Exploring Advanced Imaging Techniques in Cardiology

How can we use 3-dimensional echocardiography and extended reality technology in innovative ways to improve heart care?

Doctors and surgeons at Children’s Hospital Colorado’s Heart Institute are finding new ways every day to use technology to improve outcomes and enhance treatment. Our cardiology team is pioneering ways to leverage cutting-edge tools like 3-dimensional echocardiography (3DE) and extended reality technology to enhance patient outcomes, optimize procedures and improve safety for both patients and providers. The headsets might look like virtual reality headsets, but our doctors are actually looking at real 3D images of true anatomy instead of a virtual image that is digitally created. So rather than virtual reality, or VR, using the technology in this way is called extended reality, or XR.

Placing leads in patients with pacemakers and implantable cardioverter-defibrillators (ICDs) traditionally uses fluoroscopy, which is an X-ray based technology. Inherent limitations in this imaging modality can result in leads being placed in suboptimal locations, which may put patients at risk for long-term cardiac dysfunction, all while exposing patients and staff to radiation.

After analyzing 59 cases and 72 controls, our team found that 3DE guidance for pacemaker and ICD lead placement improves the accuracy of lead placement to the desired location over fluoroscopic guidance alone, with significantly decreased radiation exposure and a trend toward improved electrical conduction patterns. The data presented here suggest that the use of 3DE for transvenous lead placement results in multiple short- and long-term benefits to both patients and staff.

The team is also exploring ways we can use XR to enhance the use of 3DE and found several ways that the synergies between XR and 3DE can help us refine diagnoses and procedural strategies at large. Taking 3DE images and importing them into XR segmentation software has helped improve surgeons’ understanding of anatomy, boost confidence in surgical strategies and allow for planned adjustments for future surgeries.

The integration of XR with 3DE represents a significant advancement in both clinical practice and education. The ability to create immersive, interactive 3D models from echocardiographic images enhances procedural planning, training and diagnostic accuracy.

Virtual reality will play an increasingly central role as technology evolves in refining preoperative strategies, facilitating intraprocedural guidance and improving surgical outcomes, especially in complex congenital heart disease cases. Moreover, the accessibility and safety of XR simulations offer promising educational benefits, ensuring that trainees acquire essential skills without the limitations of traditional training methods.

Looking ahead, the team believes XR will play a growing role in shaping cardiac care, particularly for patients with complex congenital heart conditions. Our cardiology team has already expanded the use of VR/XR and 3DE to plan for pulmonary valve replacement. With better planning, improved precision and greater educational reach, these technologies are already redefining what’s possible in pediatric cardiology.