Computed tomography learning via high-fidelity simulation for undergraduate radiography students

From classroom to clinic: innovating radiotherapy treatment planning education through real-world end-to-end case study simulation with an anthropomorphic phantom

BACKGROUND

The incorporation of simulation-based learning in healthcare education, particularly in radiotherapy, is necessary for enhancing training and professional competencies to serve patient safety and treatment accuracy. This study aimed to incorporate an innovative end-to-end case study methodology, utilizing an anthropomorphic head phantom, into an undergraduate radiotherapy program at a United Kingdom (UK) based university. The objective was to enhance students' practical learning and theoretical understanding in radiotherapy treatment planning, a field where precision and accuracy are paramount.

METHODS

The study began with an exploratory literature review to identify key educational challenges and opportunities in radiotherapy treatment planning. A qualitative approach was employed, using a focus group methodology to gather in-depth insights from subject experts, including educational and clinical professionals involved in undergraduate radiotherapy teaching. The focus group discussions explored the integration of an anthropomorphic head phantom within a simulated, case study-based training framework. This innovative approach combined practical skills development with theoretical learning, promoting active engagement and mirroring real-world clinical scenarios.

RESULTS

Focus group discussions showed favorability towards the end-to-end case study method in simulation-based learning. Participants emphasized evaluating plans through assessments and using supplementary tools like video guides and workbooks to enhance learning. Incorporating the anthropomorphic phantom marked a notable advancement, offering authentic training possibilities in radiotherapy undergraduate education.

CONCLUSIONS

The study demonstrates the potential of integrating an end-to-end teaching concept in radiotherapy education. By providing a realistic and comprehensive training experience, the approach can further enhance student engagement and learning outcomes. While real-world testing is pending, this innovative methodology shows promise in shaping proficient future radiotherapy graduates, highlighting the need for continuous evolution in educational strategies to meet the demands of modern healthcare training.

Learning on a Limb: An outreach module to engage high school students in orthopaedics

Orthopaedic researchers need new strategies for engaging underrepresented minority (URM) students. Our field has demonstrated noticeable gaps in racial, ethnic, and gender diversity, which inhibit our ability to innovate and combat the severe socioeconomic burden of musculoskeletal disorders. Towards this goal, we designed, implemented, and evaluated Learning on a Limb (LoaL), an orthopaedic research outreach module to teach URM high school students about orthopaedic research. During the 4-h module, students completed hands-on activities to learn how biomechanical testing, microcomputed tomography, cell culture, and histology are used in orthopaedic research. Over 3 years, we recruited 32 high school students from the Greater Philadelphia Area to participate in LoaL. Most participants identified as racial/ethnic or gender minorities in orthopaedic research. Using pre/post-tests, we found that students experienced significant learning gains of 51 percentage points from completing LoaL. In addition to teaching students about orthopaedic research, post-survey data demonstrated that participating in LoaL strongly influenced students' interest in orthopaedic research and scientific confidence. Several students acted on this interest by completing summer research experiences in the McKay Orthopaedic Research Laboratory at the University of Pennsylvania. LoaL instructors also benefited by having the opportunity to "pay it forward" to the next generation of students and build community within their department. Empowering institutions to host modules like LoaL would synergistically inspire URM high school students and strengthen community within orthopaedic departments to ultimately enhance orthopaedic research innovations.

Diagnostic radiography workforce expectations of learners against the 2023 HCPC standards of proficiency: Results of a UK Delphi study

INTRODUCTION

The UK Health and Care Professions Council revised the Standards of Proficiency for diagnostic radiographers in 2023 to reflect modern practices and service needs. This will impact on the training and assessment of learners throughout their programmes in order to support them to meet the threshold standards.

METHODS

A Delphi survey was distributed to UK diagnostic radiographers to ascertain the stage of training in which they expect each standard of proficiency to be demonstrated by the learner.

RESULTS

Ninety-four diagnostic radiographers responded to the survey and 58.5% (n = 55) completed the second round of the survey. Participants agreed on the stage of pre-registration training that 74.9% of standards should be met. However, for 19.6% of standards there was no consensus. In 5.5% of standards participants expected these to be met one year post qualification.

CONCLUSION

Agreement of when three quarters of the new Standards would be expected to be met during pre-registration training could support practice placement learning and assessment. However, there is some uncertainty around the Standards and the ability to provide appropriate resources, support, and expertise to enable learners to meet them.

IMPLICATIONS FOR PRACTICE

The consensus of expectations could inform stage appropriate learning opportunities aligned to the 2023 HCPC Standards within practice placements, and a standardised assessment, should the appetite be established. However, the UK diagnostic radiography profession still has some work to do in aligning expectations with the statutory regulatory body requirements and preparing all staff to support learners to meet all threshold standards at point of qualification.

The perceptions and experiences of final year undergraduate diagnostic imaging students when facilitating peer-assisted learning within the simulated learning environment

INTRODUCTION

The persistent shortage of radiographers in the UK has prompted the exploration of innovative education models to enhance practice-based learning. Peer-Assisted Learning (PAL) has been advocated as a viable method to increase clinical training capacity, yet its application in Diagnostic Imaging is constrained by regulations on ionising radiation. This study investigates the perceptions and experiences of final-year undergraduate Diagnostic Imaging students facilitating PAL within a simulated learning environment.

METHODS

Final-year students were recruited via convenience sampling to act as mentors in simulated role-play activities. Data was collected through semi-structured interviews with three student mentors following the simulation. Thematic analysis of interview transcripts identified key themes related to the research question.

RESULTS

The analysis revealed four main themes: RELATIONSHIPS: Students valued the peer-to-peer teaching dynamic and the psychological safety provided by the simulation, which fostered reciprocal learning and enhanced inter-student relationships.

LEARNING ENVIRONMENT

The informal, responsive nature of the simulation was perceived as beneficial for encouraging participation and allowing students to learn from mistakes without real-world consequences.

LEARNING DESIGN

The timing of the simulation was noted as effective, aligning with academic learning. Feedback delivery and mentor preparation were also discussed, with disagreement on the value of the latter noted.

CONFIDENCE

Students reported increased confidence in their clinical and mentorship abilities.

CONCLUSION

The findings support existing literature on the benefits of PAL and simulation-based education (SBE), highlighting the positive impact on psychological safety, inter-student relationships, and confidence. However, the lack of formal training for mentors suggest areas for further research.

IMPLICATIONS FOR PRACTICE

The study underscores the potential for integrating PAL and SBE in radiography education to enhance readiness for clinical practice and foster effective peer mentoring.

Learning on a Limb: An outreach module to engage high school students in orthopaedics

Orthopaedic researchers need new strategies for engaging diverse students. Our field has demonstrated noticeable gaps in racial, ethnic, and gender diversity, which inhibit our ability to innovate and combat the severe socioeconomic burden of musculoskeletal disorders. Towards this goal, we designed, implemented, and evaluated Learning on a Limb, an orthopaedic research outreach module to teach diverse high school students about orthopaedic research. During the 4-hr module, students completed hands-on activities to learn how biomechanical testing, microcomputed tomography, cell culture, and histology are used in orthopaedic research. Over three years, we recruited 32 high school students from the Greater Philadelphia Area to participate in Learning on a Limb. Most participants identified as racial/ethnic or gender minorities in orthopaedic research. Using pre/post-tests, we found that students experienced significant learning gains of 51 percentage points from completing Learning on a Limb. In addition to teaching students about orthopaedic research, post-survey data demonstrated that participating in Learning on a Limb strongly influenced students' interest in orthopaedic research. Several students acted on this interest by completing summer research experiences in the McKay Orthopaedic Research Laboratory at the University of Pennsylvania. Learning on a Limb instructors also benefited by having the opportunity to "pay it forward" to the next generation of students and build community within their department. Empowering institutions to host modules like Learning on a Limb would synergistically inspire diverse high school students and strengthen community within orthopaedic departments to ultimately enhance orthopaedic research innovations.

An exploration of simulation-based education from other health professionals, to create an informed and effective simulation delivery in a new diagnostic radiography programme

INTRODUCTION

The recent validation of three Diagnostic Radiography programmes in the south of England involved a rigorous approval process with multiple Professional and Statutory Regulatory Bodies (PSRB's). Part of the validation process was evidencing that approximately 50% of each programme is spent undertaking practice-based learning. As well as clinical placements, practice-based learning includes simulation-based education (SBE).

METHODOLOGY

From May 2022 to June 2022, a questionnaire was sent to all 22 simulation education facilitators from health courses belonging to the University School Simulation Group. Ethical approval was reviewed and approved by the Learning and Teaching Hub Research Ethics Panel.

RESULTS

Of the initial 22 participants invited, the response rate was 59% (13 participants). The main themes arising from the analysis was the use of a theoretical or conceptual framework, a breakdown of the simulation session components and the role of simulation training.

CONCLUSION

This questionnaire study demonstrated that there was a need for a standardised guide on how to deliver SBE. There is also a lack of feedback, training, and reassurance for facilitators. However, facilitators would welcome training or further training and HEE and the University have taken steps to prioritise SBE.

IMPLICATIONS FOR PRACTICE

The study highlighted how health professionals are delivering SBE within their subjects in innovative and creative ways. These ideas have helped to structure SBE within the new diagnostic radiography courses at the University.

Radiographers' perceptions of first year diagnostic radiography students' performance following implementation of a simulation-based education model

INTRODUCTION

Simulation-based education (SBE) partially replaced the clinical placement learning for a cohort of first year students on a BSc (Hons) Diagnostic Radiography programme. This was in response to the pressures on hospital-based training caused by increasing student numbers and following increased capability and positive outcomes for student learning in delivering SBE as a result of the COVID-19 pandemic.

METHODS

A survey was distributed to diagnostic radiographers, across five NHS Trusts, involved in the clinical education of first year diagnostic radiography students at one UK university. The survey sought radiographers' perception of student performance in undertaking radiographic examinations, safety procedures, knowledge of anatomy, professionalism, and the impact of embedding simulation-based education through multichoice and free text questions. Descriptive and thematic analysis of the survey data was undertaken.

RESULTS

Twelve survey responses from radiographers across four Trusts were collated. Responses indicated the majority of radiographers perceived students to require the expected level of assistance in undertaking appendicular examinations, applying infection control and radiation safety measures, and had the expected level of radiographic anatomy knowledge. Students also interacted appropriately with service users, demonstrated increased confidence in coming into the clinical environment and were receptive to feedback. Some variation was noted, particularly in professionalism and engagement, though not always attributed to SBE.

CONCLUSION

Replacement of clinical placement with SBE was perceived to have provided appropriate learning opportunities and some additional benefits, however it was felt by some radiographers that SBE could not replace the experience of the real imaging environment.

IMPLICATIONS FOR PRACTICE

Embedding simulated-based education requires a holistic approach and close collaboration with placement partners to ensure complimentary learning experiences in the clinical placement setting, and support achievement of the learning outcomes.

Immersive virtual reality for pre-registration computed tomography education of radiographers: A narrative review

To be registered as a medical radiation practitioner, The Medical Radiation Practice Board of Australia (MRPBA) requires radiographers to be capable of performing computed tomography (CT) imaging examinations safely and effectively. Universities meet this requirement by offering practical CT training to radiography students on-campus and during clinical placements. However, institutions face challenges when facilitating on-campus CT practicum. Virtual reality (VR) has been suggested as a possible solution for radiography students to gain CT scanning experience. This narrative review explored relevant literature to investigate the potential for immersive VR to be incorporated into CT practicum. Benefits and limitations of this education technology are examined with resultant recommendations made for integration into the CT curriculum. Results found that VR enhances CT learning for students, increases confidence and raises motivation for the simulated CT task. CT simulation provides a viable alternative in the context of pandemic-imposed restrictions and reduced CT placement duration. However, it remains debatable as to whether immersive VR truly enhances student learning compared with other VR modalities, such as computer-based CT simulation. In addition, a lack of staff training, availability of resources and technical problems were flagged as limitations. We concluded that before immersive VR is integrated into CT education, significant optimisation of the simulation is needed. This includes ensuring VR scenarios are based on learning paradigms and feedback is integrated as part of simulation learning. Engaging clinical partners during the CT VR rollout is imperative to ensure successful transition of students from university learning to clinical placement.

Survey of clinical placements within pre-registration diagnostic radiography programmes in the UK and Ireland

INTRODUCTION

Placement capacity is a challenge in supporting the clinical education of diagnostic radiography students within the UK at a time where growth in the workforce is required if service delivery needs are to be met. COVID-19 has been one of the catalysts in the growth of innovative and simulated clinical placement models. This survey seeks to understand the current picture of clinical education models and the drivers for it.

METHODS

A short online MS Forms survey with mixed question types was distributed to higher education institutions (HEIs) delivering pre-registration diagnostic radiography programmes in the UK and Ireland. Descriptive and thematic analysis of data was undertaken to gain insight into the clinical placement models used.

RESULTS

Responses related to 24 programmes from 17 HEIs were collated. Capacity issues, increased student numbers and ability to achieve the learning outcomes were the drivers for the model and arrangement of clinical placements. Clinical practice hours varied widely across programmes as did the proportion of simulation-based education. Respondents felt an increase in the use of placements in modalities and other settings could further increase training capacity.

CONCLUSION

Opportunities to further change the clinical placement model have been identified which may alleviate some pressure points on capacity. Guidance around clinical practice hours may facilitate a sustainable approach to workforce training. Innovative placement models will require assessment strategies that align in order that students demonstrate relevant capabilities in a range of settings and value varied learning opportunities.

IMPLICATIONS FOR PRACTICE

The collective engagement and innovation of higher education institutions and service providers will be needed to create sustainable quality models of clinical training and assessment to meet diagnostic radiography workforce requirements.

Mapping Simulated-Based Learning Experiences Incorporated Into Professional Placements in Allied Health Programs: A Scoping Review

SUMMARY STATEMENT

Emerging literature continues to demonstrate the use of innovative practices such as simulated-based learning experiences to prepare students for professional placements. This scoping review aimed to provide a broad overview of how simulated-based learning experiences have been implemented within or immediately before the professional practice placements of entry-level allied health programs. Four databases (MEDLINE, EMCARE, CINAHL, and Scopus) were searched up to August 2020. Kirkpatrick's evaluation framework was used to categorize outcomes, and the Simulation-Based Research Extension for the CONSORT statement was used to appraise the quality of simulation reporting. The search revealed 6584 unique abstracts with 321 full-text articles reviewed. Forty-eight studies met the inclusion criteria. This review has shown a clear trend toward using simulation within or immediately before the professional practice placements of allied health programs. Using Kirkpatrick's evaluation framework, most studies reported on student reaction (level 1) and learning (level 2) obtained during the simulation experience. There was limited evidence showing how the benefits gained in simulation translated to the clinical environment (level 3) or impacted the organization (level 4). Further research is required to review the optimal proximity of simulation to allied health professional placements and how gains are obtained from simulation transition to the clinical environment. In addition, more consistent reporting of simulation methodologies and evaluation methods are needed to strengthen the evidence base.

Simulation-based education for medical radiation students: A scoping review

Simulation-based education is a significant aspect of teaching clinical skills in tertiary medical radiation science programmes, allowing students to experience the clinical setting in a safe environment. As an educational tool, simulation exists in many valid forms including role play, interprofessional simulation and virtual reality simulation. This scoping review looks at the current literature in this field to identify the evidence surrounding simulation-based education for medical radiation students. The purpose of this review is to provide an evidence-based guide for educators, identify gaps in the literature and suggest areas of future research. Data extraction was performed on 33 articles where the interventions could be categorised into either role play simulation, virtual simulation, simulation videos or online learning environments. Most studies demonstrated that simulation could improve clinical competence and increase preparedness and confidence for clinical placement. Student satisfaction remained high throughout the studies; however, it is the view of many that although simulation-based education is a valid and effective tool, it is complementary to and not a replacement for clinical placement.

Augmented Reality in Radiology for Education and Training—A Design Study

Education is an important component of every healthcare system. Patients need to be educated about their planned procedures; healthcare professionals need to be trained in their respective profession. Both patient education and the training of healthcare professionals are often completed in person, which requires resources and is bound to certain times and places. Virtual educational environments can potentially save human and monetary resources, increase learner engagement, and enable users to learn according to their own schedules. This design study describes proofs of concept for two augmented reality-enabled (AR) educational tools, utilizing a Microsoft HoloLens head-mounted display. In the first use case, we demonstrate an AR application which could be used to educate cancer patients about their radiotherapy treatment and potentially reduce patient anxiety. The second use case demonstrates an AR training environment, which could complement the practical training of undergraduate radiography students. Two prototypes—VIPER, for patient education, and ARTUR for the training of radiography students—were developed and tested for viability and usability, both based on individual user tests. Both patient and student education were evaluated as viable and usable additions to conventional educational methods, despite being limited in terms of accessibility, usability, and fidelity. Suitable hardware is becoming more accessible and capable, and higher-fidelity holograms, better utilization of real-world objects, and more intuitive input methods could increase user immersion and acceptance of the technology.

Real Or Not Real: The Impact of the Physical Fidelity of Virtual Learning Resources on Learning Anatomy

Technological advancements have made it possible to create realistic virtual representations of the real world, although it is unclear in medical education whether high physical fidelity is required in virtual learning resources (VLRs). This study, therefore, aimed to compare the effectiveness of high-fidelity (HF) and low-fidelity (LF) VLRs for learning anatomy. For this study, HF and LF VLRs were developed for liver anatomy and participants were voluntarily recruited from two cohorts (cohorts 1 and 2). Knowledge outcomes were measured through pre- and post-tests, task outcomes including activity score and completion time were recorded and participants' perceptions of the VLRs were surveyed. A total of 333 participants (165 HF and 168 LF) took part in this study. Knowledge outcomes were higher for the HF activity in cohort 1 and for the LF activity in cohort 2, although not significantly. There were no significant differences in activity score within either cohort, although completion time was significantly longer for the HF activity in cohort 1 (P = 0.001). There were no significant differences within either cohort in perceptions of the VLRs regarding usefulness for reviewing conceptual knowledge, esthetics, quality, mental effort experienced, or future use, although the LF VLR was scored significantly higher regarding the value for understanding in cohort 1 (P = 0.027).This study suggests that high physical fidelity is not necessarily required for anatomy VLRs, although may potentially be valuable for improving knowledge outcomes. Also, level of prior knowledge may be an important factor when considering the physical fidelity of anatomy VLRs.

An observation of the peer-assisted learning (PAL) method in the clinical teaching of vertigo/dizziness-related diseases for standardized residency training (SRT) students in China: a randomized, controlled, multicenter study

BACKGROUND

Vertigo and dizziness (VD) are among the most frequently seen symptoms in clinics and are important for medical students, especially for those in Chinese standardized residency training (SRT). The aim of our study was to examine the PAL method's feasibility in the clinical teaching of VD-related diseases for SRT students in China.

METHODS

This is a randomized, controlled, multicenter study. A total of 228 residents were invited to participate in this study, of which 198 completed the program. The students were randomized into two groups, and VD-related diseases were taught using lecture-based learning (control group) or peer-assisted learning (PAL). An examination paper and a rating scale were used to evaluate students' performance in the mastery of VD-related theoretical knowledge and clinical skills, meanwhile students' perceptions, satisfaction, and risk of burnout were also analyzed using a questionnaire. Independent-samples t-test and chi-square analysis were performed to evaluate statistical significance for continuous variables and categorical variables, respectively, using SPSS 18.0 software.

RESULTS

The PAL group performed better in mastering theoretical knowledge and clinical skills than the control group. And more students believed that PAL could help improve their personal qualities such as teamwork skills. However, more students reported that PAL increased the risk of burnout.

CONCLUSIONS

PAL was a suitable and effective method in the clinical teaching of some specialized diseases, especially it was recommended for students who had gained initial knowledge and skills, such as Chinese SRT students. However, we should draw attention to the increased risk of burnout if PAL is intended to be widely used in clinical teaching.

TRIAL REGISTRATION

ISRCTN registry, ISRCTN53773239 , 05/07/2021, retrospectively registered.

Computer based simulation in CT and MRI radiography education: Current role and future opportunities

OBJECTIVE

The use of Computer-based simulation (CBS), a form of simulation which utilises digital and web based platforms, is widely acknowledged in healthcare education. This literature review explores the current evidence relating to CBS activities in supporting radiographer education in CT and MRI.

KEY FINDINGS

Journal articles published between 2010 and 2020 were reviewed (n = 663). The content was evaluated and summarised with the following headings; current utility, overview of CBS types, knowledge acquisition and evaluation, and student perspective. CBS utility in CT and MRI radiography education is limited. Its current use is for pre-registration education, and the interfaces used vary in design but are predominantly used as a preclinical learning tool to support the training of geometric scan planning, image acquisition and reconstruction, and associated technical skills. CBS was positively acknowledged by student radiographers; based on its inherent flexibility, self-paced learning and the ability to practice in a safe environment. Nonetheless, the educational validation of CBS in CT and MRI education pertaining to knowledge and skill acquisition has not been fully assessed through rigorous academic assessments and metrics.

CONCLUSION

The current use of CBS in CT and MRI education is limited. The development of software programmes with functionality and capability that correlates with current clinical practice is imperative; and to enable more research in CBS utility to be undertaken to establish the efficacy of this pedagogical approach.

IMPLICATIONS FOR PRACTICE

Due to limited placement opportunities, the use of simulation is increasing and evolving; in line with the approach to design and deliver high quality Simulation Based Education (SBE) in Diagnostic Radiography education. The continued development, utility and evaluation of CBS interfaces to support student radiographers at pre and post registration level is therefore essential.

Research on simulation in radiography education: a scoping review protocol

BACKGROUND

Today, there are fewer opportunities for health care students and staff for skills training through direct patient contact. The World Health Organization therefore recommends learning about patient safety through hands-on experience and simulation. Simulation has the potential to improve skills through training in a controlled environment, and simulation has a positive effect on knowledge and skills, and even patient-related outcomes. Reviews addressing the use of simulation across the different radiography specialties are lacking. Further knowledge on simulation in radiography education is needed to inform curriculum design and future research. The purpose of this scoping review is to explore, map, and summarize the extent, range, and nature of published research on simulation in radiography education.

METHODS

We will follow the methodological framework for scoping reviews originally described by Arksey and O'Malley. We will search the MEDLINE, Embase, Epistemonikos, The Cochrane Library, ERIC, Scopus, and sources of grey literature. A comprehensive search strategy for Ovid MEDLINE was developed in collaboration with a research librarian. An example of a full electronic search from the Ovid MEDLINE (1641 articles records, January 9, 2020) is provided and will be used to adapt the search strategy to each database. Two independent review authors will screen all abstracts and titles, and full-text publications during a second stage. Next, they will extract data from each included study using a data extraction form informed by the aim of the study. A narrative account of all studies included will be presented. We will present a simple numerical analysis related to the extent, nature, and distribution of studies, and we will use content analysis to map the different simulation interventions and learning design elements reported. Any type of simulation intervention within all types of radiography specializations will be included. Our search strategy is not limited by language or date of publication.

DISCUSSION

An overview of publications on simulation in radiography education across all radiography specialties will help to inform future research and will be useful for stakeholders within radiography education using simulation, both in the academic and clinical settings.

SYSTEMATIC REVIEW REGISTRATION

Open Science Framework (OSF). Submitted on October 18, 2020.

Patients', radiographers' and radiography students' experiences of 360° virtual counselling environment for the coronary computed tomography angiography: A qualitative study

INTRODUCTION

The aim of this study was to describe patients', radiographers' and radiography students' experiences of the developed 360° virtual counselling environment (360°VCE) for the coronary computed tomography angiography (cCTA).

METHODS

A descriptive qualitative approach was used. The participants were cCTA patients (n = 10), radiographers (n = 10) and radiography students (n = 10) who used the 360°VCE and visited or worked at a university hospital in Finland. The 360°VCE, resembling the authentic environments of a CT imaging unit, included digital counselling materials in text, image, animation and video formats. Data were gathered through thematic interviews individually to obtain an understanding of participants' perspectives and analyzed by inductive content analysis.

RESULTS

Five main categories and 15 categories were identified. Identified benefits of the 360°VCE for patients included improvements in knowledge, spatial and environmental orientation, and senses of security and self-efficacy, with reductions in fear and nervousness. Patients found the counselling materials engaging, and that the 360° technology conveniently provided reassuring familiarity with the environment before their visit. Identified benefits for radiographers and radiography students included improvements in patients' mental preparedness, knowledge, spatial and environmental orientation, and reductions in patients' fear, which eased procedures and enhanced diagnostic success. The 360°VCE also provided useful information and familiarization with the cCTA unit for students during clinical practice and staff of referring units.  CONCLUSION: It seems that patients', radiographers' and radiography students' experiences of 360°VCE respond to patients' needs by improved knowledge and reduced fears. Thus, current counselling practices can be usefully complemented with spherical panoramic imaging technology and online information delivery.

IMPLICATIONS FOR PRACTICE

The results may be used to improve patient counselling and care, thereby optimizing the cCTA examination procedure and reducing fear. However, further research is needed to characterize experiences of the 360° VCE more comprehensively.