Evaluation of a Linear Measurement Tool in Virtual Reality for Assessment of Multimodality Imaging Data—A Phantom Study

Natasha Stephenson*, Kuberan Pushparajah, Gavin Wheeler, Shujie Deng, Julia A. Schnabel, John M. Simpson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


This study aimed to evaluate the accuracy and reliability of a virtual reality (VR) system line measurement tool using phantom data across three cardiac imaging modalities: three-dimensional echocardiography (3DE), computed tomography (CT) and magnetic resonance imaging (MRI). The same phantoms were also measured using industry-standard image visualisation software packages. Two participants performed blinded measurements on volume-rendered images of standard phantoms both in VR and on an industry-standard image visualisation platform. The intra- and interrater reliability of the VR measurement method was evaluated by intraclass correlation coefficient (ICC) and coefficient of variance (CV). Measurement accuracy was analysed using Bland–Altman and mean absolute percentage error (MAPE). VR measurements showed good intra- and interobserver reliability (ICC ≥ 0.99, p < 0.05; CV < 10%) across all imaging modalities. MAPE for VR measurements compared to ground truth were 1.6%, 1.6% and 7.7% in MRI, CT and 3DE datasets, respectively. Bland–Altman analysis demonstrated no systematic measurement bias in CT or MRI data in VR compared to ground truth. A small bias toward smaller measurements in 3DE data was seen in both VR (mean −0.52 mm [−0.16 to −0.88]) and the standard platform (mean −0.22 mm [−0.03 to −0.40]) when compared to ground truth. Limits of agreement for measurements across all modalities were similar in VR and standard software. This study has shown good measurement accuracy and reliability of VR in CT and MRI data with a higher MAPE for 3DE data. This may relate to the overall smaller measurement dimensions within the 3DE phantom. Further evaluation is required of all modalities for assessment of measurements <10 mm.

Original languageEnglish
Article number304
JournalJournal of Imaging
Issue number11
Publication statusPublished - Nov 2022
Externally publishedYes

Bibliographical note

Funding Information:
This work was supported by the British Heart Foundation-funded 3D Heart project [TA/F/20/210021] and the Evelina London Children’s Charity. This work was also supported by previous funding from the NIHR i4i grant [II-LA-0716–20001]. The research was funded/supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London and supported by the NIHR Clinical Research Facility (CRF) at Guy’s and St Thomas’. The views expressed are those of the author(s) and not necessarily those of the NHS, the BHF, the NIHR or the Department of Health.

Publisher Copyright:
© 2022 by the authors.


  • 3D measurement tools
  • computed tomography
  • echocardiography
  • magnetic resonance imaging
  • measurement accuracy
  • preoperative imaging
  • virtual reality


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