ASCO Reading Room | Mohamed El Beheiry, PhD, on Virtual Reality Analysis of Breast Cancer MRI Scans

Surgeons tend to perform less than optimally when analyzing magnetic resonance imaging (MRI) scans of patients with breast cancer, primarily due to a lack of radiologic training. A new virtual reality tool, however, improved that ability, researchers reported in JCO Clinical Cancer Informatics.

Mohamed El Beheiry, PhD, of the Pasteur Institute in Paris, and colleagues conducted a study with 18 breast surgeons, half of whom were residents and the other half practicing surgeons. The surgeons analyzed MRI scans of 25 patients using a standard slice-based visualization tool and a 3D virtual reality tool called DIVA, which instantly generated 3D patient reconstructions from original MRI scans in their native DICOM file format.

The surgeons analyzed the scans significantly faster and more accurately with DIVA. The median time it took them to determine the number of lesions and their location was 145 seconds with slice-based visualization and 37 seconds with DIVA, nearly four times faster (P<0.001). There were also improvements in determining which breast and which quadrant contained lesions.

“In DIVA, we demonstrate a method to potentially significantly improve surgeon proficiency in reading MRI examinations without the need for massive retraining,” El Beheiry and colleagues wrote. “The reported increase in efficiency of medical image reading has the potential to improve surgical planning and greatly improve communication between surgeons and radiologists.”

In the following interview, El Beheiry, an engineer and physicist, elaborated on the technique and its potential benefits.

Can you describe the 3D virtual environment created by DIVA? What do doctors see, and how can they interact with it?

El Beheiry: Doctors using DIVA are introduced to an immersive 3D representation of their patient’s MRI in virtual reality, which can be considered a patient “avatar.” The avatar is represented to the exact physical scale and can be fully explored with the aid of a handheld virtual reality controller. For example, the doctor can virtually “cut” into the avatar to better visualize internal organs and also perform precise 3D measurements.

What special equipment is needed?

El Beheiry: DIVA simply requires a computer powered by a VR-compatible graphics card (eg, NVIDIA 10 Series equivalent or better) running Windows and a commercial PC VR headset (our preferred headset is the HTC VIVE).

One of the most notable findings in your study was how much faster surgeons were able to analyze the breast MRI scans with DIVA. Please tell us more about this.

El Beheiry: This finding, although remarkable, was not necessarily surprising. The immersive nature of the patient reconstructions generated by DIVA provides a level of abstraction with respect to the medical image. The surgeons are not looking at greyscale radiological slices; they are looking at a realistic virtual representation of their patient. Interactions with these representations are designed to be simple, rapid, and highly intuitive.

The implications are potentially highly significant. For a high-volume cancer center like the Curie Institute — more than 3,000 breast surgeries per year — the time savings per surgeon are considerable (several man-days per year). What is additionally remarkable is that the accuracy of image analysis is also improved with these time savings.

You noted additional medical benefits that resulted from using DIVA. What were these?

El Beheiry: The services at the Curie Institute that have deployed DIVA report a better understanding and culture of medical images broadly speaking. In a way, DIVA is a shortcut to understand medical images for the non-radiologists. Other medical benefits include:

  • We demonstrate the general level of proficiency surgeons have in reading MRI sequences
  • Our results show a considerable reduction in the MRI analysis time per patient using DIVA, which is time gained for doctor-patient interactions
  • DIVA opens the possibility for medical imaging information to be easily shared and understood by patients to further involve them in treatment decisions

What future technical developments will further improve DIVA?

El Beheiry: The DIVA technology is currently being commercialized by AVATAR MEDICAL SAS, a startup company founded in 2020. Included in the latest iterations of the technology, perhaps ironically, is a radiological interface that is fully synchronized to the virtual reality context presented in our article in JCO. The idea here is to envelop surgeons in the culture of medical images. The richness of the clinical information contained in these data should be made accessible to all clinicians, and future developments will be driven in this spirit.

Read the study here.

The study was supported by the Institut Pasteur, Gilead Science, and L’Agence Nationale de la Recherche.

El Beheiry is an employee of Avatar Medical. The Institut Pasteur and Avatar Medical have an R&D agreement regarding the development of some components of a software program based on the DIVA technology.