Simulation supported training in oral radiology : methods and impact on interpretative skill

Abstract: Simulation is an important tool when training is hazardous, time consuming, or expensive. Simulation can also be used to enhance reality by adding features normally not available in the real world. The aim with this work has been to develop and evaluate methods that could improve learning in oral radiology utilising a radiation-free simulator environment. Virtual reality software for radiographic examinations was developed. The virtual environment consisted of a model of a patient, an x-ray machine, and a film. Simulated radiographic images of the patient model could be rendered as perspective projections based on the relative position between the individual models. The software was incorporated in an oral radiology simulator with a training program for interpretation of spatial relations in radiographs. Projection geometry was validated by comparing length dimensions in simulated radiographs with the corresponding theoretically calculated distances. The results showed that projection error in the simulated images never exceeded 0.5 mm. Dental students participated in studies on skill in interpreting spatial information in radiographs utilising parallax. Conventional and simulator based training methods were used. Training lasted for 90 minutes. Skill in interpreting spatial information was assessed with a proficiency test before training, immediately after training, and eight months after training. Visual-spatial ability was assessed with mental rotations test, version A (MRT-A). Regression analysis revealed a significant (P<0.01) association between visual-spatial ability and proficiency test results after training. At simulator training, proficiency test results immediately after training were significantly higher than before training (P<0.01). Among students with low MTR-A scores, improvement after simulator training was higher than after conventional training. Eight months after simulator training proficiency test results were lower than immediately after training. The test results were, however, still higher than before training. In conclusion, the simulation software produces simulated radiographs of high geometric accuracy. Acquisition of skill to interpret spatial relations in radiographs is facilitated for individuals with high visual-spatial ability. Simulator training improves acquisition of interpretative skill and is especially beneficial for individuals with low visual-spatial ability. The results indicate that radiology simulation can be an effective training method.