Use of Three-Dimensional (3D) Airway Modeling and Virtual Reality for Diagnosis, Communication, and Surgical Planning of Complex Airway Stenosis.

Objective: We hypothesized that a method to segment human airways from clinical cases and import them into a case presentation environment in Virtual Reality (VR) could be developed to model and visualize complex airway stenosis for efficient surgical planning.

Methods: One normal and two pathological airways modeled from CT scans at a slice thickness of 0.625 mm were processed. A multidisciplinary team composed of airway surgeons, VR engineers, educators, and radiologists collaborated to create a clinically relevant VR rendering and explanatory Narrations of the three clinical cases. Segmentation and postprocessing were completed in the Mimics Innovation Suite v24 from Materialize. Structures were segmented from the level of bifurcation of common carotid arteries to the level of bifurcation of the main bronchi, including cartilaginous and bony airway structures, vessels, and soft tissues. They were then postprocessed into 3D image volumes and imported into syGlass (IstoVisio Inc.), a VR software.

Results: Direct visualization and free manipulation of these 3D airway models within the VR environment provided improved geometrical and anatomical details compared to traditional two-dimensional (2D) CT. Then, specialized presentation and active learning tools developed for scientific communication using the VR environment permitted the creation of VR Narrations to explain pathological cases.

Conclusion: The method to segment human airways from clinical cases used in this paper, combined with intuitive VR tools to overlay segmentation and image data in an active learning environment, shows potential in the use of 3D airway modeling and VR in clinical practice for the description and surgical planning of complex airways. Further work is needed to validate the use of these models in clinical practice and patient education.

Level of evidence: Level 4.