Health Sciences Education Symposium

First Author Information

Emma Fields, MD, Assistant Professor, Department of Radiation Oncology

Additional Author(s) Information

Sherry Zhao, MD, PGY-2 Radiation Oncology Resident

Louise Francis, CMD, Dosimetrist, Department of Radiation Oncology

Dorin Todor, PhD, Medical Physicist, Department of Radiation Oncology

Presentation Format


Type of Activity


Original Presentation Date


Date of Submission

May 2017

Abstract/Short Description

Radiation therapy is the mainstay of treatment for women with cervical cancer with disease outside of the uterine cervix. To deliver the high doses needed for cure, brachytherapy (BT) is necessary to avoid toxicity to normal tissues (1). Technique is of utmost importance for outcomes of BT, but due to a lack of training during residency, the use of BT is declining nationwide (2, 3). The effectiveness of procedural simulation training, especially proficiency-based training, has been well established in other medical specialties, but there is no simulation training for cervical cancer brachytherapy used anywhere else in the country at this time (4-8). To combat this problem, we developed and implemented a structured proficiency-based BT simulation curriculum that will be able to be modified and replicated at training programs across the country and will be particularly practical for programs with less exposure to gynecologic brachytherapy. Residents who participated in the simulation training had measurable improvements in the time to perform the procedure, applicator placement quality and confidence, which translate to fewer complications and better tumor control for patients.

Purpose/Research Question

To determine if simulation-based proficiency training on a pelvic model will improve the quality of tandem and ovoid placement, improve resident confidence with the procedure, and decrease the time needed to complete the procedure (less anesthesia time for the patient).


1. Training in the placement of tandem and ovoid applicators using a pelvic model will improve the quality of implantation which will facilitate the optimization of dosimetry.

2. Simulation training will increase resident confidence and long-term competence with intracavitary cervical brachytherapy.

3. Simulation training will decrease overall procedural time.


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2. Han K, Milosevic M, Fyles A, Pintilie M, Viswanathan AN. Trends in the utilization of brachytherapy in cervical cancer in the United States. Int J Radiat Oncol Biol Phys. [Research Support, Non-U.S. Gov't]. 2013 Sep 01;87(1):111-9.

3. Eifel PJ, Moughan J, Erickson B, Iarocci T, Grant D, Owen J. Patterns of radiotherapy practice for patients with carcinoma of the uterine cervix: a patterns of care study. Int J Radiat Oncol Biol Phys. [Comparative Study Multicenter Study Research Support, U.S. Gov't, P.H.S.]. 2004 Nov 15;60(4):1144-53.

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6. Ahlberg G, Enochsson L, Gallagher AG, Hedman L, Hogman C, McClusky DA, 3rd, et al. Proficiency-based virtual reality training significantly reduces the error rate for residents during their first 10 laparoscopic cholecystectomies. Am J Surg. [Randomized Controlled Trial]. 2007 Jun;193(6):797-804.

7. de Almeida CE, Rodriguez M, Vianello E, Ferreira IH, Sibata C. An anthropomorphic phantom for quality assurance and training in gynecological brachytherapy. Radiother Oncol. [Research Support, Non-U.S. Gov't]. 2002 Apr;63(1):75-81.

8. Nattagh K, Siauw T, Pouliot J, Hsu IC, Cunha JA. A training phantom for ultrasound-guided needle insertion and suturing. Brachytherapy. [Evaluation Studies]. 2014 Jul-Aug;13(4):413-9.

9. Viswanathan AN, Moughan J, Small W, Jr., Levenback C, Iyer R, Hymes S, et al. The quality of cervical cancer brachytherapy implantation and the impact on local recurrence and disease-free survival in radiation therapy oncology group prospective trials 0116 and 0128. Int J Gynecol Cancer. [Clinical Trial, Phase II Multicenter Study Research Support, N.I.H., Extramural]. 2012 Jan;22(1):123-31.

10. Compton JJ, Gaspar LE, Shrieve DC, Wilson LD, Griem KL, Amdur RJ, et al. Resident-reported brachytherapy experience in ACGME-accredited radiation oncology training programs. Brachytherapy. 2013 Nov-Dec;12(6):622-7.


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VCU Medical Education Symposium