Virtual Reality Helps Doctors Plan Complex Heart Procedures, Engage with Their Patients
Ryan Moore, MD, is a leader in developing virtual reality methods to improve outcomes in complex pediatric heart procedures.
In November 2021, Brayden Otten, 12, donned a virtual reality headset and “stepped” into a room with a replica of his own heart. The replica, known as a digital anatomic twin, was created using more than 1,000 slices of imaging data that doctors had captured and then input into medical modeling software. Brayden, who is no stranger to video games, immediately set to work moving his heart around to get a better look and, eventually, blew it up large enough to step inside of it. As he explored, the doctors talked to him and his parents about the procedure he was to undergo in the coming days.
While VR technology has been around for decades, using it in a healthcare setting is revolutionary. “A lot of what we’re doing is mirroring the video game and movie industry in terms of taking imaging and converting it into a 3D model and then putting that into a virtual space,” said Ryan Moore, MD, pediatric cardiologist at Cincinnati Children’s and director of the hospital’s new Digital Experience Technologies innovation lab where internal VR development occurs. Moore began his career in digital art and media before going to medical school. His passion for games and design eventually led him to connect with David Morales, MD, director of Congenital Heart Surgery at Cincinnati Children’s, who was also a proponent of using such technology in healthcare.
Morales had been using digital technology for years, particularly for Ventricular Assist Devices (VADs). VADS, which help the heart pump blood, began being implanted in adults on heart transplant wait lists more than 20 years ago. At that time, the highest mortality rates of individuals on heart transplant lists were being seen in pediatrics. Morales saw a huge benefit in using VADS for children, and he used digital technology to show that it was not only possible but had the potential to dramatically lower mortality rates. While these visualizations were on a computer, and not in a virtual space, the ability to use VADS led to eventually halving the mortality rate for children waiting on hearts.
When Morales came to Cincinnati Children’s, he met with Moore, who showed him a 3D-printed model of a heart. The two began looking at just how much digital design, particularly in a 3D virtual space, could revolutionize the way they looked at complex surgeries.
“Virtual reality provides a much different perspective than I can get even in the operating room. There, I can only see the heart from the front,” Morales said. “We’re now able to plan the most complex surgeries thanks to the work that Dr. Moore and his team have done—and we’re doing it with a moderate amount of regularity. This is how we were able to fix Brayden’s heart, a case that, for many years, we didn’t think would be possible.”
Which bring us back to Brayden exploring his heart in a VR headset. When Brayden was born, he had multiple cardiac defects which, at the time, could not be repaired to create a normal two-sided heart, and thus he was left with a single pumping chamber. Even so, after three operations as a baby, he was living a relatively healthy life as a pre-teen. In 2021, an MRI showed doctors that he was a candidate for a more complex procedure to give him a fully functioning heart by rerouting pathways and enabling his second chamber to pump.
“The purpose of many of the surgeries we do is to create a working right and left side of the heart,” Morales said. “For a long time, we thought this was impossible for certain patients like Brayden who have a condition called heterotaxy syndrome. This is partially because there are so many different tunnels and pathways that need to be created to re-route the blood. Now, using virtual reality, I can enlarge the heart and walk through it to see where everything is located and how to sequence the operation and plan out the different tunnels.”
Ryan Moore, MD, confers with medical animator Jeff Cimprich in the Critical Care Media Lab.
David Morales, MD, has been using digital technology in his practice for years.
Brayden Otten, 12, was able to virtually explore his heart to better understand the surgery he would undergo to repair his heart.
A Better-Informed Decision
Moore and his team used images of Brayden’s heart to create a digital anatomic twin and set to work with Morales to plan the procedure in VR. Once they saw the surgery was possible, they went to Brayden and his family to discuss the benefits. The discussion they had was tricky because they needed to show that, while Brayden felt well, this procedure would give him an even better quality of life into the future. Brayden’s parents, Michelle and John, were in agreement, but Morales and Moore were faced with the ever-present challenge of every pediatrician—helping a young patient understand their medical journey.
“We’ve always been able to connect with the parents of our patients and help them understand what’s happening with their child’s health,” Moore said. “The difficult part has been educating the patients themselves. Now, we have this new type of technology and a new generation of kids who understand gaming, virtual reality, and the digital world. Because of that, we’re able to interact more with our patients and help them understand what’s happening to a higher degree. Ultimately, one of our goals is to reduce the stress and anxiety that can occur when talking about these procedures.”
Moore and Morales knew that leveraging Brayden’s love for video games would be key to calming his anxieties around the procedure, so they invited him and his family to Cincinnati Children’s to talk them through the surgery in VR. Brayden took to the technology immediately and even showed the doctors a few features they had yet to explore. After hearing their plan and playing a few games, Brayden felt much more confident and was ready to move forward with the surgery.
The use of VR didn’t stop in the planning phase of Brayden’s procedure, however. Moore and his team, along with a VR rig, were also present in the operating room during the 12-hour surgery. As Morales worked, he would occasionally step away from the table, don the headset, and plan out his next steps with precise accuracy on the digital replica of Brayden’s heart.
The complex surgery was so successful that Brayden’s hospital recovery was a mere two weeks—much shorter than what the doctors had initially anticipated—and he was able to be home with his family in time for Christmas.
Moore is very hopeful for the future of VR technology in healthcare settings and expects a lot more to come. “I’m a test-the-limits-as-much-as-possible kind of person. I still think there’s a lot more we can do with this technology, and that’s really what drove my interest in the digital space,” he said. “We see how video games and movies have evolved over the past 10 years, so this technology is constantly moving. A lot of what we’re going to be looking into is more interaction, more realism, and more connectivity. The opportunity is to continue to improve patient outcomes and to help kids better understand and be involved in their healthcare journeys.”
Watch this TEDxCincinnati Talk by Aimee Gardner about medicine and digital experience technology