Bundeswehr Institute of Radiobiology affiliated to the University Ulm, Neuherbergstrasse 11, Munich 80937, Germany.
Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, 81675 Munich, Germany.
J Radiol Prot. 2021 Nov 15;41(4). doi: 10.1088/1361-6498/ac13c2.
A collection of powerful diagnostic tools have been developed under the umbrellas of NATO for ionising radiation dose assessment (BAT, WinFRAT) and estimate of acute health effects in humans (WinFRAT, H-Module). We assembled a database of 191 ARS cases using the medical treatment protocols for radiation accident victims (= 167) and the system for evaluation and archiving of radiation accidents based on case histories (= 24) for training purposes of medical personnel. From 2016 to 2019, we trained 39 participants comprising MSc level radiobiology students in an on-site teaching class. Enforced by the covid-19 pandemic in 2020 for the first time, an online teaching of nine MSc radiobiology students replaced the on-site teaching. We found that: (a) limitations of correct diagnostic decision-making based on clinical signs and symptoms were experienced unrelated to the teaching format. (b) A significant performance decrease concerning online (first number in parenthesis) versus on-site teaching (reference and second number in parenthesis) was seen regarding the estimate time (31 vs 61 cases per hour, two-fold decrease,= 0.005). Also, the accurate assessment of response categories (89.9% vs 96.9%,= 0.001), ARS (92.4% vs 96.7%,= 0.002) and hospitalisation (93.5% vs 97.0%,= 0.002) decreased by around 3%-7%. The performances of the online attendees were mainly distributed within the lower quartile performance of on-site participants and the 25%-75% interquartile range increased 3-7-fold. (c) Comparison of dose estimates performed by training participants with hematologic acute radiation syndrome (HARS) severity mirrored the known limitations of dose alone as a surrogate parameter for HARS severity at doses less than 1.5 Gy, but demonstrated correct determination of HARS 2-4 and support for clinical decision making at dose estimates >1.5 Gy, regardless of teaching format. (d) Overall, one-third of the online participants showed substantial misapprehension and insecurities of elementary course content that did not occur after the on-site teaching.
在北约的支持下，已经开发出了一系列强大的诊断工具，用于评估电离辐射剂量（BAT、WinFRAT）和估计人类急性健康影响（WinFRAT、H-Module）。我们使用辐射事故受害者的治疗方案（= 167）和基于病史的辐射事故评估和存档系统（= 24），为医疗人员的培训目的，建立了一个包含 191 例急性放射综合征（ARS）病例的数据库。2016 年至 2019 年，我们在现场教学班上培训了 39 名包括硕士水平放射生物学学生在内的学员。2020 年，由于新冠疫情的强制要求，首次在线教授了 9 名硕士放射生物学学生，取代了现场教学。我们发现：（a）在基于临床症状和体征做出正确诊断决策方面存在局限性，这与教学形式无关。（b）在线教学（括号中的第一个数字）与现场教学（参考和括号中的第二个数字）相比，在估计时间（每小时 31 例与 61 例，减少了两倍，= 0.005）和准确评估反应类别（89.9%与 96.9%，= 0.001）、ARS（92.4%与 96.7%，= 0.002）和住院（93.5%与 97.0%，= 0.002）方面的表现均有所下降，降幅在 3%至 7%之间。在线学习者的表现主要分布在现场参与者表现较低的四分位数内，25%至 75%的四分位距增加了 3 至 7 倍。（c）培训参与者进行的剂量估计与血液学急性辐射综合征（HARS）严重程度的比较反映了剂量作为 1.5 Gy 以下 HARS 严重程度替代参数的已知局限性，但证明了在剂量>1.5 Gy 时正确确定 HARS 2-4 并支持临床决策，无论教学形式如何。（d）总体而言，三分之一的在线参与者对基础知识的理解和把握出现了严重的误解和不安全感，而这些问题在现场教学后并没有出现。
