Applications of Virtual Environments in Medicine

G. Riva

doi:10.1055/s-0038-1634379

Methods of Information in Medicine, Table of Contents

Methods Inf Med 2003; 42(05): 524-534
DOI: 10.1055/s-0038-1634379

Original Article

Schattauer GmbH

Applications of Virtual Environments in Medicine^[*]

G. Riva

¹Applied Technology for Neuro-Psychology Lab., Istituto Auxologico Italiano, Milan, Italy

› Author Affiliations

Abstract

Summary

Objectives: This paper intends to investigate the role of virtual reality (VR) in medicine. In particular it outlines the current state of research and technology that is relevant to the development of effective virtual environments in medicine.

Methods: After describing the two different visions of VR we can find in medicine – the presentation of virtual objects to all of the human senses in a way identical to their natural counterpart, and a new human-computer interaction paradigm in which users are active participants within a computer-generated three-dimensional virtual world – the paper presents some of the most interesting applications actually developed in the area. Finally, it discusses the clinical principles, technological devices and safety issues associated with the use of VR in medicine.

Results: With more than 1,000 VR papers already indexed in Medline, VR is a reality health care. Even if the number of controlled studies is still limited, its merging with emerging technologies like Ambient Intelligence and wireless communication will further improve its diffusion.

Conclusions: The possible impact of VR on health care could be even higher than the one offered by the new communication technologies like Internet. In fact, VR is at the same tima technology, a communication interface and an experience: a communication interface based on interactive 3D visualization, able to collect and integrate in single real-like experience different inputs and data sets. However, significant efforts are still required to move VR into commercial success and therefore routine clinical use.

Keywords

Virtual reality - medical education - surgical simulation - neuropsychological rehabilitation

Full Text

References

References
1 Satava RM, Jones SB. Medical applications of virtual reality. In: Stanney KM. editor. Handbook of Virtual Environments: Design, Implementation, and Applications. Mahwah, NJ: Lawrence Erlbaum Associates, Inc.; 2002. pp. 368-391.
2 Wootton R. Telemedicine: an introduction. In: Wootton R. editor. European Telemedicine 1998/99. London: Kensington Publications Ltd; 1999. pp. 10-12.
3 Riva G. From Telehealth to E-health: Internet and distributed virtual reality in health care. CyberPsychology & Behavior 2000; 3 (Suppl. 06) 989-98.
4 Riva G. Virtual reality for health care: the status of research. Cyberpsychology & Behavior 2002; 5 (Suppl. 03) 219-25.
5 Chinnock C. Virtual reality in surgery and medicine. Hosp Technol Ser 1994; 13 (Suppl. 18) 1-48.
6 Riva G, Wiederhold B, Molinari E. editors. Virtual environments in clinical psychology and neuroscience: Methods and techniques in advanced patient-therapist interaction. Amsterdam: IOS Press.; Online: http://www.cybertherapy.info/pages/book2.htm ; 1998
7 Beolchi L, Riva G. Virtual reality for health care. In: Akay M, Marsh A. editors. Information Technologies in Medicine. Toronto: John Wiley & Sons; 2001. pp. 39-83.
8 Riva G, Wiederhold BK. Introduction to the special issue on virtual reality environments in behavioral sciences. IEEE Transactions on Information Technology in Biomedicine 2002; 6 (Suppl. 03) 193-7.
9 Rubino F, Soler L, Marescaux J, Maisonneuve H. Advances in virtual reality are wide ranging. Bmj 2002; 324 7337 612.
10 McCloy R, Stone R. Science, medicine, and the future. Virtual reality in surgery. Bmj 2001; 323 7318 912-5.
11 Székely G, Satava RM. Virtual reality in medicine. Bmj 1999; 319 7220 1305.
12 Schultheis MT, Rizzo AA. The Application of Virtual Reality Technology in Rehabilitation. Rehabilitation Psychology 2001; 46 (Suppl. 03) 296-311.
13 Riva G, Rizzo A, Alpini D, Attree EA, Barbieri E, Bertella L. et al. Virtual environments in the diagnosis, prevention, and intervention of age-related diseases: A review of VR scenarios proposed in the EC VETERAN project. CyberPsychology and Behavior 1999; 2 (Suppl. 06) 577-91.
14 Rizzo AA, Wiederhold B, Riva G, Van Der Zaag C. A bibliography of articles relevant to the application of virtual reality in the mental health field. CyberPsychology & Behavior 1998; 1 (Suppl. 04) 411-25.
15 Rizzo AA, Buckwalter JG. Virtual reality and cognitive assessment and rehabilitation: the state of the art. In: Riva G. editor. Virtual reality in neuro-psycho-physiology. Amsterdam: IOS Press; 1997. pp. 123-146. Online: http://www.cybertherapy.info/pages/book1.htm.
16 Riva G, Alcañiz M, Anolli L, Bacchetta M, Baños RM, Beltrame F. et al. The VEPSY Updated project: Virtual reality in clinical psychology. CyberPsychology and Behavior 2001; 4 (Suppl. 04) 449-55.
17 Heim M. Virtual Realism. New York: Oxford University Press; 1998
18 Bricken W. Virtual reality: Directions of growth. Seattle, WA: University of Washington; 1990. Report No.: HITL Technical Report R-90-1.
19 Riva G, Mantovani G. The need for a socio-cultural perspective in the implementation of virtual environments. Virtual Reality 2000; (Suppl. 05) 32-8.
20 Riva G, Davide F. editors. Communications through Virtual Technologies: Identity, Community and Technology in the Communication Age. Amsterdam: IOS Press.; Online: http://www.emergingcommunication.com/volume1.html ; 2001
21 Biocca F, Levy MR. editors. Communication in the age of virtual reality. Hillsdale, NJ: Lawrence Erlbaum Associates; 1995
22 Steuer JS. Defining virtual reality: Dimensions determining telepresence. Journal of Communication 1992; 42 (Suppl. 04) 73-93.
23 Sastry L, Boyd DRS. Virtual environments for engineering applications. Virtual Reality: Research, development and applications 1998; 3 (Suppl. 04) 235-44.
24 Satava RM, Ellis SR. Human interface technology. An essential tool for the modern surgeon. Surg Endosc 1994; 8 (Suppl. 07) 817-20.
25 Rizzo AA, Neumann U, Enciso R, Fidaleo D, Noh JY. Performance-driven facial animation: basic research on human judgments of emotional state in facial avatars. Cyberpsychol Behav 2001; 4 (Suppl. 04) 471-87.
26 Riva G, Davide F, IJsselsteijn WA. editors. Being There: Concepts, effects and measurements of user presence in synthetic environments. Amsterdam: IOS Press.; Online: http://www.emergingcommunication.com/volume5.html ; 2003
27 IJsselsteijn WA, Lombard M, Freeman J. Toward a core bibliography of presence. Cyberpsychology & Behavior 2001; 4 (Suppl. 02) 317-21.
28 Riva G, Waterworth JA. Presence and the Self: A cognitive neuroscience approach. Presence-Connect 2003; 3 (1): Online: http://presence.cs.ucl.ac.uk/presenceconnect/articles/Apr2003/jwworthApr72003114532/jwworthApr72003114532.html.
29 Slater M, Wilbur S. A framework for immersive virtual environments (FIVE): Speculations on the role of presence in virtual environments. Presence:Teleoperators and Virtual Environments 1997; 6 (Suppl. 06) 603-16.
30 Waterworth JA, Waterworth EL. Focus, Locus, and Sensus: The three dimensions of virtual experience. Cyberpsychology and Behavior 2001; 4 (Suppl. 02) 203-13.
31 Mantovani G, Riva G. “Real” presence: How different ontologies generate different criteria for presence, telepresence, and virtual presence. Presence, Teleoperators, and Virtual Environments 1999; 8 (Suppl. 05) 538-48.
32 Schubert T, Friedman F, Regenbrecht H. The experience of presence: Factor analytic insights. Presence: Teleoperators, and Virtual Environments 2001; 10 (Suppl. 03) 266-81.
33 Zahoric P, Jenison RL. Presence as being-inthe-world. Presence, Teleoperators, and Virtual Environments 1998; 7 (Suppl. 01) 78-89.
34 Janoff-Bulman R, Frantz CM. The impact of trauma on meaning: From meaningless world to meaningful life. In: Power M, Brewin CR. editors. The transformation of meaning in psychological therapies. New York: Wiley; 1997. pp. 91-106.
35 Damasio A. The Feeling of What Happens: Body, Emotion and the Making of Consciousness. San Diego, CA: Harcourt Brace and Co, Inc.; 1999
36 ISO.. ISO/IEC 9126-Software engineering – Product quality – Part 1: Quality model. Geneva: International Organization for Standardization; 2001
37 John NW, Thacker N, Pokric M, Jackson A, Zanetti G, Gobbetti E. et al. An integrated simulator for surgery of the petrous bone. Stud Health Technol Inform 2001; 81: 218-24.
38 Dobson HD, Pearl RK, Orsay CP, Rasmussen M, Evenhouse R, Ai Z. et al. Virtual reality: new method of teaching anorectal and pelvic floor anatomy. Dis Colon Rectum 2003; 46 (Suppl. 03) 349-52.
39 Alcañiz M, Perpiña C, Baños R, Lozano JA, Montesa J, Botella C. et al. A new realistic 3D body representation in virtual environments for the treatment of disturbed body image in eating disorders. CyberPsychology and Behavior 2000; 3 (Suppl. 03) 421-32.
40 Ackerman MJ. The Visible Human Project. J Biocommun 1991; 18 (Suppl. 02) 14.
41 Spitzer V, Ackerman MJ, Scherzinger AL, Whitlock D. The visible human male: a technical report. J Am Med Inform Assoc 1996; 3 (Suppl. 02) 118-30.
42 Ackerman MJ, Yoo T, Jenkins D. From data to knowledge – the Visible Human Project continues. Medinfo 2001; 10 Pt 2 887-90.
43 Westwood JD, Hoffman HM, Mogel GT, Stredney D. editors. Medicine meets virtual reality 2002. Amsterdam: IOS Press; 2002
44 Jeffries PR, Woolf S, Linde B. Technology-based vs. traditional instruction. A comparison of two methods for teaching the skill of performing a 12-lead ECG. Nurs Educ Perspect 2003; 24 (Suppl. 02) 70-4.
45 Durlach NI, Mavor ASE. Virtual reality: scientific and technological challenges. Washington, D.C.: National Academy Press.; Online: http://www.nap.edu/books/0309051355/html/index.html ; 1995
46 Satava RM. Surgery 2001: A Technologic Framework for the Future. Surgical Endoscopy 1993; 7: 111-3.
47 Satava RM. Virtual reality surgical simulator. The first steps. Surg Endosc 1993; 7 (Suppl. 03) 203-5.
48 Satava RM. Surgical education and surgical simulation. World J Surg 2001; 25 (Suppl. 11) 1484-9.
49 Sung WH, Fung CP, Chen AC, Yuan CC, Ng HT, Doong JL. The assessment of stability and reliability of a virtual reality-based laparoscopic gynecology simulation system. Eur J Gynaecol Oncol 2003; 24 (Suppl. 02) 143-6.
50 Friedl R, Preisack MB, Klas W, Rose T, Stracke S, Quast KJ. et al. Virtual Reality and 3D Visualizations in Heart Surgery Education. Heart Surg Forum 2002; 5 (Suppl. 03) E17-21.
51 Ali MR, Mowery Y, Kaplan B, DeMaria EJ. Training the novice in laparoscopy. Surg Endosc; 2002
52 Gor M, McCloy R, Stone R, Smith A. Virtual reality laparoscopic simulator for assessment in gynaecology. Bjog 2003; 110 (Suppl. 02) 181-7.
53 Dammann F, Bode A, Schwaderer E, Schaich M, Heuschmid M, Maassen MM. Computer-aided surgical planning for implantation of hearing aids based on CT data in a VR environment. Radiographics 2001; 21 (Suppl. 01) 183-91.
54 Xia J, Ip HH, Samman N, Wong HT, Gateno J, Wang D. et al. Three-dimensional virtual-reality surgical planning and soft-tissue prediction for orthognathic surgery. IEEE Trans Inf Technol Biomed 2001; 5 (Suppl. 02) 97-107.
55 Herfarth C, Lamade W, Fischer L, Chiu P, Cardenas C, Thorn M. et al. The effect of virtual reality and training on liver operation planning. Swiss Surg 2002; 8 (Suppl. 02) 67-73.
56 Ross MD, Twombly IA, Bruyns C, Cheng R, Senger S. Telecommunications for health care over distance: the virtual collaborative clinic. Studies in Health Technology and Informatics 2000; 70: 286-91.
57 Erel E, Aiyenibe B, Butler PE. Microsurgery simulators in virtual reality: Review. Microsurgery 2003; 23 (Suppl. 02) 147-52.
58 Halligan S, Fenlon HM. Virtual colonoscopy. Bmj 1999; 319 7219 1249-52.
59 Moorthy K, Smith S, Brown T, Bann S, Darzi A. Evaluation of virtual reality bronchoscopy as a learning and assessment tool. Respiration 2003; 70 (Suppl. 02) 195-9.
60 Dunkin BJ. Flexible endoscopy simulators. Semin Laparosc Surg 2003; 10 (Suppl. 01) 29-35.
61 Vincelli F. From imagination to virtual reality: the future of clinical psychology. CyberPsychology & Behavior 1999; 2 (Suppl. 03) 241-8.
62 Vincelli F, Molinari E, Riva G. Virtual reality as clinical tool: immersion and three-dimensionality in the relationship between patient and therapist. Studies in Health Technology and Informatics 2001; 81: 551-3.
63 Norcross JC, Hedges M, Prochaska JO. The face of 2010: A Delphi poll on the future of psychotherapy. Professional Psychology: Research and Practice 2002; 33 (Suppl. 03) 316-22.
64 Menon ST. Psychological Empowerment: Definition, Measurement, and Validation. Canadian Journal of Behavioural Science 1999; 31 (Suppl. 03) 161-4.
65 Botella C, Perpiña C, Baños RM, Garcia-Palacios A. Virtual reality: a new clinical setting lab. Studies in Health Technology and Informatics 1998; 58: 73-81.
66 Emmelkamp PM, Bruynzeel M, Drost L, van der Mast CA. Virtual reality treatment in acrophobia: a comparison with exposure in vivo. CyberPsychology & Behavior 2001; 4 (Suppl. 03) 335-9.
67 Emmelkamp PM, Krijn M, Hulsbosch AM, de Vries S, Schuemie MJ, van der Mast CA. Virtual reality treatment versus exposure in vivo: a comparative evaluation in acrophobia. Behaviour Research & Therapy 2002; 40 (Suppl. 05) 509-16.
68 Rothbaum BO, Hodges LF, Kooper R, Op-dyke D, Williford JS, North M. Effectiveness of computer-generated (virtual reality) graded exposure in the treatment of acrophobia. Am J Psychiatry 1995; 152 (Suppl. 04) 626-8.
69 Garcia-Palacios A, Hoffman H, Carlin A, Furness 3rd TA, Botella C. Virtual reality in the treatment of spider phobia: a controlled study. Behavior Research and Therapy 2002; 40 (Suppl. 09) 983-93.
70 Vincelli F, Anolli L, Bouchard S, Wiederhold BK, Zurloni V, Riva G. Experiential Cognitive Therapy in the treatment of Panic Disorders with Agoraphobia: A controlled study. CyberPsychology & Behavior 2003; 6 (Suppl. 03) 312-8.
71 Riva G, Bacchetta M, Baruffi M, Molinari E. Virtual reality-based multidimensional therapy for the treatment of body image disturbances in obesity: a controlled study. Cyber-psychology and Behavior 2001; 4 (Suppl. 04) 511-26.
72 Riva G, Bacchetta M, Baruffi M, Molinari E. Virtual-reality-based multidimensional therapy for the treatment of body image disturbances in binge eating disorders: a preliminary controlled study. IEEE Transactions on Information Technology in Biomedicine 2002; 6 (Suppl. 03) 224-34.
73 Riva G, Bacchetta M, Cesa G, Conti S, Molinari E. Six-month follow-up of in-patient Experiential-Cognitive Therapy for binge eating disorders. CyberPsychology & Behavior 2003; 6 (Suppl. 03) 251-8.
74 Rothbaum BO, Hodges L, Smith S, Lee JH, Price L. A controlled study of virtual reality exposure therapy for the fear of flying. Journal of Consulting & Clinical Psychology 2000; 68 (Suppl. 06) 1020-6.
75 Rothbaum BO, Hodges L, Anderson PL, Price L, Smith S. Twelve-month follow-up of virtual reality and standard exposure therapies for the fear of flying. J Consult Clin Psychol 2002; 70 (Suppl. 02) 428-32.
76 Maltby N, Kirsch I, Mayers M, Allen G. Virtual Reality Exposure Therapy for the treatment of fear of flying: A controlled investigation. Journal of Consulting & Clinical Psychology 2002; 70 (Suppl. 05) 1112-8.
77 Wiederhold BK, Jang DP, Kim SI, Wiederhold MD. Physiological monitoring as an objective tool in virtual reality therapy. Cyberpsychology & Behavior 2002; 5 (Suppl. 01) 77-82.
78 Wiederhold BK, Jang DP, Gevirtz RG, Kim SI, Kim IY, Wiederhold MD. The treatment of fear of flying: a controlled study of imaginal and virtual reality graded exposure therapy. IEEE Transactions on Information Technology in Biomedicine 2002; 6 (Suppl. 03) 218-23.
79 Riva G. Virtual environments in neuroscience. IEEE Transactions on Information Technology in Biomedicine 1998; 2 (Suppl. 04) 275-81.
80 Rose FD, Brooks BM, Attree EA, Parslow DM, Leadbetter AG, McNeil JE. et al. A preliminary investigation into the use of virtual environments in memory retraining after vascular brain injury: indications for future strategy?. Disabil Rehabil 1999; 21 (Suppl. 12) 548-54.
81 Gourlay D, Lun KC, Lee YN, Tay J. Virtual reality for relearning daily living skills. Int J Med Inf 2000; 60 (Suppl. 03) 255-61.
82 Riva G. Virtual reality in rehabilitation of spinal cord injuries. Rehabilitation Psychology 2000; 45 (Suppl. 01) 81-8.
83 Sisto SA, Forrest GF, Glendinning D. Virtual reality applications for motor rehabilitation after stroke. Topics in Stroke Rehabilitation 2002; 8 (Suppl. 04) 11-23.
84 Tarr MJ, Warren WH. Virtual reality in behavioral neuroscience and beyond. Nature Neuroscience 2002; 5 Suppl: 1089-92.
85 Riva G. editor. Virtual reality in neuro-psycho-physiology: Cognitive, clinical and methodological issues in assessment and rehabilitation. Amsterdam: IOS Press.; Online: http://www.cybertherapy.info/pages/book1.htm ; 1997
86 Zhang L, Abreu BC, Masel B, Scheibel RS, Christiansen CH, Huddleston N. et al. Virtual reality in the assessment of selected cognitive function after brain injury. Am J Phys Med Rehabil 2001; 80 (Suppl. 08) 597-604 quiz 605.
87 Wald J, Liu L. Psychometric properties of the driVR: a virtual reality driving assessment. Studies in Health Technology and Informatics 2001; 81: 564-6.
88 Pugnetti L, Mendozzi L, Motta A, Cattaneo A, Barbieri E, Brancotti A. Evaluation and retraining of adults’ cognitive impairment: which role for virtual reality technology?. Comput Biol Med 1995; 25 (Suppl. 02) 213-27.
89 Broeren J, Bjorkdahl A, Pascher R, Rydmark M. Virtual reality and haptics as an assessment device in the postacute phase after stroke. Cyberpsychol Behav 2002; 5 (Suppl. 03) 207-11.
90 Piron L, Cenni F, Tonin P, Dam M. Virtual Reality as an assessment tool for arm motor deficits after brain lesions. Stud Health Technol Inform 2001; 81: 386-92.
91 Gross D. Technology Management and User Acceptance of VE Technology. In: Stanney KM. editor. Handbook of Virtual Environments: Design, Implementation, and Applications. Mahwah, NJ: Lawrence Erlbaum Associates, Inc.; 2002
92 Moline J. Virtual reality in health care: a survey. In: Riva G. editor. Virtual reality in neuro-psycho-physiology. Amsterdam: IOS Press; 1997. pp. 3-34.
93 Nichols S, Patel H. Health and safety implications of virtual reality: a review of empirical evidence. Appl Ergon 2002; 33 (Suppl. 03) 251-71.
94 Lewis CH, Griffin MJ. Human factors consideration in clinical applications of virtual reality. In: Riva G. editor. Virtual reality in neuro-psycho-physiology. Amsterdam: IOS Press; 1997. pp. 35-56.
95 A report of the U.S.. National Advisory Mental Health Council. NIH Publication. Washington, D.C.: U.S. Goverment Printing Office; 1995. Report No.: 95-3682.
96 Riva G, Bacchetta M, Cesa G, Conti S, Molinari E. Virtual reality and telemedicine based Experiential Cognitive Therapy: Rationale and Clinical Protocol. In: Riva G, Galimberti C. editors. Towards CyberPsychology: Mind, Cognition and Society in the Internet Age. Amsterdam: IOS Press; 2001. pp. 273-308.
97 Klein RA. Treating fear of flying with virtual reality exposure therapy. In: VandeCreek Leon, (Ed); Jackson Thomas L. (Ed). (1999) Innovations in clinical practice. A source book. Vol. 17. pp. 449-465 Sarasota FL, US.: 1999
98 Botella C, Baños RM, Villa H, Perpiña C, Garcia-Palacios A. Telepsychology: Public speaking fear treatment on the internet. CyberPsychology and Behavior 2000; 3 (Suppl. 06) 959-68.
99 Vincelli F, Choi YH, Molinari E, Wiederhold BK, Riva G. A VR-based multicomponent treatment for panic disorders with agoraphobia. Studies in Health Technology and Informatics 2001; 81: 544-50.
100 Riva G, Bolzoni M, Carella F, Galimberti C, Griffin MJ, Lewis CH. et al. Virtual reality environments for psycho-neuro-physiological assessment and rehabilitation. In: Morgan KS, Weghorst SJ, Hoffman HM, Stredney D. editors. Medicine Meets Virtual Reality: Global Healthcare Grid. Amsterdam: IOS Press; 1997. pp. 34-45.
101 Hughes T, Clark DD, Banks PM, Lineberger WC. editors. Funding a Revolution: Government Support for Computing Research. Washington, DC: National Academy Press.; Online: http://stills.nap.edu/html/far/contents.html ; 1999
102 Riva G, Bacchetta M, Baruffi M, Borgomainerio E, Defrance C, Gatti F. et al. VREPAR Projects: The use of virtual environments in psycho-neuro-physiological assessment and rehabilitation. CyberPsychology & Behavior 1999; 2 (Suppl. 01) 69-76.

Applications of Virtual Environments in Medicine[*]

Applications of Virtual Environments in Medicine^[*]