Effect of Neurofeedback and Simulation-based Training Interventions on Radiation Therapy Therapists’ (RTTs) Mental Workload, Situation Awareness, and Performance

Abstract

To help with ongoing quality assurance (QA) and patient safety improvement efforts in radiation therapy (RT) the objective of this research was to assess the impact of validated Alpha-Theta neurofeedback and simulation-based training interventions on radiation therapy therapist (RTT) mental workload, situation awareness and performance during routine treatment delivery tasks. 32 RTTs completed routine QA and treatment delivery tasks on clinical scenarios in a simulation laboratory. Participants, equally randomized to 4 groups (+/- neurofeedback, +/- simulation-based training; 8 per group) had pre- and post-intervention assessments of mental workload, situation awareness, and performance. We used analysis of variance (ANOVA) to compare the four study groups. Mental workload was quantified subjectively using the NASA Task Load Index (NASA-TLX). Situation awareness was quantified subjectively using the Situation Awareness Rating Technique (SART) and objectively using Situation Awareness Global Assessment Technique (SAGAT). Performance was quantified based on procedural compliance (adherence to pre-set/standard QA time-out tasks) and error detection (detection and correction of embedded treatment planning errors). Both neurofeedback and simulation-based training interventions were associated with significant improvements in performance (p<0.01), but had no significant impact on mental workload or subjective or objective quantification of situation awareness. Innovative interventions like simulation-based training and neurofeedback might be effective tools to improve RTTs performance; which in turn can lead to improvements in patient safety.