An Evaluation of the 2020 Change to the Saudi Emergency Residency Program Assessment

Background Several changes have been made to the assessment component of Saudi residency training programs. Among those is the implementation of three examinations over the course of the year. Aim We aimed to explore the emergency residents’ perspective on the change in the number of examinations, and the impact of such changes in terms of time management, knowledge gain, and social life. Methods This cross-sectional study was carried out from September to October 2022, using an electronic survey targeting emergency board trainees. Results One hundred and nine emergency residents enrolled, of whom 64.2% were male. The majority, 45%, were from the central province. Junior-level residents (R1) represented 26.6% of the sample, while R2 (second year) comprised 18.3%, R3 (third year) comprised 38.5%, and 16.5% were senior (R4) level. More than half of the participants, 56 % (n=61), did not support the change from one to three examinations and believed that it had a negative influence on knowledge gain and clinical skills. The influence of the change on time management stands out as a negative impact, in addition to its impact on social life and annual leave arrangements. Conclusions The support for three examinations throughout the year was low; a contributing factor to this may be the sudden changes effected by those tests on training and time management. A re-evaluation of testing culture and involving residents in decision-making might generate acceptance.

Authentication of Absorbed Dose Measurements for Optimization of Radiotherapy Treatment Planning

The optimum treatment outcome of radiation therapy depends on accurate determination of radiation dose which is possible only after the detail analysis of quality assurance procedures in the Radiotherapy Treatment Planning, ensuring dosimetric characteristics of the machines and precise treatment execution. It was intended to develop dosimetric phantoms to imitate the actual patient’s anatomy for authentication of absorbed dose in target tumor and to assure the quality of radiotherapy treatment. An anthropomorphic PRESAGE ® phantom was created in the shape of a breast for external beam radiotherapy and brachytherapy. Five fields intensity modulated radiation therapy (IMRT), three field partial breast and SAVI 6-1 applicator brachytherapy plan was used to evaluate the breast phantom. The anthropomorphic breast PRESAGE ® was scanned with the Duke midsized optical CT scanner (DMOS-RPC) and optical density (OD) was converted to dose distribution. Comparisons were performed between the dose distribution calculated with the Pinnacle 3 treatment planning system, GAFCHROMIC® EBT2 film and PRESAGE ® for IMRT and 3DCRT partial breast plan. Oncentra® Master Brachy planning was also used for the comparison of PRESAGE ® and GAHCHROMIC® EBT2 film measurements. For IMRT, Gamma map comparisons showed that Pinnacle 3 well agreed with PRESAGE ® for more than 95% of comparison points of the planning tumor volume (PTV), passed ±3%/±3 mm criterion when the outer 8 mm of phantom data were excluded. Edge artifacts were observed in the optical CT reconstruction, from the surface to a depth of almost 8 mm. For 3DCRT partial breast planning Dose Volume Histograms (DVHs) of gross tumor volume (GTV), clinical tumor volume (CTV) and PTV for the PRESAGE ® dosimeter and Pinnacle 3 treatment planning system confirmed a likeness of 97.8% of the prescribed dose. Gamma map comparisons showed that all three distributions agreed with greater than 95% of comparison points passing the ±3% / ±2 mm criterion. DVHs of the skin and PTV_EVAL (PTV_ Evaluation) Brachytherapy for PRESAGE® and Oncentra® differed by a maximum of 4 to 8% respectively. A prostate anthropomorphic viRPC (Radiological Physics Center) phantom was also used which contained TLD (Thermoluminescent dosimeters) and GAFCHROMIC® EBT2 film to evaluate the spot scanning proton therapy. The results of spot scanning proton therapy shows that the Right/Left, Inferior/Superior and Posterior/Anterior aspects of the coronal/sagittal and EBT2 film measurements were within ±7%/±4mm of the treatment planning system (TPS). This work demonstrates the feasibility of the PRESAGE ® to be fashioned into anthropomorphic shape and establishes the accuracy of Pinnacle 3 for breast IMRT as well as for 3D and brachytherapy planning. Furthermore, the extension of this work can lead to investigate 3D dosimetry with more complex anthropomorphic phantoms. RPC-Anthropomorphic prostate phantom could be used to establish quality assurance of spot scanning proton beam within certain confidence levels. The quality of treatment can be improved with the utilization of PRESAGE® in both external beam radiotherapy as well as brachytherapy. An anthropomorphic phantom is a good substitute of actual patients’ and can be a valuable tool for treatment planning in all types of radiation therapy including spot scanning proton therapy for authentication of absorbed dose measurements and resultantly can increase the accuracy and quality of the treatment.