Using a virtual environment in Radiotherapy teaching

Interview with Dr. Andrew Williams

Dr. Andrew Williams is a Senior Lecturer on the BSc (Hons) Radiography (Radiotherapy and Oncology) course in the School of Radiology.

Andrew joined AECC University College in 2020, after almost 15 years as a Senior Lecturer at the University of Portsmouth, and a long and varied clinical career in Radiotherapy departments in the UK and internationally.

He tells us more about Virtual Environment Radiotherapy Training (VERT), an exciting facility that AECC University College students use on the course to develop their learning and prepare them for clinical placements:

What is VERT?

“VERT is based on one of the workhorses of Radiography, which is the Linear Accelerator. This machine produces high energy X-rays, which deliver doses of radiation deep within the body to kill cancer cells.

“When planning a dose, you need to find a balance between risk and benefit. You need to find a dose that’s high enough to effectively kill cancer cells, whilst avoiding permanent damage to normal cells and structures in the body.

“Planning and preparation of the patient for treatment is essential. You need to make sure that your patient is in the correct position each and every day that they are being treated. There is literature published that says that Radiotherapy is one of the most complex medical processes because of the number of different steps that we go through to achieve the treatment plan.

“There are a lot of invisible physical principles involved in Radiotherapy: we obviously can’t see radiation. Therapeutic Radiographers need to be able to visualise the measurements of the tumour that they are treating and its position in the body. This is challenging for students who are new to Radiotherapy and this is where VERT can help.”

How do students use VERT?

“In the early stages, it’s getting your head around the machine’s capabilities. It’s a real advantage to be able to practice on a machine that you can’t break – in contrast to real Linear Accelerators, which cost upwards of £1.75million. You’re also in a safe environment, without the time pressures of a clinical setting.

 “You have full control over the equipment itself and can practice the technical skills needed to operate the machine. We encourage our students to practice movement of the X-ray tube and the treatment couch. Our screen is the size of a classroom wall and we can view images either in 2D or in 3D.

“We almost encourage students to make mistakes at this stage. We can then break these mistakes down and discuss what happened, why it happened, and how we can stop it happening again. 

“Learning on VERT increases student confidence and the engagement of the students when they go out onto their first clinical placement. They know what the machine is and what it’s capable of.”

Breaking down the learning process

“Where VERT really comes into its own is in its facility for breaking down the Radiotherapy process. We have a range of real Radiotherapy treatment plans embedded within the platform, which we refer to as virtual patients, or virtual plans. These have been developed within Radiotherapy departments and then shared with the VERT community.

“VERT uses this scan data to create 3D models of tumours and the surrounding organs. We can use these to practice doing a series of calculations to work out how much dose we need to deliver and how much radiation each of the surrounding organs is going to receive.

“We can treat the patient with the machine at different angles, so the beam enters the patient from different directions. This gives us that balance of maximum dose to the tumour and as low a dose as possible to the surrounding organs. In a typical treatment plan, we could programme as many as 200 different sized X-ray beams to enter the body from different directions.

“VERT models all this: the position of the organs and the direction, the size and shape of the beams. We’re modelling Radiotherapy treatment delivery: we can see the organs that the radiation is travelling through on the way to the tumour and out the other side.”

Building a mental model

“This helps us to build a mental model. Students can develop their critical thinking skills, learning to ask themselves: is this the appropriate thing to do for this patient today and if it isn’t, what do we do about it? They can practice complex clinical decision-making skills that they will need, right here on campus.

“For me, VERT is a visualisation platform and this visualisation capability has the potential to be used for other professions where building that mental 3D model is important. For example, Diagnostic Radiographers or Chiropractors, or for anatomy teaching across a number of healthcare professions.

“We find students often request more time in the VERT suite. At the end of the day, these students are training for a practical job and to train sitting behind a desk in a classroom can be quite challenging. VERT is hands-on and students can see the impact of what they’re doing.

“Because it’s in its own dedicated room, students can use VERT to experiment on their own if it’s not being used for scheduled teaching. They can use it for problem-solving, or to break down complicated concepts into component parts. It’s a real asset for the course.”

You can find out more about the BSc (Hons) Radiography (Radiotherapy and Oncology) course here.