Virtual reality and augmented reality in radiation oncology education - A review and expert commentary

The clinical pathology laboratory in 360° virtual reality

OBJECTIVES

This study aimed to enhance medical education by integrating virtual reality (VR) tours into the clinical pathology curriculum, comparing VR with traditional didactic methods.

METHODS

Seven 360° VR tours were developed for the Microbiology and Transfusion Services laboratories. A controlled crossover study involved 171 medical students (83% MS4) from April 2021 to April 2023. Students were randomly assigned to either the VR or PowerPoint (PP) presentation groups. Surveys and assessments measured understanding, interactivity, relevance, and engagement.

RESULTS

With more than a 90% response rate, VR participants rated the interactivity significantly higher than PP participants (mean, 4.48 vs 3.48; P < .001). The VR format also showed higher scores for understanding the laboratory environment (mean, 4.38; P = .6) and engagement (mean, 4.21; P = .004). Although assessment scores were slightly lower for VR participants (6.2 vs 6.5; P = .1), the VR tours increased engagement and provided a more interactive learning experience.

CONCLUSIONS

Integrating 360° VR tours into the clinical pathology curriculum enhances interactivity and learner engagement, offering a scalable solution for remote learning. This method addresses the limitations of traditional remote learning, promoting a more immersive educational experience.

Radiotherapy and theranostics: a Lancet Oncology Commission

Following on from the 2015 Lancet Oncology Commission on expanding global access to radiotherapy, Radiotherapy and theranostics: a Lancet Oncology Commission was created to assess the access and availability of radiotherapy to date and to address the important issue of access to the promising field of theranostics at a global level. A marked disparity in the availability of radiotherapy machines between high-income countries and low-income and middle-income countries (LMICs) has been identified previously and remains a major problem. The availability of a suitably trained and credentialled workforce has also been highlighted as a major limiting factor to effective implementation of radiotherapy, particularly in LMICs. We investigated initiatives that could mitigate these issues in radiotherapy, such as extended treatment hours, hypofractionation protocols, and new technologies. The broad implementation of hypofractionation techniques compared with conventional radiotherapy in prostate cancer and breast cancer was projected to provide radiotherapy for an additional 2·2 million patients (0·8 million patients with prostate cancer and 1·4 million patients with breast cancer) with existing resources, highlighting the importance of implementing new technologies in LMICs. A global survey undertaken for this Commission revealed that use of radiopharmaceutical therapy-other than 131I-was highly variable in high-income countries and LMICs, with supply chains, workforces, and regulatory issues affecting access and availability. The capacity for radioisotope production was highlighted as a key issue, and training and credentialling of health professionals involved in theranostics is required to ensure equitable access and availability for patient treatment. New initiatives-such as the International Atomic Energy Agency's Rays of Hope programme-and interest by international development banks in investing in radiotherapy should be supported by health-care systems and governments, and extended to accelerate the momentum generated by recognising global disparities in access to radiotherapy. In this Commission, we propose actions and investments that could enhance access to radiotherapy and theranostics worldwide, particularly in LMICs, to realise health and economic benefits and reduce the burden of cancer by accessing these treatments.

A systematic review of immersive educational technologies in medical physics and radiation physics

Objective

This systematic review aims to analyze and synthesize the current state of research on the role of immersive technologies, specifically augmented reality (AR), virtual reality (VR), and mixed reality (MR), in medical physics and radiation physics education. The primary focus is to evaluate their impact on learning outcomes, performance, and engagement across various educational contexts.

Methods

We conduct a comprehensive search of four major databases: Scopus, Web of Science, PubMed, and IEEE Xplore, covering the period from 2012 to 2023. A total of 316 articles are initially identified. After removing duplicates and screening for relevance based on titles and abstracts, 107 articles are selected for full-text review. Finally, 37 articles met the inclusion criteria and are included in the analysis. The review follows the PRISMA guidelines and utilizes the PICOS framework to structure the research question.

Analysis

Data extraction focuses on key variables such as the type of immersive technology used, educational context, study design, participant demographics, and measured outcomes. The studies are analyzed for their reported effects on learning outcomes, performance, and engagement.

Results

The review found that immersive technologies significantly enhance learning outcomes and engagement. Specifically, 36.4% of the studies reported increased engagement, while 63.6% of studies focusing on practical skills noted performance improvements. The use of AR, VR, and MR showed broad applicability across different educational levels, from undergraduate courses to professional training programs.

Conclusion

Immersive technologies have considerable potential to transform medical and radiation physics. They enhance student engagement, improve learning outcomes, and boost performance in practical skills. Nevertheless, future research should focus on standardizing methodologies, expanding participant demographics, and exploring long-term impacts on skill retention and clinical practice. This review provides a valuable resource for guiding future research and implementing innovative educational strategies in the dynamic fields of medical physics and radiation physics.

Global Workforce and Access: Demand, Education, Quality

There has long existed a substantial disparity in access to radiotherapy globally. This issue has only been exacerbated as the growing disparity of cancer incidence between high-income countries (HIC) and low and middle-income countries (LMICs) widens, with a pronounced increase in cancer cases in LMICs. Even within HICs, iniquities within local communities may lead to a lack of access to care. Due to these trends, it is imperative to find solutions to narrow global disparities. This requires the engagement of a diverse cohort of stakeholders, including working professionals, non-governmental organizations, nonprofits, professional societies, academic and training institutions, and industry. This review brings together a diverse group of experts to highlight critical areas that could help reduce the current global disparities in radiation oncology. Advancements in technology and treatment, such as artificial intelligence, brachytherapy, hypofractionation, and digital networks, in combination with implementation science and novel funding mechanisms, offer means for increasing access to care and education globally. Common themes across sections reveal how utilizing these new innovations and strengthening collaborative efforts among stakeholders can help improve access to care globally while setting the framework for the next generation of innovations.

The metaverse in nuclear medicine: transformative applications, challenges, and future directions

The metaverse, a rapidly evolving virtual reality space, holds immense potential to revolutionize nuclear medicine by enhancing education, training, diagnostics, and therapeutics. This review explores the transformative applications of the metaverse in nuclear medicine, where immersive virtual learning environments, simulation-based training, artificial intelligence (AI)-powered decision support systems integrated into interactive three-dimensional (3D) visualizations, and personalized dosimetry using realistic patient-specific virtual models are seamlessly incorporated into the metaverse ecosystem, creating a synergistic platform for healthcare professionals and patients alike. However, the responsible and sustainable adoption of the metaverse in nuclear medicine requires a multidisciplinary approach to address challenges related to standardization, accessibility, data security, and ethical concerns. The formation of cross-disciplinary consortia, increased research and development (R&D) investment, and the strengthening of data governance and cybersecurity measures are crucial steps in ensuring the safe and effective integration of the metaverse in healthcare. As the metaverse continues to evolve, researchers, practitioners, and policymakers must collaborate and explore its potential, navigate the challenges, and shape a future where technology and medicine seamlessly integrate to enhance patient care and outcomes in nuclear medicine. Further research is needed to fully understand the implications of the metaverse in clinical practice, education, and research, as well as to develop evidence-based guidelines for its responsible implementation. By embracing responsible innovation and collaboration, the nuclear medicine community can harness the power of the metaverse to transform and improve patient care.

Factors Associated With Continuous Use of a Cancer Education Metaverse Platform: Mixed Methods Study

BACKGROUND

Early detection of cancer and provision of appropriate treatment can increase the cancer cure rate and reduce cancer-related deaths. Early detection requires improving the cancer screening quality of each medical institution and enhancing the capabilities of health professionals through tailored education in each field. However, during the COVID-19 pandemic, regional disparities in educational infrastructure emerged, and educational accessibility was restricted. The demand for remote cancer education services to address these issues has increased, and in this study, we considered medical metaverses as a potential means of meeting these needs. In 2022, we used Metaverse Educational Center, developed for the virtual training of health professionals, to train radiologic technologists remotely in mammography positioning.

OBJECTIVE

This study aims to investigate the user experience of the Metaverse Educational Center subplatform and the factors associated with the intention for continuous use by focusing on cases of using the subplatform in a remote mammography positioning training project.

METHODS

We conducted a multicenter, cross-sectional survey between July and December 2022. We performed a descriptive analysis to examine the Metaverse Educational Center user experience and a logistic regression analysis to clarify factors closely related to the intention to use the subplatform continuously. In addition, a supplementary open-ended question was used to obtain feedback from users to improve Metaverse Educational Center.

RESULTS

Responses from 192 Korean participants (male participants: n=16, 8.3%; female participants: n=176, 91.7%) were analyzed. Most participants were satisfied with Metaverse Educational Center (178/192, 92.7%) and wanted to continue using the subplatform in the future (157/192, 81.8%). Less than half of the participants (85/192, 44.3%) had no difficulty in wearing the device. Logistic regression analysis results showed that intention for continuous use was associated with satisfaction (adjusted odds ratio 3.542, 95% CI 1.037-12.097; P=.04), immersion (adjusted odds ratio 2.803, 95% CI 1.201-6.539; P=.02), and no difficulty in wearing the device (adjusted odds ratio 2.020, 95% CI 1.004-4.062; P=.049). However, intention for continuous use was not associated with interest (adjusted odds ratio 0.736, 95% CI 0.303-1.789; P=.50) or perceived ease of use (adjusted odds ratio 1.284, 95% CI 0.614-2.685; P=.51). According to the qualitative feedback, Metaverse Educational Center was useful in cancer education, but the experience of wearing the device and the types and qualities of the content still need to be improved.

CONCLUSIONS

Our results demonstrate the positive user experience of Metaverse Educational Center by focusing on cases of using the subplatform in a remote mammography positioning training project. Our results also suggest that improving users' satisfaction and immersion and ensuring the lack of difficulty in wearing the device may enhance their intention for continuous use of the subplatform.

Qualitative evaluation of a multidisciplinary master of cancer sciences: impacts on graduates and influencing curricular factors

BACKGROUND

Evaluations of continuing professional development programs typically focus on short-term knowledge and skill acquisition. There is a need for more comprehensive program evaluation methods that assess a broader range of impacts and can elicit how and why these outcomes occurred. We conducted a qualitative study to investigate the impacts of a multidisciplinary, online health professional postgraduate degree and to gain insights into the factors that led to these impacts.

METHODS

Participants were graduates of the University of Melbourne's Master of Cancer Sciences who could participate in an online interview. Semi-structured, qualitative interviews were conducted exploring a broad range of impacts, including changes in professional practice and career trajectory since graduation, and how the degree influenced these impacts. Data were analysed inductively.

RESULTS

Fifteen participants (female: 80%, 31-50 years old: 67%) from a range of professions were interviewed. A number of major themes were uncovered. Impacts on career trajectory included expanded career horizons (e.g. increased role diversity and complexity), and increased confidence in their professional identity. Impacts on professional practice included individual improvements in patient care and research, as well as changes in organisational practice. Factors identified as leading to these impacts were: (i) active, interactive and interprofessional learning; (ii) networking, informal mentoring, and role-modelling; and (iii) support at multiple levels.

CONCLUSION

This study provides preliminary evidence of the positive impact of a Master of Cancer Sciences on graduate career trajectory and professional practice. In addition, the inductive methodology enabled identification of the curricular features (both planned and emergent) that influenced these impacts, facilitating potential transferability of learnings to other teaching programs.

Incorporating Technology Adoption in Medical Education: A Qualitative Study of Medical Students' Perspectives

Introduction

The integration of technology into medical education has witnessed significant growth in recent years, with tools such as virtual reality, artificial intelligence, and telemedicine gaining prominence. These tool in medical education, offering immersive, experiential learning experiences.

Methods

We approached medical students currently enrolled in medical education programs and who are familiar with and actively use AI in medical education. Initially, we invited 21 random students to participate in the study; however, only 13 agreed to interviews. Some students cited their busy exam schedules as the reason for not participating. The participants were informed of the objective of the study before the commencement of the recorded interviews. Semi-structured interviews were used to guide the record interviews. Audio recordings were transcribed and analyzed using Atlas.ti, a qualitative data analysis software.

Results

Participants exhibited a diverse range of perceptions and levels of awareness regarding VR, AI, and telemedicine technologies. Learning with virtual reality was considered to be fun, memorable, inclusive, and engaging by participants. The use of virtual reality technology is seen as complementing current teaching and learning approaches, helping to build learners' confidence, as well as providing medical students with a safe environment for problem-solving and trial-and-error learning. The students reported that AI was seen as a potential game-changer in the healthcare sector. Participants hoped that telemedicine would provide healthcare services to remote and underserved populations.

Conclusion

The study conducted focus group discussions with medical students and residents in Saudi Arabia to explore their views on integrating VR, AI, and telemedicine in medical education and practice. Their insights highlight the need for informed decision-making and strategic development to optimize the benefits and address challenges like initial investments, technical issues, ethics, and regulations. These considerations are crucial for fully realizing the potential benefits of technology in medical education globally.

The application of virtual environment radiotherapy for RTT training: A scoping review

BACKGROUND

Virtual Environment Radiotherapy Training (VERT) is a virtual tool used in radiotherapy with a dual purpose: patient education and student training. This scoping review aims to identify the applications of VERT to acquire new skills in specific activities of Radiation Therapists (RTTs) clinical practice and education as reported in the literature. This scoping review will identify any gaps in this field and provide suggestions for future research.

METHODS

In accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) extension for scoping reviews and Arskey and O'Malley framework, an electronic search was conducted to retrieve complete original studies, reporting the use and implementation of VERT for teaching skills to RTTs. Studies were searched in PubMed, EMBASE, and SCOPUS databases and included retrieved articles if they investigated the use of VERT for RTTs training.

RESULTS

Of 251 titles, 16 articles fulfilled the selection criteria and most of the studies were qualitative evaluation studies (n=5) and pilot studies (n=4). The specific use of VERT for RTTs training was grouped into four categories (Planning CT, Set-up, IGRT, and TPS).

CONCLUSION

The use of VERT was described for each category by examining the interaction of the students or trainee RTTs in performing each phase within the virtual environment and describing their perceptions. This system Virtual Reality (VR) enables the development of specific motor skills without interfering and pressurising clinical resources by using clinical equipment in a risk-free offline environment, improving the clinical confidence of students or trainee RTTs. However, even if VR can be integrated into the RTTs training with a great advantage, VERT has still not been embraced. This mainly due to the presence of significant issues and limitations, such as inadequate coverage within the current literature, software and hardware costs.

Revolutionizing Oncology: A Comprehensive Review of Digital Health Applications

Digital health is poised to revolutionize the field of oncology, offering innovative solutions that enhance diagnostics, treatment, and patient care. This comprehensive review delves into the multifaceted landscape of digital health in oncology, encompassing its definition, significance, applications, benefits, challenges, ethical considerations, and future trends. Key findings highlight the potential for early detection, personalized treatment, enhanced care coordination, patient empowerment, accelerated research, and cost efficiency. Ethical concerns surrounding privacy, equitable access, and responsible data use are discussed. Looking ahead, the future of digital health in oncology is bright, driven by advancements in artificial intelligence, virtual and augmented reality, predictive analytics, global collaboration, and evolving regulations. This review underscores the need for collaboration among stakeholders and a patient-centered approach to harness the transformative power of digital health, promising a future where the burden of cancer is lessened through innovation and compassionate care.

Smartphone-based augmented reality patient education in radiation oncology

We built an augmented reality (AR) patient education application for portable iOS and Android devices that allows patients to view a virtual simulation of themselves receiving radiation treatment. We created software that reads data from the clinical treatment planning system and renders the patient's actual radiotherapy plan in AR on a tablet or smartphone. The patient's CT simulation data are converted into a 3D translucent virtual human shown being treated with visible radiation beams from a virtual linear accelerator. We conducted a patient study to determine if showing patients this AR simulation improves patient understanding of radiotherapy and/or reduces anxiety about treatment. A total of 75 patients completed this study. The most common plans were 3D breast tangents and intensity modulated radiotherapy lung plans. Patients were administered questionnaires both before and after their AR viewing experience. After their AR viewing, 95% of patients indicated that they had a better understanding of how radiotherapy will be used to treat their cancer. Of the 35 patients who expressed anxiety about radiotherapy beforehand, 21 (60%) indicated that they had decreased anxiety after the AR session. In our single-arm prospective patient study, we found that this simplified low-cost tablet-based personalized AR simulation can be a helpful educational tool for cancer patients undergoing radiotherapy.

The Multidomain Metaverse Cancer Care Digital Platform: Development and Usability Study

BACKGROUND

As cancer treatment methods have diversified and the importance of self-management, which lowers the dependence rate on direct hospital visits, has increased, effective cancer care education and management for health professionals and patients have become necessary. The metaverse is in the spotlight as a means of digital health that allows users to engage in cancer care education and management beyond physical constraints. However, it is difficult to find a multipurpose medical metaverse that can not only be used in the field but also complements current cancer care.

OBJECTIVE

This study aimed to develop an integrated metaverse cancer care platform, Dr. Meta, and examine its usability.

METHODS

We conducted a multicenter, cross-sectional survey between November and December 2021. A descriptive analysis was performed to examine users' experiences with Dr. Meta. In addition, a supplementary open-ended question was used to ask users for their suggestions and improvements regarding the platform.

RESULTS

Responses from 70 Korean participants (male: n=19, 27% and female: n=51, 73%) were analyzed. More than half (n=37, 54%) of the participants were satisfied with Dr. Meta; they responded that it was an interesting and immersive platform (n=50, 72%). Less than half perceived no discomfort when using Dr. Meta (n=34, 49%) and no difficulty in wearing and operating the device (n=30, 43%). Furthermore, more than half (n=50, 72%) of the participants reported that Dr. Meta would help provide non-face-to-face and noncontact services. More than half also wanted to continue using this platform in the future (n=41, 59%) and recommended it to others (n=42, 60%).

CONCLUSIONS

We developed a multidomain metaverse cancer care platform that can support both health professionals and patients in non-face-to-face cancer care. The platform was uniquely disseminated and implemented in multiple regional hospitals and showed the potential to perform successful cancer care.

Designing a wholly online, multidisciplinary Master of Cancer Sciences degree

BACKGROUND

Improving oncology-specific knowledge and skills of healthcare professionals is critical for improving the outcomes of people with cancer. Many current postgraduate education offerings may be inaccessible to busy professionals, contain minimal consumer input or do not focus on the multidisciplinary nature of cancer care. In response to these needs, a Master of Cancer Sciences degree was developed. Our aim is to describe the development of the Master of Cancer Sciences.

METHODS

We describe the development of the Master of Cancer Sciences, including its theoretical and its pedagogical underpinnings.

RESULTS

Our approach to curriculum design was guided by Kern's Six-Step Approach to Medical Curriculum and underpinned by the Seven Principles of Online Learning. These approaches were further underpinned by the Cognitive Theory of Multimedia Learning which informed our approach to audio and visual information design. The pedagogy is interactive, experiential, interprofessional and importantly, includes consumers as educators. In practice, learning activities include peer feedback, multidisciplinary team meeting simulations, group work and clinical role plays. The online environment was visually shaped through infographics, high-quality educational videos and gamification.

CONCLUSION

We have designed a Master of Cancer Sciences that is one of the first wholly online, cancer-specific Masters' programs. Its industry-led curriculum using evidence-based pedagogical choices utilises a range of novel digital formats and integrates the consumer perspective to provide a holistic overview of the field. Quantitative and qualitative evaluation of learning outcomes is ongoing.

Virtual reality and augmented reality in radiation oncology education - A review and expert commentary

The field of radiation oncology is rapidly advancing through technological and biomedical innovation backed by robust research evidence. However, cancer professionals are notoriously time-poor, meaning there is a need for high quality, accessible and tailored oncologic education programs. While traditional teaching methods including lectures and other in-person delivery formats remain important, digital learning (DL) has provided additional teaching options that can be delivered flexibly and on-demand from anywhere in the world. While evidence of this digital migration has been evident for some time now, it has not always been met with the same enthusiasm by the teaching community, in part due to questions about its pedagogical effectiveness. Many of these reservations have been driven by a rudimentary utilisation of the medium and inexperience with digital best-practice. With increasing familiarity and understanding of the medium, increasingly sophisticated and pedagogically-driven learning solutions can be produced. This article will review the application of immersive digital learning tools in radiation oncology education. This includes first and second-generation Virtual Reality (VR) environments and Augmented Reality (AR). It will explore the data behind, and best-practice application of, each of these tools as well as giving practical tips for educators who are looking to implement (or refine) their use of these learning methods. It includes a discussion of how to match the digital learning methods to the content being taught and ends with a horizon scan of where the digital medium may take us in the future. This article is the second in a two-part series, with the companion piece being on Screen-Based Digital Learning Methods in Radiation Oncology. Overall, the digital space is well-placed to cater to the evolving educational needs of oncology learners. Further uptake over the next decade is likely to be driven by the desire for flexible on demand delivery, high-yield products, engaging delivery methods and programs that are tailored to individual learning needs. Educational programs that embrace these principles will have unique opportunities to thrive in this space.

Screen-based digital learning methods in radiation oncology and medical education

The field of radiation oncology is rapidly advancing through technological and biomedical innovation backed by robust research evidence. In addition, cancer professionals are notoriously time-poor, meaning there is a need for high quality, accessible and tailored oncological education programs. Digital learning (DL) is well-placed to cater to these needs, as it provides teaching options that can be delivered flexibly and on-demand from anywhere in the world. The evidence for usage of these techniques in medical education has expanded rapidly in recent years. However, there remains many reservations in the oncological community to adopting and developing DL, largely due to a poor familiarity with the pedagogical evidence base. This article will review the application of the screen-based DL tools that are at educators' disposal. It will summarize best-practice in developing tailored, made-for-screen videos, gamification, and infographics. It also reviews data behind the following practical tips of 1) strategically combining text with graphics to decrease cognitive load, 2) engaging users through use of interactive elements in digital content, and 3) maximizing impact through thoughtful organization of animations/images. Overall, the digital space evolving is well placed to cater to the evolving educational needs of oncology learners. This review and its practical tips aim to inspire further development in this arena, production of high-yield educational products, use of engaging delivery methods and programs that are tailored to individual learning needs.