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      Geometric validation of a computer simulator used in radiography education

      research-article
      , DCR (R), BSc (Hons), PGCE, PGC D Prof 1 , , , PhD 1
      BJR Open
      The British Institute of Radiology.

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          Abstract

          Objectives:

          The radiographical process of projection of a complex human form onto a two-dimensional image plane gives rise to distortions and magnifications. It is important that any simulation used for educational purposes should correctly reproduce these. Images generated using a commercially available computer simulation widely used in radiography education (ProjectionVR TM) were tested for geometric accuracy of projection in all planes.

          Methods:

          An anthropomorphic skull phantom was imaged using standard projection radiography techniques and also scanned using axial CT acquisition. The data from the CT was then loaded into the simulator and the same projection radiography techniques simulated. Bony points were identified on both the real radiographs and the digitally reconstructed radiographs (DRRs). Measurements sensitive to rotation and magnification were chosen to check for rotation and distortion errors.

          Results:

          The real radiographs and the DRRs were compared by four experienced observers and measurements taken between the identified bony points on each of the images obtained. Analysis of the mean observations shows that the measurement from the DRR matches the real radiograph +1.5 mm/−1.5 mm. The Bland Altman bias was 0.55 (1.26 STD), with 95% limits of agreement 3.01 to −1.91.

          Conclusions:

          Agreement between the empirical measurements is within the reported error of cephalometric analysis in all three anatomical planes. The image appearances of both the real radiographs and DRRs compared favourably.

          Advances in knowledge:

          The commercial computer simulator under test (ProjectionVR TM) was able to faithfully recreate the image appearances of real radiography techniques, including magnification and distortion. Students using this simulation for training will obtain feedback likely to be useful when lessons are applied to real-world situations.

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          Most cited references41

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          The analysis of errors in orthodontic measurements.

          W Houston (1983)
          The sources of error in cephalometric measurement and their analyses are discussed. The importance of distinguishing bias and random errors is emphasized, and methods of control are discussed. Randomization of record measurement is one of the most important methods of avoiding bias, but it is rarely undertaken in cephalometric studies. Random errors are particularly important in the evaluation of individual radiographs, and a measurement that has a high error in relation to its total variability will be of little value in clinical assessment. In serial studies of facial change, the error variance is always a major part of the total variance and thus results have to be interpreted with caution. In cross-sectional studies it is not possible to specify exactly the acceptable limits of random errors, because this will depend on the difference between groups that would be of interest and on the number of cases. The judicious replication of measurements can be important in the control of random errors. In many papers, adequate error evaluation and control is lacking. In these circumstances, the results are of limited value because it is not possible to tell whether an apparent effect is the result of bias in measurement or whether a real effect is being obscured by random errors. It is incumbent on authors to consider how their measurement errors should affect the interpretation of results.
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            Simulation-based medical education: an ethical imperative.

            Medical training must at some point use live patients to hone the skills of health professionals. But there is also an obligation to provide optimal treatment and to ensure patients' safety and well-being. Balancing these two needs represents a fundamental ethical tension in medical education. Simulation-based learning can help mitigate this tension by developing health professionals' knowledge, skills, and attitudes while protecting patients from unnecessary risk. Simulation-based training has been institutionalized in other high-hazard professions, such as aviation, nuclear power, and the military, to maximize training safety and minimize risk. Health care has lagged behind in simulation applications for a number of reasons, including cost, lack of rigorous proof of effect, and resistance to change. Recently, the international patient safety movement and the U.S. federal policy agenda have created a receptive atmosphere for expanding the use of simulators in medical training, stressing the ethical imperative to "first do no harm" in the face of validated, large epidemiological studies describing unacceptable preventable injuries to patients as a result of medical management. Four themes provide a framework for an ethical analysis of simulation-based medical education: best standards of care and training, error management and patient safety, patient autonomy, and social justice and resource allocation. These themes are examined from the perspectives of patients, learners, educators, and society. The use of simulation wherever feasible conveys a critical educational and ethical message to all: patients are to be protected whenever possible and they are not commodities to be used as conveniences of training.
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              Teaching anatomy without cadavers.

              Anatomy learning is generally seen as essential to medicine, and exposure to cadavers is generally seen as essential to anatomy learning around the world. Few voices dissenting from these propositions can be identified. This paper aims to consider arguments relating to the use of cadavers in anatomy teaching, and to describe the rationale behind the decision of a new UK medical school not to use cadaveric material. First, the background to use of cadavers in anatomy learning is explored, and some general educational principles are explored. Next, arguments for the use of human cadaveric material are summarised. Then, possible arguments against use of cadavers, including educational principles as well as costs, hazards and practicality, are considered. These are much less well explored in the existing literature. Next, the rationale behind the decision of a new UK medical school not to use cadaveric material is indicated, and the programme of anatomy teaching to be employed in the absence of the use of human remains is described. Curriculum design and development, and evaluation procedures, are briefly described. Issues surrounding pathology training by autopsy, and postgraduate training in surgical anatomy, are not addressed in this paper. Evidence relating to the effect on medical learning by students not exposed to cadavers is scant, and plainly opportunities will now arise through our programme to gather such evidence. We anticipate that this discussion paper will contribute to an ongoing debate, in which virtually all previous papers on this topic have concluded that use of cadavers is essential to medical learning.
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                Author and article information

                Contributors
                Journal
                BJR Open
                BJR Open
                bjro
                BJR Open
                The British Institute of Radiology.
                2513-9878
                2020
                3 February 2020
                : 2
                : 1
                : 20190027
                Affiliations
                [1 ]org-divisionTeesside University , Middlesbrough, United Kingdom
                Author notes
                Address correspondence to: Dr Philip Cosson. E-mail: P.cosson@ 123456tees.ac.uk
                Author information
                http://orcid.org/0000-0003-2184-9903
                Article
                BJRO-D-19-00027
                10.1259/bjro.20190027
                7594885
                312e1bae-7a9b-4176-933f-6fd86f4ea52e
                © 2020 The Authors. Published by the British Institute of Radiology

                This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.

                History
                : 09 June 2019
                : 08 January 2020
                : 10 January 2020
                Page count
                Figures: 10, Tables: 4, Equations: 0, References: 50, Pages: 0, Words: 5832
                Categories
                Original Research
                bjro, BJRO

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