3-D Simulation Helps Patients See Radiation Therapy Plan Firsthand

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The Virtual Environment Radiotherapy Training (VERT™) system, originally designed to teach medical students and physicians about administering radiation therapy, is being used to explain to people who have prostate cancer what their treatment will look like.

The number of patients with cancer set to receive radiation therapy as part of their initial treatment plan is expected to increase by 22 percent by 2020, according to the American Cancer Society. Yet, most people do not understand how radiation therapy even works, let alone how effective it could be in treating their cancer.

The radiation therapy team at Tuality/Oregon Health and Science University (OHSU) Cancer Center in Hillsboro, Oregon, has decided to fix just that. The center now offers a unique experience for patients with prostate cancer — a simulation tool designed to show a 3-D virtual explanation and preview of planned radiation treatment.

The Virtual Environment Radiotherapy Training (VERT™) system offers a 3-D visualization of patient images and their organs, as well as radiation treatment beams and doses. The system was originated to teach medical students and physicians about administering radiation therapy. In Europe, institutions began using this system as a learning tool for patients as well.

Similarly, OHSU has become the first in the United States to use this technology to help patients. Patients with prostate cancer, as well as their friends and families, can see their diagnosis first-hand, while also experiencing a simulation of radiation therapy to help them understand what treatment will be like.

How It Works

Kristi Tonning M.S., R.T., director of the radiation therapy program at the OHSU Knight Cancer Institute, and colleagues implemented this educational program with two goals in mind - to introduce patients to their inter-professional team before using the tool, and then to show them the treatment path. “There is a strong inter-professional team that works in radiation oncology to develop and plan and administer radiation, and patients do not typically know that,” Tonning said in an interview with CURE.

First, the institution offers patients a brief and simple explanation on the background of what radiation therapy is — high-energy X-rays that target cancer cells and bare normal tissue. In addition, the medical team explains why patients with prostate cancer need to come for treatment as often as they do. Next, patients are shown a brief video, also on how radiation therapy works.

After patients put on 3-D glasses, the health care team starts the virtual experience by taking an actual patient’s treatment plan and image set specific to a prostate cancer diagnosis. First, the experience includes a simulation of the actual room the patient will be receiving treatment in. “[This is so the patients] know what they are actually going to see. It looks almost exactly the same,” Tonning added.

Next, the simulation includes simple demonstrations of the treatment such as lights, lasers, where the patient will lay, their view of the machine, how the machine sounds, and so on. After this, the patient is shown their actual plan and how the lasers will match up to their treatment tattoos.

Most importantly, the simulation allows the team to show patients exactly where the prostate is located in the body. “Most people do not know where it is or what the size of it is. So, they actually get to see that in context with their backbones and pelvis and what not. And then we show all of the organs around there that we are blocking and protecting and making sure the radiation does not get to them,” Tonning said.

This is also important for patients to understand how close the prostate is located to the bladded. “The thing about prostate patients is that we ask them to have a full bladder for treatment,” said Tonning. “And that is kind of their contribution to the process, because if they have a full bladder, it pushes their bowel out of the way, it reduces the side effects for the bladder and it really helps them. So, if they understand why and how close the bladder is to the prostate, it typically kind of inspires them and increases compliance for them to do it.”

Implementation in the US

The VERT™ system has been used in this capacity in other countries such as the UK, Denmark and Australia. However, OHSU is currently the only cancer center in the United States using the technology for this purpose.

“We built upon other people’s ideas, which is kind of what healthcare does, and saw the need where we are at [OHSU],” said Tonning, who helped in the effort to bring this concept to reality for patients at OHSU. “So, we just worked on implementing it and offering it to patients right away without any cost.”

OHSU has been using this technology in its interprofessional education training programs since 2016. Following the purchase of the original educational system, Charles Thomas Jr., M.D., professor and chair of radiation medicine at OHSU School of Medicine, and chair of the radiation oncology program at the OHSU Knight Cancer Institute, helped to raise funding for center to use the technology for this specific purpose.

In an interview with CURE, Jan Antons, senior radiotherapy product specialist at Vertual Ltd, noted Thomas’s efforts were the fundamental in making this idea a reality for OHSU. “The key is to get clinician buy-in for this technology and how it can help patients.”

After receiving enough funding to purchase a second educational system, Vertual Ltd worked with the hospital to train physicians on how they would be using the device among patient populations. The company also put OHSU in touch with a group in the UK who was already researching and implementing use of the VERT™ system for patient use.