Knowledge and Experience Are Keys to Going from Anatomy to Repair

Brun and colleagues present a proof-of-concept and feasibility study of a single data set to construct a hologram of congenital heart disease to facilitate surgical planning (1). This concept is not entirely new (2) and has not yet spread widely in clinical practice. Why would an obviously interesting digital innovation take so long to enter clinical practice?

Hologram technology is still limited, partially because it does not replace training and experience in practical anatomy for the professionals involved and, therefore, does not always present additional information. Training involves diagnostic tools (3) used on anatomical specimens, with wetlab sessions and observation employing diagnostic techniques and therapeutic interventions in humans either surgical or percutaneous. All this in a setting where learning curves are to be avoided and ample experience is expected.

Virtual reality and 3D prints are not in widespread use in congenital cardiac interventions as the techniques have not yet realised the level required for practical demand. What is needed is real-time representations of the hologram in the diagnostic facility, operating theatre or catheterisation lab preferably with projection through magnifying-glasses worn by the operator or surgeon. In this regard, separate facilities for virtual reality projections are not serving clinical practice effectively (1;2). Ideas from commercial or military projection of screen data ought to be adapted for medical use. 

In recent years, multidisciplinary decision-making in the context of heart teams has gained an increasingly important role in deciding available therapy options for individual patients (3). With this in mind, 3D representations whether as rendered volume representations, casts, or holograms could provide a common platform where routine clinical diagnostic information, angiography from different sources, and anatomic experience could meet and, thus, support clinical decision-making in general, rather than surgical planning per se.   

In general, and specifically in congenital heart disease, thorough knowledge and ample experience are essential to advance from pathological anatomy to adequate repair, either surgical or interventional.

Holograms may assist in insight, but do not present more information than is already present in limited data sets. As Brun and colleagues describe (1), holograms can at least play a role in a better understanding of basic (pathological) anatomy. Thus, a hologram may play a more prominent role in basic and specific training, improving communication between different professions. At the end of this sequence, surgeons (or interventionalists) need all of their knowledge and experience to obtain optimal results of the repairs at hand. Hologram technology still needs to make that extra step in meeting medical expectations by morphing from gadget to regular tool.