR, with a trend towards improved diagnostic accuracy in complex anatomical abnormalities. Immersion is a crucial feature of displays of medical images for diagnostic accuracy in collaborative discussions.