Margy McCook had been dreading the next step in her treatment for breast cancer.

Since her diagnosis in January, McCook had already endured surgery and chemotherapy, but it was the  radiation she would receive at Penn Medicine's Abramson Cancer Center that scared her the most.

"I feel like my whole life I've heard radiation is bad for you," said McCook, 54, of Blue Bell.

As she waited for her first treatment at the Roberts Proton Therapy Center, McCook found herself transported to a different place — sitting on the dock of a lake, watching the sun rise. Using Penn's new virtual reality mindfulness program, McCook watched a tree swing move with the breeze, several birds travel across the morning sky, and a large fish swim about as dawn began to break. A soothing voice encouraged her to "breathe deeply and enjoy the next 10 minutes of quiet and serenity."

"At the end of the 10 minutes, I was relaxed, I was at peace," McCook said. "I felt like I was in the here and now and OK and I'm going to do this radiation."

The 360-degree, three-dimensional computer-generated experience may be more familiar to video gamers than hospital patients, but in the last 15 years, as the prices for the technology have dropped and the devices have become smaller and more portable, hospitals have begun to embrace virtual reality. In the spring, the health-care market-research firm Kalorama reported that the virtual and augmented reality market grew from $525 million in 2012 to  $976 million in 2017.

Much of the focus so far has been on using the technology with children, for whom distraction therapy has proven to be effective in reducing pain during treatments such as wound care for burn injuries. Now, local hospitals are looking to the technology to provide patient education and wellness, as well as training for medical students and professionals.

An ‘immersive experience’

At Abramson Cancer Center, the unassuming virtual reality station has a comfy chair and a headset. Nearby, a small television monitor lets others view what the user is seeing.

The program is intuitive to use, and most patients catch on quickly, said Fern Nibauer-Cohen, director of patient engagement and business development at Penn Medicine.

"It relaxes even the most anxious of minds," Nibauer-Cohen said.

Michael Kent, an alumni patient, uses the virtual reality relaxation station at the Roberts Proton Therapy Center.
DAVID MAIALETTI / Staff Photographer
Michael Kent, an alumni patient, uses the virtual reality relaxation station at the Roberts Proton Therapy Center.

Created for patients, caregivers, and staff, the program debuted in September. Penn partnered with Philadelphia-based production group Blue Design for the project.

To create the short meditative program, developers drew from the experiences of family and friends and gathered input from Penn to come up with the script, said Howard McCabe, creative director of Blue Design.

"With this kind of immersive experience, you can really transport yourself to another world while you are sitting here in our lobby," said William P. Levin, associate professor of radiation oncology at Penn, who helped develop the current program. Future programs could include a virtual reality trip to a local museum or even Machu Picchu, the ancient Incan city set high in the mountains of Peru, he said.

For patients who are anxious about visiting the hospital, Penn also plans a virtual tour of the oncology department that could be used at home with a platform such as Google Cardboard, Nibauer-Cohen said.

"This is just the tip of the iceberg," said James M. Metz, chair of radiation oncology at Penn. There are multiple uses for virtual reality programs, he said, such as education so patients can better understand their diagnoses, treatments, and side effects, as well as stress relief for health-care providers.

Eventually, Levin hopes to combine the virtual reality technology with that used in a biofeedback study to address the effects of stress and anxiety on patients, caregivers, and medical professionals.

Virtual reality for radiation patients has also been used at Children's Hospital of Philadelphia.

Young patients undergoing proton radiation need to remain completely still during the precisely targeted therapy session. Those who can't are usually put under general anesthesia, said Jorge Galvez, a pediatric anesthesiologist who created the program.

To avoid anesthesia, the hospital offers kids a smart phone with a simple plastic headset that allows them to tour the waiting room, nurses station, changing area, and the room where the scanner is kept. Child-life specialists then answer any questions patients might have, he said.

"Most of them thought it was pretty cool," said Galvez.

At Thomas Jefferson University, researchers are testing a virtual reality program designed to encourage cardiac-rehab patients to exercise.

Pavitra Krishnamani, a medical student at Jefferson and a former clinical fellow in health-care innovation at the school's Digital Innovation and Consumer Experience Group, said patients may benefit from using an interactive technology as opposed to paper materials.

"It provides controlled training in an immersive and realistic way," she said.

Students use virtual reality, too

Pop into the Innovation Space at Temple University's Ginsburg Health Sciences Library, and you are likely to see a medical student outfitted with a virtual reality headset and gripping two hand controllers.

The students, faculty, and staff at the Lewis Katz School of Medicine have been using virtual reality — and augmented reality, which superimposes digital information into what you see — for anatomy training. The technology can also serve as a stress buster, helping students blow off steam through popular games such as Beat Saber, which lets the user slash cubes with light sabers like a Jedi Knight to the beat of rhythmic music.

Bhargava Reddy Banala, a graduate student in electrical engineering, demonstrates one of the virtual reality programs students use to relax and unwind at the Ginsburg Health Sciences Library at Temple.
JESSICA GRIFFEN / Staff Photographer
Bhargava Reddy Banala, a graduate student in electrical engineering, demonstrates one of the virtual reality programs students use to relax and unwind at the Ginsburg Health Sciences Library at Temple.

"The students that come in to study stay longer," said Patrick Lyons, librarian of the Innovation space. The library first began using the virtual reality program, which was developed at the University of Brisbane in Australia, in 2017, he said.

It allows students to explore all systems of the human body, down to tiny veins. They can remove each part of the eye to see the inner workings, or step into a beating heart to view how the valves open and close. Once students have learned how a healthy body operates, the program can show them what tumors or clogged arteries look like from the inside.

"The only thing it is really not good for is really tiny things, like the inner-ear bones," Lyons said.

Standing inside a box outlined on the floor with yellow tape, second-year medical student Benjamin Sussman pulled apart a skeleton, visible to those in the room on a large wall screen. He isolated each bone and rotated it 360 degrees to get a better understanding of the anatomy.

"The whole body can be taken apart," said Sussman. The program is easy to use and moves beyond a model of a skeleton or a textbook. If he makes a mistake when assembling the bones and puts the thumb where the pinkie finger belongs, he said, he can just hit restart.

"Nothing will replace a cadaver," said Sussman. "This is the next best thing."

Benjamin Sussman, a second-year medical student, demonstrates virtual reality used for training medical students at the Lewis Katz School of Medicine at Temple.
JESSICA GRIFFIN / Staff Photographer.
Benjamin Sussman, a second-year medical student, demonstrates virtual reality used for training medical students at the Lewis Katz School of Medicine at Temple.