Extended Reality Offers New Ways to View Congenital Heart Disease

Researchers are evaluating the technology’s potential to improve clinical practice, trainee and family education, and patient outcomes.

What if you could put on a headset and teleport inside a model of a patient’s beating heart? What if you could interact with that heart — touch it with your fingertips, zoom in or out or view cross sections — in a shared, three-dimensional, virtual space?

These scenarios could be made possible with current extended reality (XR) technologies, according to Arash Salavitabar, MD, director of The Heart Center XR Program at Nationwide Children’s Hospital. He believes extended reality has the potential to revolutionize how clinicians, trainees and patients understand congenital heart disease. With colleagues at Nationwide Children’s and around the world, he is working to integrate and validate the impact of XR on patient experience, training and procedural preparation.

Experiencing the Heart in Three Dimensions

Treating congenital heart disease requires an understanding of each patient’s unique, three-dimensional (3D) anatomy. Historically, clinicians had to infer 3D anatomy and spatial relationships from two-dimensional (2D) data. Their reach expanded with the development of 3D imaging modalities, such as magnetic resonance imaging, computed tomography (CT) and 3D rotational angiography. However, Dr. Salavitabar says a significant limitation remains: The 3D models created by these imaging methods are viewed on 2D computer screens.

“I noticed gaps in how we as health care providers were understanding patient anatomy and physiology, as well as how we were helping families and patients understand their heart problems and how we were going to solve them,” says Dr. Salavitabar, who is also an assistant professor of pediatrics at The Ohio State University College of Medicine. “We were not using all the potential benefits of the technologies that exist in the world to make those outcomes the best that they can be.”

To address these needs, Dr. Salavitabar is working to incorporate extended reality technologies into congenital heart disease care.

XR is an umbrella term comprising immersive technologies that merge the virtual and physical. This includes augmented reality, in which a virtual object is projected onto the user’s real-world environment, and virtual reality, which is a simulated experience in a new, digital environment.

“The possibilities for XR technologies in congenital heart disease are numerous and exciting”, says Dr. Salavitabar. He is currently conducting several studies of XR in the clinic, inpatient units, during patient management discussions, and as a training aid.

Ongoing Studies Tracking Improvements to Care and Training

At The Heart Center at Nationwide Children’s, Dr. Salavitabar has helped integrate XR into weekly clinical team meetings. To review complex cases and plan upcoming procedures, team members now don 3D glasses electronically synched to a 3D projector. This allows them to view and interact with 3D models of patients’ hearts together. An ongoing study is evaluating the types of anatomies for which these models are most helpful.

Another recent project showed that XR can bring remote clinicians together virtually to plan procedures. With colleagues at Nationwide Children’s and Children’s Hospital Colorado, Dr. Salavitabar used XR to create a shared virtual space where cardiologists separated by physical distance could meet to discuss and view 3D models of patients’ hearts prior to intervening.

XR also provides improved opportunities for teaching the visuospatial aspects of congenital heart defects. In a current project, Dr. Salavitabar, with the Nationwide Children’s Research and Innovation group and The Heart Center XR Program Coordinator Marc Dutro, has created a custom virtual reality cardiac catheterization laboratory. Trainees can enter the virtual space wearing haptic gloves that allow them to experience tactile sensations while they manipulate virtual objects.

“The concept is that you can develop muscle memory and practice a procedure once or 100 times from beginning to end before you ever enter the procedure room,” says Dr. Salavitabar. “We are developing that custom software here at Nationwide Children’s and studying its feasibility and utility for different training opportunities.”

Finally, The Heart Center’s XR team is exploring the usefulness of augmented reality in conversations with patients. Families with children who have had cardiac imaging through CT are given the opportunity to see and interact with a virtual 3D model of their child’s heart with their provider.

“Interacting on that intimate level with their children’s 3D heart models along with their providers offers an additional level of inclusivity and understanding that didn’t necessarily exist before this technology,” says Dr. Salavitabar.

Optimizing the Technology

Because XR was not originally built for health care purposes, Dr. Salavitabar’s team is working to modify and develop the technology for use in the context of congenital heart disease care.

“My hope is that the technology will catch up to our needs, and that will only happen with the support of an institution like Nationwide Children’s that innovates on a regular basis,” he says. “We are at the forefront of developing custom applications of XR technologies and studying their effectiveness, but we need to continue to push those limits.”

Dr. Salavitabar’s ultimate goal is the integration of XR into the daily workflow of The Heart Center. He would like the technology to be accessible in real time and on demand to assist with everything from trainee and patient education to pre-procedural planning and intra-procedural guidance.

“What excites me is taking concepts that I wish were true every day and working to make them a reality with emerging technologies,” says Dr. Salavitabar. “Our work with XR in The Heart Center exemplifies how all of us strive to improve patient care and encourage innovation throughout Nationwide Children’s.”

References:

1. Salavitabar A, Dutro M, Zablah JE. 2024. Virtual reality remote collaboration for preprocedural planning of complex percutaneous congenital interventions: A case series. JSCAI. 3(3):101302.
2. Salavitabar A, Figueroa CA, Lu JC, Owens ST, Axelrod DM, Zampi JD. 2020. Emerging 3D technologies and applications within congenital heart disease: teach, predict, plan and guide. Future Cardiology 16(6):695-709.

Image credit: Nationwide Children’s