Implementing a simulation-based curriculum for hybrid intracavitary/interstitial brachytherapy using a new, commercially available, US/MR/CT-compatible gynecologic phantom

Published:December 16, 2022DOI:



      To establish a simulation-based workshop for teaching hybrid intracavitary/interstitial (IC/IS) brachytherapy skills using a new, commercially available US/CT/MRI-compatible gynecologic phantom prototype.


      The VIOMERSE gynecological trainer phantom consisted of tissue-like colloid material and was US, CT, and MRI-compatible. We designed a hands-on workshop incorporating the phantom prototype to teach skills for hybrid IC/IS brachytherapy including pre-implant planning, procedural steps of implant placement, and post-implant evaluation. The workshop impact was evaluated with pre- and post-workshop surveys and responses were analyzed with Wilcoxon matched-pairs signed-rank test.


      Thirteen residents, divided into small groups, attended one of three separate 1-h workshop sessions held during the gynecologic education block. Workshop steps included IC applicator placement, tumor mapping and pre-planning desired location and depth of needles for hybrid IC/IS application, IS needle labelling and insertion, image review of needle placements, comparison of IC-alone versus IC/IS brachytherapy plans. Responses to questions ascertaining knowledge, confidence, and ability in planning and executing hybrid IC/IS procedures all demonstrated significant improvement from pre- to post-workshop. In response to whether the session was an effective learning experience, all residents rated the workshop with a score of 9 (n = 1) or 10 (n = 12) out of 10, with a score of 10 indicating “strongly agree.”


      Implementation of a hybrid IC/IS brachytherapy workshop utilizing a new, commercially-available phantom prototype was successful, with clear, subjective benefit for the residents in our program. This experience may inform continued efforts towards standardizing brachytherapy curricula across programs and increasing trainee exposure to interstitial procedures.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Brachytherapy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Han K
        • Milosevic M
        • Fyles A
        • et al.
        Trends in the utilization of brachytherapy in cervical cancer in the United States.
        Int J Radiat Oncol Biol Phys. 2013; 87: 111-119
        • Korenaga TK
        • Yoshida EJ
        • Pierson W
        • et al.
        Better late than never: Brachytherapy is more important than timing in treatment of locally advanced cervical cancer.
        Gynecol Oncol. 2022; 164: 348-356
        • Gill BS
        • Lin JF
        • Krivak TC
        • et al.
        National cancer data Base analysis of radiation therapy consolidation modality for cervical cancer: the impact of new technological advancements.
        Int J Radiat Oncol Biol Phys. 2014; 90: 1083-1090
        • Shinde A
        • Li R
        • Amini A
        • et al.
        Resident experience in brachytherapy: an analysis of accreditation council for graduate medical education case logs for intracavitary and interstitial brachytherapy from 2007 to 2018.
        Brachytherapy. 2020; 19: 718-724
        • Marcrom SR
        • Kahn JM
        • Colbert LE
        • et al.
        Brachytherapy training survey of radiation oncology residents.
        Int J Radiat Oncol Biol Phys. 2019; 103: 557-560
        • Motola I
        • Devine LA
        • Chung HS
        • et al.
        Simulation in healthcare education: a best evidence practical guide. AMEE Guide No. 82.
        Med Teach. 2013; 35: e1511-e1530
        • Ahlberg G
        • Enochsson L
        • Gallagher AG
        • et al.
        Proficiency-based virtual reality training significantly reduces the error rate for residents during their first 10 laparoscopic cholecystectomies.
        Am J Surg. 2007; 193: 797-804
        • Lynch B
        • Einspruch EL
        • Nichol G
        • et al.
        Effectiveness of a 30-min CPR self-instruction program for lay responders: a controlled randomized study.
        Resuscitation. 2005; 67: 31-43
        • Villanueva C
        • Xiong J
        • Rajput S.
        Simulation-based surgical education in cardiothoracic training.
        ANZ J Surg. 2020; 90: 978-983
        • Mittal MK
        • Dumon KR
        • Edelson PK
        • et al.
        Successful implementation of the american college of surgeons/association of program directors in surgery surgical skills curriculum via a 4-week consecutive simulation rotation.
        Simul Healthc. 2012; 7 (0.1097/SIH.0b013e31824120c6): 147-154
        • Fernandez C
        • Croke J
        • Alfieri J
        • Golden DW
        A guide to curriculum inquiry for brachytherapy simulation-based medical education.
        Brachytherapy. 2020; 19: 749-757
        • Damast S
        • Felder S
        • Fields E
        • Singer L.
        Feasibility of deploying a U.S. simulation-based gynecological brachytherapy educational workshop to an international setting.
        Brachytherapy. 2020; 19: 777-782
        • Fields EC
        • Joyner MM
        • Singer L
        • Todor D.
        A new development in ultrasound-compatible gynecologic brachytherapy simulators.
        Brachytherapy. 2020; 19: 783-786
      1. Williams VM, Mansoori B, Young L, et al. Simulation-based learning for enhanced gynecologic brachytherapy training among radiation oncology residents. Brachytherapy. 202; 20:128-135. doi:10.1016/j.brachy.2020.08.022

        • Donnelly ED
        • Sachdev S
        • Zhang H
        • et al.
        Development of a gynecologic brachytherapy curriculum and simulation modules to improve radiation oncology trainees' skills and confidence.
        Brachytherapy. 2020; 19: 732-737
        • Taunk NK
        • Shah NK
        • Hubley E
        • et al.
        Virtual reality-based simulation improves gynecologic brachytherapy proficiency, engagement, and trainee self-confidence.
        Brachytherapy. 2021; 20: 695-700
        • Pötter R
        • Tanderup K
        • Schmid MP
        • et al.
        MRI-guided adaptive brachytherapy in locally advanced cervical cancer (EMBRACE-I): a multicentre prospective cohort study.
        Lancet Oncol. 2021; 22: 538-547
        • Shiao JC
        • Santoso A
        • Stuhr K
        • et al.
        Gynecologic interstitial brachytherapy curriculum using a low-cost phantom with ultrasound workshop and a treatment planning workshop is effective.
        Brachytherapy. 2022; 21: 110-119
        • Singer L
        • Damast S
        • Lin L
        • et al.
        Development of a multi-institutional simulation-based gynecologic brachytherapy curriculum.
        Int J Radiat Oncol Biol Phys. 2019; 104: 1175-1176
        • Nattagh K
        • Siauw T
        • Pouliot J
        • et al.
        A training phantom for ultrasound-guided needle insertion and suturing.
        Brachytherapy. 2014; 13: 413-419