Surgeons are utilizing Meta's Quest 2 to simulate operations, allowing physicians to practice from their own residences. Adoption of virtual reality technologies has been increasing in the field of pain control. Medical schools are beginning to include virtual reality in their educational programs.
Just days before participating in his first major shoulder-replacement surgery last year, Dr. Jake Shine donned a virtual reality headset and began the preparation process. The third-year orthopedics resident at Kettering Health Dayton in Ohio took the headset home to practice twice daily before the surgery. In the VR lab at the medical center, Shine and his attending physician had rehearsed the procedure, a reverse total shoulder arthroplasty, with the help of Meta Quest 2 headsets. This simulated practice allowed them to do the menuvering around neurovascular structures, around the lungs, and to acquire the necessary knowledge of what to do and what not to do in the surgery without putting the patient in any risk. As a result, the actual procedure went without a hitch and the patient recovered fully. According to Shine, it was smoother and quicker than if the attending physician had to walk him through every step of the actual case.
Extended realities such as VR and AR are emerging technologies receiving growing traction in health care, even though determining its cost-effectiveness is still a question to be answered. Companies like Facebook (under its rebranded name Meta) and Apple are investing heavily in the development of VR and AR, yet they remain niche products in the consumer world. Meta is expected to launch the Meta Quest 3 as soon as next month, while Apple is preparing its $3,500 Vision Pro for launch early next year, touting its ability to offer medical students a hyper-realistic 3D model with which to practice and apply their knowledge with patients.
To date, VR has had one of its main applications in healthcare, which is largely aimed at managing pain. According to Dr. Brennan Spiegel, director of health services research at Cedars-Sinai in Los Angeles, pain has both a physical and an emotional component that can be addressed through VR. He believes that by using the technology, people are being trained to divert their attention away from painful experiences. Cedars-Sinai is now developing a virtual platform to aid those with gastrointestinal issues, anxiety, addiction, and perimenopausal health. Additionally, the U.S. Department of Veterans Affairs is taking advantage of extended reality in over 160 of its facilities to help patients with pain management, rehabilitation, and behavioral therapy. In the last few years, the technology has developed to the point where the VA has identified more than 40 separate use cases for it.
Caitlin Rawlins, the immersive program manager at the VA, has seen firsthand the profound effect that VR has on patients. She recounted the story of an elderly man with severe knee pain who found relief in just a few minutes of using VR. She also told of an Army vet confined to a wheelchair and experiencing cognitive issues, whom VR helped to become a "completely different person", smiling and laughing. According to Rawlins, these types of experiences have been repeated over and over again.
Spiegel and Rawlins both said their entities are hardware platform agnostic, meaning they can integrate headsets created by Meta, Apple or any other brand as long as they are compatible with the right software. Spiegel indicated that many people may be interested in purchasing headsets but may not understand their applications in healthcare. Meta has identified healthcare as a target audience, releasing case studies and videos of futuristic surgeons in training. Nonetheless, it seems their focus remains on gaming and entertainment. Cedars-Sinai’s software is available on the Meta Quest Store, however it is only found in the App Lab section which is not as accessible or easily discoverable by search. Meta declined comment and referred CNBC to their Sept. 7 post discussing the use of metaverse technology, “Training for surgery is just one of the many industries being transformed in ways that are positively impacting lives.” Ultimately, Meta believes that virtual technology is ‘positively impacting lives’ and ‘bringing people together in the virtual world’.
Technology is now becoming a fixture in many medical schools and residency programs. At Kettering Health Dayton, Virtual Reality (VR) recently became a required element of the first-year orthopedics residents' curriculum. During July, these new doctors did clinical services in the mornings and practiced in VR during the afternoons, with the goal of completing at least three modules a week and achieving a score of over 70%. For higher-level residents, like Shine, VR training is not yet mandatory; however, the hospital is working to make this technology a part of each level in the program. Referencing the way he trained in the late 80s, Dr. Brent Bamberger, the director of the orthopedic surgery residency program at Kettering Health Dayton, stated, "We didn't have videos at that time. You may go to a lecture, you may get lucky and have a specimen lab or some type of lab to do it, but you were learning by watching."
The first-year resident Dr. Reem Daboul noted that headsets can't replicate the physical feeling of a procedure, yet she has found them to be helpful in various ways. For instance, she can already use the headset to learn the steps of an anterior hip replacement, which many orthopedic surgeons do not learn until their third year of residency or later. “Being able to have something help me and see what I'm supposed to be doing and be able to walk through the steps, it's been super helpful for me,” Daboul said in an interview. The hospital’s orthopedics program uses software from PrecisionOS, a company that builds VR modules for training surgeons, medical residents, and medical device representatives (nearly 80 customers across the globe). This software is described as “sophisticated” and “very realistic,” especially as a way to learn the steps of a procedure. Dr. Richard Miller, a retired professor at the University of Rochester, finds it so compelling that he has been actively helping the orthopedics department implement the technology, even after three years since his retirement.
The VR is a valuable way for residents to hone their skills without dealing with the pressures of the operating room, as well as to practice from home. Miller stated, “I can be at home in my study at night, and they can be in their dorm at night, and we can do a procedure together in the virtual world.” However, he points out that for quality of care, the software must be able to update regularly with standards of care, best practices, and surgery techniques. Miller added, “Who's going to bring it up to date?” Pricing is another issue; Miller has not been able to get straight answers from anyone about what it costs and who does what. PrecisionOS declined to share specific pricing information with CNBC. Goel commented that costs of using the company's software vary depending on the institution and the partnership. Kettering’s Bamberger also noted the clunkiness of the hardware. Other professionals in the same field see the current limitations, such as Dr. Rafael Grossmann, a surgeon at Portsmouth Regional Hospital in New Hampshire. Grossmann was the first person to use Google Glass during a surgery in 2013 to stream the procedure to a room of students. Though Google Glass never gained traction due to issues with privacy and jokes on late-night television, Grossman is confident there is a current market for the technology, particularly in healthcare. Despite his optimism, he acknowledges headsets are still bulky and not entirely functional for doctors.
As technology advances with health care, extended reality will need to pass regulatory tests. Ryan Beams of the U.S. Food and Drug Administration is leading the way for this research along with a team of researchers, consulting a variety of experts regarding the newly developed AR, VR and mixed reality devices. Beams commented on assisting companies with getting these devices to market quickly and safely. Dr. Spiegel of Cedars-Sinai also formed the American Medical Extended Reality Association in 2022, aimed to lead the future of this field. Currently, there are 300 paying members, which Spiegel hopes to increase in the coming years. To accompany this undertaking is the Journal of Medical Extended Reality, the first of its kind. “This is not an area of fringe science anymore, but is now mainstream,” Spiegel remarked. Although a lot of work is still needed, tremendous progress has been achieved, making this a legitimate science.
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