Streamlining the Epilepsy Pre-surgical Evaluation Workflow with Virtual Reality
Creators: name: Aminolroaya, Zahra
Publisher: name: Science
Year: 2023
Subjects: subject: Virtual Reality
subject: Epilepsy
subject: Design Approach
subject: Pre-surgical Evaluation
subject: Education--Technology
subject: Education--Health
subject: Information Science

description: We introduce RealityFlow, a novel virtual reality (VR) system designed to assist neurologists in a clinical workflow of planning epilepsy surgery. We describe RealityFlow ’s prototyping process and present our video-based approach for the prototyping feedback elicitation from physicians with limited availability. Currently, the clinical workflow is laborious, time-consuming, and requires high mental loads of physicians. Neurologists with tight schedules use desktop-based systems with 2D magnetic resonance imaging (MRI) representations of the brain to analyze the brain, mentally imagining how seizures propagate through the brain. Then, they write summaries of their analyzes and present seizure propagation information in meetings. Also, while designing a tool to help neurologists requires their engagement in a design process, the neurologists’ limited availabilities reduce opportunities for them to give feedback on critical design decisions. RealityFlow aims to assist neurologists in preparing and presenting seizure propagation data. RealityFlow offers 3D direct VR manipulation to prepare data and integrates required spatio-temporal information of a seizure spread for demonstration in a 3D space. It introduces a novel visualization of seizure propagation to help neurologists better understand and present user-defined seizure propagation types. The system’s visualization aims to enable neurologists to identify seizure changes and compare different seizure propagation types in a VR environment. Neurologists will be able to place different layouts showing seizure spread information in RealityFlow for analysis and presentation of data. Based on experts’ reflections, we discuss the criteria for integrating RealityFlow into surgery planning rounds. Feedback from domain experts suggests a promising future for RealityFlow. Participants stressed that the new VR tool can provide easier interactions with a 3D brain improving anatomical orientation compared to traditional desktop-based systems. It also potentially supports a better understanding of seizure propagation than a current clinical workflow and can be used as an educational tool. The successful integration of RealityFlow’s VR technology in clinical practice depends on neurologists’ adaptation to its use. The incorporation of a new VR tool like RealityFlow in the clinical process should enhance the clinical workflow while eliminating unnecessary steps, like inserting temporal information in VR instead of reading the available information from medical tools. Also, in our RealityFlow prototyping process, we developed a remote feedback collection process in which we created videos of the VR design process and used these videos to ground iterative input from neurologist collaborators. We utilized the videos from the high-fidelity prototype to elicit feedback from the neurologists who are VR beginners and to help them better grasp the 3D design concepts compared to low-fidelity prototyping approaches, like traditional paper prototyping. The short videos were easily accessible through the Internet for neurologists with limited availability. Using the recorded videos allowed us to elicit feedback from neurologists based on their availability and to develop the VR prototype in a fast-paced prototyping process. We describe our approaches, takeaways, and challenges for developing RealityFlow and the video-based feedback collection to play a role in future VR prototyping.