Advancing Education for Prostate Brachytherapy: Evaluation of a Virtual Reality Simulator and Needle Insertion Module

Purpose/Aim

Clinicians face challenges in prostate brachytherapy education, partly because in-person training is constrained by limited time and space in the operating room (OR). Currently, radiation therapy curriculum does not effectively integrate brachytherapy education and clinical training. Virtual reality (VR) offers a scalable, accessible, and asynchronous solution for health professions education, making it a promising tool for addressing training challenges. To bridge the educational gap, our institution developed a VR training simulator with a needle insertion module designed to improve understanding of prostate brachytherapy workflows. The aim of this phase of the project was to evaluate the effectiveness of the VR simulator in improving the perceived confidence levels of radiation therapists, medical physicists, and radiation oncologists in prostate brachytherapy practice.

Methods/Process

An open-sourced three-dimensional modeling tool and game engine were used to develop a simulation allowing users to view and interact with a virtual replica of a brachytherapy OR using a commercially available VR headset. An iterative feedback loop was used during development to ensure that the VR simulator features were realistic and intuitive for users. A prostate brachytherapy training module was developed to simulate a needle insertion workflow. Participants in this study were asked to complete a virtual needle insertion and then answer questions regarding their experiences. Pre- and post-surveys were developed to assess the perceived confidence of users in recalling and explaining the needle insertion workflow before and after completing the module, as well as documenting any VR-related adverse effects. Each survey consisted of 6 Likert-scale questions, including 4 paired questions that were identical in both the pre- and post-survey to enable direct comparison of responses. Open ended questions were also included to gather participant demographics, feedback, and suggestions for improvement. Responses from paired questionnaires were analyzed using Wilcoxon signed-rank tests.

Results or Benefits/Challenges

The prostate brachytherapy needle insertion training module was completed by 27 participants, including radiation therapists (59%), radiation oncologists (26%), and medical physicists (15%). Wilcoxon signed-rank test results of participant pre- and post-survey responses demonstrated improved confidence rankings for recalling workflow steps (W=355, p<0.01), explaining steps (W=347, p<0.01), identifying equipment (W=355, p<0.01) and explaining equipment function (W=354, p<0.01) following completion of the module. Minor motion sickness with use of the VR simulator was experienced by 19% of participants. Feedback gathered from open-ended questions was positive, while highlighting areas for improvement.

Conclusions/Impact

The results of this study demonstrate the educational potential of our VR simulator for clinicians training in prostate brachytherapy. Further evaluation with a larger group of clinicians is required to help further refine our training module with the goal of making this learning experience available to trainees in brachytherapy. Additional modules detailing other steps within the prostate brachytherapy process are currently under development and evaluation. Future directions include incorporation of augmented reality to allow participants to interact with high fidelity phantoms in the virtual space and development of VR training modules for gynecological brachytherapy.