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Friday, December 3, 2021

VR helps parents visualise child’s surgery


Six-month-old Archie was born with a condition where the growth lines in his skull had fused too early.

His parents had to make a difficult choice: risk surgery or let nature take its course, with all of the physical and psychological consequences that could result.

But, thanks to a game-changing new technology, Amanda and Judd Michnowiec were able to preview the changes in virtual reality.

That, according to the doctor behind it, is more information than most parents receive.

A VR solution

Archie’s condition, known as Sagittal Synostosis, means that his skull cannot grow sideways to accommodate his growing brain.

Instead, it expands to the front and back of the head, distorting the shape of the head.

While the condition is not fatal, it can cause speech and language delays as well as increased intracranial pressure.

Amanda with her six-month-old son Archie

“It’s been quite overwhelming,” his mother, Amanda, said. “I’ve had a lot of appointments and a lot of time away [from work].”

So Amanda and Judd jumped at the chance to be the first to use a groundbreaking new artificial intelligence (AI) platform that predicts the outcome of a life-changing operation in virtual reality when Great Ormond Street Hospital for Children approached them.

The immersive environment allowed them to see a reconstruction of Archie’s head generated from a CT scan from all angles during their first consultation. Overlaid in green on top of this was a rendering of his head after the reshaping procedure.

The VR environment shows the current shape of Archie’s head (grey) and the predicted changes after surgery (green)

The algorithms required to create these latter images were made possible by combining data from 60 operations over the last seven years.

“We’re excited, and obviously there’s always that worry about what he’ll have done,” Amanda said following the consultation.

“Although it’s a lot to take in, it’s reassuring to know that’s what we can expect and that it’s been explained, and that we won’t be left wondering what’s going on.”

However, the technology not only allows the couple to see and understand the differences that the procedure will make, but it also encourages them to suggest potential changes to the surgeon.

‘Truly informed consent’

According to Dr. Noor Ul Owase Jeelani, a consultant paediatric neurosurgeon at the hospital, the technology gives the couple a better idea of what the future holds.

“Now, when they sign the consent form, it’s what I’d call truly informed consent,” he said.

What I would like to see as a surgeon in ten, or perhaps twenty years’ time is that most surgical practise is done in this manner, with the parents and patients having a great deal of control and power.”

Dr Jeelani has pioneered the technique used to help correct sagittal synostosis

Archie underwent surgery a few weeks later, after his parents had confirmed their decision to proceed.

The procedure entailed inserting a small spring into his skull, which immediately began to correct his head shape.

This spring’s placement and impact were also depicted in the VR environment. The spring was removed after four weeks.

BBC Click presenter Lara Lewington holds an example of the spring which is inserted into Archie’s skull

Dr. Jeelani invented the technique 13 years ago, and it has not only reduced the operation time from three hours to 40 minutes, but it has also reduced blood transfusions by 90%.

This has resulted in more predictable outcomes, and it is because of this predictability that the data can now be used for VR visualisations with 90% accuracy.

While the technology was developed for a specific condition, it is hoped that it will be applicable to many different types of surgery in the future.

A 3D scan of Archie’s head after surgery

“What we’ve seen here is essentially proof of principle,” Dr. Jeelani explained. “That if you take a condition, an art form, and make it granular enough that you can study it, then you can actually predict the future with a reasonable amount of accuracy.”

Archie and his family are doing well two weeks after surgery.

“We’re relieved to be on the other side now,” Amanda said. “We’ve been told that there shouldn’t be any issues with development or anything, so we’re very pleased with how things went.”

“Being able to do the VR really reassured us that we were doing the right thing.”

“Having the ability to see the “before and after” did relieve some of the pressure. It was a big weight off our shoulders, but we’re relieved.”

The full video documenting Archie’s journey can be viewed now on iPlayer.

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