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 Table of Contents  
Year : 2022  |  Volume : 8  |  Issue : 1  |  Page : 24

Extended reality metaverse application in cancer radiotherapy: New opportunities and challenges

Department of Oncology, Xinqiao Hospital, Army Medical University, Chongqing, China

Date of Submission12-May-2022
Date of Decision04-Aug-2022
Date of Acceptance15-Aug-2022
Date of Web Publication21-Oct-2022

Correspondence Address:
Jianguo Sun
Department of Oncology, Xinqiao Hospital, Army Medical University, Chongqing 400037
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/digm.digm_26_22

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How to cite this article:
Zhao L, Sun J. Extended reality metaverse application in cancer radiotherapy: New opportunities and challenges. Digit Med 2022;8:24

How to cite this URL:
Zhao L, Sun J. Extended reality metaverse application in cancer radiotherapy: New opportunities and challenges. Digit Med [serial online] 2022 [cited 2023 Jun 8];8:24. Available from: http://www.digitmedicine.com/text.asp?2022/8/1/24/359356

  Preface Top

Recently, the metaverse craze has started again, according to the transition to an untact society due to the corona virus disease 2019 (COVID-19) pandemic.[1],[2],[3] The following 4 existing metaverse types, including augmented reality (AR), lifelogging, mirror world, and extended reality (ER), are accelerating the utilization of the metaverse as it evolves into a new type of convergence service.[4] It also breaks down the boundaries between these types of the metaverse. Due to the COVID-19 continues to spread, traditional face-to-face communication becomes a difficult activity. That were thought to be only possible offline activities are being converted to ER and are rapidly extending into various areas such as tourism, medical care, fashion, and education.

ER is a type of the metaverse that simulates the real process of the radiotherapy.[5],[6],[7] ER technology includes sophisticated three-dimensional (3D) graphics, avatars, and instant communication tools. It is characterized by the sense of reality and immersion, as well as interactivity, which greatly strengthens the ability of data interaction between human and computer. The technologies of ER including virtual reality (VR), AR, and mixed reality are gradually applied to cancer radiotherapy. In a broad sense, ER includes augmented and mixed realities.[8] The ER technology can vividly simulate the whole process of radiotherapy, identify the problems during the process, and correct them in time. However, ER makes us see a flat image in three dimensions based on the working principle of our eyes. It is also characterized as an internet-based 3D space that multiple users can access synchronously and take part in process by creating an avatar that is on behalf of the user's self.

  The applications of Extended reality metaverse in radiotherapy Top

In recent years, there has been renewed interest in the application of virtual environments to education,[9–11] despite ongoing inconclusive evidence on the use of virtual environments for enhancing student educational achievement. ER plays a role in medical training in which ER has been an application in radiation therapy. ER is being merged into the medical school course by way of an ER platform in the radiation therapy center and has become a share of many therapeutic imitation centers. For educational training, ER-based tools which can be applied at home or in a medical classroom and is different from requiring simulation entity model or tools can offer unbiased appraisal of a trainee's performance and give convenience in [Figure 1]. The add of ER to quality assurance training has a result of increasing trainee presentation and decreasing the time of operating room and be better than traditional simulator environments. The relevant research suggested that the adoption of virtual environments early in the students' educational journey can have a positive effect on students' learning experience.[12] The team of Talbot in the University of Canterbury developed a system which acts as a visual guide for patient setup in external-beam radiotherapy using a technology known as ER.[13] The function of the system was explored in a clinical environment via it to position an anthropomorphic phantom lacking the aid of extra setup methods. The setup errors were determined by means of cone-beam computed tomography and image registration.
Figure 1: ER-based tool for education training. ER: Extended reality.

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Improved access to technology in respiratory therapy (RT) training of students and workforce has resulted in opportunities for an evolution in patient education methodology. Pyramidally, verbal and written educational inform are being supported or replaced by video or other online resources, in addition to ER systems. Effective education should provide adequate information for informed consent, address patient concerns, and prepare patients for the RT process including its potential side effects.

  The Future Of Extended Reality Metaverse In Radiotherapy Top

The mirror world is a type of ER of the outer world that indicates to an informationally superior virtual model or “reflection” of the real world. In medicine, digital twin models use real-time data to adjust treatment, monitor response, and track lifestyle modifications. Similarly, each equipment in the radiotherapy center would have a digital twin. The radiologist and physicist would obtain the operation data of the radiotherapy equipment monitoring system in real time, carry out fault prediction and timely maintenance, and could achieve remote assistance, operation, and emergency commands.[14],[15],[16]

When designed for use in radiation oncology especially, ER may possess an apparent advantage over our traditional systems. Recently, various examples of ER technology are emerging, for example, the virtual environment for radiotherapy training (VERT),[12],[17],[18] which gives a projector-based display to imitate operating a linear accelerator for the purpose of education and training. From the functional point of view, the possible application of ER technology as a radiation therapy tool is also becoming feasibility.

Radiation therapy treatment planning design depends on understanding and working with 3D imaging for tumor target and organ at risk delineate, beam design, plan calculation, and patient positioning. The treatment planning software that we use traditionally just offers two-dimensional planar displays of computed tomography slices or possibly a static 3D version, making it unnecessarily challenging and time-consuming to interpret and manipulate the 3D information in these scans. ER is likely to allow radiotherapist to interrelate with these data directly in 3D version directly.

Under the guidance and assistance of the intelligent robot, the patient lies on the positioning bed in the most comfortable position. The intelligent positioning system[19],[20] scans the patient's body surface and position information (holographic scanning technology) and uses 3D printing technology to make personalized positioning film for the patient. 3D models of organs and treatment targets are automatically generated, which are automatically connected to VR equipment and presented to doctors and patients in a holographic 3D way, so that doctors can more accurately understand the target area and patients can more intuitively understand the treatment plan. Based on the expert-level structure database with massive optimization and artificial intelligence technology such as deep learning,[21] the intelligent target delineation system can automatically complete contour delineation, which is accurate and personalized, helping doctors to quickly and accurately identify radiotherapy target areas and organs at risk remotely. Through ER combined with Internet of Things technology, patients' recovery status will be reported to the cloud platform in real time for intelligent analysis and intervention. Through the scientific combination in and out of the hospital, we build a good medical platform for tumor patients and radiotherapy physicians, help patients simplify the medical treatment process, cooperate with treatment scientifically and efficiently, customize rehabilitation services, and improve the quality of life.

One condition that could be predominantly beneficial is for disease sites in which the delineate of the tumor clinical target is based on the 3D version of disease along topographies with complicated topographic anatomy. Even with the most advanced technology software tools, it can be problematic to exactly estimate and quantity a curved structure that may not along precisely in the traditional axial, sagittal, or coronal planes.

ER may be helpful to static beam or dynamic arc choice in treatment planning, predominantly to noncoplanar, nonisocentric treatment plans. In the ER environment, it is become easier to deliver with traditional linear accelerator safely and plan with cutting-edge optimization algorithms more proficiently. Meanwhile, confirming these complex radiation environment may minimize or even eliminate the danger of collisions and are suitable for giving the treatment anatomy appropriately. The 3D version provided by ER metaverse can be proved to be a cooperative, allowing technology for the next generation of radiation treatment planning and delivery procedures.

Furthermore, ER metaverse may have a character in interactive the complications of radiation therapy treatments both to radiation therapy center's staff and to patients. It may be importantly easy using ER-based metaverse techniques in which the 3D version can make it easier to explain where the tumor and organ at risk as well as the relationship of them with clearly details. Even though it is an old habit for radiation oncologists to analyze the isodose and beam planning along cross sectional images. A relevant research using the VERT system[22] for students to improve their learning experience. This study demonstrated that including VERT into medical dosimetry education can improve students' learning experience, by improving their self-confidence, as well as reducing time required for their self-study and practice. As ER metaverse technologies continue to progress, they are possible to become a cost-effective tool to help students understanding the principle of treatment planning and to be familiar with the relationship of the target and the organ at risk without changing the radiotherapy curriculum.[12]

The revolution of ER metaverse radiotherapy based on artificial intelligence is coming. ER metaverse radiotherapy is an interdisciplinary boundary discipline, which is still in its formative years and progressing with each passing day. Unmanned radiotherapy center is a lofty ideal, to simplify the medical process, shorten the waiting time, improve productivity at work and accomplish homogeneous chemotherapy and radiotherapy under remote control.[19] It also breaks down the boundaries between these types of the metaverse. As face-to-face communication becomes difficult due to the spread of COVID-19,[23] activities that were thought to be only possible offline are being converted to VR and are rapidly expanding into various fields such as education, medical care, fashion, and tourism.

Financial support and sponsorship

This study was supported by the Technology Innovation and Application Development Project of Chongqing (cstccxljrc201910) and the Cultivation Program for Clinical Research Talents of Army Medical University (2018XLC1010).

Conflicts of interest

Jianguo Sun is an Associate Editor of the journal. The article was subject to the journal's standard procedures, with peer review handled independently of this editor and his research groups.

  References Top

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Kim S. Metaverse: Digital World, World of Emerging Items. Hwaseong: PlanB Design; 2020. p. 376.  Back to cited text no. 2
Lee S. Log in Metaverse: Revolution of Human × Space × Time (IS-115). Seongnam: Software Policy & Research Institute; 2021. Available from: https://spri.kr/posts/view/23165. [Last accessed on 2021 Mar 18].  Back to cited text no. 3
Go SY, Jeong HG, Kim JI, Sin YT. Concept and developmental direction of metaverse. Korea Inf Processes Soc Rev 2021;28:7-16. Available from: http://www.koreascience.kr/article/JAKO202122450520317. [Last accessed on 2021 Mar 31].  Back to cited text no. 4
Uruthiralingam U, Rea PM. Augmented and virtual reality in anatomical education – A systematic review. Adv Exp Med Biol 2020;1235:89-101.  Back to cited text no. 5
Stromberga Z, Phelps C, Smith J, Moro C. Teaching with disruptive technology: The use of augmented, virtual, and mixed reality (HoloLens) for disease education. Adv Exp Med Biol 2021;1317:147-62.  Back to cited text no. 6
Moro C, Birt J, Stromberga Z, Phelps C, Clark J, Glasziou P, et al. Virtual and augmented reality enhancements to medical and science student physiology and anatomy test performance: A systematic review and meta-analysis. Anat Sci Educ 2021;14:368-76.  Back to cited text no. 7
Smith RT, Clarke TJ, Mayer W, Cunningham A, Matthews B, Zucco JE. Mixed reality interaction and presentation techniques for medical visualisations. Adv Exp Med Biol 2020;1260:123-39.  Back to cited text no. 8
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Nelson BA, Lapen K, Schultz O, Nangachiveettil J, Braunstein SE, Fernandez C, et al. The radiation oncology education collaborative study group 2020 spring symposium: Is virtual the new reality? Int J Radiat Oncol Biol Phys 2021;110:315-21.  Back to cited text no. 10
Jimenez YA, Cumming S, Wang W, Stuart K, Thwaites DI, Lewis SJ. Patient education using virtual reality increases knowledge and positive experience for breast cancer patients undergoing radiation therapy. Support Care Cancer 2018;26:2879-88.  Back to cited text no. 11
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Talbot J, Meyer J, Watts R, Grasset R. A method for patient set-up guidance in radiotherapy using augmented reality. Australas Phys Eng Sci Med 2009;32:203-11.  Back to cited text no. 13
Björnsson B, Borrebaeck C, Elander N, Gasslander T, Gawel DR, Gustafsson M, et al. Digital twins to personalize medicine. Genome Med 2019;12:4.  Back to cited text no. 14
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