Purpose: There has been a decline in the utilization of brachytherapy even though it has been shown beneficial for a number of indications. One of the reasons for this decline is inadequate training due to an insufficient patient caseload. Simulation-based mastery learning (SBML) has been observed to improve procedural skills among medical trainees. In this work, we developed an SBML program for interstitial transrectal ultrasound (TRUS)-based prostate LDR/HDR brachytherapy using a low-cost prostate phantom developed in-house.
Methods: The SBML program is hands-on consisting of all components of interstitial brachytherapy, including (a) preparation of training materials including fabrication of prostate phantoms and dummy radioactive seeds, (b) mock calibration of radioactive seeds, (c) instruction in brachytherapy procedures/safety, (d) operation of survey meter, TRUS, and brachytherapy applicator, (e) brachytherapy needle placement, (f) treatment planning and treatment delivery, (g) quality assurance and radiation survey, (h) review of potential hazards, and (i) post-implant dosimetry. Pre-session and post-session surveys were taken by trainees to assess confidence in each step of the procedure, with scoring ranging from 1 (extremely uncomfortable) to 5 (extremely comfortable).
Results: Each prostate phantom and dummy seed set were fabricated in 1.5-hours by trainees, with material costs being approximately $30 for each phantom. Trainees in our SBML laboratory included seven physician residents and five medical physics residents. After participation in the laboratory, confidence in overall workflow increased from 2.1 to 4.2 (p=0.005), patient preparation from 2.2 to 3.5 (p=0.038), equipment operation from 1.9 to 4.1 (p=0.005), and familiarity with treatment planning from 1.7 to 3.9 (p=0.013). The confidence levels increased in all evaluation categories.
Conclusion: This SBML approach supplements patient caseload and is a valuable opportunity for trainees to increase their knowledge and confidence in prostate LDR/HDR brachytherapy procedures. Low-cost prostate phantoms and dummy seeds make SBML affordable, promoting increased utilization of brachytherapy.