It provides a life size model of the linear accelerator with full functionality except evidence to support its use in radiotherapy. Early prototype versions of VERT had
for the production of radiation. Users wear special glasses that interface with
Artificial
been tested with students in particular contexts
5
and the potential of the technology
the projection system so that they are immersed in a three dimensional view had been championed by both the developers and early users. But, is there a clear
projected into space around them. The environment is a hybrid one in that the
environments
rationale and associated evidence base underpinning the implementation and use
virtual linear accelerator is controlled using an actual hand-pendant, identical to of a virtual reality environment (VRE) in education generally, or in radiotherapy
that used in the clinical setting.
allow learners
education specifically that justifies the considerable expenditure?
It is possible to import images and radiotherapy treatment plans (in DICOM
to make errors
Based to some extent on the work of Winn and Jackson
6
, Dalgarno, Hedberg and
format), thereby allowing a vast range of simple and complex treatment plans to Harper
7
summarised neatly eight contributions of virtual reality environments
be visualised in 3-D, as well as the related anatomical data.
that would not
(VREs) to learning. VREs can, in principle:
Different systems are provided in universities and clinical departments. Universities
be tolerated in
1. Facilitate familiarisation of inaccessible environments;
use a system called Immersive VERT. These systems are housed in a purpose built 2. Facilitate task mastery through practice of dangerous or expensive tasks;
bespoke auditorium and employ rear projection using active stereoscopy requiring
the real world
3. Improve transfer by situating learning in a realistic context;
liquid crystal display (LCD) shutter glasses. A tracking system is provided that 4. Improve motivation through immersion;
enables the image to be projected according to the user’s position relative to the 5. Reduce cognitive load through integration of multiple information
projection screen thus further enhancing the degree of ‘immersion’. Radiotherapy representations;
departments use a system called Seminar VERT. These systems can be situated 6. Facilitate understanding of complex environments and systems;
in seminar or meeting rooms and require no significant refurbishment to install 7. Facilitate understanding of complex ideas through metaphorical
them. Seminar VERT features front projection using passive stereoscopy requiring representations;
polarizing glasses. User tracking is not provided. The cost of Seminar VERT is 8. Facilitate exploration of complex knowledge bases.
approximately one tenth of that of Immersive VERT.
One of the most popular applications of VREs is skills development as artificial
The large screen stereoscopic projection, faithful representation of the treatment room environments allow learners to make errors that would not be tolerated in the real
and linear accelerators, use of real hand pendants and, in universities, use of a tracking world and from which they can learn important lessons. It is not surprising that
system all contribute to a high degree of physical and psychological ‘presence’ – the such applications have been developed and implemented in medical education.
phenomenon whereby users are convinced they are part of a ‘real’ environment. Laporoscopic and endoscopic skills simulators have been widely reported on and
evaluated in the literature
8-10
. A rigorous meta-analysis of the effectiveness of VR
The VERT technology claims to offer a number of potential advantages: laparoscopy and endoscopy simulators by Srinivasan, Mital and Haque
10
looked at
A cost effective alternative to training in clinical environments; transference of skills to the operating room and suggested that the results indicate
Unlimited practice opportunities without risking harm to patient or equipment; VR simulators provide for skills comparable with (and perhaps even better than)
Radiotherapy treatment rooms become more efficient as training demands are those of well validated traditional techniques. Such evidence does, therefore, appear
reduced; to support the use of a virtual environment for skills development in radiotherapy.
A realistic insight into the experience of using the equipment, but without the The use of real life control systems in a hybrid virtual environment may further
stress of being in a clinic; enhance the transfer of psychomotor skills. In an evaluation of an early version
Enhances the understanding of those radiotherapy concepts that are often of VERT
5
students reported that the ‘feel’ and ‘control’ of the virtual machine was
difficult to teach in a classroom and/or placement setting; identical to the real one. It should be acknowledged, however, that actual skills
Student attrition is reduced as the learning experience is enhanced. transference to the clinical environment was not formally evaluated at that time.
A rationale for VERT VREs are intrinsically motivating
11
and the extent to which this occurs is linked to
Although the NRAG report indicated that the crisis in radiotherapy education was the degree of presence and immersion. Learners become very engaged in the
substantial, it is possible to question the basis on which the Department of Health learning task and usually report high levels of enjoyment; for example, Bridge et
was willing to invest such a substantial amount for technology with relatively little al
5
. Given that the VERT platform is designed to provide users with a high degree
18
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IMAGING & ONCOLOGY
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2009
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