Abstract
PurposeConsumer-grade virtual reality (VR) has recently enabled various medical applications, but more evidence supporting their validity is needed. We investigated the accuracy of simulated surgical planning in a VR environment (VR) with temporal bones and compared it to conventional cross-sectional image viewing in picture archiving and communication system (PACS) interface.MethodsFive experienced otologic surgeons measured significant anatomic structures and fiducials on five fresh-frozen cadaveric temporal bones in VR and cross-sectional viewing. Primary image data were acquired by computed tomography. In total, 275 anatomical landmark measurements and 250 measurements of the distance between fiducials were obtained with both methods. Distance measurements between the fiducials were confirmed by physical measurement obtained by Vernier caliper. The experts evaluated the subjective validity of both methods on a 5-point Likert scale qualitative survey.ResultsA strong correlation based on intraclass coefficient was found between the methods on both the anatomical (r > 0.900) and fiducial measurements (r > 0.916). Two-tailed paired t-test and Bland–Altman plots demonstrated high equivalences between the VR and cross-sectional viewing with mean differences of 1.9% (p = 0.396) and 0.472 mm (p = 0.065) for anatomical and fiducial measurements, respectively. Gross measurement errors due to the misidentification of fiducials occurred more frequently in the cross-sectional viewing. The mean face and content validity rating for VR were significantly better compared to cross-sectional viewing (total mean score 4.11 vs 3.39, p < 0.001).ConclusionOur study supports good accuracy and reliability of VR environment for simulated surgical planning in temporal bones compared to conventional cross-sectional visualization.
Highlights
One key issue for successful and safe surgery is thorough preoperative planning
Of the 26 errors made in the cross-sectional viewing, 14 (54%) were most likely due to a misidentification of the fiducial measurement points
This study demonstrated that the accuracy of the virtual reality (VR) environment for the assessment of Temporal bone (TB) anatomy is at least comparable to conventional cross-sectional viewing, but with the added benefit of providing more comprehensive information on topographical and spatial relation of anatomic structures
Summary
One key issue for successful and safe surgery is thorough preoperative planning. The foundation for detailed preoperative planning of surgical procedures is based on individual image data and should be considered mandatory for modern operative care. Preoperative imaging is mostly performed with computed tomography (CT) and magnetic resonance imaging (MRI). The image-stack manipulation and measurements are usually based on picture archiving and communication system (PACS) tools and volume renderings. These limit the image view to two-dimensional (2D) cross-sections and screens, missing stereoscopy and freedom of dimensional control. Despite the advances in preoperative imaging, images are still examined in 2D cross sections requiring the surgeon to construct and
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