Online surgical education adopted among urology residency programs in response to COVID-19: A pilot study

OBJECTIVE

To understand the residents' perceptions of the, COVID-19 driven, newly implemented online learning systems adopted among accredited urology residency programs nationwide, and their sustainability following the pandemic era.

MATERIALS AND METHODS

A survey was designed and dispersed to urology program coordinators and directors to distribute to their residents. In the survey, Online education models was the all-encompassing term to describe any form of resident education that occurred online. Anonymous surveys were exported from Survey Monkey and data was analyzed for statistical significance.

RESULTS

Over 70% of urology residents agreed or were neutral to the statement that Online education models were equivalent to in-person learning. Only 13% of residents stated that online learning should not be continued following the pandemic. Several different parameters were assessed, and only 5 of them showed statistical significance. Stress, personal engagement, interpersonal communication efficiency and non-verbal cues were all lower with online education models. The only attribute that was scored higher by residents was network connectivity issues.

CONCLUSIONS

An overwhelming majority of urology residents in the United States believe Online education models should continue to be adopted once the pandemic is over.

Urolithiasis in pregnancy: Advances in imaging modalities and evaluation of current trends in endourological approaches

OBJECTIVE

Given the challenges involved in diagnosis and treatment of pregnant women with urolithiasis, we aim to review the imaging modalities and current endourological management of these patients.

MATERIALS AND METHODS

We performed a review of the available literature on urolithiasis in pregnancy. This included evaluation, diagnostic imaging, and therapeutic options. The databases we searched from included Google Scholar and PubMed. A total of 346 abstracts were screened. After our inclusion/exclusion criteria were met, we were left with 42 sources: 18 retrospective studies, 10 reviews/meta-analyses, 8 sets of guidelines, 5 randomized control trials, and 1 prospective cohort.

RESULTS

We begin our review with the literature available on the safety and efficacy of imaging modalities in the surgical planning for urolithiasis in pregnant patients. This includes renal ultrasound, abdominal x-ray, computed tomography scan, and magnetic resonance imaging. While computed tomography may result in an added radiation exposure, with possible safety concerns, magnetic resonance imaging seems to be safer, however a less sensitive test. We next describe safety, efficacy, and outcomes of various surgical interventions for urolithiasis in pregnant patients. This encompasses ureteral stenting, percutaneous nephrostomy, ureteroscopy, extracorporeal shock wave lithotripsy, and percutaneous nephrolithotomy. Ureteroscopy is a safer approach, but percutaneous nephrolithotomy offers higher stone-free rates. Using an evidence-based approach, we propose an algorithm for management of the pregnant women with renal colic.

CONCLUSION

Management of the pregnant women with suspected urolithiasis is a unique challenge for healthcare providers. A multi-disciplinary approach should be taken to optimize outcomes through an evidence-based approach.

LA EDUCACIÓN QUIRÚRGICA EN LÍNEA IMPLEMENTADA EN LOS PROGRAMAS DE RESIDENCIA UROLÓGICA COMO RESPUESTA AL COVID-19: ESTUDIO PILOTO

Objetivo

Comprender la percepción de los residentes respecto a los sistemas de aprendizaje en línea, los cuales, impulsados por la pandemia de la COVID-19, han sido recientemente implementados a nivel nacional en los programas de residencia urológica acreditados. Adicionalmente, nos proponemos analizar su sostenibilidad tras la era de la pandemia.

Material y métodos

Se diseñó una encuesta para, a través de los coordinadores y directores de programas de urología, difundirla a los residentes de urología.

En la encuesta, los modelos de educación en línea englobaron cualquier forma de educación recibida por los residentes que se diera en línea. Las encuestas anónimas se exportaron de Survey Monkey y se analizaron los datos para determinar la significación estadística.

Resultados

Más del 70% de los residentes de urología estuvieron de acuerdo, o mostraron una actitud neutral, ante la afirmación de que los modelos de educación en línea eran equivalentes al aprendizaje presencial. Solo el 13% de los residentes afirmaron que el aprendizaje en línea no debería continuar tras la pandemia. Se evaluaron diversos parámetros, y solo 5 de ellos mostraron significación estadística. El estrés, el compromiso personal, la eficacia de la comunicación interpersonal y las señales no verbales fueron más bajos para los modelos de educación en línea. El único aspecto al que los residentes dieron mayor puntuación fue el de los problemas de conectividad a una red.

Conclusiones

La gran mayoría de los residentes de urología en Estados Unidos cree que los modelos de educación en línea deben mantenerse una vez terminada la pandemia.

Collision prediction for intracranial stereotactic radiosurgery planning: An easy-to-implement analytical solution

PURPOSE

Gantry collision is a concern in linac-based stereotactic radiosurgery (SRS). Without collision screening, the planner may compromise optimal planning, unnecessary re-planning delays can occur, and incomplete treatments may be delivered. To address these concerns, we developed a software for collision prediction based on simple machine measurements.

MATERIALS AND METHODS

Three types of collision were identified; gantry-couch mount, gantry-couch and gantry-patient. Trigonometric formulas to calculate the distance from each potential point of collision to the gantry rotation axis were generated. For each point, collision occurs when that distance is greater than the gantry head to gantry rotational axis distance. The colliding arc for each point is calculated. A computer code incorporating these formulas was generated. The inputs required are the couch coordinates relative to the isocenter, the patient dimensions, and the presence or absence of a circular SRS collimator. The software outputs the collision-free gantry angles, and for each point, the shortest distance to the gantry or the colliding sector when collision is identified. The software was tested for accuracy on a TrueBEAM® machine equipped with BrainLab® accessories for 80 virtual isocenter-couch angle configurations with and without a circular collimator and a parallelepiped phantom.

RESULTS

The software predicted the absence of collision for 19 configurations. The mean absolute error between the measured and predicted gantry angle of collision for the remaining 61 cases was 0.86 (0.01-2.49).

CONCLUSION

This tool accurately predicted collisions for linac-based intracranial SRS and is easy to implement in any radiotherapy facility.

Poster - Thur Eve - 36: Out-of-Field dose in craniospinal irradiation

The risk of radiotherapy induced secondary cancer depends on the integral dose delivered to the patient where the dose delivered within the radiation field is accounted for, as well as dose to out-of-field organs from scattered and leakage radiation. While commercial treatment planning systems allow accurate determination of in-field dose, they are generally not capable of accurate out-of-field dose prediction. Secondary cancer risk is especially an issue in craniospinal treatments where involved patients are often children or young adults. In this work we therefore propose a mathematical model that accurately predicts out-of-field dose for patients treated by craniospinal irradiation at the American University of Beirut Medical Center. An anthropomorphic phantom was imaged, planned and treated, with thermoluminescent dosimeters inserted in the phantom at in-field and out-of-field locations. The measurements showed that our treatment planning system calculated accurately (within 2%) dose inside the field, but did not perform well at points just outside the field edge and consistently underestimated the dose at points further away from the field edge. From the out-of-field measured data, a model was developed that predicts out-of-field dose at a point in the patient based on the distance of that point to the treatment field edge. The developed model is of the double-gaussian type; it contains parameters that can be tuned to make it applicable in other centers where linac geometry and treatment techniques may differ.

Immunity to schistosomiasis before puberty: humeral or cell mediated

To determine if the cell mediated immunity, induced by T-helper type-1 lymphocytes (Th1) response, during schistosomiasis mansoni has the potential to protect against infection, intensities of infections and re-infections, reflected in the egg count were followed up to 20 months among 119 individuals aged 5-22 years (Ys) with different number of previous infections whose yearly levels and pattern of water contact were similar. They were classified into 5 groups. Delayed hypersensitivity skin tests (DHT) to adult schistosome excretory-secretary antigens (ESAgs) and anti-schistosomula (ESAgs) isotypes were measured on detecting re-infection. The group with a mean age of (8.6 +/- 2.6 Ys) and infected less than 5 times showed only 6.5 percentage reduction of the egg count (PREC) and low cellular and humoral responses. Th1-associated cellular (DHT) and antibody responses (IgG2, IgG3) to the five infections were significantly higher in the (13.5 +/- 1.4 Ys) than in (18 +/- 2.2 Ys) age group. This was reflected in significant difference in PREC; being 41.5% among the first and 13.5% among the second. Th2-associated antibody responses (IgG1, IgG4, IgE) went on rising as patients allowed for age and number of infections increased over 5, being significantly higher in the (19 +/- 1.8 Ys) than in (14 +/- 1.1 Ys) age groups with PREC 45.5% and 12.9% respectively. These results imply a substantial protective role for cell mediated immunity in the pre-puberty stage and provide evidence that Th1-based vaccination strategy can work if augmented.