Using virtual reality technology, physicians can now practice various cardiovascular catheter-based procedures, such as carotid stenting, on a virtual patient simulator. This technology allows for practicing a procedure using the patient's exact anatomy virtually, and then to subsequently perform the exact same technique on the live patient once the procedure has been mastered.
Dr. Christopher Cates, MD, director of vascular intervention at Emory Hospitals, reports on the first virtual reality "mission rehearsal" of a carotid stenting procedure in the Jan. 17 issue of the Journal of the American Medical Association (JAMA). The mission rehearsal is the same idea that the aviation industry and military uses in preparing for military missions or practicing landings in flight simulators, but this represents the first use of this concept in medicine.
The first procedure in humans involved a patient with severe chronic obstructive pulmonary disease. The carotid stenting rehearsal on a simulator was immediately followed by the operator performing the actual procedure on the patient.
According to Dr. Cates, virtual training could help reduce medical errors. He says that many of these mistakes are caused by human factors associated with invasive, image-guided procedures learned in the traditional way, with doctors learning new procedures working on patients with the guidance of experienced teachers.
"Virtual reality simulation training to proficiency has been recommended in the certification process for carotid stenting," says Dr. Cates. "Virtual reality simulation also allows mission rehearsal - practicing a procedure using an individual patient's anatomy in a virtual environment prior to the actual procedure, which is a revolutionary step in medicine.
"Although this concept is used by the military and in aviation, this case represents the first implementation in medical practice," he says. "We have performed what we believe to be the first mission rehearsal carotid stenting case using a specific patient's digital vascular anatomy, which has vast implications for the future of procedural medicine and the ways procedures are done."
In the virtual reality simulation, magnetic resonance angiogram images of the patient's aortic arch vessels and cerebral anatomy were converted into digital format, loaded on the simulator, and then used to recreate the patient's vascular anatomy in virtual reality.
Dr. Cates also notes that the use of new virtual technology in medicine represents a paradigm shift in the way physicians are trained in procedural-based medicine, from looking over the shoulder of a doctor working on a real patient to being able to measure the trainee's learning curve in a virtual environment and a 'patient-safe' environment. This ensures that the doctor has reached a level of competence before he then works on his first patient.
"As we have now learned, we are able to transfer a patient's exact anatomy into a digital format in order to first safely 'practice' the procedure, before performing the actual procedure on that very same patient," he says. "In the future, I suspect most complex procedures will be practiced by the doctor on the exact patient anatomy in a virtual environment before doing the procedure on the real patient. This will prove the old adage that, in medicine, 'practice makes perfect.'"