Virtual Environment For Radiotherapy Training Research Articles

Enhancing conceptual knowledge: an approach to using Virtual Environment for Radiotherapy Training in the classroom

AbstractThis report discusses the approach to teaching undergraduate radiation therapy students in New Zealand using the Virtual Environment for the Radiotherapy Training (VERT) system. In conjunction with VERT being used to teach clinical skills, integration of conceptual knowledge occurs across all 3 years of the programme; this report gives examples of how this is achieved in practice.

PO-1015: Virtual training in patient information sessions prior to external beam radiotherapy

Purpose or Objective: The aim of the study was to explore the prostate patients’ perceptions of Virtual Environment for Radiotherapy Training (VERT) as an information giving resource prior to radiotherapy delivery. The objectives were: • To determine the level of knowledge of those patients who attended (VERT) for a pre-treatment talk • To explore patients perceptions who utilised (VERT) as an information giving resource prior to radiotherapy treatment • To identify the benefits and limitations of using VERT as pre-treatment information giving resource Material and Methods: A survey design was utilised to address the aims and objective of the study. The study was conducted over 2 phases: Phase 1 - participants were invited to attend a (VERT)patient information session four weeks prior to their planning CT scan. Phase 2 – patients were asked to complete a questionnaire two weeks after start of radiotherapy treatment. The questionnaire was designed to collect data on the prostate cancer patient’s knowledge attitudes and beliefs regarding pre-treatment information provided prior to their radiotherapy treatment. A total population sample was used for this study. All patients being referred for radical radiotherapy to the prostate were invited to participate, over a five month data collection period (March – August 2015). A total of n=40 patients were included in the sample. Results: Statistical package SPSS (Version 21) was used for data analysis. Descriptive statistics and frequency tables were the first steps in the data analysis. Thereafter, Chisquared tests were used to analyse the data further. Open ended questions were analysed thematically. Results are currently being analysed however preliminary results are very positive, a summary of the preliminary results are outlined below (the final presentation will include frequency tables): •Most patients found the (VERT) session to be very helpful •Most patients stated that the session helped them to understand the importance of following bowel and bladder instructions prior to treatment and enhanced their knowledge about radiotherapy side effects •The sessions were highly recommended for other patients and future recommendations included family members and carers to be included. •Most patients were comfortable being part of a group during the presentation. •Patients believed the sessions reduced their anxiety and stress about their upcoming treatment. Conclusion: 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 instruction.

From education to research: a journey of utilising virtual training

AbstractBackgroundLondon South Bank University (LSBU) has successfully implemented Virtual Environment for Radiotherapy Training (VERT) across the therapeutic radiography training curricula and are now supporting the use of VERT for patient education in clinical departments. A number of publications have reported on the use of VERT in education and training; more recent literature has focused on the use of VERT for patient education.Materials and methodsThe successful introduction of VERT before students’ first clinical placements resulted in the development of a ‘Pre-Clinical week’ where students practice and improve their technical skills, using the hand controls without a patient present, leading to increased confidence in clinical practice. Other examples of VERT curriculum integration at LSBU focused on the use of VERT for anatomy teaching. The more recent innovation at LSBU relevant to VERT integration has been the design, development and implementation of collaborative research projects where the aims of the studies were to explore patients’ perceptions of VERT as an information giving resource before radiotherapy delivery.SummaryThe introduction of VERT as education tool has enabled academic staff to develop a range of teaching methods to embed virtual training into the traditional classroom setting, demonstrating innovation and collaboration.

The use of a virtual reality simulator to explore and understand the impact of Linac mis-calibrations

Purpose: In recent years there has been interest in using Computer Simulation within Medical training. The VERT (Virtual Environment for Radiotherapy Training) system is a Flight Simulator for Radiation Oncology professionals, wherein fundamental concepts, techniques and problematic scenarios can be safely investigated.Methods: The system provides detailed simulations of several Linacs and the ability to display DICOM treatment plans. Patients can be mis-positioned with 'set-up errors' which can be explored visually, dosimetrically and using IGRT. Similarly, a variety of Linac calibration and configuration parameters can be altered manually or randomly via controlled errors in the simulated 3D Linac and its component parts. The implication of these can be investigated by following through a treatment scenario or using QC devices available within a Physics software module.Results: One resultant exercise is a systematic mis-calibration of 'lateral laser height' by 2mm. The offset in patient alignment is easily identified using IGRT and once corrected by reference to the 'in-room monitor'. The dosimetric implication is demonstrated to be 0.4% by setting a dosimetry phantom by the lasers (and ignoring TSD information). Finally, the need for recalibration can be shown by the Laser Alignment Phantom or by reference to the front pointer.Conclusions: The VERT system provides a realistic environment for training and enhancing understanding of radiotherapy concepts and techniques. Linac error conditions can be explored in this context and valuable experience gained in a controlled manner in a compressed period of time.

An evaluation of the utilisation of the virtual environment for radiotherapy training (VERT) in clinical radiotherapy centres across the UK

AimThe purpose of the survey was to evaluate the utilisation of the Virtual Environment for Radiotherapy Training (VERT) in clinical radiotherapy centres across the UK. MethodsA survey questionnaire was constructed using the Survey Monkey™ tool to evaluate the utilisation of the Virtual Environment for Radiotherapy Training. Once constructed, an online link to the survey questionnaire was emailed to all radiotherapy centre managers in the UK (n = 67) who were invited to provide one response per centre. The survey comprised forty-five questions which were grouped into eleven sections. Key resultsThe results indicate that 61% of UK radiotherapy centres have VERT installed, twenty centres are currently without a VERT installation and only 1 centre is intending to install a system in the near future. The results also indicate that the use of VERT varies considerably in differing radiotherapy centres with the most frequent use of VERT being for the training of staff, specifically for the training of pre-registration therapeutic radiographers and preparation time for trainers. The majority of centres using VERT for any of the purposes investigated feel it provides benefits. Conclusions and recommendationsThe survey highlighted the varied use of VERT in radiotherapy centres across the UK and indicated that when VERT is used in clinical radiotherapy centres, a wide variety of benefits are experienced. Because of the variation in use, it is concluded that the benefits of the VERT installations in radiotherapy centres across the UK are not being fully realised. It is recommended that all radiotherapy service managers commit adequate resources to develop and implement VERT fully and effectively so that its full potential is realised in all radiotherapy centres across the UK.

WE-G-BRA-06: Calibrating an Ionisation Chamber: Gaining Experience Using a Dosimetry 'flight Simulator'.

Recently there has been great interest in the use of simulation training, with the view to enhance safety within radiotherapy practice. We have developed a Virtual Environment for Radiotherapy Training (VERT) which facilitates this, including the simulation of a number of 'Physics practices'. One such process is the calibration of an ionisation chamber for use in Linac photon beams. The VERT system was used to provide a life sized 3D virtual environment within which we were able to simulate the calibration of a departmental chamber for 6MV and 15 MV beams following the UK 1990 Code of Practice. The characteristics of the beams are fixed parameters in the simulation, whereas default (Absorbed dose to water) correction factors of the chambers are configurable thereby dictating their response in the virtual x-ray beam. When the simulation is started, a random, realistic temperature and pressure is assigned to the bunker. Measurement and chamber positional errors are assigned to the chambers. A virtual water phantom was placed on the Linac couch and irradiated through the side using a 10 × 10 field. With a chamber at the appropriate depths and irradiated iso-centrically, the Quality Indices (QI) of the beams were obtained. The two chambers were 'inter-compared', allowing the departmental chamber calibration factor to be calculated from that of the reference chamber. For the virtual 6/15 MV beams, the QI were found to be 0.668/ 0.761 and the inter-comparison ratios 0.4408/ 0.4402 respectively. The departmental chamber calibration factors were calculated; applying these and appropriate environmental corrections allowed the output of the Linac to be confirmed. We have shown how a virtual training environment can be used to demonstrate practical processes and reinforce learning. The UK CoP was used here, however any relevant protocol could be demonstrated. Two of the authors (Beavis and Ward) are Founders of Vertual Ltd, a spin-out company created to commercialise the research presented in this abstract.

WE-G-BRA-04: The Development of a Virtual Reality Dosimetry Training Platform for Physics Training.

Recently there has been a great deal of interest in the application of Simulation methodologies for training. We have previously developed a Virtual Environment for Radiotherapy Training, VERT, which simulates a fully interactive and functional Linac. Patient and plan data can be accessed across a DICOM interface, allowing the treatment process to be simulated. Here we present a newly developed range of Physics equipment, which allows the user to undertake realistic QC processes. Five devices are available: 1) scanning water phantom, 2) 'solid water' QC block/ion chamber, 3) light/ radiation field coincidence phantom, 4) laser alignment phantom and 5) water based calibration phantom with reference class and 'departmental' ion chamber. The devices were created to operate realistically and function as expected, each has an associated control screen which provides control and feedback information. The dosimetric devices respond appropriately to the beam qualities available on the Linac. Geometrical characteristics of the Linac, e.g. isocentre integrity, laser calibration and jaw calibrations can have random errors introduced in order to enable the user learn and observe fault conditions. In the calibration module appropriate factors for temperature and pressure must be set to correct for ambient, simulated, room conditions. The dosimetric devices can be used to characterise the Linac beams. Depth doses with Dmax of 15mm/29mm and d10 of 67%/77% respectively for 10cm square 6/15MV beams were measured. The Quality Indices (TPR20/10 ratios) can be measured as 0.668 and 0.761 respectively. At a simple level the tools can be used to demonstrate beam divergence or the effect of the inverse square law; They are also designed to be used to simulate the calibration of a new ion chamber. We have developed a novel set of tools that allow education of Physics processes via simulation training in our virtual environment. Both Authors are Founders and Directors of Vertual Ltd, a spin-out company that exists to commericalise the results of the research work presented in this abstract.

The influence of VERT™ characteristics on the development of skills in skin apposition techniques

The introduction of the Virtual Environment for Radiotherapy Training (VERT™) has enabled pre-registration students to prepare for practice placements. The novelty of this resource means that its impact upon human performance in certain radiotherapy techniques has yet to be tested. This study investigated the influence of virtual environment characteristics on the development of skills previously honed exclusively in the clinical environment. Specifically the development of the electron treatment skin apposition technique. A specific treatment site was selected on the virtual patient and student performance, in terms of set-up to the treatment site, was determined by dataset software indicators. Forty four year 1 and 2 pre-registration radiotherapy students were involved in the study. Their perceptions with regard to confidence and skills development in terms of electron skin apposition were analysed with questionnaires. Respondents found the resource intrinsically motivating and perceived enhanced skin apposition skills (80%) and confidence levels (89%) as a consequence of using VERT™. Further study of this resource is on-going to examine its influence on student performance within the clinical environment.

Preliminary findings on the Virtual Environment for Radiotherapy Training (VERT) system: simulator sickness and presence

AbstractBackground:Virtual environments in medical education are becoming increasingly popular as a learning tool. However, there is a large amount of evidence linking these systems to adverse effects that mimic motion sickness. It is also proposed that the efficacy of such systems is affected by how well they engage the user, which is often referred to as presence.Purpose:This primary purpose of this study was to look at the side effects experienced and presence in the Virtual Environment for Radiotherapy Training (VERT) system which has recently been introduced.Method:A pre-VERT questionnaire was given to 84 subjects to ascertain general health of the subjects. The simulator sickness questionnaire was utilised to determine the side effects experienced, whereas the igroup presence questionnaire was used to measure presence. Both questionnaires were given immediately after use of the VERT system.Results:The majority of symptoms were minor; the two most commonly reported symptoms relating to ocular issues. No relationship was seen between simulator sickness and presence although subjects with a higher susceptibility to travel sickness had reported higher levels of disorientation and nausea. There was also a decrease in involvement with the system in subjects with a higher susceptibility to travel sickness.

The Adoption of Virtual Reality Training in Radiation Oncology

In providing effective training of radiation oncology professionals, common difficulties are access to treatment machines and the inability to practice and explore problematic scenarios. Akin to a 'flight simulator', VERT (Virtual Environment for Radiotherapy Training) is a commercially available system providing a life-size VR Linac and treatment room. It offers an effective means to gain clinical experience in a completely safe environment, without the usual time pressures. It has been installed in ten 'Therapy Radiography/RTT/Therapist' training schools in England and integrated into their training curriculum. The fully articulated virtual Linac is controlled using actual hand pendants and displays all the expected functionality. 3D glasses and life size projection improve the sense of realism when using the system. Patient plans can be loaded from any treatment planning system and placed on the treatment couch. Basic concepts related to the operation of the Linac can be demonstrated and treatment scenarios explored using purpose designed training aids. More advanced techniques, such as IMRT and IGRT where correct patient positioning is critical for organ sparing whilst providing adequate target doses, can be intuitively explored. VERT has shown benefits in accelerating the appreciation of relevant clinical concepts by fresh students. London Southbank University reported that new students were able to set virtual patients into treatment positions using surface anatomy within 3 weeks. Nationally, students are reported to be better prepared for clinical placements, more confident with the handset and asking more advanced questions for the stage of training. The 'seminar VERT' system is a smaller version suitable for any clinical facility, of which 30 are installed in England. Several institutions use this with trainee oncologists to cover basic plan delivery for Head and Neck, prostate, breast and use of the Linac. This reflects the practice that evolved in Aarhus, Denmark, an early adopter of VERT, where VERT allowed the throughput of trainees to be doubled and is used for training Oncologists and Therapists. Such reports indicate gains in efficiency and quality of training. VERT can be beneficial for radiation therapist training, oncology registrar training on radiation therapy technique, assistant practitioner training, physicists, associated team members and patient education.