The Use of Virtual Reality for 3D Diagnostic Imaging Review Enhances Understanding and Education of Patients with Cancer

Douglas E Holt; Alaina L Carr; Sydneyjane Roberts; Sarah A Milgrom; Elissa Kolva; Brian D Kavanagh; Galen E Switzer; Chad Eitel; Jordan Nelson; Brian Miller; Jay Shiao; Adam C Mueller; Sana D Karam; Tod R Clapp

doi:10.1016/j.ijrobp.2025.02.038

The Use of Virtual Reality for 3D Diagnostic Imaging Review Enhances Understanding and Education of Patients with Cancer

Int J Radiat Oncol Biol Phys. 2025 Mar 28:S0360-3016(25)00180-4. doi: 10.1016/j.ijrobp.2025.02.038. Online ahead of print.

Authors

Douglas E Holt¹, Alaina L Carr², Sydneyjane Roberts³, Sarah A Milgrom⁴, Elissa Kolva⁵, Brian D Kavanagh⁴, Galen E Switzer⁶, Chad Eitel⁷, Jordan Nelson⁷, Brian Miller⁸, Jay Shiao⁹, Adam C Mueller¹⁰, Sana D Karam¹¹, Tod R Clapp⁷

Affiliations

¹ Idaho Cancer Center, Idaho Falls, Idaho; Department of Radiation Oncology, University of Colorado, Denver, Colorado. Electronic address: douglas.holt@cuanschutz.edu.
² Department of Psychology, University of Colorado, Denver, Colorado; Georgetown Lombardi Comprehensive Cancer Center, Washington, District of Columbia.
³ Department of Psychology, University of Colorado, Denver, Colorado.
⁴ Department of Radiation Oncology, University of Colorado, Denver, Colorado.
⁵ Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
⁶ Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
⁷ Department of Biomedical Sciences, Colorado State University, Fort Collins, Colorado.
⁸ Department of Radiation Oncology, University of Colorado, Denver, Colorado; Department of Radiation Oncology, University of Arizona, Tucson, Arizona.
⁹ Department of Radiation Oncology, University of Colorado, Denver, Colorado; Department of Radiation Oncology, University of Kansas, Kansas City, Kansas.
¹⁰ Department of Radiation Oncology, University of Colorado, Denver, Colorado; Department of Radiation Oncology, University of Pittsburgh, PA Pennsylvania.
¹¹ Department of Radiation Oncology, University of Colorado, Denver, Colorado; Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri.

PMID: 40152846
DOI: 10.1016/j.ijrobp.2025.02.038

Abstract

Background: Patients with cancer can struggle to understand their disease, symptoms, therapy, and treatment-related toxicities with current educational methods. Virtual reality (VR) may more effectively convey this abstract and complex information through interaction and exploration of patient-specific 3-dimensional (3D) rendered volumetric medical diagnostic imaging. This study aimed to assess the impact of VR-based imaging review with patients and their caregivers.

Methods and materials: This prospective mixed methods study enrolled patients with cancer who were treated with radiation therapy and their caregivers. A total of 38 participants were shown their own diagnostic imaging with 2D-planar views on a computer screen then in 3D using VR. Data were collected with pre- and post-VR Likert-scale questionnaires and interviews. Quantitative data analyzed using Wilcoxon signed-rank test. Interview data were analyzed qualitatively.

Results: Patients ranged from 11 to 95 years old. The time from diagnosis to VR was a median of 5 months. Qualitatively participants noted poor comprehension of their disease and treatment with traditional educational approaches. However, they reported VR as a more informative, effective, and easier method to convey this information. Quantitatively patients' and caregivers' self-reported understanding of their disease significantly improved from pre-VR (mean 5.6) to post-VR (mean 9.2; P < .0001; 0 = none, 10 = full). VR was the top-rated educational tool by 83% of participants over all other educational strategies, and 97% preferred reviewing diagnostic imaging in 3D using VR, over 2D on a computer screen. VR led to a higher level of patient-reported understanding over 2D imaging review in every survey domain (P < .0001). VR was recommended by 97% of participants to become standard-of-care.

Conclusion: In this prospective mixed methods study, patients and caregivers reported significantly improved understanding using VR-based 3D imaging review compared with currently utilized methods. VR was patients' most preferred and top-rated educational tool. Further study is warranted to optimize the use of VR to improve patients' understanding of their disease and treatment.