Five major applications of VR and medical treatment

　　We set up our own doctor group based on our past belief that doctors have always been a neglected group in China's entire medical industry ecosystem. In the past, in our traditional system, when doctors were hospital employees, their labor and creativity were actually constrained to a certain extent. After we independently established a doctor group, the entire ecosystem, including insurance, medical care, hospitals, the Internet, drugs, equipment, etc., all links rely on doctors to realize its application. After we came out, we were also favored by various industry organizations, and our creativity was also released. VR is one of the very important areas.

　　My interest in VR technology started with a practical training course during college.

　　Speaking of VR, I had no idea about it before. When I was in college, I had a headache taking anatomy classes because the anatomy shown in the books did not have a three-dimensional concept. There was no 3D anatomy at that time, and the concept of 3D was obtained through the dissection of corpses. And corpses were in short supply, so about eight people went to dissect them in a group, and the remaining parts had to be left to the doctors of the affiliated hospital. So a corpse was very expensive and we had few opportunities to touch it. If we could enter the anatomy class to dissect corpses, there were not many courses. A group of several people took turns to dissect, and few people could really see this thing. If one person in front of them dissected it badly, they could not see the original appearance. And the corpses were all soaked in formalin, so everyone was in tears when they entered the class. Even so, everyone was still very enthusiastic, because through dissection, what we learned from the books can indeed emerge in our minds.

　　At that time, I had an idea that it would be great if it was a three-dimensional model. At that time, there were some models, such as anatomical specimens or something, but there was no interaction between people and specimens. At that time, I felt that learning anatomy was a very painful thing. I kept thinking, if there is a simulation, like playing a game, where you can open it at any time and look at it back and forth, how helpful it would be for our anatomy.

　　That was actually a prototype of VR. At that time, there were no computers or many other things. It was just an idea. I wondered if there was such a thing in the world. At that time, I thought only aliens had this thing, but now I find that many things today are better than I thought. Today, let's talk about what imaginable applications virtual reality can have in doctor groups.

　　From a doctor's perspective, VR technology can be roughly divided into five major applications. These five categories of applications may provide ideas for our VR technology research and development institutions in the future, because doctors know which VR technologies can truly improve our medical quality during application, so I will share these five applications with you.

　　The first application is to solve our anatomy learning problem.

　　Our current university education system is eight years. I often think that with the continued development of the Internet, if our medical studies can be improved through VR technology, I think at least the course of anatomy can be shortened by 80%, which is based on a very realistic, three-dimensional, and interactive virtual reality. The virtual reality of the heart is very realistic. I can hold the heart in my hand and turn it around at any time, open the muscles to see, and see the blood flow. This can greatly shorten our learning cycle. Especially for surgeons, a very important knowledge for surgeons is anatomical knowledge, local anatomy knowledge. In the past, we learned local anatomy knowledge through books, and we only saw flat things. There were few three-dimensional concepts in our minds and we could not interact. The emergence of VR technology allows surgeons to gain experience in local anatomy before performing surgery, which can effectively improve the safety of surgery. And our medical students will greatly speed up their learning speed through VR anatomy technology, while reducing the cost of learning. Of course, we are not only in medical anatomy, I think that in physiology and biochemistry, we can simulate scenes through VR technology, which involves some things that we cannot see with the naked eye, such as chemical reactions and physiological changes. Such changes can be simulated through virtual reality. If we can obtain very vivid information, doctors' knowledge expansion and learning speed will be accelerated.

    The second application is that we will reduce our internship costs in the future for medical students.

　　Our doctors' internships are now on-site, with teachers to guide them. They need to arrange how to wear clothes in the operating room, how to ensure sterility, etc. This kind of scene can be set in VR products in the future. In other words, many times we don't need to go to the real scene of the hospital. We can get familiar with the entire process of the hospital directly in the virtual scene. Now in our public hospitals, a lot of doctors go in to watch the patient's surgery, and the patient can't say anything. In the future, more and more patients will say that they don't like it. I don't want so many people around me. What should I do at this time? The necessity of learning cannot be cancelled casually, so there must be a simulated scene to reflect the real learning process, that is, the VR scene. In this way, the privacy of patients is protected, and the second is to reduce costs. It is a teacher teaching, and the whole lecture process does not need to be repeated repeatedly. In the past, we were divided into four groups, and each group had a turn to go. The teacher would give a lecture once, so the teacher might repeat it four times.

　　Then each student can only enter this scene once, and some students with poor memory will forget what they learned after they come out. VR technology can solve this problem. You can review repeatedly, and the teacher doesn't have to talk so much. In this sense, the cost of teaching will be greatly reduced. The first two categories are based on our future training of young doctors, basic knowledge, or how new employees can become familiar with our field. Our doctor group is still constantly optimizing our treatment scenarios. For some new doctors to become familiar with this scenario, we can complete all the procedures at home at the fastest speed.

　　The third is simulated surgery, which I think will develop very rapidly internationally in the future.

　　Because when I attended the American Society of Surgeons Annual Meeting, you will see that about half of the booths outside the entire conference are simulated surgeries. This is different from China, where most of the booths are gray income booths, stents or equipment. They have a large number of simulated surgery booths, which is very different from us. From this we can see that simulation training is widely used in medical treatment abroad.

　　In the past, doctors only had the opportunity to practice their skills on patients, so it is often said that famous doctors have stepped on the blood of many people to get to where they are. The price paid is too high. In the future, simulated surgery is very important in the growth of doctors. You can simulate various scenarios without harming the patient. The simulated scenarios may be more than the situations you actually encounter. In this way, the effect of simulated training actually exceeds the real practice of the knife. On the one hand, simulated training can be repeated at home to deepen the impression, which cannot be done on patients because the patient's resources are limited. In the past, when we performed surgery, several graduate students surrounded the outside in a circle, inside and outside, so the doctor had very few opportunities to really contact the patient. Simulated surgery is to present each operation in front of you, and everyone has unlimited opportunities. You can watch it repeatedly, and it does not harm the patient.

　　From this point of view, when a doctor who has undergone simulation training performs surgery on a patient, his learning cycle will be very short, which is actually a great protection for the interests of patients. Simulation surgery is already available in China. For example, we visited Johnson & Johnson. The surgical training center of Kehui Company already has laparoscopic simulation, interventional surgery simulation, and of course da Vinci surgery simulation, but this kind of simulation is not a real scene. In other words, in the future, VR technology can completely enter the operating room and perform simulated surgery in a real scene, which may be closer to reality.

　　The fourth major area is that I believe VR technology will directly enter our treatment field in the future, that is, it can cure diseases.

　　We believe that virtual reality will be widely used in rehabilitation. Our current rehabilitation mainly focuses on sports training and psychological help. The simplest example is that when a patient is undergoing sports rehabilitation, virtual reality can allow him to experience obstacles in the outside world in a safe treatment environment, making his training more interesting and allowing him to perform some movements more realistically.

　　We can even imagine a patient with frozen shoulder who cannot lift his arm but must do some hand-raising movements. Then, can we let him go to the orchard to pick apples? The apples should be high and low. He can pick a few apples and then enter this real virtual world to raise his hands to pick apples. This is much more effective than the motivation that the doctor asks him to raise his hands.

We have set up the only vascular rehabilitation center in China with Beijing United Family Hospital, which mainly targets patients with lower extremity arterial occlusive disease. The therapeutic effect of exercise training is sometimes better than that of stents. These exercise training must be under the guidance of doctors, and its treatment cycle is generally about three months. At this time, if virtual reality technology is introduced, if a scene is set when the patient is walking, for example, the first five minutes are in the park, or he likes to walk on the beach, or on the streets abroad, I believe this kind of training will be a great help to the patient's motivation and interest. Our exercise training requires him to insist on walking for a distance when he can't walk. If there is such a scene, it is more simulated real life for him and more interesting and fun.

　　Therefore, VR has a unique advantage in sports training. Of course, I think psychological support is more important. Virtual reality is a visual stimulation to people, and the visual stimulation is very strong. In real life, when many people are in a bad mood, they will think about going to Lijiang for a walk. They have to go to a faraway place to relax their minds. So why can't we complete the entire travel process at home, and even design scenes that don't exist in real life to interact with personal emotions.

　　In this picture, you can actually see that the heart you see when you put on the helmet is the same as the one in the picture. It is completely real and right in front of you. You can bring it closer, put it in your hand, open it, and turn it in a circle. This is very useful for learning anatomy. In the future, after the deep development of virtual reality, it will not be a static anatomical picture designed, but a dynamic one, such as blood flow dynamics will be integrated into it. You can even see a simulated blood flow. If a stent is placed in this part of my aorta, how will the blood flow change? Virtual reality can help doctors judge the possible changes in blood flow in the future, that is, to understand the impact of stents of different sizes on blood flow changes in a virtual way, which is very helpful for doctors to formulate plans.

　　The last part is that for our doctor group, we envision improving patient experience in the future.

　　Because in the past, when patients went to the hospital, they were unfamiliar with the scene. In the past, when we went to the hospital, the doctor didn't know the patient at all. The tension in the doctor-patient relationship now is actually related to the patient's experience. In other words, it is actually quite difficult for patients and doctors to establish trust when they are completely unfamiliar with each other. Because in the United States, many doctors are family doctors, and patients have a prior understanding of the doctor. Another thing is that it takes time to establish trust between doctors and patients. In the United States, doctors are taught how to establish trust with patients in the shortest time. The model of seeing a doctor in our country is a little different. If there are many people in the current public hospitals, it takes three to five minutes to see a patient, so the trust between doctors and patients has not been established before the treatment ends, and conflicts are very likely to arise at this time.

　　Our doctor group has a very good relationship with patients because we have plenty of time, but even so, there is still some tension or distance. He is not familiar with the entire process of coming to the hospital. Can we use VR technology to present his process to patients in the future? He has reviewed it at home in advance, and he is very familiar with the process after arriving at the hospital. In addition, some patients will feel mysterious about the operating room. At this time, we can consider letting the patient experience the entire process of the operation and let him know what the operation is about. This may be very helpful for him to eliminate his fear.

　　How can we guide our patients after they return home after surgery? Of course, we used to watch pictures, videos, and recordings, but if there is a virtual reality, the patient will feel like they are in the hospital, which is very helpful for the patient's entire recovery process.

　　On the other hand, our doctors also provide them with a lot of information. From a technical point of view, they will consider very perfect details. But from the doctor's point of view, which links can be simplified and which links are the key points, then the solutions we propose may greatly reduce their costs, and at the same time increase their overall importance of product training. Because a training course must have a focus, which fatal errors will definitely cause the failure of the operation, which are relatively minor problems, and how to design a product closer to reality, our doctor team can provide a lot of useful information to the medical production team. We have already done one issue, and we haven't seen the surgery thing yet. Now, let's invite Mr. Pan from Yiweixun to introduce their products and their views on VR. I also hope to know why the Yiweixun team chose our doctor group and look forward to what kind of help the doctor group can give them in terms of products. I will stop here first, and please continue this topic.

　　Mr. Pan Geng, CEO of Yiweixun, shared his thoughts

　　Many of our product designs are based on the personal experience of professional doctors. You just saw a video of a 3D virtual reality product we made, which was just released this afternoon. This product is a virtual interactive device based on HTC Vive. As Dr. Zhang Qiang said, it allows users to perform surgical operations in a virtual operating room. Due to time constraints, this group of demos did not cooperate with Dr. Zhang Qiang. We chose a relatively simple bone fixation operation for the demo.

　　Just now, Dr. Zhang Qiang talked about several applications of VR in the medical field. I would like to add a little about anatomical teaching. When we contacted doctors, everyone generally mentioned the problem. In fact, the combination of anatomy and 3D virtual technology has started a long time ago, but unfortunately, there is no anatomical model specifically for Oriental people in China. The anatomical atlas used in the "Anatomy" published by the People's Medical Publishing House is derived from the version introduced by the Soviet Union in the 1950s. Most of the more representative virtual anatomy software you have seen are anatomical software developed based on the characteristics of Westerners. This is a pity for us as a digital 3D production company. Therefore, we still spend a lot of time on some medical animations or medical virtual interactions, and we can't do research on virtual anatomy. This is the difficulty we are currently facing. Although we don't have a complete anatomical 3D model data map now, our existing data on system anatomy is complete. Our company's data in some fields such as cardiovascular, orthopedics, and orthopedic surgery can meet the requirements. Therefore, in the products we design in the future, we will follow Dr. Zhang Qiang's suggestion. When we perform virtual surgery, we will use 3D models as an important auxiliary means, and we can call out the three-dimensional model before, during, and even after the operation. It constantly reminds the doctor from another perspective of the progress of the current operation, the location of the operation, what blood vessels need to be avoided, and the location of the main lesions.

　　The second question is about the experience of medical students on the product. Dr. Zhang Qiang said that this is a very good idea. Because we, who have never been in the operating room, or R&D personnel who rarely come into contact with surgeons, cannot experience the tension of entering the operating room and the effects of the environment. I have been in the operating room, and I was deeply impressed by the tension and excitement at that time. VR technology can reshape the product and help us adapt to the environment as quickly as possible.

　　The third question is about the research on simulated surgery. Dr. Zhang Qiang also mentioned its significance and value earlier. We found that a very important issue is that surgery now has a trend of standardization and normalization. In this process, the difficulty mainly lies in the inability to provide effective guidance. So in the process of VR surgery training, we hope to complete the work of normalization and normalization. Another difficulty is from a technical perspective, which is to make VR surgery as close to reality as possible.

　　As you can see in this demo, we spent a lot of effort on studying physical collision and surgical accuracy. Because surgery is not the same as a game. In fact, there is a game called "CrazySurgeon" in HTC Vive. But the biggest problem with this game is that it is too casual. In the end, it became a heavy game because you can use any device to randomly scratch people. I personally think this is a frivolous behavior. Our approach is not to turn it into a software that people can operate casually.

　　We used some binding and locking, and the user must follow the surgical steps step by step. If there are jumps or unconventional operations, the user cannot proceed. At the same time, it is also autonomous, and this autonomy means that we have some means to help surgeons deal with emergencies during surgery. For example, when cutting with a scalpel, there will be special effects if it exceeds the range of the standard incision, reminding that the incision must meet the standard.

　　However, surgery is indeed too complicated. The project we are working on now is quite strenuous, but its significance and value are very great. I want to emphasize one point here. Yiweixun is a technology application innovation company. We do not produce surgical knowledge. We are just a disseminator of medical experience. Therefore, we now spend a lot of money on communication and exchanges with medical experts. There is a very important problem in the process of these communications and exchanges. Although our team members have people with surgical backgrounds as project managers, most of them do not have medical backgrounds. Therefore, we have to spend a lot of time on internal discussions; the process documents we produce also need to be communicated in depth with experts and doctors, and the demos we produce also need to be tested with them.

　　This process is relatively long, but we are willing to do it. Because as Dr. Zhang Qiang just said, a good medical simulation device can help surgeons solve big problems, so that they no longer need to practice on humans, animals or corpse specimens. These are scarce and irreversible resources. I often joke that surgery is like painting, but if the painting is not good, you can tear it up and repaint it, but if the surgery is not done well, can you do it again? No, this is a disrespect for the patient's right to life. I personally think that the biggest feature of VR technology is that although the production cost is very expensive, the cost of actual teaching application is very low. Because you can practice and simulate many times, there is no harm if you make a mistake.

　　In addition, in my last sharing, I mentioned the clinical assistance of VR technology, which is a development direction besides education. For example, the core of 3D printing, which is very popular now, is to restore the patient's complex lesions and anatomical relationships through 3D reconstruction of patient imaging data. As we all know, its ultimate goal is to make preoperative designs. Although 3D printing technology is very mature now, the cost is very expensive.

　　I saw a report some time ago that there was a conjoined twin in the Children's Hospital of Fudan University, and they spent a lot of time printing the 3D model of the conjoined twin. I personally feel that with VR technology, we can directly observe the model that does not need to be printed in the VR world and restore the scene in 3D. Just like the picture that Dr. Zhang Qiang just shared, it can truly restore the flatulence, lesions, and surgical path in 3D space. I am not saying that 3D printing is not good. At least in a sense, we really don't need to print the case into a physical object to view it. I believe this is very valuable for clinical assistance.

　　In addition, I mentioned AR technology last time. Its application space in the future is more imaginative than VR. If we can superimpose the 3D reconstruction of the patient's image and the physical position, as we just did, the doctor can observe the direction of important nerves and blood vessels in the surgical area in real time by wearing AR equipment during surgery, and can also clearly indicate the location of the lesion, so that the surgical control will be stronger. I think there is a lot of room for imagination in this regard.

　　I would also like to share with you the application of VR technology in motion capture. You should know that in sports, such as football and gymnastics, there are slow-motion replays and motion capture to analyze whether the athletes' movements are in place and what the reasons are for mistakes. This technology can also be used in surgery. Through motion capture or gesture recognition and VR technology, after surgeons learn or try, they can restore the operation and see the process of the operation. If there are mistakes, what are the reasons. This kind of replay can greatly help doctors improve their skills. This is our latest research. I am also looking for domestic suppliers of gesture recognition and wearable devices to work together to overcome this difficulty.

　　In addition, I would like to talk about the application for patients mentioned by Dr. Zhang Qiang. When patients arrive in an unfamiliar environment, they will inevitably have a stress response. I once talked to a patient and he felt that when he was waiting outside the operating room and the anesthetic had not yet taken effect, his nervousness and fear were the strongest, and he even had a near-death experience. Let's think about it now, this experience is very bad for everyone. If VR technology is used to play a piece of content that is easy to relax him in this environment, so that he can have a general understanding of what the operating room and the surgical process are like before entering the operating room, his fear of the unknown environment can be eliminated. I believe this is a humanistic care for patients, which can be effectively applied in improving the level of medical services. Dr. Zhang Qiang now attaches great importance to patient services, and I believe this is where we have the opportunity to cooperate in the future.

　　Finally, I want to talk about another issue, which is the problem of doctor-patient communication. Just now, Dr. Zhang Qiang also emphasized that even if there is ample time for communication like the Zhang Qiang Doctors Group, it is very tiring to simply speak, use pictures, or even draw diagrams by hand, because the complexity and professionalism of medical knowledge, including some technical terms, are really selective memory for patients. They may forget the second half after listening to the first half of the sentence, or even miss the most important things, and understand your meaning in fragments. This is the voice of all doctors when communicating with patients.

　　In fact, we can really use virtual reality technology to simulate a general cause, pathology, plan, and process of the surgery. We don't need to explain it in great detail, just give a general idea. The important thing is to talk about the risks of the surgery and our response measures to reassure the patient. This is much better than putting a cold surgical consent form in front of the patient. I believe that this way of communication is helpful in resolving the current tension between doctors and patients. I hope that VR will do some research on patient education and doctor-patient communication in the next step. I will stop here for today. Finally, I would like to thank Dr. Zhang Qiang. I hope that Dr. Zhang Qiang and all the doctors under his group will continue to support our project as always.