The Application of Digital Twins in Healthcare: Comparison
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Digital twins (DTs) play a crucial role in the ongoing Industry 4.0 revolution, leveraging advanced data analytics and the connectivity of Internet of Things (IoT) to drive transformative changes across industries. The metaverse presents the potential for transformative changes in healthcare by offering virtual health services, supporting mental health, managing reality, and enabling virtual management. These innovations have the capacity to enhance accessibility, convenience, and the overall patient experience, bringing healthcare closer to individuals and ensuring that they receive the necessary care, regardless of physical distance or limitations.

  • digital twin
  • healthcare
  • metaverse
  • artificial intelligence

1. Introduction

Digital twins (DTs) play a crucial role in the ongoing Industry 4.0 revolution, leveraging advanced data analytics [1,2][1][2] and the connectivity of Internet of Things (IoT) to drive transformative changes across industries [3]. The proliferation of IoT technology has substantially increased data availability across sectors, such as manufacturing [4], healthcare [5], and smart cities [6]. The abundance of data in various sectors like manufacturing and smart cities, coupled with robust data analytics capabilities, offers significant potential for applications, such as predictive maintenance, fault detection, and advancements in manufacturing processes and smart city infrastructure [7]. Furthermore, DTs enable anomaly detection in fault detection systems [8,9[8][9][10],10], patient care processes, and the efficient management of traffic in smart cities [11,12][11][12]. These applications demonstrate the significant value of DTs in optimizing processes [13,14][13][14] and enhancing operational efficiency across multiple domains [15]. The DT environment enables a smooth and seamless exchange of information between the physical and virtual realms, empowering organizations to derive valuable insights and make informed, data-driven decisions. This integration fosters a deeper understanding of complex systems, improves operational efficiency, and supports optimization efforts across various domains. By harnessing the potential of DTs, industries can unlock new opportunities for process improvement, predictive maintenance, and resource optimization, leading to enhanced productivity, cost savings, and overall business success.
The metaverse concept, first introduced by Neal Stephenson in his renowned science fiction novel Snow Crash, has captured considerable attention and transformed into the idea of a computer-generated universe that incorporates real-world economic systems. It encompasses immersive shared spaces that integrate elements from the physical, human, and digital realms [16]. The metaverse is gradually transitioning from a conceptual idea to a tangible reality as various technologies continue to advance. These technologies include wearable sensors [17], non-fungible tokens (NFTs) [18], augmented reality (AR) [19,20,21][19][20][21], 5G connectivity [16,22[16][22][23][24],23,24], DTs [3], blockchain [25[25][26][27],26,27], virtual reality (VR) [28[28][29],29], brain–computer interfaces [30], and artificial intelligence (AI) [31]. This progression has sparked global interest, leading major technology firms like “Meta” (formerly Facebook), Microsoft, Tencent, and NVIDIA to invest in its development [32]. The evolution of the metaverse [33] can be understood through three distinct phases: DTs [34], digital natives [35[35][36],36], and surreality. The initial phase focuses on creating highly detailed DT representations of humans and objects within virtual environments, effectively replicating physical reality in a vivid digital form. Subsequently, in the phase of digital twins, represented by avatars, active contribution to content creation and innovation occurs within the metaverse, erasing the traditional boundaries between the actual and virtual worlds. Finally, in the ultimate phase, the metaverse transforms into a persistent and self-sustaining surreality world, seamlessly integrating the physical and virtual realms and expanding beyond the physical world’s limitations [37].
The metaverse, a conceptual technology, is digitalizing numerous facets of society, industries, and everyday life, presenting significant potential for advancing various services [38]. By merging virtual and physical assets within cyberspace, the metaverse empowers individuals to embody themselves through avatars [39]. Moreover, the integration of techniques and technologies, such as AI [40[40][41],41], machine learning (ML) [42,43[42][43][44][45][46],44,45,46], deep learning (DL) [47], DTs, IoT [48[48][49],49], edge computing [50,51][50][51], and cloud computing [52], further augments this transformative technology [53,54][53][54].
While the metaverse has witnessed notable advancements in platforms such as social media [55], diagnosis [56[56][57][58][59],57,58,59], and treatment planning [60], its utilization in the medical domain, specifically in cancer diagnosis, treatment, and examination, necessitates additional enterprise, deliberation, and research. Through the fusion of virtual and physical realms, the metaverse encompasses extended reality, mixed reality, AI, high-speed internet, blockchain, DTs, and augmented and virtual reality. This convergence holds immense potential to revolutionize healthcare and significantly impact overall health and clinical practice [61]. The immersive and interactive attributes of the metaverse present healthcare professionals with the opportunity to engage with patients in a personalized and captivating manner, ultimately resulting in enhanced care and patient satisfaction [62]. Furthermore, the metaverse enables seamless information and resource sharing, promoting more efficient and effective healthcare treatment. As a result, the metaverse has the potential to bring about transformative and substantial improvements to the healthcare industry.
In the past, healthcare has primarily relied on in-person interactions between patients and healthcare providers for crucial aspects, such as surgery, treatment, and diagnosis. While telehealth has introduced some changes by enabling remote consultations, exciting technological advancements such as the metaverse hold the promise to revolutionize the healthcare industry. The metaverse presents the potential for transformative changes in healthcare by offering virtual health services, supporting mental health, managing reality, and enabling virtual management [63]. These innovations have the capacity to enhance accessibility, convenience, and the overall patient experience, bringing healthcare closer to individuals and ensuring that they receive the necessary care, regardless of physical distance or limitations.

2. The Application of Digital Twins in Healthcare 

2.1. Healthcare

In recent studies, there has been emerging research on the utilization of DTs in healthcare [66][64]. Numerous practical implementations have been documented, covering a diverse range of areas. For example, DT has been successfully applied to promote well-being in smart cities [67][65], enhance fitness-related activities [68][66], simulate the spread of viral infections [69][67], facilitate remote surgical procedures [70][68], and improve healthcare management [66][64]. DT technology holds immense potential for improving healthcare management by leveraging AI, data science, and deep learning approaches. These advancements have the capacity to revolutionize the delivery of healthcare services, offering personalized and expedited care to individuals. The application of such technologies has already resulted in the development of innovative solutions, including vital sign monitoring apps, brain–computer interfaces, the detection of liver and cardiac diseases, and food-monitoring apps. In a recent study [66][64], a conceptual model known as the human digital twin (HDT) was proposed to address key security and social ethics challenges. The HDT aims to replicate an individual’s physical body in a cyber–physical space by leveraging data from mobile phones, wearable sensors, and medical records. This model guarantees that its material is constantly updated via online services in order to retain up-to-date information [66][64]. The obtained data are analyzed with various technologies to produce pertinent assessments of the patient’s health status. Furthermore, the HDT considers aspects like relationships with other people and environmental effects. In their survey paper [71][69], the authors delve into the diverse applications of DTs across several industries, including manufacturing, construction, automotive, aerospace, and emerging applications in healthcare, specifically precision medicine. The authors emphasize the potential of DT to revolutionize connected care and transform the management of health, lifestyle, chronic diseases, and wellness. However, despite this potential, technical, regulatory, and ethical challenges impede consensus on the full extent of the revolutionary impact of DT in healthcare over the next decade. The paper discusses the technologies and applications of DT in healthcare. The technologies and applications emphasized in the article are shown in Figure 1. The paper comprehensively reviews current DT applications in healthcare, covering areas such as precision medicine, hospital operations, and clinical trial design. It identifies opportunities and challenges to the widespread adoption of DT in the healthcare domain. Additionally, the authors discuss current findings, opportunities, and challenges, and give recommendations to help with the further development of DT applications in healthcare.
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Figure 1. Technologies and applications of DT as illustrated in [71].
Technologies and applications of DT as illustrated in [69].
This study [72][70] explores the application of DTs in healthcare, specifically focusing on cancer care, with an emphasis on endometrial cancer. The study proposes a DT model integrated with AI to enhance clinical decision making and provide more patient-centric and individualized care. It investigates the role of AI techniques in developing DTs for cancer care and discusses challenges and facilitators from healthcare and technology perspectives.

2.2. Telemedicine

Telemedicine allows remote medical consultations and has several benefits, especially for patients living in disadvantaged and rural regions. Patients can remotely consult doctors and experts using the power of the metaverse, eliminating the need for travel and lowering healthcare expenses. Telemedicine offers patients advantages, including convenience, effectiveness, and price. This substitute for conventional in-person consultations cuts down on appointment wait times, simplifies the recovery process, and is reasonably priced. Additionally, it promotes continuity of care by allowing patients to continue to receive assistance and direction from medical professionals, which results in improved treatment outcomes. Despite its advantages, telemedicine has a few challenges. These challenges include technological limitations, quality of care, low patient–provider communication, security and privacy concerns, and billing issues. Patients need adequate internet connections, computers, smartphones, and other devices to access telemedicine services fully. Some complex cases may not be possible with telemedicine. Limited connectivity and concerns about possible cyberattacks also threaten patient data privacy and security [73][71].

2.3. Metaverse

The metaverse has several applications in healthcare [74][72], as shown in Figure 2, and several surveys have explored this. Enabling technologies of the metaverse include the following technologies:
Biomedinformatics 03 00039 g003 550
Figure 2.
Application of metaverse in healthcare.
  • Computer vision (CV) is used for in-house disease diagnosis and medical imaging.
  • IoT is used for surgery assistance, alerts, and providing vital information.
  • Human computer interface (HCI) is used for remote assistance and better medical services.
  • AI is used for obtaining valuable insights and making better decisions.
Another technology that is highly used in the metaverse is virtual reality (VR). VR is a three-dimensional computer-generated world that is immersive and interactive and allows for interaction through various senses, including touch and position. Nowadays, thanks to technical advancements, VR technology has extended to various fields and industries, including surgical training, sports training, language learning, and even as a therapy to overcome stage fright. Depending on their function and the technology employed, VR systems can vary greatly from one to the next, but they often fall into one of the following three categories:
  • Non-immersive: Typically, a 3D simulated environment that can be accessed through a computer screen is what this kind of VR means. Depending on the software, the surroundings could also produce sound. Using a keyboard, mouse, or other device, the user can influence the virtual world to some extent, but the environment does not communicate with the user directly. Non-immersive VR is exemplified by video games and websites that let users customize the look of a room.
  • Semi-immersive: Through a computer screen, a pair of glasses, or a headset, this kind of VR provides a limited virtual experience. It does not involve physical movement as full immersion does and instead concentrates on the visual 3D part of virtual reality. The flight simulator, used by airlines and the military to train its pilots, is a typical example of semi-immersive VR.
  • Quantum computing is used in quantum resistance security for medical applications and provides improved computational speed.
  • Blockchain is used for the security and privacy of medical data.
  • Big data provides enhanced healthcare data management and better healthcare data visualization.
  • Extended reality (XR) is used for virtual training, assistance and consultation.
  • DT helps in staffing, care models, and operational strategies.
  • 3D Modeling helps in interactive anatomical representation.
  • 5G and beyond provides a high-quality immersive experience, low latency, and high-speed communication.
  • Edge computing proves to be effective in efficient data transfer and better analytics.
  • Fully immersive: The user is entirely submerged in the virtual 3D environment thanks to this form of VR, which offers the highest quality of virtual reality. It includes hearing, seeing, and occasionally touching. Even some attempts with the addition of scent have been conducted. Users are able to completely engage with their surroundings when they are wearing specialized gear like helmets, goggles, or gloves. To give consumers the feeling of movement across the 3D world, the environment may also include items like treadmills or stationary bicycles. Although fully immersive VR technology is still in its infancy, it has already had a significant impact on the gaming and, to a lesser extent, the healthcare industries, and it is sparking a lot of interest across a variety of other industries.
In this study [65][73], a comprehensive survey is presented, focusing on the fundamentals, privacy, and security aspects of the emerging concept of the metaverse. The authors emphasize the goal of building a virtual shared space that is immersive and highly spatiotemporal for human interaction. They also recognize the potential privacy invasions and security breaches that may impede the widespread adoption of the metaverse, along with addressing the fundamental challenges related to scalability and interoperability. The paper explores a distributed metaverse architecture, delves into security and privacy threats, reviews existing countermeasures, and outlines future research directions for developing metaverse systems. The continuous end-to-end metaverse experiences are considered crucial, and the authors likely discuss approaches or measures to ensure the seamless nature of such experiences. In this study [34], the authors investigate the crucial factors involved in creating metaverse services and propose a framework that integrates DTs, 6G communication networks, blockchain, and AI. They aim to ensure continuous end-to-end metaverse experiences. The study also outlines the prerequisites for a comprehensive DT-enabled metaverse architecture and provides insights into potential future advancements in this emerging domain. Similarly, in this study [75][74], the authors initially discuss the definitions, applications, and challenges of both DT and the metaverse. They then propose a three-layer architecture that incorporates a user interface to bridge the gap between the real world and the metaverse. Additionally, the study addresses privacy and security issues that arise when utilizing DT in the metaverse, suggests potential solutions, and explores future research directions. These studies contribute to the understanding of integrating DT with the metaverse and shed light on the architecture, privacy concerns, security considerations, and potential advancements in this field. In [76][75], the authors explore the utilization of DTs in the construction of the metaverse, which is a virtual digital space that reshapes the physical world. Their focus lies in integrating tangible objects and social relations within the metaverse, including interpersonal connections and ethical considerations. The authors introduce principles such as the small-world phenomenon, broken windows theory, survivor bias, and herd behavior to guide the development of a DT model for social relations. The aim of the review is to provide insights into the mapping of real-world objects to the metaverse and to contribute to the understanding of how DT influences social dynamics within this virtual realm. The summary of the existing surveys is presented in Table 1.
Table 1.
Summary of the available surveys on DT, healthcare, and the metaverse.
Survey Year Scope Contributions and Limitations
DT Healthcare Metaverse
[16] 2022 Biomedinformatics 03 00039 i001 Biomedinformatics 03 00039 i001 Biomedinformatics 03 00039 i002
  • Countermeasures to overcome the challenges.
  • A novel distributed metaverse architecture.
  • Ternary-world interactions.
  • Exploration of the state-of-the-art approaches.
[71][69] 2022 Biomedinformatics 03 00039 i002 Biomedinformatics 03 00039 i002 Biomedinformatics 03 00039 i001
  • Applications of DTs in healthcare.
  • Exploration of precision medicine, clinical trial design, and hospital operations using DTs.
  • Identification of opportunities and challenges in the adoption of DTs in healthcare.
[72][70] 2023 Biomedinformatics 03 00039 i002 Biomedinformatics 03 00039 i002 Biomedinformatics 03 00039 i001
  • Endometrial cancer case study with AI-based DT model.
  • The role of AI in developing cancer care DTs and identifying barriers and facilitators from healthcare and technology perspectives.
[34] 2022 Biomedinformatics 03 00039 i002 Biomedinformatics 03 00039 i001 Biomedinformatics 03 00039 i002
  • Key strategies for establishing metaverse services.
  • Framework for integrating DT, 6G communication networks, blockchain, and AI.
  • Demonstration of framework to solve issues in metaverse services.
[57] 2023 Biomedinformatics 03 00039 i001 Biomedinformatics 03 00039 i002 Biomedinformatics 03 00039 i002
  • The development of a method for creating digital representations of cancer.
  • Explanation of cancer DTs for simulating diagnosis and development.
  • Description of the proposed cancer DT with ML techniques and algorithms.
[77][76] 2022 Biomedinformatics 03 00039 i002 Biomedinformatics 03 00039 i001 Biomedinformatics 03 00039 i001
  • Comprehensive view of DT in relevant domains and applications in engineering and beyond.
  • Focus on understanding the challenges and limits of DT implementation.
[78][77] 2022 Biomedinformatics 03 00039 i003 Biomedinformatics 03 00039 i002 Biomedinformatics 03 00039 i002
  • Explores metaverse’s impact on healthcare industry in seven areas: telemedicine, clinical care, education, mental health, physical fitness, veterinary care, and pharmaceuticals.
  • Examines current metaverse use and technical challenges for reliable healthcare systems.
  • Highlights potential benefits and addresses challenges for widespread metaverse integration in healthcare.
[74][72] 2023 Biomedinformatics 03 00039 i003 Biomedinformatics 03 00039 i002 Biomedinformatics 03 00039 i002
  • Comprehensive review of metaverse in healthcare, including state-of-the-art, enabling technologies, applications, and projects.
  • Identifies challenges and suggests future research directions for metaverse in healthcare.
[79][78] 2022 Biomedinformatics 03 00039 i002 Biomedinformatics 03 00039 i002 Biomedinformatics 03 00039 i001
  • Promotes a better understanding of DT.
  • Clarify some common misconceptions, and review the current trajectory of DT applications in healthcare.
[80][79] 2020 Biomedinformatics 03 00039 i002 Biomedinformatics 03 00039 i002 Biomedinformatics 03 00039 i001
  • Explore how DT can achieve precision healthcare for patients and systems.
  • The role of DT, frameworks, benefits, and challenges are also discussed.
Our survey 2023 Biomedinformatics 03 00039 i002 Biomedinformatics 03 00039 i002 Biomedinformatics 03 00039 i002
  • Applications of DT in healthcare.
  • Application of DT in healthcare with respect to the metaverse.
  • State-of-the-art techniques and methods.
  • New outlook to the open research gaps.
Note:Biomedinformatics 03 00039 i002—fully explained; Biomedinformatics 03 00039 i003—partially explained; Biomedinformatics 03 00039 i001—not explained.

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