Immersive 3D Visualisations (3D Printing, Virtual Reality) enhance spatial understanding of complex cardiac dysmorphology imaging

Background Diagnosing, managing complex CHD demands excellent morphological understanding. Individual differences in visuospatial skills, training and experience can impact spatial interpretation of volumetric cardiac imaging. Immersive 3D visualisation may help overcome these challenges, but evidence of clinical benefit is lacking. This study explores variability in visuospatial abilities and interpretation of conventionally viewed volumetric cardiac imaging data among members of a pediatric cardiac unit, and impact of using immersive 3D formats (3D-prints, Virtual Reality) on spatial understanding of complex CHD morphology. Methods Prospective cohort study involving 9 heterogenous members of an advanced pediatric cardiac program [3 consultant cardiologists, 2 cardiothoracic surgeons, 1 cardiac radiologist, 3 cardiology trainees]. Participants’ visuospatial abilities were quantified using a validated test (Revised PSVT:R). Understanding of spatial relationships between anatomical structures was assessed using structured questionnaires for 17 unique anonymised volumetric cardiac scans (15 CT, 2 MRI) of complex CHD visualised in three formats 1). conventional DICOM (CDICOM); 2). 3D prints (3DP); 3). Virtual Reality (VR). Accuracy, time taken, perceived level of difficulty, and confidence in interpretation were assessed and compared. Results Spatial abilities varied widely (median 8, IQR 6-30), independent of expertise/experience. Limitations in conventional reading were significantly overcome with immersive 3D. Mean accuracy score of 60.48% ±17.13% with CDICOM increased to 83.93% ± 7.84% with 3DP, and 90.81% ± 5.03% with VR (p<0.001). 3DP and VR permitted significantly faster interpretation (p<0.001), with significantly better ease and confidence. While immersive 3D visualisation led to significantly improved spatial understanding for all, it also minimised differences between participants with widely variable skill and experience levels. Conclusion This study provides evidence that immersive 3D visualisation can enhance spatial understanding of complex CHD morphology, overcoming challenges in spatial ability, experience, expertise. These technologies may be suitably leveraged as effective clinical and teaching tools in congenital cardiology. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any external funding.Partially funded by Institutional research grant of Amrita Institute of Medical Sciences ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics Committee of Amrita Institute of Medical Sciences, Kochi, India gave ethical approval for this work I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors * CHD : Congenital heart disease CT : computed tomography DICOM : Digital Imaging and Communication in Medicine MRI : magnetic resonance imaging PSVT:R : Perdue Spatial Visualisation Test - Test of Rotations