Virtual Environment For Radiotherapy Training Research Articles

The impact of 3D stereoscopic visualisation on performance in electron skin apposition techniques using VERT

Abstract Introduction: The Virtual Environment for Radiotherapy Training (VERT) is a simulator used to train radiotherapy students cost-effectively with limited risk. VERT is available as a two-dimensional (2D) and a more costly three-dimensional (3D) stereoscopic resource. This study aimed to identify the specific benefits afforded by stereoscopic visualisation for student training in skin apposition techniques. Method: Eight participants completed six electron skin apposition setups in both 2D and 3D views of VERT using a 7 cm × 10 cm rectangular applicator setup to 100 cm focus skin distance (FSD). The standard deviation (SD) of the mean distance from each corner of the applicator to the virtual patient’s skin surface [which we define as apposition precision (AP)] was measured along with the time taken to achieve each setup. Participants then completed a four-question Likert-style questionnaire concerning their preferences and perceptions of the 2D and 3D views. Results: There was little difference in mean setup times with 218·43 seconds for 2D and 211·29 seconds for 3D (3·3% difference). There was a similarly small difference in AP with a mean SD of 5·61 mm for 2D and 5·79 mm for 3D (3·2% difference) between views. The questionnaire results showed no preference for the 3D view over the 2D. Conclusion: These findings suggest that the 2D and 3D views result in similar setup times and precision, with no user preference for the 3D view. It is recommended that the 2D version of VERT could be utilised in similar situations with a reduced logistical and financial impact.

Becoming virtually real: using the Virtual Environment for Radiotherapy Training (VERT™) platform for the summative assessment of performance in a palliative radiotherapy treatment technique

Abstract Introduction: Direct observation in the radiotherapy clinic remains the primary method for the assessment of procedural skills. But with increasing automation and reductions in clinical placement time during the recent pandemic, the role of summative, simulation-based assessment is being revisited. The aim of this article is to share early experiences of using Virtual Environment for Radiotherapy Training (VERT) in the assessment of a palliative, parallel pair, external beam treatment delivery technique in a new pre-registration undergraduate programme. Methods: Eight first-year students completed a campus-based individual virtual assessment using virtual patient plans representing metastatic disease in the brain and pelvis and late-stage primary lung tumours. Performance was logged on a 25-item checklist for pre and post-procedure checks and treatment delivery tasks. Results: All eight students participated in the assessment with seven students (87·5%) achieving a pass grade at first attempt. The course team observed that participants demonstrated a range of skills and abilities and were able to compare and contrast individual approaches to patient positioning. Specific feed-forward action points were also highlighted as areas for students’ to focus on during their second placement. The project also identified logistical benefits for assessment teams. Conclusions: While these experiences are a single snapshot, a VERT simulation-based summative assessment is feasible and identified benefits included controlled observation and structured feedback on individual performance and scheduling pressure reductions for clinical teams. However, more work is needed to determine the psychometric qualities and predictability of performance in more complex techniques.

Utilising virtual environments for radiation therapy teaching and learning

IntroductionModern radiation therapy undergraduate education comprises the illustration of theoretical, technical concepts in a classroom setting, coupled with the acquisition of practical handling and patient communication skills within the clinical environment. In recent years, there has been renewed interest in the application of virtual environments to education, despite ongoing inconclusive evidence on the use of virtual environments for enhancing student educational achievement. Aim and objectivesThe aim of our research is to evaluate a custom-built 3D virtual radiation oncology department created within Second Life®, an online virtual world, as an alternative to traditional physical classroom-based didactic instruction, in tandem with a Virtual Environment for Radiotherapy Training (VERT) system, for the peer support and training of junior radiation therapy students in their first and second year of undergraduate studies. To achieve this aim, we investigated learning achievement outcomes, knowledge retention over a 2-week time interval and learner self-perceived confidence post-instruction, using both quantitative and qualitative analysis. MethodsInstitutional ethics approval was granted for an exempted review. Participants were currently enrolled undergraduate Year 1 and Year 2 students at our institution. Student participants were randomised into two groups; the control group attended a face-to-face classroom session centred on the illustration of theoretical, technical concepts, while the intervention group attended a virtual classroom session online on Second Life®, where similar content was delivered. Both groups then attended a VERT practical session to acquire practical handling and communication skills in radiation therapy. Upon completion of the sessions, confidence surveys, knowledge-based written and practical assessments were administered to the student participants. ResultsWe found that the instructional session conducted within the custom-built 3D virtual radiation oncology department in Second Life® compared to the traditional didactic classroom setting increased undergraduate Year 1 radiation therapy students’ perceived confidence to a greater extent compared to Year 2 students, in performing radiation therapy treatment procedures. In addition, our findings revealed that overall learning achievement outcomes and knowledge retention scores between Second Life® and non- Second Life® student participants were closely similar and statistically insignificant. Thematic analysis of the confidence survey questionnaires revealed that the students in general desired more clinical hands-on practice. DiscussionSecond Life® is equally effective in disseminating theoretical, technical course content delivery to undergraduate radiation therapy students. The use of virtual environments appears to have increased the perceived confidence of the Year 1 undergraduate students to a greater extent compared to the Year 2 undergraduates, suggesting that the adoption of virtual environments early in the students’ educational journey can have a positive effect on students’ learning experience. Conclusions and RecommendationsThe development and use of our custom-built Second Life® radiation oncology department provides a novel way of delivering remote, virtual training instruction to undergraduate radiation therapy students over traditional, didactic classroom instructional delivery. We recommend, based on the results of this pilot study, that future research can involve a larger study sample of undergraduate RT students, to explore both the short-term and long-term impact of virtual environments on student learning outcomes across their enrolled years of study. This would in turn mean progressive attempts to revamp our existing curricula structure, to deliberately incorporate the use of virtual environments, especially during early undergraduate years, towards enhanced modern RT education.

Evaluation of a VERT-based module for proton radiotherapy education and training

AbstractIntroduction:In many countries, there is a skills gap in proton therapy with many staff unprepared to work with the new technology. The new Virtual Environment for Radiotherapy Training (VERT) proton module provides learners with a simulated proton machine 3D environment. This project aimed to evaluate the role of VERT in training the radiotherapy workforce for the future use of protons.Methods:A practical teaching session using VERT was deployed after a traditional teaching session had provided basic knowledge. A questionnaire deployed before and after VERT enabled comparison of knowledge while a combination of Likert and open questions gathered participant feedback concerning the initiative.Results:A total of 38 students provided evaluation of the session. Overall, there were high levels of satisfaction and enjoyment with 35 participants reporting enjoyment and 36 indicating that the event be repeated.Discussion:Participants felt that they had learned from the experience, although quantitative data lacked statistical significance to demonstrate this. All participants agreed that VERT had provided improved understanding of proton dose deposition arising from visualisation of beams and dose deposition. Most participants agreed that the simulation was realistic and that it had improved their understanding. Feedback in relation to future sessions concerned smaller group sizes, more patient cases, more time and additional clinical datasets.Conclusion:A proton simulation module has been shown to be an enjoyable teaching tool that improves students’ confidence in their knowledge of the underpinning theory and clinical usage of the modality. Learners felt better prepared to encounter protons in clinical practice. Future work will build on these findings using smaller group work and a more robust assessment tool to identify long-term impact of the training.

The Use of the Virtual Environment for Radiotherapy Training (VERT) Improves Understanding and Reduces Anxiety in Patients Undergoing Breast Radiotherapy: a Single-centre Experience

Purpose: Sufficient patient understanding of the radiotherapy process can improve patient compliance with several steps of the treatment pathway from the planning computed tomography (CT) scan to set-up and delivery of the radiotherapy itself. Within our Trust, we have piloted the use of the Virtual Environment for Radiotherapy Training (VERT) in patients due to undergo breast radiotherapy. This study investigated the impact of this intervention on patient understanding and anxiety levels relating to the radiotherapy.

The Application of the Virtual Environment for Radiotherapy Training to Strengthen IGRT Education

The use of simulation to enhance the quality of preclinical teaching and learning in radiation therapy is increasing. This article discusses the use of the Virtual Environment for Radiotherapy Training (VERT) in supporting teaching on image-guided radiation therapy (IGRT) and image matching concepts. The authors review the capabilities of VERT and discuss how it is currently applied in undergraduate radiation therapy teaching. The integration of IGRT theory with hands-on image matching practice using VERT simulation in educational environments has many potential benefits. These include the potential to strengthen the students’ knowledge and skills in online-image acquisition and review of planar two-dimensional images and cone beam computed tomography images. It is anticipated that learner engagement will improve as well as refine analytical skills and confident practice in critical assessment of IGRT images. The authors encourage the utilization of technology that provides students with hands-on skills so they are better prepared for clinical environments.

The Role of Virtual Environment for Radiotherapy Training (VERT) in Medical Dosimetry Education

Medical dosimetry is an important component in training of radiation therapist, yet it is not easy for student to understand the principle of treatment planning and to be familiar with the relationship of the clinical target volume (CTV), planned target volume (PTV), and the nearby organs at risk (OARs) by just imagination. This study is conducted to evaluate whether using VERT in teaching medical dosimetry can help student to improve their learning experience. Students of cohort 2015 and 2016 were taught under TPS mode and TPS + VERT mode respectively. Direct comparison was conducted through self-evaluation survey, between two groups of students, in terms of their understanding of the concept of medical dosimetry and their level of confidence in completing different types of plans after the course. Both groups of students were able to understand the concept of medical dosimetry and able to complete 3D conformal plans after taking the course. Though, the students received TPS mode reported that they had lower level of confidence in completing the planning and required longer time for self-study and practice compared to the students who received the TPS + VERT mode. This study demonstrated that including VERT into medical dosimetry education can improve students’ learning experience, by improving their self-confidence, as well as reducing time required for their self-study and practice.

Evaluating VERT as a radiotherapy plan evaluation tool: comparison with treatment planning software

AbstractIntroduction:The virtual environment for radiotherapy training (VERT) helps students to gain technical skills and understanding of 3D anatomy and dosimetry. It has potential as a tool for treatment plan evaluation, although little formal evidence currently supports this.Aim:This paper reports findings from a plan evaluation workshop that facilitated comparison of VERT plan evaluation tools with those provided by conventional treatment planning software (TPS).Method:Students on a pre-registration Post-Graduate Diploma in Radiotherapy worked in small groups evaluating lung plans using both VERT and Eclipse TPS tools. All students were invited to provide ratings concerning how helpful each modality was for a range of evaluation parameters and preferences for use.Results:Most students (11 out of 14) found the session useful and expressed a desire to use VERT in future plan evaluation. The TPS was perceived to be more helpful with constraint-based evaluation while VERT was more helpful with evaluating plans for clinical set-up and delivery (p < 0·001).Conclusion:Student therapeutic radiographers found VERT to be helpful as a plan evaluation tool alongside standard TPS tools, in particular for clinical set-up and delivery aspects of planning. Future work is ongoing to identify the specific impact of VERT as a plan evaluation tool for both students and qualified planners.

Innovation in education: computer simulation in physics training

Interest in the application of Computer Simulation within Medical training continues to grow and the use of the VERT (Virtual Environment for Radiotherapy Training) system in radiotherapy training equally so. Herein we explore the use of the VERT system to understand, illustrate and experience the process required to calibrate an ion chamber and use it to obtain an accurate output measurement on a high energy Linac. The VERT system provides a detailed and accurate simulation of conventional Linacs and has a variety of physics activities that mirror the tasks medical physicists are required to become familiar with during their training. One such activity has been implemented to follow the steps defined by the IAEA TRS398 protocol. All activities on the virtual Linac can be undertaken with deliberate errors having been introduced to explore their consequences. The system was used to make the necessary ‘measurements’ to determine the various calibration factors required to correct the raw electrometer reading for ion recombination, polarity, temperature/pressure. Likewise, the Quality Index of the Linac’s 6MV beam was determined to enable the correction of the Absorbed Dose to Water factor measured in the reference Quality. The VERT system provides a simulation environment for training and enhancing the trainees understanding of radiotherapy concepts and practices. Dosimetry practice can be experienced and explored in the classroom during standard working hours rather than waiting until a clinical Linac is available. Random and systematic errors can be introduced, however, the virtual machine can be used without risk of leaving it in a mis-calibrated or unsafe condition.

Developing and evaluating virtual anatomy resources for teaching allied health disciplines

Allied health professionals require an understanding of anatomy for purposes such as planning radiotherapy, or treating muscle imbalance. In practice, they will rarely see the structure they are treating, but seeing it during their education is invaluable. To reveal deep structures in the human body, neighbouring structures are unavoidably removed as a donated human body is dissected. Academic and clinical staff approached the challenge for students’ understanding of the male reproductive and urinary system, which is indeed disrupted by dissection. An existing radiotherapy planning instrument Virtual Environment for Radiotherapy Training was used to create videos of real patients’ internal structures. Structures difficult to see in dissection, models and images were transformed from magnetic resonance and computerised tomography scans into videos that appeared three-dimensional, for use by students learning anatomy. Qualitative evaluation of these anatomy videos suggested that they can be accessed at students’ convenience and can be customised with captions, pauses or quizzes. Quantitative evaluation suggested that offering assessment-related incentives may not result in all students choosing to access the videos, but that those who did performed better on both labelling and short answer explanations of related content on immediate and short-term testing.

Radiation therapy patient education using VERT: combination of technology with human care.

The Virtual Environment for Radiotherapy Training (VERT) system is a recently available tool for radiation therapy education. The majority of research regarding VERT‐based education is focused on students, with a growing area of research being VERT's role in patient education. Because large differences in educational requirements exist between students and patients, focused resources and subsequent evaluations are necessary to provide solid justification for the unique benefits and challenges posed by VERT in a patient education context. This commentary article examines VERT's role in patient education, with a focus on salient visual features, VERT's ability to address some of the spatial challenges associated with RT patient education and how to combine technology with human care.

Simulation-based education: A narrative review of the use of VERT in radiation therapy education.

Simulation has a long history in medical and health science training and education. The literature describing this history is extensive. The role simulation plays in many health disciplines has evolved, as has the focus of the literature around it. The Virtual Environment for Radiotherapy Training (VERT) system is a relative newcomer to radiation therapy education and, similar to the literature around radiation therapy (RT) education, is still in its infancy. This narrative review sets the scene of simulation‐based education within the health sciences and considers the lessons learned from published work on VERT to date. The evidence suggests that future inquiry involving VERT should explore different ways in which VERT can be used to contribute to the skillset required by the radiation therapist of tomorrow.

Patient education using virtual reality increases knowledge and positive experience for breast cancer patients undergoing radiation therapy.

Improved access to technology in the radiation therapy (RT) workforce education has resulted in opportunities for innovative patient education methods. This study investigated the impact of a newly developed education tool using the Virtual Environment for Radiotherapy Training (VERT) system on patients' RT knowledge and anxiety. Breast cancer patients were recruited into a control group (CG) (n = 18) who underwent the standard pre-RT education package at a targeted cancer therapy centre, followed by a VERT group (VG) (n = 19). VG patients attended a VERT-based education session detailing RT immobilisation, planning and treatment. All patients completed questionnaires at four time points throughout their treatment, with survey sub-sections on RT knowledge, experience and anxiety. For both groups, anxiety levels were highest at time point 1(T1 after initial radiation oncologist consultation) (CG, 41.2; VG, 43.1), with a gradual decrease observed thereafter at time points before simulation, at the beginning of treatment and at the end of treatment (p > 0.05). The VG's RT knowledge scores were statistically significantly higher than those of the CG scores at all time points following VERT education (p < 0.05). This study reports the high value of VERT breast cancer-targeted education programs in improving RT knowledge and perhaps decreasing patient anxiety. Continued efforts are required to improve patients' accessibility to VERT in Australia, and to better understand the effect of VERT's unique educational features on patients' emotional and physical needs throughout their RT.

VERT, a virtual clinical environment, enhances understanding of radiation therapy planning concepts

IntroductionThe ability to understand treatment plan dosimetry and apply this understanding clinically is fundamental to the role of the radiation therapist. This study evaluates whether or not the Virtual Environment for Radiotherapy Training (VERT) contributes to teaching treatment planning concepts to a cohort of first‐year radiation therapy students.MethodsWe directly compared a custom‐developed VERT teaching module with a standard teaching module with respect to the understanding of treatment planning concepts using a cross‐over design. Students self‐reported their understanding of specific concepts before and after delivery of the VERT and standard teaching modules and evaluated aspects of VERT as a learning experience. In addition, teaching staff participated in a semi‐structured interview discussing the modules from an educational perspective.ResultsBoth the standard teaching module and VERT teaching module enhanced conceptual understanding and level of confidence in the student cohort after both teaching periods. The proportion of students reporting a perceived increase in knowledge/confidence was similar for the VERT teaching module for all but two scenarios. We propose that an integrated approach, providing a strong theoretical conceptual framework, followed by VERT to situate this framework in the (simulated) clinical environment combines the best of both teaching approaches.ConclusionThis study has established for the first time a clear role for a tailored VERT teaching module in teaching RT planning concepts because of its ability to visualise conceptual information within a simulated clinical environment.

Utilising the Virtual Environment for Radiotherapy Training System to Support Undergraduate Teaching of IMRT, VMAT, DCAT Treatment Planning, and QA Concepts

The use of three-dimensional virtual reality technologies in education has been widely reported in the literature. The goal of this article is to review how the virtual environment for radiotherapy training (VERT) can be utilised to support the teaching of intensity-modulated radiotherapy (IMRT), volumetric-modulated arc therapy, and dynamic conformal arc therapy techniques. Utilising Pinnacle v14 (Philips Radiation Oncology Systems, Madison, WI) and Monaco v 5.10 (Elekta CMS, Maryland Heights, MO), we exported IMRT, volumetric-modulated arc therapy, and dynamic conformal arc therapy treatment plans to VERT. Quality assurance (QA) plans were also exported from the Monaco planning software to demonstrate theoretical concepts and virtual plan delivery using the ArcCHECK phantom (Sun Nuclear Corp, Melbourne, FL) and solid water IMRT phantom. Several VERT features were utilised to critically evaluate dose coverage and organ at risk sparing on inverse treatment plans. The display of gantry and multileaf collimator motion and fluence maps could be a useful feature in the education of treatment planning concepts. QA could be delivered on VERT to demonstrate patient-specific QA concepts in a virtual environment. Anecdotal evidence shows that the use of VERT for collaborative plan evaluation sessions is likely to engage the students and improve their ability to evaluate treatment plans. VERT can be utilised to reinforce understanding of treatment plan evaluation skills, QA, and treatment delivery of inverse plans in educational environments.

International audit of Virtual Environment for Radiotherapy Training usage

AbstractIntroductionThe Virtual Environment for Radiotherapy Training (VERT) is a high-fidelity simulation hardware and software resource that replicates the expensive and high-pressure clinical environment of a radiotherapy treatment machine. The simulation allows students to gain confidence with clinical techniques in a safe and unpressured academic environment before clinical placement. The aim of this study was to establish the current and future role of VERT and explore the potential for collaborative resource development and research.MethodsAn anonymous online survey was made available to all users of the software internationally (n=52). A mixture of fixed and open response questions gathered usage data and user feedback.ResultsThe study had a 90% response rate (n=47). Most participants (78·5%) used the resource 1 day/week or less; around 8,000 hours worldwide. It was clear that most participants used the simulation resource to help student to either gain understanding of concepts and techniques or to gain practice with techniques and practical skills. There was good support for collaborative resource development, deployment and evaluation to help VERT users to fully exploit its range of pedagogical uses.ConclusionsThis audit demonstrated high levels of engagement and enthusiasm for collaborative resource development and ongoing research among the radiotherapy simulation community. Adoption of an international Academic Community of Practice for collaborative simulation resource deployment and support may be of significant value and is worthy of further discussion and consideration.

Successful implementation of Virtual Environment for Radiotherapy Training (VERT) in Medical Physics education: The University of Sydney's initial experience and recommendations.

This report outlines the University of Sydney's initial experience with the Virtual Environment for Radiotherapy Training (VERT) system in the Master of Medical Physics program. VERT is a commercially available system, simulating linear accelerators, patient computed tomography (CT) sets, plans and treatment delivery. It was purpose built for radiation therapy (RT) education and offers learners the opportunity to gain knowledge and skills within an interactive, risk-free environment. The integration of VERT into the RT physics module of the Master of Medical Physics program was intended to enhance student knowledge and skills relevant to the curriculum's learning objectives, and to alleviate some of the burden associated with student access to clinical equipment. Three VERT practical sessions were implemented: "RT treatment planning systems", "(CT) Anatomy for physicists" and "Linear accelerator measurements". Our experience and student evaluations were positive and demonstrated the viability of VERT for medical physics (MP) student education. We anticipate that integration of VERT into MP teaching is a valuable addition to traditional methods and can aid MP students' understanding and readiness for practice. Additional evaluations should be conducted to ascertain VERT's role in delivering efficient quantity and quality of MP education, and its potential in alleviating burdens placed on clinical departments.

Radiation Therapy Patient Education Review and a Case Study Using the Virtual Environment for Radiotherapy Training System

IntroductionThe emergence of modern learning environments for radiation therapy (RT) education offers innovative opportunities for RT patients. This article presents a descriptive review of the current state of practice for two recently available tools, the “Virtual Environment for Radiotherapy Training” (VERT) and the “Patient Education And Radiotherapy Learning” (PEARL) systems. Subsequently, a case study summarizes the instructional design and development of an RT breast cancer patient education program, with the intention of providing a blueprint for further patient education initiatives that incorporate VERT. MethodsA total of 278 articles were identified for the descriptive review, using academic databases and a grey literature search. After screening for descriptive accounts of patient education interventions using VERT or PEARL, five full articles were retrieved and coded using a data extraction protocol. This information was used to inform the subsequent development of a breast cancer education program using a three-step development model, encompassing (1) consultation process and literature review; (2) program content and instructional process; and (3) program evaluation plan. The VERT integration process within the second stage is the focus of the case study presented. ResultsThe literature search found that methods for the design, delivery, and evaluation of the education programs varied across studies. Positive impacts of VERT and PEARL in patient education have been demonstrated. The development of the 1-hour education program was based on comprehensive, evidence-based learner literature and was designed with the intention of specifically engaging learners with the three-dimensional VERT system. In particular, the VERT integration process aimed to exploit VERT's range of visualization features and draw upon the multidisciplinary nature of radiation cancer care. DiscussionVERT and PEARL offer innovative education opportunities and have been justly recognized as valuable tools for RT patient education. When aligned to an educational framework, rich visual displays offered by VERT and PEARL have the potential to support patient education programs and exploit the advantages of a virtual RT environment. With the increasing accessibility of these tools, the data presented in this article offer information for educators interested in development and evaluation of future patient education programs. Feasibility and economic aspects need to be addressed within local departments, and further research is required to ascertain specific capability of VERT and PEARL in supporting psychological and health-related patient outcomes.

Breast Cancer Patients' Perceptions of a Virtual Learning Environment for Pretreatment Education.

The process and technicalities of radiation therapy (RT) for cancer treatment can be challenging for patients to understand as RT involves complex procedures, highly specialised equipment, and radiation itself has limited sensory characteristics. Hence, it is imperative that education programs are specifically planned and developed to suit the needs of patients, address radiation as an entity and include salient visual aids. In this context, the Virtual Environment for Radiotherapy Training (VERT) system, primarily created for RT practitioner simulation, may provide unique opportunities for patient education. This article reports on patient feedback of a newly developed breast cancer patient education program, which integrates the VERT system as the focal education tool. The education program content included RT immobilisation, simulation, planning and treatment components, along with an introduction to the VERT system. Nineteen breast cancer patients (n=19) completed an evaluation questionnaire at the completion of their VERT education program. Open-ended questions were used to detect the least and most useful aspects of the education session. Patient feedback indicated a high regard for the comprehensiveness of the education program, with particular acknowledgement of the three dimensional visual features of the VERT system. It is proposed that VERT's high visual impact should be exploited in tailored patient education programs in order to obtain maximum patient engagement and make significant gains in effective knowledge transfer.

The utilisation of virtual images in patient information giving sessions for prostate cancer patients prior to radiotherapy

The aim of the study was to explore the prostate patients' perceptions of a Virtual Environment for Radiotherapy Training (VERT) as an information giving resource prior to radiotherapy delivery.A survey design was used to determine the level of knowledge of those patients who attended VERT for a pre-treatment talk and identify the benefits and limitations of using VERT as pre-treatment information giving resource. Participants were invited to attend a VERT patient information session four weeks prior to their planning CT scan, and then complete a questionnaire two weeks after start of radiotherapy treatment. A sample of n = 38 patients were recruited over a five month data collection period.Results showed that patient perceptions on the use of VERT as information giving tool prior to radiotherapy treatment were very positive. The sessions enable patients to understand the potential impact of treatment volumes if the internal organ shape and location differed from that originally planned, enabling them to comply with radiotherapy treatment instructions. Additional key findings have demonstrated excellent levels of communication associated with the use of VERT emphasising the need for future patient preparation strategies to consider the use of virtual technology.