Department of Radiation Oncology, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA.
Radiation Oncology Division, MD Anderson Cancer Center, Houston, TX.
Brachytherapy. 2020 Nov-Dec;19(6):783-786. doi: 10.1016/j.brachy.2020.09.011. Epub 2020 Nov 7.
Gynecologic brachytherapy is an essential component in the curative treatment of cervical cancer. With the decline in brachytherapy utilization, gynecologic brachytherapy simulators are being used to provide a mechanism to enhance proficiency-based resident training. However, most models that have been used lack procedural fidelity as they are either repurposed from OB/GYN basic models or from physics phantoms. Therefore, we set out to develop a high-fidelity, ultrasound- and CT-compatible gynecologic brachytherapy training simulator.
Based on prior experience with gynecologic training simulators on the market, we developed a wish list for an ultrasound-compatible brachytherapy training model. A custom simulator was developed based on an existing pelvic ultrasound trainer. Features included a cervical os and endometrial canal as well as a palpable and hypoechoic cervical tumor.
The model took about 3 months from the initial meeting with the developer to completion. The properties of the material were equivalent to water for ultrasound, CT, and also MRI and the model did not show signs of degradation after multiple tandem insertions.
A high-fidelity ultrasound-compatible simulator was effectively developed and utilized to improve resident training to perform brachytherapy implants with a derivative benefit in the long term of improving survival for women with advanced gynecologic malignancies through having access to more proficient brachytherapists. Future directions include enhancing the model to allow for repetitive needle insertion and suturing for interstitial training as well as creating variations in anatomy (e.g., retroverted uterus, bulky tumors, etc.) for more advanced technical training.
妇科近距离放射治疗是宫颈癌有治愈可能的治疗方法中的重要组成部分。随着近距离放射治疗应用的减少，妇科近距离放射治疗模拟器被用于提供一种增强以能力为基础的住院医师培训的机制。然而，大多数被使用的模型由于缺乏程序保真度，要么是从妇产科基本模型重新利用，要么是从物理模型中重新利用。因此，我们着手开发一种高保真、超声和 CT 兼容的妇科近距离放射治疗培训模拟器。
根据我们在市场上现有的妇科培训模拟器的经验，我们为超声兼容近距离放射治疗培训模型制定了一个愿望清单。一个定制的模拟器是基于现有的盆腔超声训练器开发的。该模型具有宫颈口和子宫内膜管以及可触及的低回声宫颈肿瘤等功能。
从与开发者的第一次会议到完成，该模型大约需要 3 个月的时间。该模型的材料性质与超声、CT 以及 MRI 中的水等效，并且在多次串联插入后没有显示出退化的迹象。
成功开发并利用了一种高保真超声兼容模拟器，以提高住院医师进行近距离放射治疗植入的培训水平，从长期来看，通过让更多熟练的近距离放射治疗师能够接触到这种治疗方法，从而提高患有晚期妇科恶性肿瘤的女性的生存率。未来的方向包括增强模型，以允许进行重复的针插入和缝合，用于间质培训，以及创建不同的解剖结构（例如，子宫后倾、大肿瘤等），以进行更高级的技术培训。
