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A Guide to Stereoscopic 3D Displays in Medicine

Posted Jul 31, 2011 Updated Apr 10, 2023
By Robert T. Held PhD , Tiffany T. Hui BS
21 min read

Stereoscopic displays can potentially improve many aspects of medicine. However, weighing the advantages and disadvantages of such displays remains difficult, and more insight is needed to evaluate whether stereoscopic displays are worth adopting. In this article, we begin with a review of monocular and binocular depth cues. We then apply this knowledge to examine how stereoscopic displays can potentially benefit diagnostic imaging, medical training, and surgery. It is apparent that the binocular depth information afforded by stereo displays 1) aid the detection of diagnostically relevant shapes, orientations, and positions of anatomical features, especially when monocular cues are absent or unreliable; 2) help novice surgeons orient themselves in the surgical landscape and perform complicated tasks; and 3) improve the three-dimensional anatomical understanding of students with low visual-spatial skills. The drawbacks of stereo displays are also discussed, including extra eyewear, potential three-dimensional misperceptions, and the hurdle of overcoming familiarity with existing techniques. Finally, we list suggested guidelines for the optimal use of stereo displays. We provide a concise guide for medical practitioners who want to assess the potential benefits of stereo displays before adopting them.

Stereoscopic displays can be found in applications ranging from cinema to medical imaging to scientific visualization . Because these displays can convey more accurate depth information than nonstereo displays, they can potentially benefit several aspects of image-based medicine. In particular, stereo imaging could 1) make complicated shapes and structures easier to identify, 2) aid the user in assessing large data sets, and 3) through its integration in virtual-reality modules, decrease the cost of training and health care in general. However, the technology has drawbacks, including equipment complexity and the current necessity for eyewear. Stereo displays therefore must demonstrate a clear advantage over existing techniques if they are to be widely adopted. We provide a resource for evaluating and implementing stereo displays for a wide range of medical applications. We begin by discussing the unique visual cues afforded by stereoscopic displays. We then discuss the specific advantages and disadvantages of existing medical applications of stereo displays, and possible reasons why it has not been adopted more widely. The general advantages and disadvantages are also summarized, followed by tips for the optimal use of stereo displays to help avoid misperceptions and visual fatigue.

Depth and displays

All stereo displays operate on the same basic mechanism: a unique image is presented to each eye. The differences between the images (known as a stereo pair) are interpreted by the visual system as depth information in a process known as stereopsis. The relative positions of an object’s projections onto the two retinas are used by the visual system to recover the distance to that object . Stereopsis is not the only source of depth information in typical images. In fact, the name three-dimensional (3D) display is a misnomer because images have always conveyed 3D information. The key distinction in 3D displays is that they provide stereoscopic depth information in addition to the monocular depth cues attainable with any display. Therefore, for the remainder of this review we will use the term stereoscopic display or stereo display in place of the more common 3D display .

To differentiate between stereoscopic and conventional displays, we begin with a discussion of the visual depth cues afforded by each technology.

Monocular Depth Cues

Any conventional display can present monocular depth cues. These are cues to depth that are useful to the visual system, even if they are acquired by only one eye. The depth cues most relevant to our discussion are perspective projection, occlusion, familiar size, shading, and the motion-based cues known as structure from motion and motion parallax.

“Perspective projection,” or how a 3D scene is projected onto a two-dimensional (2D) image plane, offers several depth cues. Objects that are farther away from the imaging device are projected to smaller sizes than objects that are close. Parallel lines that recede into the scene (such as the lines on a road) project to converging lines in an image. Portions of the parallel lines that are spaced farther apart on the image surface are closer to the observer than portions that are spaced closer together. This phenomenon is evident with the parallel lines on the wall in the right-hand portion of Figure 1 . Perspective projection also produces texture gradients. Texture patches, like those that make up wallpaper, will project to have larger and more widely spaced elements on the image when they are closer to the imaging device. The orientation of texture elements can also reveal 3D shape .

Figure 1, Several examples of monocular depth cues. Perspective projection causes the more distance supports in the handrail on the right side of the image to project to smaller sizes in the image. Occlusions make it obvious that the tractor is closer to the camera than the board that it is partially blocking from view. Shadows reveal the three-dimensional shape of the shovel on the front of the tractor. Familiar size also makes it possible to estimate the relative distances to the red car and the people in the scene.

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Stereoscopic Depth

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Figure 2, Stereogram of a field of dots with floating patches. To view the stereogram, hold the page at arm’s length and either (a) cross your eyes so the left eye is directed at the left image and the right eye is directed at the middle image ( divergent fusing ), or (b) point the left eye at the right image and the right eye at the middle image ( cross fusing ). In both cases, once fusion is attained, four images will be visible. With divergent fusing, attend to the image second from the left. With cross fusing, attend to the image second from the right. Without fusing the images, it is impossible to tell which of the patches is closer. However, once the images are fused, their depth ordering becomes apparent, as well as the three-dimensional positions of the random dots.

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Stereo Imaging and Virtual Reality

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Medical applications of stereo displays

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Diagnostics

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Ophthalmic imaging

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Mammography

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Figure 3, Example mammography stereogram. See viewing instructions from Figure 2 . Viewed individually, the images in each panel do not provide depth information. But viewed stereoscopically, the three-dimensional (3D) structure of the tissue becomes apparent, including the location of the mass on the left side. Reproduced from Getty D & Green P, “Clinical applications for stereoscopic 3D displays”, published in the Journal of the Society for Information Display, Vol. 15, No. 6, with permissions by the authors and The Society for Information Display.

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Vascular imaging

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Figure 4, Example angiographic stereogram. The connectedness and depth ordering of the vessels are most easily understood under stereoscopic viewing. Images courtesy of Maksim Shapiro ( http://neuroangio.org ).

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Orthopedic imaging

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Medical Training

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Figure 5, Example image from stereoscopic laparoscopy. The lack of strong perspective cues like straight lines and right angles and unfamiliar lighting makes it difficult to recover three-dimensional shape information from a single image. When viewed stereoscopically, however, the tissues’ shapes become evident. In particular, note how the thin flap of tissue is perceived as more separated from the background during stereoscopic viewing. Images courtesy of Peter Mountney and colleagues (94) .

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Surgical Planning

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Laparoscopy

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Telesurgery

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Augmented Reality Surgery

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Figure 6, Stereogram of an augmented reality system in use on a surgical phantom. The overlaid computer-generated imagery provides a virtual view directly into the surgical site. Note that the use of stereo imagery more convincingly makes the overlaid graphic appear to be a hole, rather than a texture projected onto the surface of the phantom. Images are from Figure 5 of Fuchs H et al. “Augmented reality visualization for laparoscopic surgery,” in the Proceedings of the First International Conference on Medical Image Computing and Computer-Assisted Intervention, Vol. 1496. Copyright Springer-Verlag Berlin Heidelberg (1998) and appears with kind permission from Henry Fuchs and Springer Science+Business Media B.V.

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Summary of benefits

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Summary of drawbacks

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Hardware

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Resistance to New Technology

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Lost Detail from Slice Data

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Viewer Discomfort

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Figure 7, Variations in vergence and accommodation with natural viewing and typical stereoscopic displays. (a) The eyes’ vergence and accommodative states are coupled in natural viewing. Here, vergence and accommodation are both set to the far corner of an open-hinge stimulus. The light from the edges of the hinge are physically closer to the eyes than the far corner, so they appear out of focus. (b) On a typical stereo display, vergence and accommodation are uncoupled. Vergence can vary through the three-dimensional scene (here it is trained on the corner of the hinge), but accommodation must remain fixed on the surface of the display to keep the image sharp. Note that the entire hinge is imaged sharply, because all of the light is originating at the surface of the display. The mismatch between the vergence and accommodative states of the eyes has been proven to be a source of discomfort and fatigue with stereoscopic displays. (c) Partially blurred retinal image. (d) Completely sharp retinal image. Figure adapted with permission from David Hoffman and colleagues (79) .

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Stereoscopic Misperceptions

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Figure 8, Common distortions with stereoscopic displays. (a) A viewer at the correct viewing location, observing a stereoscopic image of a 3D cross-section of a human skull. Because the observer is in the correct location, he or she correctly perceives the shape of the skull. However, sitting too far (b) or too close (c) to the display causes the perceived shape to expand or compress, respectively. Stereoscopic viewing software sometimes allows one to adjust the spacing between the left and right images. But (d) shows how increasing the spacing can expand objects in depth and move them farther away. Finally, (e) depicts how 3D shapes shift and shear as the observer moves to the left and right of the optimal viewing location. See the section Avoiding Stereoscopic Misperceptions with Stereoscopic Displays for tips on avoiding such misperceptions. Skull model created by W.E. Lorenson (95) , based on data from the Visible Human Project (96) .

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Avoiding misperceptions with stereoscopic displays

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Figure 9, The keystone effect. When the bodies of a pair of stereo cameras are set to converge, vertical magnification of the two images’ projections vary with horizontal position. The mismatch causes regions of misalignment and can produce misperceptions.

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Tips and guidelines

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Tip 1: Parallel Cameras

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Tip 2: Do Not Flip Images

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Tip 3: Keep Eyes Centered and Parallel Relative to Display

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Tip 4: Minimize Vergence-accommodation Conflict

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Tip 5: Appropriate Use of Pictorial Blur

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Conclusions

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Acknowledgment

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