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Background: Radiation protection remains abstract in medical training as ionizing radiation is not perceptible to human senses. Theoretical instruction often fails to bridge the gap to safe clinical behavior in the operating room. This study evaluates a newly developed, curricular virtual reality (VR) course designed to visualize scatter radiation and improve medical students’ safety-related self-efficacy.

Methods: In a prospective study at the University of Münster (winterterm 2025/26), a VR radiation protection module was implemented as a mandatory curricular component for 169 third-year medical students. Data from 139 students who provided written informed consent were included in the evaluation. The core intervention consisted of an immersive VR simulation featuring a virtual operating room with a C-arm based on the proof-of-concept by Süncksen et al. [1] and was specifically adapted for this course. Scatter radiation was rendered as real-time 3D heatmap. Evaluation was conducted via pre- and post-intervention surveys (5-point Likert scales), including the NASA Task Load Index (NASA-TLX) to assess mental demand and frustration. Statistical analysis presented in mean (M)±SD, utilized paired samples t-tests and Cohen’s d.

Results: The module achieved a global rating of 71.2±21.7 (scale 1-100). Students reported high immersion (M=3.6±0.9) and enjoyment (M=4.1±1.0) with low physical demand (M=1.7±0.9). NASA-TLX scores indicated moderate mental demand (M=2.4±1.1) and task complexity (M=2.5±0.9), suggesting a well-balanced challenge. Comparisons of self-assessment scores in the pre- and post-intervention questionnaires revealed significant improvements across all competency domains (p<0.001). The most pronounced effect was observed for safe positioning within the room (d=1.1; pre: M=2.3±1.0, post: M=3.3±0.9). Overall, 91.7% of students recommended the permanent integration of the VR course.

Discussion: Virtual reality effectively bridges the gap between theory and practice by rendering invisible radiation hazards visible. The immersive 3D heatmap enables students to experience spatial dose distributions, transforming abstract safety principles into tangible experiences. Our results align with prior research [2], while highlighting the specific impact of high-fidelity heatmaps on spatial awareness. NASA-TLX data confirm the simulation is intellectually stimulating without inducing excessive cognitive demand, ensuring feasibility for mandatory curricular use. Building on institutional VR-expertise [3], this module can help to establish a scalable educational standard that effectively prepares students for radiation-safe behavior in clinical practice.

Take-home messages: Immersive 3D heatmaps significantly enhance student self-efficacy in radiation-safe positioning. The balanced cognitive load and high student acceptance made this scalable VR module a useable approach for risk-free practical training.

Literatur

[1] Süncksen M, Bott OJ, Dresing K, Teistler M. Simulation of scattered radiation during intraoperative imaging in a virtual reality learning environment. Int J Comput Assist Radiol Surg. 2020;15(4):691-702. DOI: 10.1007/s11548-020-02126-x
[2] Rainford L, Tcacenco A, Potocnik J, Brophy C, Lunney A, Kearney D, O’Connor M. Student perceptions of the use of three-dimensional (3-D) virtual reality (VR) simulation in the delivery of radiation protection training. Radiography (Lond). 2023;29(4):777-785. DOI: 10.1016/j.radi.2023.05.009
[3] Junga A, Kockwelp P, Valkov D, Schulze H, Bozdere P, Hätscher O, Ahrens H, Marschall B, Risse B, Holling M. Teach the Unteachable with a Virtual Reality (VR) Brain Death Scenario - 800 Students and 3 Years of Experience. Perspect Med Educ. 2025;14(1):44-54. DOI: 10.5334/pme.1427