Robotics and augmented reality promise to improve access to care and reduce patient anxiety

SAN FRANCISCO, CA – Innovative technology that changes reality in a way that benefits both doctors and patients may soon find its way into the catheterization lab, experts said here today at TCT 2019 during a a session devoted to intelligent interfaces, robotics and remote manipulation.

Louis Aaron Cannon, MD (Northern Michigan Heart and Vascular Research Center, Charlevoix), told TCTMD that the use of robotics could have the potential to address demographic disparities.

“Wealthier people are treated very differently than people who don’t have access to supersub-specialists, and I think robotics is going to help solve that problem,” he commented. “We’re already developing robotic catheters and different haptics, and it’s all going to converge into a situation where we’re really going to be able to treat patients better.”

Cannon, who presented a keynote on emerging cath lab trends, said the technology could also be useful in cases where patients in a remote location, who have a heart attack or stroke, and who don’t have access to an interventional cardiologist or an interventional radiologist, could be treated by someone thousands of miles away.

“I think this will potentially change what we do on the battlefield; cruise ships could also use this technology because they have large elderly populations at risk,” Cannon observed. “If you only have a lab or a suite and you contract with a major medical institution, you would be able to care for a patient with an MI or a stroke without having to bring in a helicopter or moving it.”

Gaps in stroke care, improving patient experience

According to Cannon, remote care via virtual reality may also be a key to addressing stroke care needs. He said the United States is projected to have an estimated shortage of 61,800 stroke specialists by 2030. Of all US hospitals, only 3.8% are comprehensive stroke centers, leaving the major part of the country with limited access to advanced stroke care.

“You can easily imagine where you have robots in these areas with an interventional radiologist at the base who can manipulate catheters and take care of a stroke 100 or 1,000 miles away, or on a cruise ship or on an island “, Cannon mentioned. But turning this concept into reality will require, among other things, a rapid response system, skilled experts in arterial access and catheter manipulation, and strong computer and telecommunications networks.

Virtual reality technology can 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 combined with mindfulness to reduce the need for sedation during diagnostic angiogram in 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 tranquil lake. No IV sedatives were used and all patients received 100 µg of nitrate in the radial artery. Only one case of radial spasm has been documented, without conversion to femoral access. Pulse and systolic blood pressure did not vary between the pre-, intra- and postoperative 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, patients’ average score was mild to moderate at 50. According to Koganti, after the procedure, several patients asked to be able to reuse the virtual reality device for subsequent procedures.

Virtual reality “is feasible, safe and, for the first time ever demonstrated in the literature, effective in the catheterization laboratory at the time of interventional procedures,” Koganti said in his presentation. Although the study is small and limited to angiograms, he said other procedures that might be good candidates for this type of technology to reduce the need for sedation include PCI, pacemaker implantation cardiac devices, implantable cardioverter defibrillators and certain structural cardiac interventions, including TAVR.

We must not forget with all these technologies that we take care of human beings. Giora Wiesz

During the same session, Radoslaw Parma, MD, PhD (Medical University of Silesia, Katowice, Poland), showed a first attempt at augmented reality that went less well. In the study, operator-worn glasses were used in an attempt to improve TAVR by providing patient-specific multi-slice CT overlay of peripheral vessels. The concept is that overlays can improve TAVR operators’ field of view and help select optimal arterial segments to perform a safe puncture. The researchers used mixed-reality smart glasses known as HoloLens (Microsoft), but quickly 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 hopes that an updated version of the device, which is lighter, offers better spatial mapping and allows the operator to pinch, drag and push the overlay might prove more useful.

No replacement for ‘Human Touch’

Panelist Giora Weisz, MD (Montefiore Medical Center, New York, NY), noted that communication will be key to the success of remote or augmented reality procedures, to ensure the operator has access to all data of the patient, including “real-time integrated” imaging.

Obviously, more studies are 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 he future could be here before we know it.

“I look at my smart phone and I say to myself that barely 10 years ago, where were we? ” he said. In the digital revolution, “things will change enormously”. Lotan then wondered aloud if robots could one day completely replace doctors in the cath lab.

But Weisz countered that while machines can do many things as well as men and women, that sentiment isn’t true for one thing: human contact. “We must not forget with all these technologies that we take care of human beings,” he said.