Conclusion
This chapter demonstrates that the prototype provides an
immersive, interactive environment for cardiology training, enabling learners
to develop surgical reflexes through guided and autonomous experiences. The
development process exposed technical and design challenges, from complex 3D
models to smooth physiological transitions, strengthening our optimization and
iterative refinement skills. Although limitations remain compared to advanced
commercial systems such as absence of haptic feedback, assessment tools and
complex scenarios, the prototype's accessible cost, offline functionality, and
user-friendly design make it a promising, adaptable, and scalable foundation
for cardiology education. Overall, the chapter shows that the solution
represents a meaningful step toward bridging the gap between theoretical
knowledge and practical skills in immersive medical training.
33
General conclusion and perspectives
This work is part of a dynamic of pedagogical innovation
through the use of virtual reality. We have designed and developed an immersive
application prototype that simulates two major surgical procedures used in the
treatment of coronary obstructions: Coronary Artery Bypass Grafting (CABG) and
Percutaneous Coronary Intervention (PCI). This solution aims to offer learners
a safe, interactive, and autonomous environment to become familiar with
surgical techniques, instruments, and the overall process of these
procedures.
One of the main strengths of our application is its ability to
combine guided assistance with autonomous learning, serving as a complementary
tool to support the practical preparation of cardiology students in conjunction
with existing training methods. It is expected to provide added value to
surgical education, as suggested by studies and tests conducted in several
countries [46, 47], by allowing learners to explore, practice, and reinforce
their knowledge in a safe, risk-free environment.
The design process we adopted was based on a rigorous analysis
of user needs, followed by a technical implementation using tools such as
Blender for 3D modeling, Unity for interactive development, and a suitable SDK
for VR integration.
Although this first version can still be improved particularly
in terms of graphical realism and scenario diversity,it opens the door to
promising developments. Future developments will aim to enhance graphical
realism, incorporate complex autonomous scenarios with unexpected
complications, integrate haptic feedback to support fine motor skills, enable
collaborative multi-user experiences, and implement detailed assessment tools
such as performance metrics and error tracking. Optimization challenges,
including build size, performance with complex assets, and broader device
compatibility, will also be addressed. By tackling these limitations, the
application can become a more immersive, educationally effective, and widely
deployable tool, supporting the ongoing digital transformation of cardiology
training while complementing existing teaching methods.
34
Bibliography
[1] Manuel indispensable pour Unity, 18 03 2016, Julien
Faujanet.
[2] A taxonomy of mixed reality visual displays,Milgram, P.,
& Kishino, F. (1994).
[3] A structural equation modeling investigation of the
emotional value of immersive virtual reality in education. Education Tech
Research Dev 66, 1141-1164 (2018).
https://doi.org/10.1007/s11423-018-9581-2
, Makransky, G., Lilleholt, L.
https://link.springer.com/article/10.1007
/s11423-018-9581-2
[4] Learning Blender: "A Hands-On Guide to Creating 3D
Animated Characters", Olivier Villar, 2014
[5] Workflow for Percutaneous Coronary Intervention With Optical
Coherence Tomography-Guidance: MAXing the MLD? Circ Cardiovasc Interv. 2022
Nov;15(11):882-883. doi: 10.1161/CIRCINTERVENTIONS.122.012608. Epub 2022 Nov
15. PMID: 36378740, Razzouk L, Attubato MJ.
[6] Mise en place d'une application mobile pour la
rééducation en réalité virtuelle: cas de simulation
d'imagerie motrice, Bachelor's thesis, University of Abomey-Calavi, IFRI,
Benin, 2023, Oloufèmi Adéwoumi Lazare Jean-deluxe FAGBOHOUN.
[7] Application de simulation médicale en
réalité virtuelle: cas de l'appendicectomie, Bachelor's thesis,
University of Abomey-Calavi, IFRI, Benin, 2019, Afis Mahoutin Malick KOUSSE.
35
Webography
[8] World Health Organization,
https://www.who.int/health-topics/cardiovascular-diseases/#tab=tab_1,
Last visit: 03 May 2025,10:55 ,
[9] Coronary artery disease,
https://www.mayoclinic.org/diseases-conditions/coron
ary-artery-disease/symptoms-causes/syc-20350613, Last visit: 03 May 2025, 14:55
,
[10] World Health Organization,
https://www.who.int/health-topics/cardiovascular-diseases/#tab=tab_1,
Last visit: 03 May 2025, 10:55.
[11] World Health Organization, Regional Office for Africa,
https://www.afro.who.int/hea
lth-topics/cardiovascular-diseases, Last visit: 11 May 2025, 09:43.
[12] World Heart Federation, *World Heart Report 2023*,
https://world-heart-federation
.org/wp-content/uploads/World-Heart-Report-2023.pdf, Last visit: 11 May 2025,
09:45.
[13] World Health Organization, *Noncommunicable Diseases
Country Profile: Benin*, https:
//www.afro.who.int/sites/default/files/2023-08/Benin.pdf, Last visit: 11 May
2025, 09:47.
[14] Sanofi IMPACT, *Tackling Non-Communicable Diseases in
Benin*,
https://www.impact
.sanofi/news/tackling-non-communicable-diseases-in-benin, Last visit:
11 May 2025, 09:48.
[15] Tossou, O. A. et al., *Les maladies cardiovasculaires
à l'Hôpital de Zone de Suru-Léré*, Open Journal of
Internal Medicine, vol. 11, pp. 202-210, 2021.
https://www.scirp.org/journal/
paperinformation.aspx?paperid=110241, Last visit: 11 May 2025, 09:50.
[16] Percutaneous Coronary Intervention (PCI),
https://www.yalemedicine.org/condition
s/percutaneous-coronary-intervention-pci, Last visit: 18 june 2025, 18:50.
[17] ACC/AHA Guidelines for Percutaneous Coronary
Intervention (Revision of the 1993 PTCA Guidelines),
https://www.ahajournals.org/doi/10.1161/01.cir.103.24.3019,
Last visit: 12 july 2025, 11:57.
[18] What equipment is used in angioplasty?,
https://www.tjmedtech.com/What-equipmen
t-is-used-in-angioplasty-id49296876.html,Lastvisit: 12 july 2025, 12:37.
[19]
36
Catheters used in PCI ,
https://www.medtronic.com/en-ca/healthcare-professionals/products/cardiovascular.html#aq=%40pagetype%3D%22product-model%22&cq=%40products_category%3D%22Cardiovascular%22%20OR%20%40ontol
ogy_isa%3D%22Cardiovascular%22, Last visit: 17 july 2025, 22:20.
[20] Coronary Artery Surgery,
https://www.ncbi.nlm.nih.gov/books/NBK562187/,
Last visit: 19 july 2025, 07:27.
[21] Coronary Artery Surgery,
https://www.fmptr.com/Instruments-for-Coronary-Ar
tery-Bypass-Graft--CABG--Surgery--An-In-Depth-Guide, Last visit: 19 july 2025,
08:08.
[22] Coronary Artery Surgery Procedure,
https://stanfordhealthcare.org/medical-tr
eatments/c/coronary-artery-bypass-graft-surgery/procedures/during.html, Last
visit: 19 july 2025, 08:27.
[23] Coronary Artery Surgery Complications,
https://stanfordhealthcare.org/medical-treatments/c/coronary-artery-bypass-graft-surgery/complications.html,
Last visit: 19 july 2025, 08:45.
[24] Bori Bata, K., Sonou, A., Dohou, H., Aïkpon, D.,
Agbo, M., et al. (2023). Acute Aortic Dissection at the Cardiology Clinic to
the University National Hospital Hubert Koutoukou Maga of Cotonou (BENIN).
International Journal of Cardiovascular and Thoracic Surgery, 9(6), 71-76.
https://doi.org/10.11648/j.ijcts.20230906.11
,
https://www.sciencepg.com/arti
cle/10.11648/j.ijcts.20230906.11, Last visit: 19 july 2025, 12:24.
[25] BMC Medical Education: Effects of simulation in
improving the self-confidence of student nurses in clinical practice: a
systematic review ,
https://bmcmededuc.biomedcentral.com
/articles/10.1186/s12909-023-04793-1, Last visit: 25 july 2025, 23:42.
[26] BMC Medical Education: Stress responses in high-fidelity
simulation and standard simulation training among medical students ,
https://bmcmededuc.biomedcentral.com/articles/
10.1186/s12909-023-04101-x, Last visit: 25 july 2025, 23:53.
[27] Yount KW, Yarboro LT, Narahari AK, Ghanta RK, Tribble CG,
Kron IL, Kern JA, Ailawadi G. Outcomes of Trainees Performing Coronary Artery
Bypass Grafting: Does Resident Experience Matter? Ann Thorac Surg. 2017
Mar;103(3):975-981. doi: 10.1016/j.athoracsur.2016.10.016. Epub 2017 Jan 26.
PMID: 28131424. ,
https://pubmed.ncbi.nlm.nih.gov/28131424/,
Last visit: 26 july 2025, 06:28.
[28] Patrick WL, Iyengar A, Han JJ, Mays JC, Helmers M, Kelly
JJ, Wang X, Ghoreishi M, Taylor BS, Atluri P, Desai ND, Williams ML. The
learning curve of robotic coronary arterial bypass surgery: A report from the
STS database. J Card Surg. 2021 Nov;36(11):4178-4186. doi: 10.1111/jocs.15945.
Epub 2021 Aug 29. PMID: 34459029; PMCID: PMC9128069. ,
https://pubmed.ncbi.nlm.ni
h.gov/34459029/, Last visit: 26
july 2025, 06:41.
[29] L'essentiel sur...La réalité virtuelle ,
https://www.cea.fr/comprendre/Pages/nouvelle
s-technologies/essentiel-sur-realite-virtuelle.aspx, Last visit: 26 july 2025,
08:46.
[30]
37
Slater, M. (2003). A note on presence terminology. Presence
Connect. ,
https://www.resear
chgate.net/publication/242608507_A_Note_on_Presence_Terminology,
Last visit: 26 july 2025, 08:55.
[31] Virtual reality system helps surgeons, reassures patients ,
https://med.stanford.edu
/medicalgiving/news/virtual-reality-system-helps-surgeons-reassures-patients.html,
Last visit: 26 july 2025, 09:18.
[32] Seymour NE, Gallagher AG, Roman SA, O'Brien MK, Bansal
VK, Andersen DK, Satava RM. Virtual reality training improves operating room
performance: results of a randomized, double-blinded study. Ann Surg. 2002
Oct;236(4):458-63; discussion 463-4. doi: 10.1097/00000658200210000-00008.
PMID: 12368674; PMCID: PMC1422600. ,
https://pmc.ncbi.nlm.nih.gov
/articles/PMC1422600/?pStoreID=epp, Last visit: 27 july 2025, 09:05.
[33] The effectiveness of virtual and augmented reality in
health sciences and medical anatomy Christian Moro, Zane tromberga, Athanasios
Raikos, Allan Stirling ,
https://anatomypubs.
onlinelibrary.wiley.com/doi/10.1002/ase.1696, Last visit: 27 july 2025,
09:56.
[34] Ageing and Dementia Research Centre (ADRC) and Alzheimer's
Research UK launches immer-sive VR dementia training ,
https://blogs.bournemouth.ac.uk/research/2019/06/1
2/ageing-and-dementia-research-centre-adrc-and-alzheimers-research-uk-launches-immersive-vr-dementia-training/,
Last visit: 27 july 2025, 10:30.
[35] VR-NRP: A Virtual Reality Simulation for Training in the
Neonatal Resuscitation Program. Mustafa Yalin Aydin, Vernon Curran, Susan
White, Lourdes Pena-Castillo, Oscar Meruvia-Pastor ,
https://arxiv.org/abs/2406.15598,
Last visit: 27 july 2025, 10:44.
[36] Virtual reality simulation as a training tool for
perfusionists in extracorporeal circulation: Establishing face and
content validity. ,
https://www.jtcvstechniques.org/article/S2666-2507(23)00198-0/fulltext,
Last visit: 27 july 2025, 22:14.
[37] vCathLab website ,
https://vcathlab.com/, Last visit:
29 july 2025, 16:22.
[38] Cardiologist-approved VR for interventional procedures
headed to ACC.24 ,https: //
cardiovascularbusiness.com/topics/clinical/structural-heart-diseas
e/cardiologist-approved-vr-interventional-procedures-headed-acc24?, Last visit:
30 july 2025, 10:27.
[39] What is Unified Modeling Language (UML)? ,
https://www.visual-paradigm.com/gui
de/uml-unified-modeling-language/what-is-uml/, Last visit: 02 august 2025,
21:42.
[40] Blender's official site ,
https://www.blender.org/, Last
visit: 03 august 2025, 01:32.
[41] Blender's History ,
https://www.blender.org/about/history/,
Last visit: 03 august 2025, 01:39.
[42] XR Interaction Toolkit Documentation ,
https://docs.unity3d.com/Packages/com.un
ity.xr.interaction.toolkit@3.2/manual/index.html, Last visit: 03 august 2025,
03:09.
[43]
38
About the Oculus XR Plugin ,
https://docs.unity3d.com/Packages/com.unity.xr.o
culus@4.5/manual/index.html, Last visit: 03 august 2025, 04:11.
[44] Communiqué 1 - Probatoire Cardio 2025 ,
https://fr.scribd.com/document/88535505
7/Communique-1-Probatoire-Cardio-2025, Last visit: 14 september 2025, 09:13.
[45] Annuaire des statistiques UAC de l'année
académique 2019-2020 ,
https://www.research
gate.net/publication/366719572_Annuaire_des_statistiques_UAC_de_l%27an
nee_academique_2019-2020, Last visit: 14 september 2025, 09:17.
[46] Effectiveness of Immersive Virtual Reality in Surgical
Training--A Randomized Control Trial ,
https://www.joms.org/article/S0278-2391(17)31250-8/abstract,
Last visit: 16 september 2025, 11:12.
[47] Virtual Reality Training Improves Operating Room
Performance ,
https://pmc.ncbi.nlm.n
ih.gov/articles/PMC1422600/,
Last visit: 16 september 2025, 11:32.
39
Contents
Dedication ii
Acknowledgements iii
Résumé iv
Abstract iv
iv
v
List of Figures vi
List of Tables vii
List of Acronyms viii
Glossary ix
Introduction 2
1 State of Art 4
Introduction 4
1.1 Coronary artery diseases 4
1.1.1 Overview 4
1.1.2 Coronary artery disease's treatments 5
1.2 Cardiology training issues 8
1.2.1 Current methods of training cardiology students with
contextual focus on Benin
8
1.2.2 Limitations of the theoretical approach alone 8
1.2.3 Complication and error rates in initial coronary surgery
experiences 9
1.2.4 Existing digital solutions (Excluding immersive
technologies) 9
1.3 Immersive technologies in the medical field 11
1.3.1 Virtual Reality as a key immersive technology in medical
training 11
1.3.1.1 Types of Virtual Reality experiences in medical education
12
1.3.1.2 Tools and equipment in VR training 12
1.3.1.3 Modalities of use in medical education 12
1.3.2 Pedagogical benefits and cognitive impacts of immersive
technologies 13
1.4 VR applications in cardiology 13
1.4.1 Existing projects and tools in cardiology training 13
40
1.4.2 Comparative analysis of existing solutions and benefits of
our solution. . . . 16
Conclusion 16
2 Conception and technical choices 18
Introduction 18
2.1 Analysis and design 18
2.1.1 Needs analysis 18
2.1.2 Design 19
2.1.2.1 Technical design 19
2.1.3 Fundamental design 20
2.2 Technical choices 21
2.2.1 Choice of 3D modelling and animation software 21
2.2.2 Choice of game engine and programming language 22
2.2.3 IDE 23
2.2.4 Choice of SDK and frameworks for VR 23
2.2.5 Others softwares 24
2.3 Development methodology 24
Conclusion 25
3 Presentation of the solution and discussions
26
Introduction 26
3.1 Presentation of the software 26
3.1.1 Visual Identity 26
3.1.1.1 Main logo design 26
3.1.1.2 Color palette and visual harmony 27
3.1.1.3 Logo variations and adaptations 27
3.1.1.4 Logo usage guidelines and restrictions 28
3.1.1.5 Visual applications 28
3.1.2 Software interfaces 29
3.2 Challenges encountered and solutions 31
3.3 Discussion 32
Conclusion 32
Conclusion 33
Bibliography 34
Webography 35
Contents 39
41
| 
