Notes
Pyrus Medical’s Ryan James demonstrates his company’s Bosc software using an Oculus Rift headset (Photo by Molly Duttry)
VR Hardware and Software
Virtual reality has officially gone mainstream. Technology that was previously reserved for organizations with tens of thousands of dollars to spend on dedicated VR studios, is now marketed to consumers. VR headsets now cost as little as a few hundred dollars and are designed for use in people’s homes.
This mass market appeal has brought with it increased interest from hardware and software developers. From industry leaders like the HTC Vive and Oculus Rift, to more recently released options like Microsoft’s line of Windows Mixed Reality headsets, consumers now have a handful of hardware options for their VR setups.
As part of its VR project, the University of Washington Health Sciences Library explored and tested many of the options currently available for a medical VR setup. This section looks at hardware and software required to start a VR studio, based on the HSL staff’s experience. Topics and questions include:
Room size How much floor space is needed for a VR play area?
Headsets Which headset best meets the needs of a library’s specific VR project?
Computer How much horsepower is needed to drive a VR headset?
Software What medical software is available?
Second setup How can installing a second VR setup in the same space improve efficiency?
Digital privacy Can VR keep patient data secure?
Current VR technology has advanced significantly since the early days of VR, with cumbersome headsets and clunky controllers usually housed in a futuristic-looking dedicated VR lab. Today’s gear is far sleeker, lightweight, portable, and designed to be used in people’s homes.
Technology heavyweights like Microsoft, Facebook, Google, and HTC have developed new and better gear. Increased marketplace competition has driven down prices and made VR more accessible than ever, and software developers are increasingly bringing their new offerings to VR platforms.
For health sciences libraries, VR offers an innovative realm for clinical and educational services that is economically and logistically feasible.Three main components constitute VR technology: the headset that creates a virtual world, the computer that powers it, and the software that guides the user through it.
- HEADSET: The VR headset is the gateway between the physical and the virtual worlds. It uses twin high-definition screens and tracking sensors to simulate immersive VR environments. Though the current generation of VR gear is still dominated by the Oculus Rift and HTC Vive, new and advanced options are emerging each year.
- COMPUTER: Immersive and interactive VR environments require significant graphical and computational horsepower. VR tricks the mind into accepting the virtual world as real, but insufficient power can cause stuttering and create a disconnect between the real and the virtual.
- SOFTWARE: Once the headset is up and running, software programs are added to support the intended service offerings. VR’s software market is dominated by video games, but educational programs are creating a niche. Health sciences VR programs fall into two broad categories: anatomical education using generic models and clinical case preparation using patient-specific renderings.
VR Headset Options
Although the number of available headsets is increasing, the market is still largely dominated by two giants: the HTC Vive and the Oculus Rift.
HTC Vive
Developers: HTC (New Taipei City, Taiwan) and Valve Corporation (Bellevue, Washington)
Launched in 2016, the HTC Vive allows users to move around the room-scale environment. It has an “inside-out” tracking system with embedded sensors that pick up external signals from two base stations installed at opposite corners of the play area to track the user’s location. The base stations plug into standard outlets, and communicate with the headset via Bluetooth, making the system easily adaptable to rooms of all sizes. Base stations can either be installed permanently (mounted on a wall or rail) or mobile (mounted on an adjustable light stand). The headsets are physically connected to a computer via USB port.
The Vive’s front-facing camera lets users view the actual room while still wearing the headset in a mode that resembles that portrayed in The Matrix. The Vive was slimmed down in 2017, reducing it from 555 grams to 470, on par with the Oculus Rift.
Users can connect to Valve’s market-dominating Steam software platform, providing Vive users with access to thousands of games and apps. Users can also connect to the dedicated Viveport app store.
Oculus Rift
Developers: HTC (New Taipei City, Taiwan) and Valve Corporation (Bellevue, Washington)
Launched in 2016, the HTC Vive allows users to move around the room-scale environment. It has an “inside-out” tracking system with embedded sensors that pick up external signals from two base stations installed at opposite corners of the play area to track the user’s location. The base stations plug into standard outlets, and communicate with the headset via Bluetooth, making the system easily adaptable to rooms of all sizes. Base stations can either be installed permanently (mounted on a wall or rail) or mobile (mounted on an adjustable light stand). The headsets are physically connected to a computer via USB port.
The Vive’s front-facing camera lets users view the actual room while still wearing the headset in a mode that resembles that portrayed in The Matrix. The Vive was slimmed down in 2017, reducing it from 555 grams to 470, on par with the Oculus Rift.
Users can connect to Valve’s market-dominating Steam software platform, providing Vive users with access to thousands of games and apps. Users can also connect to the dedicated Viveport app store.
Head-to-Head Comparison
| VS. | ||
|---|---|---|
| US$499 | COST | US$399 |
| 2160 x 1200 pixels (1080x1200 per eye) | RESOLUTION | 2160 x 1200 pixels (1080x1200 per eye) |
| 90Hz | REFRESH RATE | 90Hz |
| 6 | DOF (Degrees of Freedom) | 6 |
| 2 in high corners of room | SENSORS | 2 on desktop (optional third) |
| Yes | ROOM SCALE | Requires third sensor |
| Min.: 2m x 1.5m Max.: 5m on diagonal | PLAY AREA | Min.: 1m x 1m Max.: 2.5m x 2.5m |
Alternative Headsets for Library Use
Windows Mixed Reality
Developers: Multiple
Price: Varies by model
The Rift and Vive-dominated VR market was somewhat upended in 2017 with the release of the Windows Mixed Reality (WMR) headsets. Various developers, including Acer, Dell, HP, Lenovo, and Samsung, launched their own headsets based on the same general platform. Despite the somewhat misleading name, WMR headsets are the same as other VR headsets: immersive goggles that block the user’s vision of the real world. Unlike the Rift and Vive, the WMR gear relies on headset-mounted cameras rather than external sensors for tracking. Specs and designs vary from model to model, with all of them falling into the same general price point (US$250-$450). The WMR headsets are compatible with software in the Microsoft store and with some but not all of the offerings in Valve’s Steam platform.
Pros:
- Room scale
- No external sensors
Cons:
Quality varies between developers
Many software programs aren’t supported yet
Oculus Go
Developers: Oculus VR (Irvine, California) and Facebook (Menlo Park, California)
Price: US$199 for 32GB, US$249 for 64GB
Oculus took a massive leap forward in 2018 with its release of the Oculus Go, a self-contained and self-powered VR headset with no external sensors and no accompanying computer. The Go connects to the user’s smartphone via the Oculus app and transfers VR apps from phone to headset. The ability to move essentially untethered significantly increases portability, allowing users to take it virtually anywhere without a computer. This eliminates the largest financial barrier for VR beginners. However, that bonus comes with a significant reduction in horsepower. The Go isn’t capable of creating a room-scale environment, so users are unable to walk around virtually, and it probably will not be able to process complex images like anatomical models without experiencing major slowdown. Software is also an issue, as the newly launched Go has a limited catalog so far.
Pros:
- Self-contained, doesn’t require a computer
- More affordable than other headsets
Cons:
No room scale
Significantly lower specs than other VR headsets
Google Cardboard
Developers: Google (Mountain View, California)
Price: US$15
Launched in 2014, Google’s aptly-named Cardboard is truly an entry-level option for VR. The contraption is essentially a cardboard box that holds a smartphone in front of the user’s eyes as it runs a VR-compatible video or software program. The setup allows new users to get a first taste of VR. But simplicity has its drawbacks. The smartphone must power the VR experience with significantly less horsepower than a gaming computer. Similarly, controllers can’t be used with Google Cardboard, so users are more likely to experience the equivalent of a 360-degree movie than an immersive experience. Google also released Daydream View, a more robust headset made of fabric, in 2016 (US$99). Other smartphone-powered options are also available, such as the Samsung Gear VR ($130).
Pros:
- Inexpensive introduction to VR
- No additional gear required
Cons:
Made of cardboard (fragile)
Limited processing power
Microsoft Hololens
Developers: Microsoft (Redmond, Washington)
Price: US$3,000, US$5,000 for commercial use
Unlike the other headsets on this list, the Microsoft HoloLens is not virtual reality but augmented reality (AR). Holographic images are projected into and interacted with in the real-world environment the user is standing in. AR has been used in other smartphone apps in recent years, such as the Pokémon Go game, Snapchat face filters, and the short-lived Google Glass. To some, AR represents the wave of the future, because it allows users to bring new information into the real world instead of traveling entirely in a virtual one. Currently, though, its large price tag is hindering its widespread adoption. As a result, developers favor VR’s significantly higher adoption rate, limiting the number of commercially available AR apps.
Disclaimer: The UW HSL’s project focused on VR options and did not utilize a HoloLens beyond demonstrations.
Pros:
- Holograms projected into the real world
- Potentially the wave of the future for mixed reality
Cons:
- Major price tag
- Less software available than for VR
Second VR Headset Setup: Improving case presentation efficiency
Consider adding a second VR station for case conference presentations. Depending on the software, this can allow two users to take part in the same VR environment. For medical case presentations, this allows for quick switching between patient models. A new setup can be ready to launch as soon as the first one concludes, minimizing wasted downtime.
The HTC Vive can even use the same Lighthouse sensors to track multiple VR headsets within the same play area, with a pair of caveats. First, keep in mind that this will probably require a separate computer for heavy-duty applications; even high-powered gaming laptops are sometimes stretched to their limits supporting one VR headset—adding a second will have a serious negative impact on performance. Second, VR users are effectively blind when wearing the headsets, and would need a chaperone to prevent them from walking into each other.
VR Computer Requirements
Significant processing power is mandatory for proper support of the Oculus Rift, HTC Vive, and other VR experiences. The setup must constantly generate high-definition images in a simulated 360-degree environment, placing a significant load on the attached computer’s graphical capabilities. Many of the recommended high-end VR computers on the market are essentially identical to upper-echelon gaming computers.
That intense level of computing prowess comes at a cost—a gaming laptop or computer is substantially more expensive than the VR headset, controllers, and sensors—but skimping on it could have a detrimental effect on the VR experience. Inadequate hardware results in plummeting frame rates and stuttering graphics, especially as users pivot their heads, creating a disconnect between the real world and the virtual one, and leaving the user feeling disoriented and nauseous. Some applications are more intense than others; even a mid-level computer will struggle to run heavy-duty programs.
The HTC Vive and Oculus Rift have similar minimum and recommended specs. A computer that runs one well should also be able to handle the other. Prices vary based on time of year and the market, whether constructing a computer from scratch or buying a preassembled machine. Waiting for sales or deals is advisable.
MINIMUM SPECIFICATIONS
CPU: Intel Core i5-4590 / AMD FX-8350
Graphics: Nvidia GeForce GTX 1050 Ti / AMD Radeon RX 470, or equivalent
*Memory: *4GB RAM (for Vive), 8GB RAM (for Rift)
Ports: one HDMI video output, plus one USB 2.0 (for Vive) / one USB 3.0 port, plus two USB 2.0 or newer ports (for Rift)
*Approximate cost: *US$1,000 (for desktop), US$1,400 (for laptop)
RECOMMENDED SPECIFICATIONS
CPU: Intel Core i5-4590 / AMD FX 8350
Graphics: Nvidia GeForce GTX 1060 / AMD Radeon RX 480, or equivalent
Memory: 4GB RAM (for Vive), 8GB RAM (for Rift)
Ports: one HDMI video output, plus one USB 2.0 (for Vive) / three USB 3.0 ports, plus one USB 2.0 or newer port (for Rift)
Digital Privacy for Libraries: Understanding VR data concerns
Today, it is virtually impossible to avoid sharing personal data and creating a virtual footprint. Websites, computer programs, and smartphone apps are constantly recording user data. VR is no exception; user actions are tracked through cookies, aggregated data, and IP-based information.
This data is often used to market services to the user, and shared beyond the headset manufacturer. Oculus, for example, declares in its privacy policy that it can “share information within the family of related companies that are legally part of the same group of companies that Oculus is part of,” which includes Facebook, itself no stranger to high-profile data privacy concerns. Data is often transferred across international borders, and stored in other countries.
Data sharing is by no means restricted to VR, but users should be aware of what takes place when they put on their headsets. This is particularly important with potentially sensitive material, such as identifiable patient information or models.
Software
Once the computer is on and the VR headset ready to go, the next choice is what software to purchase. With VR’s explosion into the mainstream marketplace, it has become a major focus for developers, and hundreds of new applications are being released every day.
Though gaming remains VR’s primary outlet, educational software applications are on the rise. Health sciences applications can be broken down into two areas:
- EDUCATIONAL: Applications designed to teach medical students about anatomy and human structures.
- CLINICAL: Applications designed to visualize patient-specific VR models to support pre-surgical conferences and case planning.
This primer will highlight four currently available software packages that UW HSL uses in its VR studio: 3D Organon VR and Anatomy Labs for educational applications, and Bosc and Medicalholodeck for clinical ones.
Educational
3D Organon VR
Developers: Medis Media (Surfers Paradise, Australia)
Website: 3dorganon.com
Supported headsets: Oculus Rift, HTC Vive, Windows Mixed Reality
Price: US$30
3D Organon VR is geared towards anatomical education for medical students. In many ways it is a technologically enhanced version of traditional anatomical skeletons and models. The program, available through Valve’s Steam software platform, provides over 4,000 VR models of anatomical structures in a wide array of body structures for the nervous, musculoskeletal, respiratory, endocrine, and other systems. Users can manipulate and move around each individual body part, and a separate information screen adjacent to the model provides additional information about the selected body part. 3D Organon VR offers a compelling introduction to medical VR and can be used to support teaching and learning. However, the program doesn't allow users to upload their own anatomical models into the system, limiting its use to doctors, surgeons, nurses, and other health care professionals already well-versed in anatomy.
Anatomy Labs
Developers: Anatomy Next (Seattle, Washington)
Website: anatomynext.com
Supported headsets: Windows Mixed Reality
Price: Free to download
Like 3D Organon VR, Anatomy Labs is geared towards students learning about human anatomy and anatomical structures. Developed at UW’s CoMotion Labs, Anatomy Labs allows users to fully interact with a virtual cadaver, removing body parts to reveal the underlying bone, muscle, and other body structures. The program also includes built-in quizzes that test users on their abilities to accurately dissect the model. In the summer of 2018, UW HSL’s TRAIL hosted the Anatomy Next team as it partnered with the School of Dentistry in using VR as a teaching aid for students enrolled in a head-and-neck anatomy course. Anatomy Next also produces a desktop, non-VR version of the program. As of September 2018, Anatomy Labs is only available on Windows Mixed Reality headsets.
Clinical
Bosc
Developers: Pyrus Medical (Seattle, Washington)
Website: pyrusmedical.com
Supported headsets: Oculus Rift, HTC Vive, Google Cardboard
Price: Institutional license required
Co-founded and developed by UW PhD student Ryan James, Pyrus Medical’s Bosc served as the foundation for UW HSL’s first foray into VR for clinical planning. The program allows users to upload DICOM (Digital Imaging and Communications in Medicine) files generated from MRI and CT scans onto the Pyrus Medical cloud, then download and view them within the Bosc platform. Bosc’s user interface includes a selection of tools for analyzing the model, including opacity and density sliders to remove body parts unrelated to the surgical plan (such as bones). A cut plane allows the user to slice into the model to take a better look inside and a drawing tool can be used to annotate the model for others in the room or for future viewings. Pyrus Medical is currently working on updating Bosc to allow multiple users to view the same model simultaneously, either in a dedicated headset or via a web-based video displayed in Google Cardboard or similar headset.
Medical Holodeck
Developers: Nooon.io (Zürich, Switzerland)
Website: medicalholodeck.com
Supported headsets: HTC Vive, Windows Mixed Reality
Price: Limited free version, US$900 / year (Basic), US$2,450 / year (Pro), US$3,850 (Cloud)
This application also goes by the name DICOM Viewer for Virtual Reality (VR). Medicalholodeck offers similar functionalities as Bosc, with users able to upload DICOM files and view them as 3D models in VR. It offers a comparable set of tools, including filters for removing extraneous body parts and cut planes for sectioning away portions of the anatomy. Medicalholodeck includes a series of built-in anatomical models of various parts of the body, including a beating heart, and allows users to load multiple models simultaneously, though doing so has a negative impact on frame rate. A free version with limited functionality is available on Valve’s Steam software platform. Features included for each of Medicalholodeck’s payment levels is available on the company’s website.
VR Software Licensing: Complying with programs’ terms of services
With VR software still in its relative infancy, licensing models are basic. Most programs are marketed to the general public or for-profit corporations rather than academic institutions. As a result, few VR applications offer educational licenses. This poses a problem for academic libraries with limited budgets that don’t wish to pay massive fees for an institutional license.
With licensing still in a gray area, library directors need to be cautious in deciding what applications to purchase and how to offer them to patrons. Many VR programs are available for relatively low one-time fees through services like Valve’s Steam software platform, but these platforms are inherently designed for single-person use with digital rights management (DRM) language in the terms and conditions. In such a murky environment, purchasing a single-person license then providing it to a wide audience may land the library in hot water.