video walking through a transjugular intrahepatic portosystemic shunt (TIPS) case. Dr. Haskal made this immersive demonstration available to anyone in the world with a phone, which can be converted to a stereoscopic VR viewer using affordable mobile device accessories like Google Cardboard. This demonstration was an engaging way to attract aspiring trainees, while also providing patients with a better understanding of their planned procedures. Additional studies since then have demonstrated the value of AR-guided endovascular puncture for successful TIPS placements.2


For many medical students, and even interested pre-medical students, IR is an abstract and nebulous specialty. The opportunity to immerse oneself into a virtual IR suite and interact with different instruments or even view procedures could help with improve outreach and spreading awareness of this field.3


For residents, fellows and attending staff, it is important to have continued exposure to IR tools and procedures. Not all institutions and IR training programs are exposed to the same volume of procedures, nor will those procedures necessarily fall within the IR scope of practice at those institutions. As a result, trainees can experience and learn those procedures virtually via simulation and attending staff can continue to hone those skills as a form of continuing medical education.


Patient imaging can also be utilized for collaborative surgical planning and practical scenario training. With this training modality, there are no lasting real-world complications, and the simulated environment allows a safe space in which to hone technical capabilities.4–6


Patient education XR has also been utilized in patient education and communication. One notable example is for patients with cancer who will undergo chemoradiation. Because cancer diagnoses are understandably anxiety inducing, many studies have utilized XR technologies to help augment patient education and introduce them to the treatment process while setting


12 IRQ | WINTER 2024


Another important factor of XR is addressing the physical footprint and ensuring that the equipment does not impede the quality of clinical care, such as with large displays and wires that could potentially limit tabletop movement and C-arm mobility.


expectations.7 This approach has the


potential to improve physician–patient communication while reducing patient fears. Similar efforts have taken place in vascular surgery, where VR has been used in patient education of abdominal aortic aneurysm treatment.8


IR could adopt this approach by developing patient education modules for more advanced procedures, especially within the interventional oncology, hepatobiliary and vascular realms. This technology could also be used to show patients the progression of their treatment in follow up clinic visits—whether that is their shrinking fibroids, postablation malignancies or stabilization of endografts. This may also have the unexpected side effect of enhancing the general population’s knowledge about the field of IR.


Pain management To date, VR has primarily been utilized in the medical setting for psychiatric disorders. More recent research has utilized VR as a positive distractor for acute pain during medical procedures and hospitalizations. Relying on its ability to provide an immersive environment, VR is thought to overwhelm the patient with sensory input to help limit the patient’s processing of nociceptive pain.9


These


findings have spurred further research into whether VR can also be utilized for the treatment of neuropathic pain, and initial findings are promising.10


Studies


have shown the technology may be an effective adjunct in multimodal


pain management with the hopes that it can help decrease the use of pain medications, specifically opioids.


XR has exciting potential to enhance IR's expanding repertoire of techniques for oncology-related pain management. Pain management could one day be supported with the use of VR technologies. Recent studies have also used VR technologies for symptom management in palliative care.11,12


VR


can also be an important tool pre- and post-procedurally by helping to reduce anxiety prior to a procedure and for postoperative pain management.


Quality improvement A study demonstrated that use of AR guidance decreased the number of needle passes, reduced radiation dosing by decreasing the number of interval CT scans and shortened procedural time. Many advancements and IR-use cases have come from the interventional oncology space with percutaneous needle insertion and biopsies.13,14


There


have also been early studies using AR for tumor ablations.15,16


Barriers to use From its fledgling beginnings to its iterative medical innovations, XR has seen its fair share of use cases globally.


The most important concern moving forward is addressing the economy of scale and how to encourage more widespread adoption of this technology. A systematic review of wearable heads-up display devices in the operating room identified IR as having the fewest number of published studies among 10 other procedural specialties.5


As minimally invasive


and image-guided physicians, it’s important that we support further experimentation, development and adoption of technologies that aid in doing so. While high financial costs are currently a barrier to adoption and use, as the demand for this technology increases there should be a proportionate saving in costs.


Another important factor of XR is addressing the physical footprint and ensuring that the equipment does not impede the quality of clinical care, such as with large displays and wires


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