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Mulherkar R, Shah C, Bulat M, Thaker NG, Kamrava M, Beriwal S. Role of simulation-based training and assessment to improve brachytherapy competency among radiation oncology residents. Brachytherapy 2024; 23:489-495. [PMID: 38643045 DOI: 10.1016/j.brachy.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/13/2024] [Accepted: 02/29/2024] [Indexed: 04/22/2024]
Abstract
Simulation is a technique used in healthcare to replicate clinical scenarios and improve patient safety, efficacy, and efficiency. Simulation-based medical education facilitates training and assessment in healthcare without increasing risk to patients, supported by ample evidence from surgical/procedural specialties. Simulation in radiation oncology has been leveraged to an extent, with successful examples of both screen-based and hands-on simulators that have improved confidence and performance in trainees. In the current era, evidence substantiates a significant deficit in brachytherapy procedure education, with radiation oncology residents reporting low confidence in this procedural skill, largely attributable to insufficient caseloads at some centers. Simulation-based medical education can facilitate structured training and competency-based assessment in brachytherapy skills. This review discusses existing advances and future directions in brachytherapy simulation, using examples from simulation in surgical specialties.
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Affiliation(s)
- Ria Mulherkar
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA
| | - Chirag Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic Cancer Center, Cleveland, OH
| | - Mitchell Bulat
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA
| | - Nikhil G Thaker
- Department of Radiation Oncology, Capital Health Medical Center, Pennington, NJ
| | - Mitchell Kamrava
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Sushil Beriwal
- Department of Radiation Oncology, AHN Cancer Institute, Pittsburgh, PA.
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Karius A, Kreppner S, Strnad V, Schweizer C, Lotter M, Fietkau R, Bert C. Inter-observer effects in needle reconstruction for temporary prostate brachytherapy: Dosimetric implications and adaptive CBCT-TRUS registration solutions. Brachytherapy 2024; 23:421-432. [PMID: 38845268 DOI: 10.1016/j.brachy.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 05/08/2024] [Accepted: 05/08/2024] [Indexed: 07/19/2024]
Abstract
PURPOSE To investigate geometric and dosimetric inter-observer variability in needle reconstruction for temporary prostate brachytherapy. To assess the potential of registrations between transrectal ultrasound (TRUS) and cone-beam computed tomography (CBCT) to support implant reconstructions. METHODS AND MATERIALS The needles implanted in 28 patients were reconstructed on TRUS by three physicists. Corresponding geometric deviations and associated dosimetric variations to prostate and organs at risk (urethra, bladder, rectum) were analyzed. To account for the found inter-observer variability, various approaches (template-based, probe-based, marker-based) for registrations of CBCT to TRUS were investigated regarding the respective needle transfer accuracy in a phantom study. Three patient cases were examined to assess registration accuracy in-vivo. RESULTS Geometric inter-observer deviations >1 mm and >3 mm were found for 34.9% and 3.5% of all needles, respectively. Prostate dose coverage (changes up to 7.2%) and urethra dose (partly exceeding given dose constraints) were most affected by associated dosimetric changes. Marker-based and probe-based registrations resulted in the phantom study in high mean needle transfer accuracies of 0.73 mm and 0.12 mm, respectively. In the patient cases, the marker-based approach was the superior technique for CBCT-TRUS fusions. CONCLUSION Inter-observer variability in needle reconstruction can substantially affect dosimetry for individual patients. Especially marker-based CBCT-TRUS registrations can help to ensure accurate reconstructions for improved treatment planning.
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Affiliation(s)
- Andre Karius
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany.
| | - Stephan Kreppner
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Vratislav Strnad
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Claudia Schweizer
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Michael Lotter
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Christoph Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
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Mittal P, Chopra S, Kamrava M, Vashistha R, Konrad S, Senapati S, Pradhan S, Reddy VA, Sharma DN, Engineer R, Sarin R, Budrukkar A, Ghoshal S, Shrivastava SK, Agarwal JP, Sturdza AE. Brachytherapy training in India: Results from the GEC-ESTRO-India survey. Brachytherapy 2023; 22:562-569. [PMID: 37193616 DOI: 10.1016/j.brachy.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/30/2023] [Accepted: 04/07/2023] [Indexed: 05/18/2023]
Abstract
INTRODUCTION Brachytherapy (BT) is integral in treatment of gynecological malignancies and is also an option for many other cancers. Data on training and proficiency levels of early career oncologists is limited. Like other continents a survey was conducted for early career oncologists in India. METHODS AND MATERIALS An online survey was conducted from November 2019 to February 2020, through Association of Radiation Oncologists of India (AROI) for early career radiation oncologists expected to be within 6 years of training. The survey used a 22 item questionnaire that was also used for European survey. Responses to individual statements were recorded on a 1-5 Likert-type scale. Descriptive statistics were used to describe proportions. RESULTS One-hundred twenty-four (17%) of 700 recipients responded to the survey. Majority of the respondents (88%) stated that being able to perform BT at the end of their training was important. Two-thirds of the respondents (81/124) had performed >10 intracavitary procedure and 22.5% had performed >10 intracavitary-interstitial implants. Many respondents had not performed nongynecological procedure- breast (64%), prostate(82%), gastro-intestinal (47%). Respondents predicted that in next 10 years, the role of BT is likely to increase. Lack of dedicated curriculum and training was perceived as the greatest barriers to achieving independence in BT (58%). Respondents suggested that BT training should be prioritized during conferences (73%) and online teaching modules (56%), along with development of BT skills labs (65%). CONCLUSION This survey identified a lack of proficiency in gynecological intracavitary-interstitial brachytherapy and non-gynecological brachytherapy, despite BT training being regarded as highly important. Dedicated programs, including standardized curriculum and assessment need to be developed for training early- career radiation oncologists in BT.
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Affiliation(s)
- Prachi Mittal
- Department of Radiation Oncology and Medical Physics, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Supriya Chopra
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
| | - Mitchell Kamrava
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Rajesh Vashistha
- Department of Radiation Oncology, Max Super-Specialty Hospital, Bathinda, India
| | - Stefan Konrad
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Surendra Senapati
- Department of Radiation Oncology, Acharya Harihara Regional Cancer Centre, Cuttack, Odisha, India
| | - Satyajit Pradhan
- Homi Bhabha Cancer Hospital and Mahamana Pandit Madan Mohan Malaviya Cancer Centre, Varanasi, India
| | - Vijay Anand Reddy
- Department of Radiation Oncology, Apollo Hospitals, Hyderabad, India
| | - Daya Nand Sharma
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Reena Engineer
- Department of Radiation Oncology and Medical Physics, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Rajiv Sarin
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Ashwini Budrukkar
- Department of Radiation Oncology and Medical Physics, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sushmita Ghoshal
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Jai Prakash Agarwal
- Department of Radiation Oncology and Medical Physics, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Alina Emiliana Sturdza
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
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Swain M, Budrukkar A, Rembielak A, Kron T, Agarwal JP. Challenges in the Sustainability of Brachytherapy Service in Contemporary Radiotherapy. Clin Oncol (R Coll Radiol) 2023:S0936-6555(23)00205-4. [PMID: 37302881 DOI: 10.1016/j.clon.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/10/2023] [Accepted: 05/22/2023] [Indexed: 06/13/2023]
Abstract
Brachytherapy has a long history of delivering a highly conformal radiation dose to the target volume with sparing of adjacent normal tissue and has an irreplaceable role in certain cancers, such as cervical and prostate cancers. There have been futile attempts to replace brachytherapy with other radiation techniques. Despite that there are multifaceted challenges in preserving this dying art, from establishment, to a trained workforce, to maintenance of the equipment and source replacement costs. Here we focus on the challenges to access brachytherapy, the availability and distribution of care across the globe and appropriate training leading to proper implementation of the procedure. Brachytherapy holds a significant place in the treatment armamentarium of most common cancers, such as cervical, prostate, head and neck and skin cancers. However, there is an uneven distribution of brachytherapy facilities, not only across the globe, but also at a national level, with a larger proportion of facilities concentrated in certain regions, more so in low and low-middle income countries. The regions with the highest incidence of cervical cancer have the least access to brachytherapy facilities. Attempts to bridge the gap are essential and should be focused on uniform distribution and access to care, improving training of the workforce through specialised training programmes, reducing the cost of care, planning to reduce the recurring cost, generating evidence and research guidelines, renewing interest in brachytherapy through rebranding, use of social media and building an attainable long-term roadmap.
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Affiliation(s)
- M Swain
- Department of Radiation Oncology, Tata Memorial Hospital, HomiBhabha National Institute (HBNI), Parel, Mumbai, India
| | - A Budrukkar
- Department of Radiation Oncology, Tata Memorial Hospital, HomiBhabha National Institute (HBNI), Parel, Mumbai, India
| | - A Rembielak
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - T Kron
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, HomiBhabha National Institute (HBNI), Parel, Mumbai, India.
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Mäurer MA, Drozdz S, Ehrenpfordt J, Schwedas M, Friedlein M, Hille N, Riede C, Schrott S, Graf M, Wurschi G, Kamp MA, Wittig A, Knippen S. Development, implementation, and results of a simulation-based hands-on brachytherapy workshop for medical students. Strahlenther Onkol 2023; 199:370-378. [PMID: 36881115 PMCID: PMC9990013 DOI: 10.1007/s00066-023-02058-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/05/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE The new Medical Licensing Regulations 2025 (Ärztliche Approbationsordnung, ÄApprO) require the development of competence-oriented teaching formats. In addition, there is a great need for high-quality teaching in the field of radiation oncology, which manifests itself already during medical school. For this reason, we developed a simulation-based, hands-on medical education format to teach competency in performing accelerated partial breast irradiation (APBI) with interstitial multicatheter brachytherapy for early breast cancer. In addition, we designed realistic breast models suitable for teaching both palpation of the female breast and implantation of brachytherapy catheters. METHODS From June 2021 to July 2022, 70 medical students took part in the hands-on brachytherapy workshop. After a propaedeutic introduction, the participants simulated the implantation of single-lead catheters under supervision using the silicone-based breast models. Correct catheter placement was subsequently assessed by CT scans. Participants rated their skills before and after the workshop on a six-point Likert scale in a standardized questionnaire. RESULTS Participants significantly improved their knowledge-based and practical skills on APBI in all items as assessed by a standardized questionnaire (mean sum score 42.4 before and 16.0 after the course, p < 0.001). The majority of respondents fully agreed that the workshop increased their interest in brachytherapy (mean 1.15, standard deviation [SD] 0.40 on the six-point Likert scale). The silicone-based breast model was found to be suitable for achieving the previously defined learning objectives (1.19, SD 0.47). The learning atmosphere and didactic quality were rated particularly well (mean 1.07, SD 0.26 and 1.13, SD 0.3 on the six-point Likert scale). CONCLUSION The simulation-based medical education course for multicatheter brachytherapy can improve self-assessed technical competence. Residency programs should provide resources for this essential component of radiation oncology. This course is exemplary for the development of innovative practical and competence-based teaching formats to meet the current reforms in medical education.
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Affiliation(s)
- Matthias A Mäurer
- Department for Radiotherapy and Radiation Oncology, University Hospital Jena, Friedrich-Schiller-University, Bachstr. 18, 07743, Jena, Germany.
- Clinician Scientist Program "OrganAge", Jena University Hospital, 07747, Jena, Germany.
| | - Sonia Drozdz
- Department for Radiotherapy and Radiation Oncology, University Hospital Jena, Friedrich-Schiller-University, Bachstr. 18, 07743, Jena, Germany
| | - Juliet Ehrenpfordt
- Department for Radiotherapy and Radiation Oncology, University Hospital Jena, Friedrich-Schiller-University, Bachstr. 18, 07743, Jena, Germany
| | - Michael Schwedas
- Department for Radiotherapy and Radiation Oncology, University Hospital Jena, Friedrich-Schiller-University, Bachstr. 18, 07743, Jena, Germany
| | - Melissa Friedlein
- Department for Radiotherapy and Radiation Oncology, University Hospital Jena, Friedrich-Schiller-University, Bachstr. 18, 07743, Jena, Germany
| | - Nadine Hille
- Department for Radiotherapy and Radiation Oncology, University Hospital Jena, Friedrich-Schiller-University, Bachstr. 18, 07743, Jena, Germany
| | - Cora Riede
- Department for Radiotherapy and Radiation Oncology, University Hospital Jena, Friedrich-Schiller-University, Bachstr. 18, 07743, Jena, Germany
| | - Steffen Schrott
- Department for Radiotherapy and Radiation Oncology, University Hospital Jena, Friedrich-Schiller-University, Bachstr. 18, 07743, Jena, Germany
| | - Maximilian Graf
- Department for Radiotherapy and Radiation Oncology, University Hospital Jena, Friedrich-Schiller-University, Bachstr. 18, 07743, Jena, Germany
| | - Georg Wurschi
- Department for Radiotherapy and Radiation Oncology, University Hospital Jena, Friedrich-Schiller-University, Bachstr. 18, 07743, Jena, Germany
- Clinician Scientist Program "CSP-11", Jena University Hospital, 07747, Jena, Germany
| | - Marcel A Kamp
- Department of Neurosurgery, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Andrea Wittig
- Department for Radiotherapy and Radiation Oncology, University Hospital Jena, Friedrich-Schiller-University, Bachstr. 18, 07743, Jena, Germany
| | - Stefan Knippen
- Department for Radiotherapy and Radiation Oncology, University Hospital Jena, Friedrich-Schiller-University, Bachstr. 18, 07743, Jena, Germany
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Aima M, Simiele SJ, Richardson SL, Melhus CS. AAPM BTSC Report 377: Physicist Brachytherapy Training in 2021-A survey of therapeutic medical physics residency program directors. J Appl Clin Med Phys 2023; 24:e13859. [PMID: 36651371 PMCID: PMC9924109 DOI: 10.1002/acm2.13859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/07/2022] [Accepted: 11/21/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Brachytherapy (BT) was the first radiotherapeutic technique used to treat human disease and remains an essential modality in radiation oncology. A decline in the utilization of BT as a treatment modality has been observed and reported, which may impact training opportunities for medical physics residents. A survey of therapeutic medical physics residency program directors was performed as part of an assessment of the current state of BT training during residency. METHODS In March 2021, a survey consisting of 23 questions was designed by a working unit of the Brachytherapy Subcommittee of the American Association of Physicists in Medicine (AAPM) and approved for distribution by the Executive Committee of the AAPM. The survey was distributed to the directors of the Commission on Accreditation of Medical Physics Education Programs (CAMPEP)-accredited therapeutic medical physics residency programs by the AAPM. The participant response was recorded anonymously in an online platform and then analyzed using MATLAB and Microsoft Excel software. RESULTS The survey was distributed to the program directors of 110 residency programs. Over the course of 6 weeks, 72 directors accessed the survey online, and 55 fully completed the survey. Individual responses from the directors (including partial submissions) were evaluated and analyzed. Nearly all participating programs (98%) utilize high dose rate BT treatments with 74% using low dose rate BT techniques. All programs treated gynecological sites using BT, and the next most common treatment sites were prostate (80%) and breast (53%). Overall, the residency program directors had a positive outlook toward BT as a radiotherapeutic treatment modality. Caseload and time limitations were identified as primary barriers to BT training by some programs. CONCLUSIONS Based on the responses of the program directors, it was identified that the residency programs might benefit from additional resources such as virtual BT training, interinstitutional collaborations as well as resident fellowships. Programs might also benefit from additional guidance related to BT-specific training requirements to help program directors attest Authorized Medical Physicist eligibility for graduating residents.
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Affiliation(s)
- Manik Aima
- Department of Radiation OncologyStanford UniversityStanfordCaliforniaUSA
| | - Samantha J. Simiele
- Department of Radiation PhysicsUniversity of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | | | - Christopher S. Melhus
- Department of Radiation OncologyTufts University School of MedicineBostonMassachusettsUSA
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Poder J, Rivard MJ, Howie A, Carlsson Tedgren Å, Haworth A. Risk and Quality in Brachytherapy From a Technical Perspective. Clin Oncol (R Coll Radiol) 2023:S0936-6555(23)00002-X. [PMID: 36682968 DOI: 10.1016/j.clon.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/23/2022] [Accepted: 01/04/2023] [Indexed: 01/15/2023]
Abstract
AIMS To provide an overview of the history of incidents in brachytherapy and to describe the pillars in place to ensure that medical physicists deliver high-quality brachytherapy. MATERIALS AND METHODS A review of the literature was carried out to identify reported incidents in brachytherapy, together with an evaluation of the structures and processes in place to ensure that medical physicists deliver high-quality brachytherapy. In particular, the role of education and training, the use of process and technical quality assurance and the role of international guidelines are discussed. RESULTS There are many human factors in brachytherapy procedures that introduce additional risks into the process. Most of the reported incidents in the literature are related to human factors. Brachytherapy-related education and training initiatives are in place at the societal and departmental level for medical physicists. Additionally, medical physicists have developed process and technical quality assurance procedures, together with international guidelines and protocols. Education and training initiatives, together with quality assurance procedures and international guidelines may reduce the risk of human factors in brachytherapy. CONCLUSION Through application of the three pillars (education and training; process control and technical quality assurance; international guidelines), medical physicists will continue to minimise risk and deliver high-quality brachytherapy treatments.
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Affiliation(s)
- J Poder
- Department of Radiation Oncology, St George Cancer Care Centre, Kogarah, New South Wales, Australia; School of Physics, University of Sydney, Camperdown, New South Wales, Australia; Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia.
| | - M J Rivard
- Department of Radiation Oncology, Alpert Medical School of Brown University, Providence, RI, USA
| | - A Howie
- Department of Radiation Oncology, St George Cancer Care Centre, Kogarah, New South Wales, Australia
| | - Å Carlsson Tedgren
- Department of Health, Medicine and Caring Sciences (HMV), Radiation Physics, Linköping University, Linköping, Sweden; Medical Radiation Physics and Nuclear Medicine, The Karolinska University Hospital, Stockholm, Sweden; Department of Oncology Pathology, The Karolinska Institute, Stockholm, Sweden
| | - A Haworth
- School of Physics, University of Sydney, Camperdown, New South Wales, Australia
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Frank SJ. A CALL TO ARMS: The Case for MRI-Assisted Radiosurgery (MARS) vs. Stereotactic Body Radiation Therapy or Robotic-Assisted Radical Prostatectomy. Brachytherapy 2023; 22:12-14. [PMID: 36725197 DOI: 10.1016/j.brachy.2022.09.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 09/28/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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Doyle AJ, Cody D, King DM, Sullivan PFJ, Browne JE. Use of a novel anthropomorphic prostate simulator in a prostate brachytherapy transrectal ultrasound imaging workshop for medical physicists. Phys Med 2022; 95:156-166. [PMID: 35182938 DOI: 10.1016/j.ejmp.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/03/2022] [Accepted: 02/05/2022] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Ultrasound imaging training is not required as part of radiation oncology training programs nor does any objective competency measure exist to independently assess performance. Physical simulation training can provide a structured approach to this training but only if suitably challenging training simulators exist. This study describes the design and preliminary evaluation of a simulation-based transrectal ultrasound (TRUS) imaging training workshop developed for medical physicists involved in low-dose-rate (LDR) prostate brachytherapy (PBT). METHODS The study incorporated novel high-fidelity anthropomorphic PBT TRUS training simulators and a TRUS imaging module with a blended-learning pedagogical approach, to address TRUS image optimisation and managing image quality. RESULTS Results demonstrated a significant improvement in knowledge, with an average increase in multiple choice question score of 61% (P < 0.0002), and that there was a 46% (P < 0.0001) average increase in the participants perceived understanding of TRUS scanner operation, and an increase of 36% (P < 0.001) in participants readiness to optimise image quality and mitigate image artefacts. Focus group data explored participants' experiences, perceptions and challenges with TRUS LDR PBT. CONCLUSIONS This study suggests a benefit in offering a simulation training workshop to medical physicists and the potential benefit to other healthcare professionals involved in prostate brachytherapy, by incorporating novel high-fidelity anthropomorphic PBT TRUS training simulators, in a simulated environment to practice ultrasound image optimisation for PBT image guidance. This approach to training would enable competency-based skill acquisition and continued proficiency or health professionals in the TRUS PBT procedure, outside of the surgical environment without direct exposure to patients.
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Affiliation(s)
- Andrea Jane Doyle
- School of Physics and Clinical and Optometric Sciences, Medical Ultrasound Physics and Technology Group, Centre for Industrial and Engineering Optics, Focas, Technological University Dublin, Dublin, Ireland; RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Ireland.
| | - Dervil Cody
- School of Physics and Clinical and Optometric Sciences, Medical Ultrasound Physics and Technology Group, Centre for Industrial and Engineering Optics, Focas, Technological University Dublin, Dublin, Ireland
| | | | - Prof Francis J Sullivan
- Prostate Cancer Institute, National University of Ireland Galway, Galway, Ireland; Department of Radiation Oncology, Galway Clinic, Ireland; School of Medicine, National University of Ireland, Galway, Ireland
| | - Jacinta E Browne
- School of Physics and Clinical and Optometric Sciences, Medical Ultrasound Physics and Technology Group, Centre for Industrial and Engineering Optics, Focas, Technological University Dublin, Dublin, Ireland; Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Competency-based medical education in radiotherapy treatment planning. Pract Radiat Oncol 2021; 12:e232-e238. [PMID: 34929401 DOI: 10.1016/j.prro.2021.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/26/2021] [Accepted: 12/04/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE To develop a technology-enhanced education methodology with competency-based evaluation for radiotherapy treatment planning. The education program is designed for integration in the existing framework of Commission on Accreditation of Medical Physics Education Programs (CAMPEP) accredited medical physics residency programs. MATERIALS AND METHODS This education program pairs an accessible, multi-institutional infrastructure with established medical education evaluation tools to modernize treatment planning education. This program includes three evaluation components: (i) competency-based evaluation, (ii) inter- and intra-modality comparison, and (iii) learner feedback. For this study, synchronous bilateral breast cancer was selected to demonstrate a complex treatment site and non-standardized technique. Additionally, an online study was made available to a public cohort of worldwide participants of certified Medical Dosimetrists and Medical Physicists to benchmark performance. Prior to evaluation, learners were given a disease site-specific education session on potential clinical treatment strategies. During the assessment, learners generated treatment plans in their institutional planning system under the direct observation of an expert evaluator. Qualitative proficiency was evaluated for all learners on a five-point scale of graduated task independence. Quantitative dosimetry was compared between the learner cohort and public cohort. A feedback session provided learners context of multi-institutional experience through multimodality and technique comparison. After study completion, learners were provided a survey that was used to gauge their perception of the education program. RESULTS In the public study, 34 participants submitted treatment plans. Across three CAMPEP-accredited residency programs, six learners participated in the education and evaluation program. All learners successfully completed treatment plans that met the dosimetric constraints described in the case study. All learners favourably reviewed the study either comprehensively or in specified domains. CONCLUSION The competency-based education and evaluation program developed in this work has been incorporated in CAMPEP-accredited residency programs and is adaptable to other residency programs with minimal resource commitment.
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Petereit DG. Increasing global access to brachytherapy: The ABS 300 in 10 initiative and ongoing international efforts. Brachytherapy 2021; 21:1-3. [PMID: 34893430 DOI: 10.1016/j.brachy.2021.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 09/22/2021] [Indexed: 12/30/2022]
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