David M. Axelrod, MD, a clinical associate professor at Stanford University School of Medicine and an attending physician in the Cardiovascular Intensive Care Unit at Lucile Packard Children’s Hospital Stanford, spoke with Cardiology about The Stanford Virtual Heart, a congenital heart disease virtual reality training experience.

What is the Stanford Virtual Heart? What inspired you to bring technology from the gaming industry to medical education?

The Stanford Virtual Heart is a virtual reality (VR) experience that provides an immersive, interactive and engaging educational platform to learn about congenital heart disease (CHD). We’ve taken traditional methods of learning cardiac anatomy and physiology – anatomical drawings, models and specimens – and integrated them into a living, beating and interactive virtual heart that the learner can teleport into and see a library of congenital heart conditions. For example, learners can inspect a ventricular septal defect by picking up the ventricle and looking at the septum and then go inside the heart to watch blood flow through the actual defect.

I was inspired by an earlier online 3D representation of a very complex defect (tetralogy of Fallot with pulmonary atresia) that Lighthaus Inc. built in 2013. At Stanford, we care for children from across the world with this defect. I frequently hear from parents that this online, interactive, 3D representation is helpful. As VR became more mainstream in the last year, it became clear we could revolutionize how we teach CHD and use this gaming technology to educate trainees and families. I contacted my partner at Lighthaus, David Sarno, and our collaboration to create the Stanford Virtual Heart was born. It’s been inspiring to merge the medical community with the gaming/tech industry – both to witness the potential of using gaming software for education and to see the excitement in the VR community for an application that’s not strictly for entertainment.

How does VR help teach people to care for patients better?

For my field, I need to know the specific anatomy and physiology of each patient at the bedside in the ICU. The care of children after heart surgery for congenital heart defects depends on the nurses and doctors understanding complex blood flows in the heart. This requires creating a sophisticated 3D picture of each patient’s heart in your mind. We’ve relied on 2D drawings and echocardiographic images and now 3D representations of congenital heart defects. Now, we believe VR can facilitate this by giving the learner an immersive, interactive 3D model.

The Stanford Virtual Heart is also being used to teach patients and their families?

We’ve just started to pilot the program with patients and families and they’ve responded with a lot of enthusiasm. First, we asked a few parents to try the VR experience and help us understand how it would be useful to them. It was remarkable to see the parent of one patient use the VR heart and compare it to the flat, 2D sketch of her child’s complex heart defect I’d given her five years ago. Seeing her experience the latest technology drove home the potential for VR in patient care. Later we took the Stanford Virtual Heart to a regional summer camp for kids with CHD and they loved learning about heart defects. The younger generation will start to expect some form of VR to accompany nearly every part of learning and education.

What’s the difference between augmented reality (AR) and VR?

The important difference between AR and VR is the surrounding in which you see the experience. In AR, an image is projected on the user’s environment. For example, in AR, an image of a flying spaceship could appear next to you. In VR, you’re inside the spaceship with a 360-degree view of its environment.

While it may be science fiction now, it’s conceivable that in the future we will be diagnosing and treating patients with VR/AR, and creating novel therapeutic devices and testing them in VR/AR.

AR allows users to manipulate and share images with other users relatively easily. However, to me, the technology for AR is not quite as engaging as VR in its current state. For a truly immersive experience, VR allows you to completely engage in a new environment and interact with a new world – just like traveling to a foreign country. I anticipate more AR applications as technology and user interfaces improve. VR will likely have advancements in multi-user experiences that allow for immersive experiences.

How much of an investment is it to start a program like this for medical education?

A complete high-end VR setup costs under $2000. The VR hardware for our Virtual Heart is a widely available gaming console. There’s an investment to build a program that produces VR content and develops educational health care and science experiences. That’s a more significant investment that requires software engineers, collaboration with industry, and significant time and energy. Right now, creating high-end and medically accurate VR experiences is not feasible for many institutions. We’re just beginning to use the technology to create medical VR/AR applications. As the VR community branches out to educational, non-gaming content, we think medical applications in VR will be part of every medical school’s curriculum.

What do you think some of the most high-impact changes will be in medicine over the next 10 years because of advances in VR and AR?

The next 10 years will likely result in every major teaching institution and medical school featuring VR in its curriculum. Clinicians and hospitals will also likely integrate VR into their treatment plans, as the applications for VR in clinical care is investigated further. What clinical, research and educational programs develop out of this new VR frontier is limitless and up to our collective imagination. While it may be science fiction now, it’s conceivable that in the future we will be diagnosing and treating patients with VR/AR, and creating novel therapeutic devices and testing them in VR/AR.

In short, the first most high impact change will be access – every physician will have VR/AR readily accessible. After widespread access, VR and AR will provide a platform for medicine that offers a unique opportunity. Can a provider diagnose and treat cancer, anticipating the future areas of metastasis using a VR application? Create and test a new heart valve, exposing the prosthetic material to 30 years of simulated cardiac work in a 10-minute VR experience? Train and educate physicians and surgeons with fully immersive, multi-user, interactive anatomy and patient interaction experiences? These are just a few of the possibilities for the future of VR/AR in medicine.

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David M. Axelrod, MD, is the developer of The Stanford Virtual Heart, in conjunction with Lighthaus Inc., for which he is lead medical advisor and a shareholder.

Keywords: ACC Publications, Cardiology Magazine, Child, Pulmonary Atresia, Heart Septal Defects, Ventricular, Schools, Medical, Universities, Investments, Tetralogy of Fallot, Heart Defects, Congenital, Education, Medical, Software, Surgeons, Heart Valves, Curriculum, Imagination, Parents, Intensive Care Units, Neoplasms, Echocardiography, Patient Care

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