VR Medical training: the virtual simulation for UniUD X-Ray technologists

An extremely interesting project in the serious game portfolio from MOLO17 is, without a doubt, the UniUD – CT Trainer or, with its working title, MIMICT (Mimic + CT), as anticipated in the previous article dedicated to the advantages of using AR / VR for medical training. The project was born from a collaboration between MOLO17 and the University of Udine (Italy) and it is targeted to the X-Ray technologist degree programme.

Demo – UniUD CT Trainer

The final product is a simulation software VR that recreates the experience of executing a broad range of CT (computed tomography) examinations from the X-Ray Technologist point of view, simulating both the patient’s interactions and the scanner usage.

Although, in this specific project, it has not been possible the use of technologies that involve “important” forms of persistence, such as Couchbase, new and different scenarios can also be opened. For example, solutions for remote supervised training can be developed and, for students, exercises and exams can be created directly online whose outcome is verifiable without having to be physically present. This has obvious and interesting implications, as the student is enabled to experience everything from home, a key possibility for any educational institution in the face of the present post-covid situation.

Virtual simulation of X-Ray room
Virtual simulation of X-Ray room

Here we will tell you about the rationale behind this tool’s existence and its peculiarities.

Training of X-Ray Technologist: CT Trainer is the solution

The training course for students of X-Ray Tech course is strongly connected to the hospital context. According to the italian law, some hundreds of internship training in different radiology specialties, units and modalities are mandatory for the degree to be a valid title in order to access the X-Ray Tech Board examination and obtain the professional license.

The exact ways to carry out the internship do vary from a University/Teaching hospital to another, but there are some constant elements, such as the closest possible monitoring from a tutor over one or two of the students that are assigned to him/her, during the normal working hours. The academic year is usually divided into alternating periods, one when the students learn the theory and another when the students undertake their exams and internship.

Pain Points

All of the above creates multiple problems that are hard to manage and that may disrupt the learning experience and quality, while taking a toll on the hospital’s insurance costs.

Law and rules

The usage of X-Ray energies on living patients is tightly regulated and the exercise of sanitary and medical professions without a license is harshly punished. This implies that the student won’t be able to actually deliver the radiation dose on the patient and will be able only to partake in setting up the exam under the tightest possible surveillance of his or her tutor.

Human interactions

The student, entering a radiology ward for the first time, has to quickly learn how to relate with the patient, with other X-Ray techs and other types of medical and healthcare operators. In the meantime he or she has to learn using the machines and the connected devices.

Also the interaction with the patient is strictly regulated by law and it has strong legal implications that contribute to rising insurance costs. 

Machine availability

Some modalities (especially CT and MRI) are a precious resource and are usually always in use for clinical reasons, so they are not available to the students to experiment on them with mannequins and dummies.

Clinical risk and insurance claims

The presence on the field of in-training operators is always considered an additional risk factor from a clinical perspective and regarding possible insurance claims and costs, in an environment that is already one of the riskiest.

Due to the above considerations and criticalities one of the future and present solutions in healthcare is the use of simulative technologies. That being said, classic simulation approaches with mannequins and dummies are not always feasible in radiology due to availability of machinery, costs and risks connected with the use of x-ray energies.

Virtual simulation, the answer is: CT Trainer

As some of our followers already know, I experienced first hand all those problems and pains, having walked the path above from getting the degree and the professional license and ending up being a registered X-Ray Technologist, albeit not practicing the profession at the moment. Together with the heads of the academic course, we more than once envisioned the idea of making a similar tool. Finally, thanks to MOLO17, it became a reality.

The final product, based on the Unity engine, is very similar to an FPS game, where the student can freely move around a model of a CT radiology ward, perfectly fitted with a control room, gantry room, infirmary and waiting room.

The student will meet the patients, he/she will have to pick them up from the waiting room and talk to them with a multiple answer interface, in which some answers will bring negative clinical and legal consequences, other will be only partially correct, and other are the best practice possible.

The patient in the CT machine during the exam
The patient in the CT machine during the exam

After receiving the patient, the student will walk him or her to the infirmary or the machine, depending on the need to apply a cannula for the contrast agent or not, as required by the current exam’s protocol that the student must know.

In the gantry room, the student will tell the patient to lay down in the CT machine, but not before having told him or her to remove the clothing and personal belongings that might interfere with the examination.

The most technically complex and really challenging part for MOLO17’s developers has been the control console in virtual simulation. We simulated a typical CT interface with a multi monitor setup. 

Of the three monitors, two are dedicated to the CT machine, while the third one is the remote control for the automatic contrast agent injector. On the latter, the student is required to set injection speed and dose of saline and iodine, if the exam protocol requires so.

The student will then need to set all the parameters required to execute the exam protocol and image reconstruction settings, learning optimizing the quality of the image, while balancing it with the concept of “as low as reasonably achievable dose”.

CT interface
CT interface

If the controls are like the real thing, the resulting images are even more real. All exams are created using real DICOM images acquired during real exams. Besides that, it is possible to load a CT DICOM dataset already available from a real exam, to let the student experience the said situation. This feature is really useful to let students learn protocols that only seldom performed or to learn how to examine rare clinical cases. Basically, we made a DICOM viewer inside a virtual world.

The user interaction with the images is totally similar to the one that happens on a real machine. After the exam, it is possible to review the images and discuss them with the tutor.

When the examination is complete, the student will tell the patient this in an appropriate manner according to the clinical condition and the activities performed. For example if the patient was administered a contrast agent, the student will send him or her to the infirmary to stay under observation for some time due to possible adverse reactions and will avoid to tell him or her to go home or to go back to the ward.

Our conclusion about CT Trainer

We strongly believe that this tool, that will go live very soon for the actual training of future X-Ray techs at UniUD, will be able to mitigate and potentially solve many of the pain points connected.

The main point here is not to substitute the mandatory and fundamental role of the internship with real patients, which has a human value that cannot be replaced, but instead to enhance its value. We wish that this tool in virtual simulation will help shape even more human-centered healthcare operators that will be able to provide higher and higher standards for healthcare quality and patients’ safety.

For more information on CT Trainer or on the development of virtual simulation environments, contact us on www.molo17.com.

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