Virtual Reality Game Play: Health Hazzard or Benefit

Benefits in the Medical Field

Elizabeth Miller

Fort Hays State University

INF 322: Game Theory & Practice

Professor Kevin Shaffer

Dec. 8, 2020
Introduction

In the episode “Jack of All Trades” of Eureka, Allison performs surgery on

Jack’s brain. Wearing gloves that control the probe entering Jack’s brain, Allison

uses a computer screen with video feed from the probe and the motion of her hands

to successfully perform the delicate procedure. Star Trek is also full of futuristic

medical procedures. The episode “Latent Image” of Star Trek: Voyager opens with

the holographic doctor taking holo-images of the crew. This allows him to view a

3D image of the person’s body in order to better examine them all the way to

“subatomic” level. Because these shows are science fiction, these medical

procedures seem like something for the distant future of the medical field.

However, advances in virtual reality have made both of these procedures closer to

reality.

In the debate on whether or not virtual reality is a health hazard or a benefit,

the medical field has found it to be a benefit. As early as 1997, Zajtchuk & Satava

acknowledge the growing benefits of virtual reality: “virtual reality is helping

improve patient care in the form of advanced educational tools and therapeutic

options.” Specifically, virtual reality is present in the medical field to support

training and disaster planning, virtual prototyping, and psychiatric therapy and

mental health (Zajtchuk & Satava, 1997). Even though virtual reality has found a

home in each of these areas, it’s surprising that nearly two and half decades later
virtual reality is not more commonplace in medical procedures, training facilities,

and medical equipment design. What are the reasons that virtual reality has not

grown beyond the predictions Zajtchuk & Satava made in 1997? Where has virtual

reality seen success in the medical field? This paper will discuss the growth of

virtual reality in the medical field along with some of the limitations and future

projections of its use.

Training and Disaster Planning

Over the years, virtual reality has been integrated into medical training,

particularly where it is difficult to replicate a medical emergency or medical

procedure. Triage Trainer and the VR training system for robotic catheter surgery

are two such training tools.

Triage Trainer

Medical professionals need to be prepared to deal with large-scale disasters

efficiently and effectively in order to save and preserve as many lives as possible.

This requires performing a “triage sieve” in which emergency medical personnel

determine which casualties need to be removed from the scene, which need

immediate attention, and which can have treatment delayed (Knight, 2013).

Although this process is fairly straight-forward and those in training typically learn

by sorting cards of sample “casualties,” this knowledge is called on infrequently.

Also, emergency personnel are not usually trained in the “shock” of making these

decisions at a large-scale, tragic scene.

Enter the virtual reality training tool called “Triage Trainer.” In the

simulation, the first responder is placed in the scene of a disaster, such as a bomb

exploding in the street. Then, he/she “is required to follow the ALSG triage sieve

protocol to tag each casualty with the appropriate priority” (Knight, 2013). The

trainee is not learning something new but rather, practicing a skill not often used.

Users who trained on this simulation found it to be beneficial and internalized the

triage sieve process faster than those solely using the cards. However, Knight

(2013) points out that in order for Triage Trainer to be a useful training tool, it

needed to be perceived as effective learning with correct and relevant content.

Knight also points out that his study of Triage Trainer was a very small sample

size. A larger study is needed in order to generalize the results.

VR Training System for Robotic Catheter Surgery

The catheterization endovascular surgery allows the surgeon to make small

incision to place the robotic catheter in the body (Wang et al., 2018). X-ray

guidance is required in order to accurately place the catheter with such a small

incision. Because long exposure to the x-rays is detrimental to physician’s health, a

teleoperation system has been developed to allow the surgeons to view the
placement of the catheter from a safe distance. However, this leads to another

problem; surgeons have to rely on haptic force providers to determine the insertion

resistance since they cannot directly feel it. As a result, it is very difficult for new

students to learn this process. However, the pairing of a virtual reality-based

training system with these tools allows students and new surgeons to practice the

procedure multiple times before performing on it on a patient.

Programmed with collision detection algorithms, the VR simulator provides

the user with different visual signs to lead to safe catheterization (Wang et al.,

2018). Combined with tactile sensation, novices learn to be better alert and avoid

potential collisions. In addition, a patient’s CT scans can be used to create a virtual,

but realistic replica to use in practice. Wang et al. (2018) found that novice

surgeons who practiced with VR training system gained and maintained skills

faster than those using animals or mentorship. Once again, it is key to note that a

very small sample size of novice surgeons was used to test this VR process.

Summary

The continued development of virtual reality training systems shows the

potential for different medical professionals to practice delicate procedures and

rare events that require their best performance. Other virtual reality training tools

include the virtual reality-based simulator for hysteroscopic procedures (Harders et

al., 2008), the interactive trauma trainer (Knight, 2013), and surgical simulators for

orthopedic and neurological surgeries (Zajtchuk & Satava, 1997). In addition,

anatomy can be taught virtually (Zajtchuk & Satava, 1997; Crawford, 2018).

However, the majority of the studies on the effectiveness of these tools include

small sample sizes that can’t be generalized to the larger medical field (Wang et

al., 2018; Knight, 2013; Harders et al., 2008).

Virtual Prototyping

“Virtual prototyping (VP)…involves the use of Virtual Reality (VR) and

other computer technologies to create digital prototypes” (Wang, 2002). The

Microsoft HoloLens “integrates 3-D medical images with the physical elements of

the user’s surrounding environment” (Crawford, 2018). The HoloLens allows the

images to interactive; many users with same device can view the image at the same

time. In addition, viewers can walk around the holographic image and interact with

it, including opening cross-sections and removing pieces. This is beneficial for

“looking for details which they can use to improve a surgical procedure or

optimize the design of an implantable device” (Crawford, 2018).

Students at Case Western Reserve University use the HoloLens to study

anatomy (Crawford, 2018). Researchers at Worcester Polytechnic Institute use it

visualize complex biological networks, such as disease systems, in 3-D. The

medical technology company uses the HoloLens to reconfigure operating rooms

for best efficiency. The holo-imager from Star Trek: Voyager is a reality.

Andrew Sweeney, an industrial designer of medical equipment at Battelle,

uses virtual reality on his phone to test products (Jontz, 2017). With VR on his

phone, he can become “an 80-year-old diabetic patient with compromised motor

skills and even poorer eyesight” attempting to use an insulin injector (Jontz, 2017).

Virtual prototyping allows him to empathize with different users of his equipment

and ensures he develops tools most users can utilize with success.

Psychiatric Therapy and Mental Health

Virtual reality as a 3D immersive simulation shows potential for psychiatric

therapy (Hodges, 2001). As the price tag for virtual reality decreases, clinicians are

beginning to use virtual reality to provide cyber therapy. Patients can be immersed

in a realistic situation in the safety and privacy of the therapist’s office. It also

allows for “cues, such as a disembodied voice giving instructions or a directional

arrow hovering in mid-air” (Hodges, 2001), allowing the therapist to provide cues

they are unable to provide in the real world.

In small studies, VR-based therapy has helped soldiers recovering from

PTSD, phobic patients overcoming their fears, burn victims remaining distracted

during therapy or dressing changes, therapists assessing attention deficit disorders,

and victims of traumatic brain injury relearning basic tasks. Hodges (2001) does

point out some limitations in who can participate in VR-based therapy; unstable

veterans were not included in the studies due to concerns about adverse reactions

to being re-immersed in the war-like environment. In addition, those with high

blood pressure and those suffering from delusional psychosis have not used VR-

based therapy.

Fast-forward to 2020, Aqlan & Yang believe COVID-19 will lead to a

mental health crisis, including an increase in mental disorders and PTSD. They

note that virtual therapy will become essential to address this need, particularly

VR-based therapy. Virtual reality “can help patients cope with pain and overcome

anxiety and depression…[and] can also be used to assess and treat a wide variety

of medical, surgical, psychiatric and neurocognitive conditions” (Aqlan & Yang,

2020). Despite all the benefits virtual reality-based therapy can provide during and

after COVID-19, Aqlan & Yang also state that more research is still needed to find

out what make VR therapies effective.

Conclusion

Virtual reality has grown as a tool in the medical field according to the

predictions made by Zajtchuk & Satava (1997). Article after article explain the

benefits of virtual reality in various medical situations. Yet, it is interesting to note

that even with the number of successful uses of virtual reality throughout the entire

medical field, there are not multiple large sample studies on the effectiveness of

VR for training, prototyping, treatments, or diagnosing. The only body of evidence

attesting to its effectiveness is the small but numerous accounts of its successful

use. Harders et al. (2008) cite this as a reason that VR has not been widely

accepted across all areas of the medical field in addition to not being proven as

more advantageous over conventional methods. Additionally, the cost of virtual

reality equipment has not decreased enough that insurance will necessarily pay for

its purchase and use. Fortunately, the growth of virtual reality on the cell phone

will hopefully displace that cost. In addition, if Aqlan & Yang (2020) are correct,

COVID-19 will move virtual reality from a novel tool into a more commonplace

tool in the medical and psychiatric field as medical experts look for ways to treat

people from a distance.

 References

Aqlan, F., & Yang, H. (2020). Detecting mental disorders with sensor-based virtual

reality. ISE: Industrial and Systems Engineering at Work, 52(10), 32-35

Crawford, M. (2018). Augmented reality gives sight to engineers and doctors.

Mechanical Engineering (New York, N.Y. 1919), 140(5), 12

Harders, M., Bachofen, D., Grassi, M., Bajka, M., Spaelter, U., Teschner, M.,

Heidelberger, B., Sierra, R., Steinemann, D., Tuchschmid, S., Zatonyi, J., &

Szekely, G. (2008). Virtual reality based simulation of hysteroscopic

interventions. Massachusetts Institute of Technology, 17(5), 441-462.

https://doi.org/10.1162/pres.17.5.441

Hodges, M. (2001). Cyber Therapy: Virtual reality shows real promise in treating

psychological disorders. Computer Graphics World, 24(1), 28-35

Jontz, S. (2017). The virtue of virtual reality for medical devices. AFCEA: Signal

(Fairfax, VA). https://www.afcea.org/content/Article-virtue-virtual-reality-

medical-devices

Knight, J. F. (2013). Acceptability of video games technology for medical

emergency training. International Journal of Gaming and Computer-

Mediated Simulations, 5(4), 86-99.

http://dx.doi.org.ezproxy.fhsu.edu:2048/10.4018/ijgcms.2013100105
Wang, G. G. (2003). Definition and review of virtual prototyping. ASME. Journal

Computing and Information Science in Engineering, 2(3), 232–236.

https://doi.org/10.1115/1.1526508

Wang, Y., Guo, S., Li, Y., Tamiya, T., & Song, Y. (2018). Design and evaluation

of safety operation VR training system for robotic catheter surgery. Medical

& Biological Engineering & Computing, 56(1), 25-35.

https://doi.org/10.1007/s11517-017-1666-2

Zajtchuk, R., & Satava, R. M. (1997). Medical applications of virtual

reality. Communications of the ACM, 40(9), 63-64