Author: Fahad Alam, Douglas A Hoover, Raffi Karshafian, Andrew Loblaw, Lucas Mendez, Lucas Mendez, Gerard Morton, Humza Nusrat, Moti R. Paudel, Mackenzie Smith, Amandeep Tagger, Anton Varlukhin 👨🔬
Affiliation: Odette Cancer Center, Sunnybrook Health Sciences Center, Department of Anesthesiology, Temerty Medicine, University of Toronto, Department of Physics, Toronto Metropolitan University, Department of Radiation Oncology, Temerty Medicine, University of Toronto, Department of Radiation Oncology, London Health Sciences Centre 🌍
Purpose: Prostate brachytherapy utilization has declined, due in part to limitations seen with in-person training including time and space constraints in the operating room. Virtual reality addresses challenges with clinical education while providing a learning experience shown to enhance engagement and retention. This study aimed to develop and evaluate the effectiveness of a two-part virtual reality simulator for prostate brachytherapy consisting of patient preparation and needle insertion modules.
Methods: A game engine was used to develop two interactive modules simulating patient preparation and needle insertion workflows for prostate brachytherapy procedures. A virtual reality headset was used to immerse users in a virtual operating room. Pre- and post- questionnaires were designed to evaluate perceived confidence levels of participants in recalling and explaining prostate brachytherapy workflows before and after the completion of each module. Responses to paired questions were analyzed using Wilcoxon signed-rank tests.
Results: The patient preparation module was completed by 11 participants. The Wilcoxon signed-rank test statistic (W) indicated increased confidence rankings from pre-survey scores for recalling procedure steps (W=65, p<0.01), explaining steps (W=51, p<0.01), identifying equipment (W=65, p<0.01), and explaining function of equipment (W=60, p<0.01). The prostate brachytherapy needle insertion module included 27 participants. The Wilcoxon signed-rank test statistic (W) demonstrated increased confidence rankings from pre-survey scores for recalling procedure steps (W=355, p<0.01), explaining steps (W=347, p<0.01), identifying equipment (W=355, p<0.01), and explaining function of equipment (W=354, p<0.01).
Conclusion: Perceived clinician confidence in prostate brachytherapy workflows significantly increased after completion of both the patient preparation and needle insertion modules. Future directions include conducting larger studies to explore the confidence of trainees within each discipline and impact on clinical practice, developing additional modules to include other cancer sites, and distributing the simulator to underserved areas to improve access to training.