Going virtual: How VR is guiding interventional radiology

A journal editor explores possibilities in medical training and patient education through a VR project

Haskal VR image
Ziv J Haskal, MD, Professor of Radiology and Medical imaging at the University of Virginia School of Medicine and Editor-in-Chief of the Journal of Vascular and Interventional Radiology, shows a colleague how to use the JVIR cardboard viewer to watch a procedure in VR. (Photos by Coe Sweet)

In this two-part feature, Elsevier Connect delves into the world of digital technologies (smart phones and apps) and immersive video environments. Part one examines how doctors are using virtual reality to inform patients about medical procedures. In part two, we’ll look at how smartphone apps can help diagnose and treat a variety of mental illnesses.

Imagine a long, well-lit hallway, doors opening and closing to reveal offices and operating rooms. Walking down the hallway, you see medical beds; then you realize the clothing you wore to the office that morning has suddenly been replaced by nothing more than a white gown and a medical bracelet – with your name on it.

Looking up, you see at the other end of the corridor an individual, possibly a doctor or a nurse, waiting for you. They invite you through the door and you walk into the next room; standing before you is the very same doctor you spoke to only a week earlier at one of your regular check-ups.

His warm, personable voice greets you as you enter. Hands clasped, he re-introduces himself: ‘Welcome to the interventional radiology wing of the University of Virginia Hospital,’ he says. ‘My name is Dr. Ziv J Haskal, and today we are going to create a transjugular intrahepatic portosystemic shunt– a TIPS – and show it to you in in virtual reality. Our hope in bringing it to you in this environment is to give you some close-up and interesting perspectives on the ways I try to standardize these procedures.’

Prof. Ziv J Haskal, MD, in his office at the UVA School of MedicineExperiments within the virtual confines of space and time may not sound like business as usual for an academic journal, but for one society and its journal, it was an experience worth exploring.

As Editor-in-Chief of the Journal of Vascular and Interventional Radiology, Dr. Ziv J Haskal developed, filmed and edited a series of virtual videos. It has given the Society of Interventional Radiology (SIR) a new way to share medical procedures en masse by engaging with its society members and fellow physicians in an interactive way and highlighting opportunities to shape the future of its practice.

Virtual reality, or VR, is the creation of a near-to-real-life experience using a computer-generated environment. It fools our senses, shuts out external distractions and offers up a world of make-believe; it removes risk from an otherwise risky situation, or drops us into an ordinary event we may not ordinarily experience.

“I’ve been an educator, a lecturer as well as a clinical doctor and academician for decades,” said Dr. Haskal. “I’ve spent 25 years interested in things such as new ways to reach physicians.”

Virtual opportunities

With over 7,000 members worldwide, SIR’s remit as a professional medical society is to promote the use of image-guided care among medical professionals. Central to that task is to improve patient care and encourage new research in interventional radiology. Coupled with SIR’s ability to support new ways of teaching, Dr. Haskal’s long-standing interest and desire to capture, package and present information more easily in his profession is being realized.

For medical students, VR can help them improve their understanding of their chosen profession and learn the procedures they will perform years into the future. For established physicians, VR can provide quick reference material when urgent care is needed in an emergency room. If an emergency room doctor can train with VR goggles or watch a refresher video before a complex procedure, Dr. Haskal theorizes, success rates will be higher for the procedure and enable physicians to do it quicker and more efficiently.

Breaking an idea into simple messages helps create that spark in a colleague’s or patient’s eye, Dr. Haskal explained. “It’s like that ‘a ha!’ moment and helps solidify the learning, helping them absorb this information rather than be apart from it.”

And for patients in some hospitals and clinics, VR can be used to explain the medical procedures they could have. Simulating the hospital environment, or walking patients through the steps of a procedure, can help put a patient’s mind at ease and provide a different perspective, raising awareness and demystifying complicated medical terminology.

Interventional radiology (IR) is the minimally invasive, image-guided treatment of medical conditions that once required open surgery.

IR harnesses the power of advanced imaging (ultrasound, X-rays, CAT scans, MRI scans and other innovative methods), to see inside the body and treat complex conditions less invasively and with unprecedented precision.

Or in Dr. Haskal’s words, “Without a doubt, the coolest speciality in medicine.”

He said they treat virtually every part of the body except the heart – from the liver and kidney to microscopic veins.

“On any given day, I may treat 20 completely different patients (whose conditions) have nothing to do with each other,” adds Dr. Haskal when describing a typical day in his office. “This is completely different than, say, a cardiologist, where everything is (about) the heart.”

To cover such a wide array of procedures, the ability to easily demonstrate and explain a procedure to patients using video can be a great advantage. As these new and exciting possibilities become more common in medical practices, VR may soon enhance healthcare practices in more remote locations.

Look at Nepal, where medical professionals are now using mobile phones and videos to speak with and treat their patients. This reality is not entirely unfamiliar to Dr. Haskal, who spent time making multiple trips to that part of the world in the early part of his career, visiting nearly 30 different hospitals in India and performing the same procedure at each location.

His hope at the time was that if a handful of doctors in India all learned the same procedure, they could help tens of thousands of other people with liver disease. With VR, such training sessions can become more efficient and widespread.

So why VR?

“VR is the natural evolution,” Dr. Haskal reasons in a recent editorial for the Journal of Vascular and Interventional Radiology(JVIR). The journal, published by Elsevier in partnership with SIR, provides the latest research on every aspect of vascular and interventional radiology. Dr. Haskal, Elsevier and the society collaborate regularly on new initatives, including regular podcasts, the JVIR Access blog with article summaries and commentary on journal articles, and most recently the JVIR Google cardboard viewer – an idea that had been percolating for sometime between Elsevier Executive Publisher Mary Heffner and Dr. Haskal.

Prof. Ziv J Haskal, MD, demonstrates the JVIR Google cardboard VR viewer.

Launched earlier this year at the society’s annual conference in Los Angeles, each delegate received a free cardboard VR viewer. For some delegates, this was the first taste of VR; Heffner thought it was an effective means to share Dr. Haskal’s innovative idea capturing his well-known TIPS procedure.

Fine tuning the presentation

With this latest project now realized, Dr. Haskal will continue to build upon this and his earlier endeavors in multimedia (as an early adopter, he taught himself HTML), launching some of the first online journals in the IR field while continuing to refine and improve the ways in which he teaches IR procedures. He is convinced that “strong adrenaline charges make things stick.”

“Information has to be packaged, it has to wash over people” to create the kind of experience that turns off your mental filter and holds people’s attention, he explained. “Something that puts you in the room and then lets you make observations, and also doesn’t stress or exhaust you.”

The VR tool is only the first project planned in a series of more procedures for the journal to disseminate, which means it is only a matter of time before the virtual world and real worlds merge to offer a new medical experience benefitting students, patients and practitioners.

Experience the journal’s VR project

To watch the TIPS procedure while looking over Dr. Haskal’s shoulder, grab your VR viewer and check out the playlist on the journal’s website. Read more about the rise of virtual and augmented reality.



Written by

Jonathan Davis

Written by

Jonathan Davis

Jonathan Davis is the Communications Officer for Elsevier. Based in Amsterdam he manages the Newsroom's services, working together with university press offices and journalists around the world to highlight the latest research published in over 2,500 journals. He is no stranger to the world of publishing, holding a degree in Publishing from Oxford Brookes University; one of his first roles was as Commissioning Editor for a small academic publishing house in the UK, before joining Elsevier in 2013.

A proud Canadian, he has now planted his roots in the Netherlands. As a recovering news and radio reporter, he can be found finding a balance between his various interests, including cycling, DJing and being a new Dad.


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