By Ron Seybold

The American Vein and Lymphatic Society is launching a new project to use immersive virtual reality (VR) technology for its educational courses. The educational an array of venous medicine techniques. VR has started to make it possible to gain a better view than ever of fundamental and cutting-edge practices, all while the VR overcomes significant training limitations.

Reading alone presents its risks for training. A physician then wants to observe new practices — the use of lasers, or a radiofrequency procedure, or superglue. That doctor must find another doctor who’s skilled in the procedure, then ask if he or she can be a visitor for a day and intrude on the normal flow of the physician’s office.

Then there’s the locating of the right patient, plus learning if there’s room to get an extra doctor in the right position around the table. Doctors who seek training must be on premise, leaving their own practices for the day, or even longer with travel.

Finally, there’s the consideration of eliminating travel by locating a doctor within a city or a short drive. The problem of competition arises at that point. A physician may not be motivated to train another who might compete for patients. There’s often a fee, if a doctor can be located.

“It becomes difficult to coordinate all of those different data points,” said Tony Jakubowski, the managing partner of Med360. Jakubowski, who’s been invested in the venous medical field for the past 20 years, is at the center of the new program in partnership with the AVLS. The society is the first medical college to adopt the technology in training.

Doctors, surgeons, phlebologists, cardiologists and other medical professionals will wear VR headsets to observe techniques with a view that’s better than any doctor can get while inside the operating room. VR opens a new perspective.

“We take medical devices and practices and teach doctors how to use them,” he said. “That requires us to be in an operating room, or in a theatre, guiding the doctor using the VR on what to do. A into B, then B into C. The training advises them, ‘I wouldn’t do this, or do that,’” Jakubowski said. “Not a lot of people like to train, too, so this fills that gap.”

The typical choices for learning new procedures and devices cover a range that goes from reading, to watching YouTube videos plus the reading, then watching a physician do the procedure. In a litigious era, physicians must monitor their liability with proof they have been proctored in new techniques. Immersive VR for medical training, still new to the industry, opens the door to that training.

The initial immersions began to be offered as part of training on April 6 in the Chicago area. That April course was the first to incorporate the Med360 immersion, a 20-40 minute module. Jakubowski said the initial training would use about 25 physicians at a time in an immersion lab. As the training goes forward, the capacity “is kind of infinite,” he said.

The VR segment at this time is a small portion of the entire course. The VR element has physicians wear a VR headset to see the live part of the training. In the future, the training content for purchase at the AVLS website will be a package of lectures, live patient training and hands-on practices.

Doctors will leave the lecture session in the lab with their headsets on and be able to ask questions and comments during the lab, “but be virtually in the room with the patient — without having to source all that at a local level in Rosemont, Illinois, for April 6.”

The training that will be for purchase on the AVLS website will include an oculus shipped to the physician’s office, then returned to Med360 afterward.

“It’s very forward thinking of the board of directors of the AVLS to do this,” Jakubowski said. “It’s where education is going to be going in the future.”

The next level of immersion into an operating room to learn surgical techniques will overtake that written, YouTube or even learning by attending in the operating room. “Can everybody see?” is a question that won’t come up in immersive VR training for anything.

“Often times it’s very difficult to describe how you’re making foam sclerotherapy,” Jakubowski said. “It’s so much easier to watch it and have that virtual reality experience.”

Four separate training courses are being filmed. Med360 filmed three different patients in various techniques for the first course. Camera setup and filming was seamless, according to the AVLS physician who led the training.

AN IMMERSIVE VENOUS VISION

Margaret Mann, MD, is an associate professor of dermatology at Case Western Reserve University and on the AVLS Board of Directors. She is the director of the AVLS sclerotherapy course, among others. The flexibility of at-home training is enhanced by the new immersion video.

“In the old model, everyone has to fly to a certain location for this to happen. We can’t have live patients there, either, because of the liability and coverage in a hotel,” where many classrooms are staged, she said.

Remote trainings have a need for a better view than 2D. She believes the VR training is the element that will let the AVLS “break through to a fully-remote course.”

“There’s nothing that replaces a physician’s ability to see somebody attending to a live patient,” Dr. Mann said. “We do that today through videos, but you’re only able to capture so much from a video versus an immersion program.

“The goal of this is to be able to have physicians be able to see almost in real time how an expert treats the patient — then to be able to see it from the comfort of their own home.”

She said introducing a remote training component like immersive VR is important for venous and lymphatic medicine. “It’s expensive for the AVLS to put up a course several times a year with the costs of arranging a facility, not to mention the costs to physicians and nurses of time away from their offices and their own patients.”

Lowering costs to create courses — which are made possible by higher-quality video instead of in-person observations — could pave the way for more courses being offered and increase access to educational opportunities for physicians and nurses looking to expand their services.

Current training practices on sclerotherapy include lectures in the mornings on the basics of sclerotherapy, then afternoon videos on how injections are performed and then a hands-on portion. Instead of offering a program where the travel to live patient observations is required, “the part that would have been video with a live patient would be the virtual reality part.”

TECHNOLOGY EMERGES

The AVLS and Med360 are working to employ the VR and augmented reality in a training series. Part of the value in creating immersive VR training is keeping the material more current, so AVLS can move on to other trainings. Doctors can be hard to locate for courses. Keeping a course online and useful might be more likely if it’s got a VR component.

In some of the core courses, the basic material doesn’t change much from year to year, Dr. Mann explained, “so that means that we can have enduring material that can be offered to physicians and nurses online rather than in person. I personally have always wanted to incorporate live cases, but we haven’t been able to do that. VR allows us the best of both worlds, virtual live cases that can be shown over and over again.”

A BETTER VIEW OF PROCEDURES

Jakubowski said better visibility during patient procedures improves on the state of the art for training. “If there’s more than one person in the room, you can’t get close enough to the patient and the doctor to see what’s happening. You have to ask questions.”

As an example of how an immersive VR view improves physician training, there can often be several people in a room doing multiple activities such as prepping the device, surgeons prepping the field or a nurse getting equipment ready. Without VR, video training is limited to shots the videographer can take, zooming in on specifics. “With these devices, if a physician misses something they can reverse the video, look at it from different perspectives, all captured in real time. In one angle a doctor can be seen; in another, the assistant appears in the VR immersion.

“With the new technology we can put a camera right into the operating room field that sees everything that a visiting physician would see if they were standing right there,” Jakubowski said. The technology is ready to do the VR presentations “so we can put as many people as we want by that physician’s side, with a view as if as only one person was standing right next to the doctor.”

Dr. Mann said the view is nearly the same as if the person is actually in the office. “You only get the perspective of the person who’s filming when you’re doing a regular video. In this case, you can kind of look around the room throughout, or the ultrasound screen.”

In-person courses will still be offered this year, but instead of employing videos in 2D on a PowerPoint “we would actually have people wear the oculus headset, and then be able to see how the table set up, and how the patient’s positioned,” she said. Future trainings will cover thermal and nonthermal techniques with a field camera as well as a 360-degree camera looking around the room.

“The resolution is fantastic,” Dr. Mann said. She narrated the sclerotherapy training. Deep venous disease training is also on the horizon.

AN INDUSTRY GUIDE APPLIES VR

Med360 has already been coordinating the technology for orthopedic procedures.

SAVINGS AND EFFICIENCY

“As physicians we always want to be learning more,” Dr. Mann said, “training in new technology and getting better educated. The problem is it’s hard to leave your office to spend the time to do that.”

The immersive VR will allow physicians to do such training from home. “You could do it at night and still go to work the next day,” she said. “You don’t have to cancel your clinic, fly and get a hotel room. So it allows physicians to be able to remove the barrier of time and money in learning new technology.”

PROMISES FOR MORE

Ablation techniques, both thermal and nonthermal, will be offered in the future by the AVLS using VR, as well as pelvic disease training, DVT, and venous and lymphatic malformations. The series of immersive content will be available online for physicians to access using the AVLS website.

One of the main tenants of AVLS is education. “Our goal is to educate our members so they can be the best vein specialists and lymphatic specialists possible,” Dr. Mann said. “It’s worth it for us to invest in this, because it allows for physicians and nurses to get the education. They need to be the best they can be. So I mean I would say from that perspective. It’s a great return for our investment.”

Future trainings, available through the AVLS, will let physicians watch regular videos of lectures including PowerPoint talks, then do the immersions. “Potentially we could even send out some sort of hands-on module that they can then practice—so it would be almost the same thing as if they went to course, but they would be able to do it at home.”

The current April training that includes the need to travel to Chicago, for example, is sold out. Creating a fully remote online training — one that relies on immersive VR as an essential element — widens the field of physicians who can practice the most complete range of techniques and medicine. It can keep the caliber of training at a high level.

“To be able to do this training at home creates flexibility for the physicians, but also for the teachers,” Dr. Mann said. “It allows all of us to not have to miss our work in order to engage.” VTN