Virtual Reality Guides Breast Biopsy Simulations

US-guided breast biopsies are the most frequently performed imaging-guided breast procedures. During training, learners may lack exposure to these biopsies due to limited volume and sensitive anatomy.

“One of the biggest challenges for trainees in residency is the limited number of biopsies available,” said presenter Kyle Kleiman, a student at Edward Via College of Osteopathic Medicine in Spartanburg, SC. “An additional challenge is that it’s a sensitive region, so patients may not want another trainee in the room or a trainee holding the biopsy needle.”

Current simulation training often involves the use of manufactured or homemade phantoms that lack a 3D, immersive environment. VR offers a promising option for training that allows learners to have flexibility in learning, real-life interactive experiences and measurable feedback.

Kleiman worked with a team of breast imagers at the University of Alabama in Birmingham to conduct a feasibility study of a novel VR breast biopsy simulation trainer. The system includes a VR headset and two handheld probes, one in the shape of a US probe and the other replicating the handle of the biopsy needle.

After a brief training session, three fellowship-trained breast radiologists were instructed to perform as many breast biopsies as possible within a 15-minute period. One biopsy cycle consisted of entering the breast with the biopsy needle and taking a sample—a step known as the biopsy fire—before removing the needle. The VR program recorded the time needed to successfully biopsy the mass.

All three breast radiologists completed the simulation without complaints of motion sickness or fatigue, two problems that often plague VR simulations. The data showed a decreased time to successful biopsy with each subsequent trial for each of the three participants. This decreased time to biopsy was associated with a higher cumulative number of successful biopsies and a reduced number of body entries and biopsy fires before a successful tissue sample.

“We saw that as our test subjects used the trainer more and more, they were able to get quicker and make fewer mistakes,” Kleiman said.

Survey results showed that the radiologists found the simulator to be engaging, realistic and something they would recommend to other healthcare professionals. The radiologists participating in the trial also provided favorable subjective feedback.

“The simulation is not intended to be a replacement for having those repetitions with patients, but it offers a good introduction to that setting,” Kleiman said. “It helps ensure that when you do your first biopsy, you’ve had some experience and have at least some idea of what you’ll be doing.”

The researchers are planning a larger study with more participants. Future research will focus on assessing the utility of the simulation in improving trainee skills.

“One thing we are focusing on for future experiments is how we can find measurable data to show how this training will translate to the clinic,” Kleiman concluded.

Access the presentation, “Feasibility Study of a Virtual Reality Breast Biopsy Simulation,” (M5A-SPNPM-1) on demand at RSNA.org/MeetingCentral.