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• W2885283639 abstract "Three-dimensional (3D) imaging is increasingly important in echocardiography. However, viewing of 3D images on a flat, two-dimensional screen is a barrier to comprehension of latent information. There have been previous attempts to visualize the full 3D nature of the data, but they have not been widely adopted. For example, 3D printing offers realistic interaction but is time consuming, has limited means for the observer to move into or through the model, and is not yet practical for routine clinical use. Furthermore, the heart beats, and 3D printed models are static. Stereoscopic viewing on 2D screens (as at a movie theater) is possible but is expensive, may not provide an immersive experience, and does not have integrated 3D input devices (controllers). Stereoscopic virtual reality (VR) is developing rapidly but is being driven by the video gaming industry, with features not directly applicable to the visualization of medical imaging data. Commonly available VR environments require surface models of structures, typically created by manual segmentation, which is time consuming, subject to user interpretation, and not feasible in real time. In contrast to displaying segmentation-based surface models, volume rendering is a visualization method that can display 3D echocardiographic (3DE) data nearly instantaneously and is notably the primary method of displaying 3DE images in current clinical practice. However, to our knowledge, there is no readily available software application that can display volume rendering of standard 3DE formats (e.g., Digital Imaging and Communications in Medicine) in VR. Furthermore, there is no scientific platform that allows end-user customization of image processing and modeling with display in VR. To address this need, we undertook significant software development to extend open-source software (3D Slicer; http://www.slicer.org) to allow native viewing and interaction of volume-rendered 3DE images in stereoscopic VR (Figure 1).1Fedorov A. Beichel R. Kalpathy-Cramer J. Finet J. Fillion-Robin J.C. Pujol S. et al.3D Slicer as an image computing platform for the Quantitative Imaging Network.Magn Reson Imaging. 2012; 30: 1323-1341Crossref PubMed Scopus (3591) Google Scholar First, we dramatically improved volume-rendering efficiency to allow display of cine 3DE images at realistic frame rates in VR on readily available computer hardware. Next, we created an importer for standard 3DE volumes (SlicerHeart) and a cine player (Sequences) to view moving 3D volumes. Finally, we created functionality (SlicerVR) to allow volume-rendered output from 3D Slicer to be viewed on OpenVR-compatible VR devices. This combination of achievements allowed the import of 3DE data obtained on a standard echocardiographic machine (Epiq 7; Philips Medical Systems, Andover, MA) into 3D Slicer running on a laptop computer and display in VR using a commercially available OpenVR–compatible headset, such as the HTC Vive (HTC, New Taipei City, Taiwan). We demonstrate viewing of 3DE data and provide examples of potential relevance to planning of surgery or catheter-based interventions (Figure 2, Video 1; available at www.onlinejase.com). Total time from import of Digital Imaging and Communications in Medicine data to interactive VR visualization in 3D Slicer is <1 min.Figure 2Depiction of interaction with volume-rendered 3DE images in VR. Volume rendering of atrial septal defect with simulated device closure. See Video 1, available at www.onlinejase.com, for demonstration of interaction with this and other volumes and the potential for the use of VR for clinical decision making.View Large Image Figure ViewerDownload Hi-res image Download (PPT) The full benefit of stereoscopic VR visualization of medical and research images is difficult to convey in the static images or even the “single-eye VR perspective” we present in Video 1; available at www.onlinejase.com. We attempt to compare the viewing experience in VR with a standard two-dimensional screen in Table 1. Spatial relationships and perception of depth are, at least subjectively, markedly improved in VR over standard on-screen viewing. Interaction with the image is intuitive; one can walk “through” structures and “into” the rendered structure to intuitively crop the image, naturally obtaining perspectives that are not typically achieved with flat-screen viewing. One can also sit at a desk and grab and manipulate a volume-rendered structure with the controller just as if one were examining a real object by moving and rotating it in virtual space.Table 1Comparison of viewing of 3D on a traditional 2D screen with VRTraditional 2D screensVRDepth perceptionRequires artificial enhancement (special color maps, lighting simulation, etc.) to indicate depth indirectlyDirect, accurate 3D depth through stereoscopic display and head-motion parallax, resulting in less ambiguityField of viewApproximately 30°100°, allowing viewing images in much higher magnificationViewpoint setupIndirect view manipulation using mouse and keyboard; manual cutting plane definitionDirect, intuitive viewpoint setting by simply moving head or body as in real life; dynamic cutting plane defined by putting head inside the region of interest3D object positioningIndirect definition of 3D position and orientation using 2D controls through series of interactionsIntuitive, direct 3D positioning, points can be placed or objects can be aligned or moved by simply grabbing them similar to physical objects2D, Two-dimensional. Open table in a new tab 2D, Two-dimensional. We believe that this is the first readily available integrated solution for the viewing of volume-rendered 3DE images in stereoscopic VR. Notably, we have made SlicerVR and the other components available in the free and open-source 3D Slicer platform, allowing both academic and commercial use without restriction. Our incorporation of 3DE import, sequential volume viewing, improved volume rendering, and VR output further extend this powerful tool for the image processing of 3D data.2Pinter C. Lasso A. Wang A. Jaffray D. Fichtinger G. SlicerRT: radiation therapy research toolkit for 3D Slicer.Med Phys. 2012; 39: 6332-6338Crossref PubMed Scopus (147) Google Scholar, 3Ungi T. Lasso A. Fichtinger G. Open-source platforms for navigated image-guided interventions.Med Image Anal. 2016; 33: 181-186Crossref PubMed Scopus (100) Google Scholar Given the complexity and motion of 3D cardiac data, we believe VR-based technology, and the related field of augmented reality, will have a significant clinical impact on how we look at and comprehend 3D cardiac images. This may be especially relevant to understanding complex structural relationships as well as conveying those relationships to surgeons and interventionalists. Further optimization of volume rendering, interaction, display resolution, and VR viewing technology will improve the viewing experience, while the cost of VR viewers will simultaneously decrease. Of course, it remains to be objectively demonstrated that this approach results in significantly improved diagnostic understanding and speed or subsequent improvements in therapeutic outcomes. We invite you to try it for yourself. Compatible hardware is readily available, and the 3D Slicer platform is available for download and documented at http://www.slicer.org. The newly developed capabilities are available in the SlicerVirtualReality extension within the 3D Slicer Extension Manager. Open-source code and documentation are available at https://github.com/KitwareMedical/SlicerVirtualReality. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiIzMTg2YjFkM2QyMTczNTAwZmVjZDliNjQyODRkMWYxOCIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc4MzA3NDgyfQ.SGKwd3x97MzyelVn5O0yDnZLBs88CKzD3zrYyBoxygS8BowhpyG3u3M3Bk0ESvkMRLA7BfbnZA8Zd5Kyso6p9-tqlBD2n0rWbLHc78Ws6A5P97p3wf4nMXprhF1FRdKo4cuVN4oxKmHuplscpm_vlZpGwb5vdjQYjv4sY91KBbqyS0UpJUIQk-p5BEzUK3KAf-O7a3E8GLP4lp32cfCQ2rSQHiMxuFTBKHxAL9R517FTLggPELX9pH4FXDGfZEVDHgytQu6qwJRgm_dqC_BmfdBv88ctS_W-xuoo7RPgBnQbUBVUFjL7kexaXj3Ci1fQhgMnHS_9QmblAvhILpeSHA Download .mp4 (32.98 MB) Help with .mp4 files Video 1Simultaneous display of the 2D screen, one eye of the VR viewer, and the interacting user. Part 1: transesophageal echocardiogram (TEE) of tricuspid valve in a patient with double-outlet right ventricle at the Fontan stage. Part 2: TEE of a child with D-transposition of the great arteries and ventricular septal defect. Part 3: TEE of a child with secundum atrial septal defect (ASD) and simulated closure with a virtual ASD occluder." @default.
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• W2885283639 title "Interaction with Volume-Rendered Three-Dimensional Echocardiographic Images in Virtual Reality" @default.
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• W2885283639 doi "https://doi.org/10.1016/j.echo.2018.06.011" @default.
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