Immersive 3D Visualisation (3D Printing, Virtual Reality) enhances spatial understanding of complex congenital heart defects
Authors: Kappanayil Mahesh , Gurav Aishwarya , Xavier Sarin , Maya Harikrishnan Anil , Srimurugan Balaji , Sudhakar Abish , Kumar Raman Krishna 
Published: May 2024

AbstractBackgroundDiagnosing, managing complex CHD demands excellent morphological understanding. Individual differences in visuospatial skills, training and experience can impact spatial interpretation of volu-metric cardiac imaging. Immersive 3D visualisation may help overcome these challenges, but evi-dence of clinical benefit is lacking.This study explores variability in visuospatial abilities and interpretation of conventionally viewed volumetric cardiac imaging data among members of a pediatric cardiac unit, and impact of using immersive 3D formats (3D-prints, Virtual Reality) on spatial understanding of complex CHD mor-phology.MethodsProspective cohort study involving 9 heterogenous members of an advanced pediatric cardiac pro-gram [3 consultant cardiologists, 2 cardiothoracic surgeons, 1 cardiac radiologist, 3 cardiology trainees]. Participants’ visuospatial abilities were quantified using a validated test (Revised PSVT:R). Understanding of spatial relationships between anatomical structures was assessed using structured questionnaires for 17 unique anonymised volumetric cardiac scans (15 CT, 2 MRI) of complex CHD visualised in three formats 1). conventional DICOM (CDICOM); 2). 3D prints (3DP); 3). Virtual Reality (VR). Accuracy, time taken, perceived level of difficulty, and confidence in interpretation were assessed and compared.ResultsSpatial abilities varied widely (median 8, IQR 6-30), independent of expertise/experience. Limita-tions in conventional reading were significantly overcome with immersive 3D. Mean accuracy score of 60.48% ±17.13% with CDICOM increased to 83.93% ± 7.84% with 3DP, and 90.81% ± 5.03% with VR (p<0.001). 3DP and VR permitted significantly faster interpretation (p<0.001), with significantly better ease and confidence. While immersive 3D visualisation led to significantly im-proved spatial understanding for all, it also minimised differences between participants with widely variable skill and experience levels.ConclusionSpatial abilities are variable. Immersive 3D visualisation can enhance spatial understanding of complex CHD morphology, overcoming challenges in spatial intelligence, experience, expertise. These technologies may be suitably leveraged as effective clinical and teaching tools in congenital cardiology.What is already known on this subjectThere is increasing exploration of use of novel immer-sive 3D technologies like 3D printing and Virtual/Augmented Reality in planning congenital car-diac surgery. Case reports and case series cite their use in visualising cardiovascular imaging data, but do not offer objective evidence or mechanistic insights onhowimmersive 3D interaction helps.What this study addsThis study provides objective and subjective evidence that 3D printed and Virtual Reality representations of volumetric cardiovascular imaging data results in improved spa-tial anatomic understanding of complex cardiac defects among members of a pediatric cardiac care team. It also highlights variability in spatial intelligence and clinical experience among team mem-bers, and that immersive 3D can help overcome these challenges while interpreting cardiac imaging information.How this study might affect research, practice or policyGreater integration of immersive 3D visualisation tools in clinical practice may improve quality of care by improving physician-under-standing of complex anatomical problems. It also makes a case for use of 3D printed and digital cardiac morphological specimens in training pediatric cardiac professionals.