Virtual Reality in Medicine and Medical Education

"In 1986 and 1987, I started getting telephone calls from people who had read about my research and wanted to know if they could apply virtual environments to problems in their own fields. ... People working with cerebral palsied patients wondered whether tongue-steered VR could free trapped minds from dysfunctional bodies. Anesthesiologists wanted a better way of displaying vital signs from all the instruments they had to monitor -- the surgical theater is getting like a jet cockpit that way." Thomas Furness (Rheingold, Virtual Reality, p.209)

Imagine that you are going to be admitted to the hospital for several days to have some tests run. You've never been in the hospital before and, even though you are optimistic about the test results, the idea of staying in the hospital frightens you. Or imagine that your child has been diagnosed with a chronic illness and that you are now faced with regular visits to the hospital for treatment. Both you and your child are nervous and afraid and worry about what it will be like. In both of these situations, much of the fear is the concern about the unknown. A walk through the hospital or even through the operating room could alleviate some of this anxiety, but staffing constraints and access restrictions make casual walkthroughs unrealistic. Fortunately, virtual reality will offer the opportunity to visit such restricted environments and can provide the reassurance that such a personal exploration of the hospital can bring. Using virtual reality technology, you could even "spend a night" in the hospital, watch the operation you are going to have, or actually experience a particular treatment before it happens in "real time".

Medical imaging technology is already quite advanced, but images are still two-dimensional. X-rays show only a single "slice". CAT scans provide consecutive slices that can be assembled into mosaic presentations. And, ultrasound, too, is only two-dimensional. Using virtual reality (VR), however, these actual diagnostic images of a patient could be used to create a three-dimensional model of the patient. The potential use of these "scientific imaging" models in medical diagnosis, treatment planning, and education will revolutionize the field. The benefits of determining the location of tumors, the placement of surgical incisions, or practicing difficult surgical procedures ahead of time are of inestimable value.

If a physician were wearing a head-mounted VR display that showed these diagnostic images while looking at the patient, it would almost be like wearing "x-ray glasses". For example, if an ultrasound scanner was hooked up to a head-mounted display, the physician could see the image superimposed on the patient's body rather than having to consult a nearby screen. Already planning for radiation treatment benefits from virtual reality support. The goal of radiation treatment is to deliver a lot of radiation to a tumor while minimizing the radiation exposure to healthy tissue. A "virtual body" of the patient can be created that allows the physician to visualize (before actual treatment) the location of the radiation beam in relation to the tumor and to the surrounding healthy tissue. This creates the opportunity to experiment with different approaches until the best one is identified. Obviously it would be counterproductive to do this directly with the patient!

Virtual reality is also a powerful tool for training people at various task, and the possibilities for its use in medical education are very exciting. Conceptually, virtual reality can be seen as an extension of multimedia. The three-dimensional virtual bodies previously mentioned are ideal for learning anatomy, practicing physical examinations, testing diagnostic procedures, or even practicing ones's "bedside techniques". Virtual reality allows a student repeatedly to simulate skills that are difficult (if not dangerous) to practice in the real world. For example, surgical activities that involve fine motor skills when using the hands on live tissues and organs. In the future, not only will virtual reality mimic the complete medical procedure involving such matters as placement of organs within the patient, but even the way the scalpel will feel when cutting through different tissues.

Another interesting possibility is to use virtual reality to create an environment that can be shared by several people. This would enable a teacher to be present to provide immediate feedback during the learning process. Procedures that require the work of a team are ideally suited for practicing in a virtual reality environment.

The potential applications of virtual reality for the disabled are almost limitless. For example, interactive virtual reality systems could be used to restore motor power (within the virtual world) to individuals with physical handicaps who wish to "escape" a world that is defined by a bed or a wheelchair. Imagine the excitement of a child with a disability, dependent on a wheelchair, when he "plays" football with his friends for the first time.

The complexities of medical VR go beyond the mere technological issues. The associated ethical issues will also be compellingly significant. The accuracy of the representations created by the computer, the skill of the designer, and the preferences of the physician are all limiting factors in the validity of the reality that is possible.

Although the patient may have a choice among several virtual reality environments, that choice is likely to be more accommodating than in daily life. And what if the patient chooses to spend more time in the "virtual world" than in the "real world"? Could the virtual reality experience be addictive? Will alternative realities seduce people into being hypochondriacs? Virtual reality is also a valuable tool in the development of therapeutic drugs. During this process, researchers look for targets or areas on proteins where molecules of a specific drug will attach themselves. Imagine trying to find the right molecular key to fit into a unique molecular lock. If a chemical can be found that makes such a fit on the protein found on a tumor cell or a pathogenic bacterium, then that chemical is potentially useful in drug development.

Virtual reality techniques allow the experimenter to create computer- generated models of the receptor sites within a human protein while another model represents the atoms of a potential drug. A researcher then manipulates the two models, moving the drug around the protein until it binds with it. The system not only displays a visual "docking" of the molecules, but it also provides feedback that allows the researcher to feel the magnitude of attraction and repulsion between the molecules. Such a molecular docking system exists at the University of North Carolina at Chapel Hill where much of the research on virtual reality in medicine is being done. Molecular docking systems also have potential in future protein design, including possible use in mapping the genetic code.

Virtual reality provides the opportunity to create controllable, repeatable environments. This technology can be used throughout the practice of medicine: to educate both patients and future health care practitioners, to practice surgical skills and diagnostic techniques, to enhance diagnosis and aid in treatment planning, and to design therapeutic drugs. As virtual reality technology is refined, its use in medicine is bound to increase dramatically.

H. McLellan, "Virtual Environments and Situated Learning," Multimedia Review, 30-37 (Fall 1991).

Howard Rheingold, Virtual Reality (New York: Summit Books, 1991).

G. Stix, "Reach Out. Touch Is Added to Virtual Reality Simulations," Scientific American, 264(2):134 (February 1991).

D. L. Wheeler, "Computer-created World of Virtual Reality Opening New Vistas to Scientists," The Chronicle of Higher Education, 37(26):A6,12,13 (31 March 1991).