Subscribe to RSS
DOI: 10.1055/a-2521-1303
Exploring Mixed Reality for Patient Education in Cerebral Angiograms: A Pilot Study

Abstract
Background
Cerebral aneurysms (CAs) affect 3 to 5% of the general population, with saccular aneurysms being the most common type. Despite advances in treatment, patient understanding of CAs and associated procedures remains limited, impacting informed consent and treatment outcomes.
Objectives
This pilot study aims to evaluate the effectiveness of mixed reality (MR) technology in enhancing patient education and understanding of cerebral angiograms and aneurysm treatment, thereby improving the patient–surgeon communication process.
Methods
A nonrandomized single-center prospective study was conducted with 16 patients diagnosed with intracranial aneurysms. Participants used a Microsoft HoloLens to view an interactive 3D presentation about cerebral angiograms and aneurysm treatments. Pre- and post-intervention surveys assessed their knowledge and anxiety levels using a 5-point Likert scale. The Wilcoxon's signed-rank test was used for statistical analysis.
Results
Post-intervention, the total survey scores improved significantly (average increase of 6.7 points, p < 0.05). Seven out of eight survey questions showed significant knowledge improvement. The mean perceived ability to explain aneurysm treatment improved by 1.38 points and understanding of access points for procedures increased by 1.31 points (both p < 0.05). The question regarding understanding of treatment risks did not show significant change (p > 0.05). Anxiety levels decreased, with 75% of participants reporting reduced anxiety post-intervention.
Conclusion
MR technology significantly enhances patient understanding and reduces anxiety regarding cerebral angiogram procedures and aneurysm treatments. These findings support the integration of MR in patient education to improve clinical outcomes and patient satisfaction. This approach offers a promising direction for future health care communication strategies, especially in complex procedures requiring detailed patient comprehension.
Keywords
mixed reality - patient satisfaction - shared decision making - surgical visualization - intracranial aneurysmPatient Consent
Prior to enrolling in the study, all participants were briefed on the objectives, potential risks, and anticipated benefits of their involvement. Compensation was not offered for participation. Risks encompassed those inherent in the utilization of a mixed-reality headset, including but not limited to discomfort or visual strain. Ethical clearance for conducting the research was obtained from the Texas Christian University IRB. Patients provided their informed consent prior to their participation in the study. All informed consent forms were stored on a Health Insurance Portability and Accountability Act (HIPAA) compliant platform provided by the corresponding author's institution. The patient consent form required for participation is provided as [Supplementary Material S1] (available in the online version only).
Protection of Human and Animal Subjects
The study adhered to the guidelines set forth by the Health Resources and Services Administration (HRSA) for the protection of human subjects and underwent review by the Texas Christian University Institutional Review Board.
Publication History
Received: 08 July 2024
Accepted: 20 January 2025
Accepted Manuscript online:
21 January 2025
Article published online:
28 May 2025
© 2025. Thieme. All rights reserved.
Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
-
References
- 1 Chalouhi N, Hoh BL, Hasan D. Review of cerebral aneurysm formation, growth, and rupture. Stroke 2013; 44 (12) 3613-3622
- 2 Thompson BG, Brown Jr RD, Amin-Hanjani S. et al. American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, and Council on Epidemiology and Prevention, American Heart Association, American Stroke Association. Guidelines for the management of patients with unruptured intracranial aneurysms: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2015; 46 (08) 2368-2400
- 3 Wiebers DO, Whisnant JP, Huston III J. et al. International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 2003; 362 (9378): 103-110
- 4 Jakubowski J, Kendall B. Coincidental aneurysms with tumours of pituitary origin. J Neurol Neurosurg Psychiatry 1978; 41 (11) 972-979
- 5 Cerebral angiography. Radiological Society of North America. Accessed 2023 at: https://www.radiologyinfo.org
- 6 Hu HZ, Feng XB, Shao ZW. et al. Application and prospect of mixed reality technology in medical field. Curr Med Sci 2019; 39 (01) 1-6
- 7 Milgram P, Takemura H, Utsumi A, Kishino F. Augmented reality: a class of displays on the reality-virtuality continuum. In: Das H. , ed.; 1995: 282-292
- 8 Hatzl J, Hartmann N, Böckler D. et al. “Mixed Reality” in patient education prior to abdominal aortic aneurysm repair. Vasa 2023; 52 (03) 160-168
- 9 Urlings J, Sezer S, Ter Laan M. et al. The role and effectiveness of augmented reality in patient education: a systematic review of the literature. Patient Educ Couns 2022; 105 (07) 1917-1927
- 10 Sander IM, Liepert TT, Doney EL, Leevy WM, Liepert DR. Patient education for endoscopic sinus surgery: preliminary experience using 3D-printed clinical imaging data. J Funct Biomater 2017; 8 (02) 13
- 11 King Jr JT, Yonas H, Horowitz MB, Kassam AB, Roberts MS. A failure to communicate: patients with cerebral aneurysms and vascular neurosurgeons. J Neurol Neurosurg Psychiatry 2005; 76 (04) 550-554
- 12 Shlobin NA, Clark JR, Hoffman SC, Hopkins BS, Kesavabhotla K, Dahdaleh NS. Patient education in neurosurgery: part 2 of a systematic review. World Neurosurg 2021; 147: 190-201.e1
- 13 Rohrbach N, Gulde P, Armstrong AR. et al. An augmented reality approach for ADL support in Alzheimer's disease: a crossover trial. J Neuroeng Rehabil 2019; 16 (01) 66
- 14 Hilt AD, Hierck BP, Eijkenduijn J. et al. Development of a patient-oriented HoloLens application to illustrate the function of medication after myocardial infarction. Eur Heart J Digit Health 2021; 2 (03) 511-520
- 15 Lu L, Wang H, Liu P. et al. Applications of mixed reality technology in orthopedics surgery: a pilot study. Front Bioeng Biotechnol 2022; 10: 740507
- 16 Chuah JH, Lok B, Black E. Applying mixed reality to simulate vulnerable populations for practicing clinical communication skills. IEEE Trans Vis Comput Graph 2013; 19 (04) 539-546
- 17 Barrow DL. Communication skills in the physician-patient relationship. World Neurosurg 2013; 80 (05) e107-e108
- 18 Duff M, Chen Y, Attygalle S, Sundaram H, Rikakis T. Mixed reality rehabilitation for stroke survivors promotes generalized motor improvements. In: Annual International Conference of the IEEE Engineering in Medicine and Biology. IEEE; 2010: 5899-5902
- 19 Prochaska MT, Press VG, Meltzer DO, Arora VM. Patient perceptions of wearable face-mounted computing technology and the effect on the doctor-patient relationship. Appl Clin Inform 2016; 7 (04) 946-953
- 20 Agarwal N, Funahashi R, Taylor T. et al. Patient education and engagement through multimedia: a prospective pilot study on health literacy in patients with cerebral aneurysms. World Neurosurg 2020; 138: e819-e826
- 21 Devoto L, Muscroft S, Chand M. Highly accurate, patient-specific, 3-dimensional mixed-reality model creation for surgical training and decision-making. JAMA Surg 2019; 154 (10) 968-969
- 22 Colombo E, Lutters B, Kos T, van Doormaal T. Application of virtual and mixed reality for 3D visualization in intracranial aneurysm surgery planning: a systematic review. Front Surg 2023; 10: 1227510
- 23 Khan MW, Muehlschlegel S. Shared decision making in neurocritical care. Neurosurg Clin N Am 2018; 29 (02) 315-321
- 24 Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff (Millwood) 2008; 27 (03) 759-769
- 25 Aristizabal-Carmona, Brayan MS. Lozada-Martínez, et al. Impact of neurosurgical consultation with 360-degree virtual reality technology on patient engagement and satisfaction. Neurosurg Open 2021; 2 (02) okab008
- 26 Condino S, Turini G, Parchi PD. et al. How to build a patient-specific hybrid simulator for orthopaedic open surgery: benefits and limits of mixed-reality using the Microsoft HoloLens. J Healthc Eng 2018; 2018: 5435097
- 27 Hough G, Williams I, Athwal C. Fidelity and plausibility of bimanual interaction in mixed reality. IEEE Trans Vis Comput Graph 2015; 21 (12) 1377-1389