In continuation of the topic of robotics and AI technologies application in healthcare, in our interview with PhD candidate, developer of robotic systems for medical diagnostics from Department of Biomedical Engineering of Hong Kong Polytechnic University Maria VIKTOROVA, we will talk about VR (virtual reality) and AR (augmented reality) technologies in healthcare. The expert explains, why these are ones of the most promising fields of the robotics market and what obstacles exist for the introduction of such technologies.
BNT: Are these technologies - VR and AR - really an important solution for the healthcare or it’s just a new hype?
MV: First, we need to distinguish between virtual (VR ) and augmented (AR) reality. Virtual reality allows you to immerse yourself in a virtual picture, while augmented reality is embedded in a real environment the non-existent object. From the point of view of medical apps, it’s a very promising technology, as it gives the opportunity to observe the patient and to improve his environment with some special properties at the same time.
BNT: What's the practical use of these techs?
MV: There are 4 main types of implementation of these technologies in a healthcare. The first is called communication environment, where there’s a situation of communication between the patient and the doctor being modeled, and this environment is somehow “played out” in a certain scenario. This is used for training or creating special conditions for the patient, which makes his treatment more comfortable and effective.
The second type of VR application is actually training and most often educational installations for medical personnel. For example, Microsoft HoloLens is an application that allows to study the entire human body as if it was right in front of you. You can move through several levels of the human body, considering the 3D-image of the vascular or, for example, the nervous system. And so you can explore the human body layer by layer, examing them in VR.
For surgeons there have been also special training facilities created, which in case of AR improved the tactile feedback, that makes it deeply close to operation environment and that’s why it is very important for the development of surgeon skills.
It was for the first time in the history of healthcare when surgeon oncologist Shafi AHMED performed an operation using VR camera at the Royal London hospital, in April 2016. Everyone could take part in observing operation in real time through the website and VR apps. This was the first case when medical students were trained in real-time surgery by observing with 360 camera the removal of a cancer in the patient's intestine
MV: In therapy, virtual reality is used for rehabilitation and relaxation of the patient. For example, in some programs different medical robots are used in recovering after stroke. But due to the fact that patient needs to re-master some function - for example, to learn squeezing his fingers or to recover a hand, - all this is carried out in the form of a game. And for this purpose, VR is directly what is needed, thus it’s often used.
The stroke has already reached the epidemic proportions. Worldwide, 1 out of 6 people has suffered from this disease at least once in life. 15 million people all over the world suffer from stroke every year and 5.8 million die from it. According to the world statistics, the US is the first among the countries by the number of cardiovascular diseases. Here, a stroke happens once in every 40 seconds. Annual statistics shows that about 795,000 people experience a new or repeated stroke in the US.
According to statistics, direct and indirect financial losses associated with general cardiovascular diseases and stroke amount to more than $329.7 billion. These costs include expenses of recovering and loss of working capacity. Total medical costs for the treatment of these diseases are projected to increase to $749 billion by 2035. The development of rehabilitation programs for stroke survivors is essential to restore their lost physical and mental functions and hence their efficiency.
The use of VR technologies is considered a promising method in rehabilitation for recovering of the usual vital functions of patients
BNT: It's more like a video game or a placebo effect. What is actually the prospect of such technologies that we are used to observe in training or entertainment programs? What can it give a patient - augmented reality, for example?
MV: Augmented reality itself carries little information if it’s not supported by any tactile feedback. This is caused by the fact that people always need to get a response to their actions to be actively involved in the learning process, and in a treatment it’s even much more important. In this case, there’s already a number of methods with a use of electro-stimulation plates, which give a response to human actions that are performed in virtual reality.
BNT: Perhaps the most interesting reports are those about the appearance of robots or AI systems in surgery, as the intervention directly into a human body is always an exciting topic. What are the developments of using VR or AR technologies in the operating room?
MV: There was an interesting experiment, when during the operation, the so-called “map” of the patient was supplemented by his MRI image. A picture of the organ made with tomographic scanner, was applied over the operated zone of patient’s body. This method can enable the doctor to see where the diseased organ is in the picture and identify more accurately the “hot spots”, which will greatly facilitate the surgical process and reduce the area of invasive intervention.
But here we need advanced algorithms. If the patient moves, his organs will also be in motion, which means that the projection of the organs will also be shifted over the operated area. Hence, there is an essential challenge to adapt the neural network analyzing and accounting all the possible movements of the body to manage them. Such studies are already underway, and I hope that operations like that will be possibly performed in the near future.
The AR market is booming, presenting the exciting insights to the world. Medsights Tech has developed software to test the possibility of using augmented reality in creating the accurate 3D reconstructions of tumors without irradiation. A medical visual system EchoPixel allows doctors to interact with organs and tissue in 3D-space. At the same time, while working with AR technology, doctors, unlike using VR devices, don’t lose their touch with reality. This is why AR can make applications to be indispensable for surgery.
However, the current problem related to AI algorithm training is seriously hampering the industry. Andrei KVASOV, doctor of computer science, Hong Kong University of Science and Technology, said in comments to Bitnewstoday.com: "We need to create an effective method to correct and train AI algorithms. Many companies, including Google, Facebook, Amazon and NVIDIA are actively working on it. I think that in the near future we will see working models on complex distributed systems, perhaps even on the blockchain. But today there is a problem: algorithms require quite a lot of data for training, but the limitations on the anonymity of private patient data greatly prevents machine learning, as the lack of information has to be replaced by random numbers or simply exclude them, which in its turn leads to the loss of correlation or patterns."
BNT: You should have known some interesting cases of using robotic systems in the field of prosthetics.
MV: Now there is a lot of attention to robotic manipulators - they look like a hand, but now they tend to be made from so-called soft robotics. This is not the hard robot, which we used to see in manufacturing. These are the robo-arms with 6 degrees of freedom made of soft materials, which are controlled by aerodynamics or tension forces. Their movement can be directed by electricity or mechanical drives in the direction where we need, and depending on the motion they can be lengthened or shortened.
Bank of America Merrill Lynch predicts that the introduction of robotic systems and AI technologies in healthcare can reduce costs in the industry from $8 trillion to $9 trillion. And active involvement of investments in R&D causes competition in the world market of medical robotics and rapid development of the entire segment.
According to Occams Business Research and Consulting, the world market of medical robotics will focus on investments in the development of technologies for surgery, rehabilitation, telemedicine, prosthetics until the end of 2020. In addition, among the priority areas - the development of exoskeletons and robotic assistants. The data from Global Industry Analysis Inc. report also confirm that during this period the most relevant areas of innovation will be provided in rehabilitation and simulation training.Thus VR and AR technologies in this light are getting the key role as a powerful diagnostic tool for fully immersive (involving, interactive) 3D-simulation in the treatment of phobias, autism, post-traumatic syndromes, depression and severe pain. Marketing analysis shows that the world market of VR tools will become one of the most promising in robotic medicine due to two factors: on the one hand - innovative technological developments in the field of medical applications, and on the other - the growing demand for the improvement of rehabilitation and interactive 3D-training. VR technology is expected to reach $3.8 billion in industry by 2020.