Robotics and Augmented Reality Show Promise for Improving Access to Care, Reducing Patient Anxiety
Despite some promising new technologies, one expert warns there is no replacement for human touch.
SAN FRANCISCO, CA—Innovative technology that alters reality in a way that benefits both physicians and patients may soon have a place in the cath lab, experts said here today at TCT 2019 in a session devoted to intelligent interfaces, robotics, and telemanipulation.
Louis Aaron Cannon, MD (Cardiac & Vascular Research Center of Northern Michigan, Charlevoix), told TCTMD that the use of robotics may hold the potential to address disparities in population demographics.
“Wealthier people are treated very differently than people that don't have access to supersubspecialists, and I think robotics is going to help address that,” he commented. “Already we're developing robotic catheters and different haptics, and all this is going to converge in a situation where we are really going to be able to treat patients better.”
Cannon, who presented a keynote lecture on emerging cath lab trends, said the technology also may be useful in instances where patients in a remote location, who have MI or stroke and no access to an interventional cardiologist or interventional radiologist, could be treated by someone thousands of miles away.
“I think this is potentially going to change what we do in the field of battle; cruise ships also could use this technology because they have large elderly populations at risk,” Cannon observed. “If you just have a lab or a suite and you contract with a large medical institution, you would be able to take care of a patient with an MI or a stroke without having to get a helicopter in to them or move them.”
Gaps in Stroke Care, Improved Patient Experience
According to Cannon, remote care via virtual reality also may be a key to addressing stroke-care needs. He said it is expected that the United States will have an estimated shortage of 61,800 specialists to treat stroke in 2030. Of all US hospitals, only 3.8% are comprehensive stroke centers, leaving most of the nation with limited access to advanced stroke care.
“You can easily picture where you have robots in these areas with an interventional radiologist at the base that can manipulate catheters and take care of a stroke from a 100 or a 1,000 miles way, or on a cruise ship or on an island,” Cannon said. But turning this concept into reality will require, among other things, a system of rapid response, experts skilled in arterial access and catheter manipulation, and strong IT and telecommunications networks.
Virtual reality technology may also directly benefit patients during their procedures.
In a small study, Sudheer Koganti, MD (Citizens Specialty Hospital, Nallagandla, India), and colleagues showed how it can be coupled with mindfulness to decrease sedation needs during diagnostic angiogram for suspected CAD. During the procedure, 30 patients wore a virtual reality headset that allowed them to have a personalized audio/visual experience such as being on a beach or near a quiet lake. No IV sedative was used, and all patients received 100 µg of nitrate into the radial artery. Only one case of radial spasm was documented, with no conversion to femoral access. Pulse and systolic blood pressure did not vary across pre-, intra-, and postprocedural periods. Additionally, pain scores were consistently low and patient satisfaction high. On the State-Trait Anxiety Inventory (STAI), with 20 being the lowest and 80 being the highest, the average patient score was mild-to-moderate at 50. According to Koganti, after the procedure, several patients asked to be able to use the virtual reality device again for subsequent procedures.
Virtual reality “is feasible, safe, and for the first time ever demonstrated in the literature, efficacious in the cath lab at the time of interventional procedures,” Koganti said in his presentation. Although the study was small and limited to angiograms, he said other procedures that may be good candidates for this type of technology to reduce need for sedation, include PCI, pacemaker implantation, implantable cardioverter defibrillators, and some structural heart interventions, including TAVR.
We should not forget with all these technologies that we’re taking care of human beings. Giora Wiesz
In the same session, Radoslaw Parma, MD, PhD (Medical University of Silesia, Katowice, Poland), showed an early augmented reality attempt that went less smoothly. In the study, glasses worn by the operator were used in an attempt to improve TAVR by providing a patient-specific multislice CT overlay of peripheral vessels. The concept is that the overlays can enhance TAVR operators’ field of vision and aid in selecting optimal arterial segments to perform a safe puncture. The researchers used mixed-reality smart glasses known as HoloLens (Microsoft), but soon learned that they were too heavy, the resolution too low, and the battery life too short to be practical. Despite this, Parma said his group is hopeful that an updated version of the device that is lighter, provides better spatial mapping and allows the operator to pinch, slide, and push the overlay may prove more useful.
No Replacement for ‘Human Touch’
Panelist Giora Weisz, MD (Montefiore Medical Center, New York, NY), noted that communication will be the key to the success of remote or augmented reality procedures, to ensure that the operator has access to all patient data, including imaging “integrated in real time.”
Clearly more study is needed before many of these new technologies are ready for prime time, but panelist Chaim S. Lotan, MD (Hadassah Medical Center, Jerusalem, Israel), observed that the future may be here before we know it.
“I’m looking at my smart phone and thinking just 10 years ago, where were we?” he said. In the digital revolution, “things are going to change tremendously.” Lotan then wondered aloud whether robots may someday replace physicians completely in the cath lab.
But Weisz countered that while machines can do many things as well as men and women, that sentiment is not true for one thing: human touch. “We should not forget with all these technologies that we’re taking care of human beings,” he said.
Cannon LA. Keynote lecture: Emerging cath lab technological trends that will impact the future of cardiovascular medicine. Presented at: TCT 2019. September 25, 2019. San Francisco, CA.
Koganti S. The use of virtual reality to decrease sedation needs during interventional procedures. Presented at: TCT 2019. September 25, 2019. San Francisco, CA.
Parma R. Augmented reality MSCT-guided puncture in TAVR procedures. Presented at: TCT 2019. September 25, 2019. San Francisco, CA.
- Koganti and Parma report no relevant conflicts of interest.
- Cannon reports relationships with Corindus Vascular Robotic Systems, Siemens Healthineers, Transmedics, and Biostar Ventures; and is a significant Shareholder in Corindus Vascular Robotics and a minority shareholder in Foldax and Vytronus.