Animal Realities

The future of veterinary medicine is one that embraces a range of emerging technologies, from Virtual and Augmented Reality to Artificial Intelligence.

Written for AIMed Magazine in 2018

What does the veterinary surgeon, or indeed clinic, of the future look like? Whilst the actual clinician and patients themselves are likely to look much as they do today, the impact of a number of emerging technologies on the way they go about training, examining, diagnosing, treating and managing their clinical work is almost certain to be profound. From Virtual and Augmented Reality (VR & AR) to Artificial Intelligence (AI) these technologies are already changing the way human doctors practice medicine and there is no reason to believe that veterinary will be any less transformed.

There are already exciting glimmers of what is to come, from the use of VR and AR in vet schools to help students better understand anatomy to AI being applied to first opinion, primary veterinary care provision through smart kiosks, freeing up overstretched veterinarians to focus on the truly vital aspects of their work and enhancing the client and patient experience in the process.


Virtual Reality

VR has been proven to be an effective tool in training, especially in situations where the knowledge may be complex, impossible or prohibitively expensive to experience in the real world, dangerous or involve understanding of very spatial concepts and development of specific psychomotor skills. For years surgeons have trained using haptic-enabled VR simulators that enable them to handle real keyhole surgical instruments but with the difference being that the patients being trained on are a combination of physical model and digital simulation, culminating in the illusion of actually performing a specific procedure. The benefits of simulations is that they can be intentionally altered, for example by introducing an unexpected complication, as may occur in the real surgery, tracked for accurate feedback on skills development and the exercises repeated multiple times without any risk to an actual patient. Solutions that dispense with physical haptic tools, such as OssoVR’s orthopaedic training simulations, delivered via consumer VR systems such as the Oculus Rift, have proven so effective in training new surgeons that multiple residency programmes have adopted them for student training.

One of the best examples of a haptic simulator specifically designed to deliver veterinary training that I have seen to date is the Haptic Cow and Horse developed by the University of Bristol’s Professor Sarah Baillie. This uses a combination of finger-tip force-feedback haptics and a visual digital simulation of the anatomical structures being palpated to train veterinary students in the vitally important skill of accurate rectal palpation, which is used for everything from reproduction assessment in cattle to detection of potentially lethal colic in horses.

Veterinary surgeons undertake a plethora of procedures, from day one skills such as routine neutering to complex soft tissue and orthopaedic surgeries. Learning any procedure for the first time currently requires a combination of traditional textbook study, observation of a more experienced colleague, practice, if possible, on models or post-mortem specimens, ultimately leading to assisting in the procedure initially and ultimately developing the skills and confidence to become the primary surgeon. This process can, and does, take a long time, is often incredibly stressful and usually requires significant investment. Keeping skills fresh and updated once acquired can also prove challenging if there is not a steady, reliable stream of patients requiring said specific procedure. VR training offers an alternative, one where the training veterinarian simply dons a headset and is guided through a simulated version of the same procedure, in the process learning vital spatial awareness and muscle memory of the steps involved, whilst developing autobiographical recall on account of having actually carried out the procedure over and over again, all in the realistic, immersive yet ultimately repercussion-free environment of the simulated world.


Augmented Reality

Whilst VR is superb in situations where full immersion in a simulated training environment is preferable, AR lends itself to medical uses where visualisation of intrinsically complex data, such as 3D scan information (CTs, MRI, X-ray), would be of significant utility to clinicians, especially where that data can be overlaid on the actual real-world patient thus providing an entirely enhanced level of context. The difference in clarity of certain medical conditions that are afforded by being able to view clinical data in three dimensions - as they occur in the body incidentally - perhaps whilst being able to easily toggle between layers of relevant information, in addition to being able to consult with colleagues or discuss the case with clients, is marked and some of the very best examples of AR that I have seen in a veterinary capacity have been anatomy training tools, such as Llama Zoo’s Easy Anatomy. This incredibly detailed and accurate application, which is viewable not only in AR but also VR and on standard screens, such as tablets, makes learning canine anatomy that much clearer and intuitive than traditional teaching, potentially offering an alternative to wet-lab dissections, which are labor intensive, complex and expensive to provide, in addition to there being some associated ethical concerns. AR also has real potential in training members of the veterinary team how to use certain key pieces of equipment, such as processing lab samples or setting up an anaesthetic circuit. By essentially annotating the real world in realtime, principles and procedures that might, on paper, appear obscure often achieve an almost instant clarity that significantly enhances the quality and retention of training knowledge.



Artificial Intelligence

There are two key areas where I personally see the greatest value proposition for AI in veterinary. The first is in medical imaging processing and assessment, from rapid yet accurate and sensitive interpretation of radiographs, ultrasound images, MRI and CT scans, right the way through to cytology assessment. As computer processing power, speed and affordability, combined with growth in machine vision reference directories, continues to increase exponentially, it is likely that in the not-too-distant future much of the standard clinical interpretation work that is currently carried out in practice, such as examining a urine sample spin-down for potential crystals or a urinary tract infection, will be delegated to AI, providing veterinarians with rapid, accurate and detailed reports and ensuring a consistency in interpretation that can be lacking in current practice given the difference in experience and skill level between individuals doing the interpretation.

The second area where I see huge potential is in first-line primary consultation. Smart kiosks, such as those developed by AdviNOW Medical in partnership with Akos Med Clinic, already exist for human patients and not only cut down on long waiting times - a significant source of dissatisfaction among patients and a source of stress for over-stretched physicians - but also ensure consistent, accurate and detailed collection of important patient history and physical examination data, all provided and collected by the patient themselves as they are guided through the process by a combination of AI and detailed AR instructions. Once the relevant healthcare data is collected, which typically takes less than 15 minutes, a complete patient work-up, including a breakdown of predicted illnesses and treatment options, is sent to the healthcare provider, who then completes a video consultation to confirm the AI-collected information, verify the diagnosis and confirm or modify the treatment plan. The AI ensures a detailed and accurate healthcare record is maintained and even automatically follows up with patients a few days later. There is already work under way to roll out veterinary-specific versions of this system and it is my belief that it promises to significantly enhance the experience not only of clients and their animals but also improve the working lives of veterinarians, who struggle with the same issues of being chronically overstretched as their human counterparts.



Whilst some fear that technology such as AI will ultimately render human professionals, including veterinarians and medics, redundant I believe that their use, whether VR or AR for training, or AI in helping to automate and improve certain healthcare tasks, will actually enhance the abilities of healthcare professionals. The veterinarian of the future is therefore likely to look as they do today yet possess skills, knowledge and be capable of providing a standard of care and service that far exceeds anything possible in the present. Those poised to gain from this include the clients, animal welfare in general and the profession, which is incredibly exciting.



AUTHOR BIO

Dr Chris Shivelton Queen is a small animal veterinarian who qualified from the University of Bristol with degrees in Veterinary Science and Biochemistry and currently practices in Dubai. He has long had a deep interest in the role technology plays in advancing the veterinary profession, especially Virtual and Augmented Reality. Dr Chris writes and speaks widely on the subject of VR and AR in healthcare and recently spent three months learning VR development skills in Vancouver, Canada, with a view to developing training tools for veterinary professionals. His latest thoughts on the subject can be found at www.thenerdyvet.com.