AR, VR Technologies Will Become Mainstream In Healthcare In A Few Years: Dr Mahesh Kappanayil

In an exclusive interaction with BW Healthcare World, Dr Mahesh Kappanayil, Clinical Professor of Paediatric Cardiology at Amrita Hospital spoke on the evolving technologies, their use cases in hospitals as well as in medical education and the dream of having an artificial heart in the near future

Technology is advancing at a breakneck speed in all areas but in healthcare, the progress has just begun with its strides getting bigger and bolder as we move forward, Dr Mahesh Kappanayil, Clinical Professor and Paediatric Cardiologist at Amrita Hospital Kochi is one such technology champion who is one of the torchbearer and a pioneer of a number of technologies such as 3D printing, Virtual Reality (VR) and Augmented Reality (AR) in Healthcare. 

Dr Mahesh founded and presently leads the in-hospital 3D printing lab as well as the AR and VR labs at Amrita Hospital Kochi. The labs are performing some of the most pioneering work not just in cardiology but in other medical fields as well. 

He says at present only a handful of doctors, hospitals or universities are using these technologies but soon enough they will become mainstream. BW Healthcare World in an exclusive conversation spoke to Dr Mahesh on these evolving technologies, their use cases in hospitals as well as in medical education and the dream of having an artificial heart in the near future. 

Edited Excerpts:

What according to you are the hurdles when it comes to the cardiology field in India?

Generally, when we speak of heart diseases we think of coronary artery disease, heart attacks, and heart surgeries etc., of course, those are complex enough but the complexity is stepped up several levels when we come to congenital heart disease or paediatric heart disease. 

In paediatric heart diseases, the simple structure of the heart itself is disrupted. The heart is on the left side, but that position could be changed to the right side or the central chest. The chambers, arteries, veins, everything can be mispositioned. So the challenge is for doctors to clearly understand what has happened to the structure of the heart. 

Heart becomes particularly challenging as it's a very dynamic structure that is constantly moving, so it's a difficult organ to image sharply. Conventional diagnosis methods like an Echocardiogram, MRI or CT give out slices of information. As treating doctors, we are supposed to piece together that information to understand the three-dimensional order of the heart. But with the advent of technologies like 3D printing Virtual Reality and Augmented Reality, these slices of information together form a three-dimensional structure.

How did you begin using 3D printing, AR and VR Technologies for better diagnosis and treatment?

In 2014, I came across a 17-year-old young boy named Hari who had a complex heart disease. His heart was on the reverse side and both his major arteries were coming from one chamber of the heart rather than from the two respective chambers. He had been denied surgery multiple times, at multiple leading institutions in the country.  I did the cardiac MRI for him and I was reasonably convinced that this surgery could be done but my team did not agree with me as they said it's too complex to operate. 

And that was a time when 3D printing was just coming in and was not yet mainstream, especially in medicine.  So, I converted this patient's MRI scan into a 3D-printed heart model. This is one of the first times that this had been done in the country. When I handed it over to the surgeons, they could actually open it up and they could see exactly where the holes were and within 10 minutes the whole story changed and they decided to operate, saving the 17 year old’s life who had lived all his life with this disability. 

After this we established the point of care 3D printing lab at Amrita Hospital, Kochi where Hari today works as an engineer as he decided to give back to the society after his treatment. So case after case we started using the 3D printing technology into complex cases of other specialities as well and today it has become a whole innovation ecosystem. 

Around 2021, we explored things further. In the Covid times the gaming tech was advancing and we began with ideas as to how we would take the CT or MRI scans, put it through software processing and convert them into digital 3D files. And that's how we ideated about bringing these digital 3D files into the VR format, which was essentially built for gaming. And that's how the AR, VR lab began.

What are the use cases AR and VR is offering to your hospital?

Today, we have doctors who are able to put on a virtual reality headset and see the medical images as holograms right in front of them in a deeply immersive and realistic three dimensional format. Literally in our hands, we can pinch, zoom and make them bigger or smaller. We developed tools, which we could use to dissect through these anatomies. We could cut open a heart, liver or a kidney in any manner virtually. 

We also started doing virtual surgeries on these holograms as a preparation and layout strategies for the actual surgery. In cardiology this brings great value because, with 3D prints there is limited access as to how much you can cut the heart model as it essentially gets broken. 

Whereas in VR and AR format you can cut it open any number of times or you can operate upon them or you can even zoom in and scale it up to as big as a room or a hall. And I can take myself and my colleagues on a walk inside the heart walking from one chamber to the other or climbing out to an artery or a vein or looking down. So this yet again changed the paradigm entirely because this was giving us an entirely new way of looking at medical images.

Not only were these models helping us in treating patients, but these virtual reality depictions or models also became an extremely useful tool for communication to patients when a complex surgery has to be explained. 

Do you think AR, VR will revolutionise medical education when we talk about training doctors? 

Absolutely, we have already begun to show that in cardiology at Amrita Hospital which runs the DM in paediatric cardiology program. We are already using these virtual reality tools for teaching our students and clearly their learning curve is getting smaller. 

The current generation with these tools can study any kind of a complex disease they want. They can look at the organ and see a particular disorder in front of them and they can consider it in all its aspects and learn very quickly. Similarly we can also build simulation tools in VR, just like games are created. 

Imagine we are creating these medical scenarios - a scene inside an operating room or inside an emergency room which are all virtual reality simulations but once you are in the environment, you are actually there and we are reacting to that environment. You are required to make certain decisions. So it's an incredibly good learning tool. At this time only some are using these technologies but I foresee that a few years down the line, we will see mainstreaming of all these technologies.

What is your opinion on the artificial heart and the advancements it's making? Can this become a reality in the near future or it still remains a distant dream?

There are a few ways in which the artificial heart technology is advancing today- one is the mechanical artificial heart which is transplanted for the time being and acts as a bridge towards transplantation of a donated heart. That is an area where existing patents have expired and now it's open to everyone. Number two is creating an actual artificial heart, here again, the 3D technologies may have a huge importance.  But they are still far from that particular dream because this involves not just creating the structure of an organ, for example, it is relatively simple, even today to create a three-dimensional structure of a heart using cells. 

But giving it the hundreds of functions that these tissues have, which include responding to various kinds of hormones and various chemical signals, and having the electrical conductance that regulates the heartbeat. All these functions would need another level of science where the integration of other parts of science like genetics and epigenetics and various neurochemical mechanisms would also need to be incorporated. 


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