Fighting Cancer with Virtual Reality
Radiation has been used therapeutically for more than a century, but from the patient perspective it retains the frighteningly futuristic feel of science fiction.
Patients must undress and lie perfectly still on a cold table while a remotely operated machine rotates around them, shooting them with invisible beams of radiation. Patients rely on radiation therapists for expertise and critical thinking in deploying this technology, but the sophistication of most educational programs lags behind advancements in radiation technology itself. Texas State University's radiation therapy program is changing that by developing a new model for educating students.
During the two-year program, students take classes on campus and work in a clinical setting, embedded with oncology teams in local hospitals. According to Dr. Ronnie Lozano, program chair, “Some programs deliver all lectures the first year, and the second year it’s all clinical practice, you’re not on campus at all.” This siloed model makes it difficult for students to integrate knowledge and practice. In contrast, Lozano explains, Texas State students work at their clinics and take classes concurrently, because “We want them to make all their mistakes and ask all their questions here, in the classroom. This is rare for a program, to have dedicated one-on-one time for each student.”
“I’m making sure Texas State is on top of the technology trend. Everything we have here is equal to or better than what students see at the cancer centers.”
— Dr. Ronnie Lozano
There is only so much students can learn from looking at photographs and examining plastic dummies. This inspired Lozano’s efforts to grow the program, over the last 20 years, into one of the most high-tech in the country. Lozano says, “I’m making sure Texas State is on top of the technology trend. Everything we have here is equal to or better than what students see at the cancer centers.”
One of the most exciting technologies is the Virtual Environment for Radiotherapy Training (VERT) system, which allows instructors to turn classrooms into virtual clinics. “What we’ve tried to do,” Lozano explains, “is bridge between the clinical learning experience and what students learn on campus, and computerization has made that possible.”
Trina Dillard, clinical lecturer and simulation computer lab manager, has been instrumental in building this bridge. Dillard, who has extensive experience setting up cancer centers, leveraged industry contacts to gain access to clinical accessories and devices complimenting advanced technologies like VERT, which she compares to a flight simulator used to train pilots.
VERT projects a dynamic image of a radiation machine, allowing the instructor to superimpose images of semi-transparent bodies. Students can explore what radiation beam angles will best target the virtual patient’s tumor. “It represents a treatment machine in a clinic,” says Dillard. “They can use the hand-control to see where the beam is going, what structures are affected, where the radiation goes in and out, and how to best position the patient.”
Practicing with VERT is invaluable for students, because the primary challenge of administering radiation is to target the tumor without damaging surrounding tissue so badly that the damage ultimately kills the patient or causes chronic health conditions. Although healthy organs often recover from this damage, radiation can cause serious health consequences such as pneumonitis, fibrosis or cardiac toxicity. Dillard explains, “For a long time, even in the eighties and nineties, we could cure cancer. What has changed in our profession is to be able to give the patient a good quality of life after the treatment. That means targeting, immobilization, and juggling the dose.”
Associate Professor Megan Trad, a 2002 graduate of the program, adds, “You always think of cancer in older patients, but we’re catching it earlier, so it’s more important now than ever to make sure you don’t give patients chronic conditions.”
Understanding scheduling, billing, and related systems is a major asset to students when they enter the job market.
VERT isn’t the program’s only technological asset. For example, the program also has a medical records system called Mosaiq. Dillard says Mosaiq access “gives our students an advantage. They can practice on this electronic chart in the classroom, to lessen the distraction in the clinic so they can focus more on the patient. It’s cloud-based, so the students can access it at home. They can play, push all the buttons. That’s how they learn.” Understanding scheduling, billing, and related systems is a major asset to students when they enter the job market.
The program’s research focuses on assessing their innovative teaching techniques. For example, students meet weekly with Jessica Smith, the program’s clinical coordinator, to test their skills in a clinical simulation lab. Trad is currently comparing two sections of the Clinical Simulation Lab to determine whether outcomes differ for students who learn in a clinic versus those who use VERT. Another study requires students to combine CT and MRI images to match cross-sectional images of the body, using VERT, to develop a deeper knowledge of anatomy and critical thinking skills.
Lozano emphasizes teaching critical thinking, which radiation therapists need both to adapt to changes in the patient’s body (such as weight loss) and to catch upstream errors in the treatment plan. “In the intro class, we say to the students, ‘Your worst enemy is the big C,’ but the big C doesn’t mean cancer, it means complacency.” Thanks to the program’s innovative approach to teaching, Texas State’s radiation therapy students are well prepared to fight both.
Accurate as of November 2019