AAPM Task Group 334: A guidance document to using radiotherapy immobilization devices and accessories in an MR environment.

Use of magnetic resonance (MR) imaging in radiation therapy has increased substantially in recent years as more radiotherapy centers are having MR simulators installed, requesting more time on clinical diagnostic MR systems, or even treating with combination MR linear accelerator (MR-linac) systems. With this increased use, to ensure the most accurate integration of images into radiotherapy (RT), RT immobilization devices and accessories must be able to be used safely in the MR environment and produce minimal perturbations. The determination of the safety profile and considerations often falls to the medical physicist or other support staff members who at a minimum should be a Level 2 personnel as per the ACR. The purpose of this guidance document will be to help guide the user in making determinations on MR Safety labeling (i.e., MR Safe, Conditional, or Unsafe) including standard testing, and verification of image quality, when using RT immobilization devices and accessories in an MR environment.

Creating augmented reality-based experiences for aviation weather training: Challenges, opportunities, and design implications for 3D authoring.

This paper examines opportunities and challenges of integrating augmented reality (AR) into education and investigates requirements to enable instructors to author AR educational experiences. Although AR technology is recognised for its potential in educational enhancement, it poses challenges for instructors creating AR-based experiences due to their limited digital skills and the complexity of 3D authoring tools. Semi-structured interviews with 17 aviation instructors identified current pedagogical approaches, gaps, and potential applications of AR in aviation weather education. Additionally, results highlighted the benefits of AR and obstacles to its integration into education, followed by outlining design priorities and user needs for educational AR authoring. For AR authoring toolkit development, this study recommended incorporating interactive AR lesson modules, early development of user requirements, and prebuilt AR modules. Findings will guide the development of a 3D authoring toolkit for non-technologist instructors, enabling wider AR use in aviation weather education and other educational fields.

Research interviews with aviation instructors were conducted to derive design implications of AR authoring toolkits for non-technologist instructors. Key findings highlighted gaps in aviation weather education, potential AR applications, and barriers to AR in education. Design recommendations emphasised incorporating interactive AR lesson modules, initial user requirements, and prebuilt AR modules.

Team Dynamics and Collaborative Problem-Solving for Lunar Construction: Lessons From Complex Construction Scenarios on Earth.

OBJECTIVE: This paper surveys the existing literature surrounding problem-solving and team dynamics in complex and unpredictable scenarios, and evaluates the applicability of studying Earth-based construction teams to identify training needs for Lunar construction crews. BACKGROUND: Lunar and other space exploration construction crews will work in extreme environments and face unpredictable challenges, necessitating real-time problem-solving to address unexpected contingencies. This work will require coordination with Mission Control and autonomous assistants, so crew training must account for multi-agent, distributed teamwork. METHOD: A narrative literature review identified processes, attributes, and skills necessary for the success of Lunar construction teams. We summarized relevant frameworks and synthesized collective findings into over-arching trends and remaining research gaps. RESULTS: While significant literature exists surrounding team performance, very little systematic inquiry has been done with a focus on Lunar construction crews and operations, particularly with respect to dynamic problem-solving and team-based decision-making. Established and standardized metrics for evaluating team performance are lacking, resulting in significant variation in reported outcomes between studies. CONCLUSION: Lunar and other space exploration construction teams will need training that focuses on developing the right approach to team-based problem-solving, rather than on preparing response execution for known contingencies. An investigation of successful Earth-based construction crews may facilitate the development of relevant metrics for training future Lunar construction crews. APPLICATION: Metrics and team training protocols developed for future Lunar construction teams may be adaptable and applicable to a wide range of extreme teams facing uncertain challenges, such as aircrews, surgical teams, first responders, and construction crews.

Characterizing barriers to closing cross-institutional referral loops: Workflow and information flow analysis.

The specialty referral process consists of primary care clinicians referring patients to specialty consultants. This care transition requires effective care coordination and health information exchange between care teams; however, breakdowns in workflow and information flow impede "closing the referral loop" and delay or prevent referrers from receiving the consultant's "visit notes," particularly in cross-institutional referrals. This study aimed to describe and map the referral process as it occurs in clinics and identify and characterize work system barriers affecting its performance. Referrers and consultants were interviewed about their perceived workflows, barriers, and clinical outcomes to inform a workflow analysis.

Assessment of Physiological Responses During Field Science Task Performance: Feasibility and Future Needs.

OBJECTIVE: By understanding the physiological demands of different types of tasks that will be performed during extravehicular activity (EVA) on Mars, human performance safety risks can be mitigated. In addition, such understanding can assist in planning EVAs with an appropriate balance of human health and safety with scientific mission return. BACKGROUND: This paper describes the results of a study of technical feasibility performed within a Mars human research analog, with participants conducting scientifically relevant planetary science sample analysis and return tasks in two distinct field locations. METHODS: The authors collected heart rate, respiration rate, and heart rate variability (HRV) data, using commercial off-the-shelf hardware and software from study participants as they performed field science tasks within a concept of operations for a Mars science return human expedition mission. These data were remotely monitored, shared in real time, and later analyzed to identify different responses to different tasks in order to determine if there were any predictable or consistent patterns among participants. RESULTS: It was ultimately determined that, while differences exist between responses to tasks, they are highly subject to multiple sources of individual variability, dynamics of evolving field science tasks, and demands of a demanding physical environment. Further, distributional analyses of participants do not support parametric statistical analysis techniques. CONCLUSION: The authors conclude that the physiology of individual astronauts should be extensively studied and modeled to support individualized automated monitoring tools for each crew member that is sent to Mars. Application: Physiological monitoring for specialized populations will require significant individual-level analysis, baselining, and bootstrap statistical methods to enable appropriate human performance determinations.

Electronic intracavitary brachytherapy quality management based on risk analysis: The report of AAPM TG 182.

PURPOSE: The purpose of this study was to provide guidance on quality management for electronic brachytherapy. MATERIALS AND METHODS: The task group used the risk-assessment approach of Task Group 100 of the American Association of Physicists in Medicine. Because the quality management program for a device is intimately tied to the procedure in which it is used, the task group first designed quality interventions for intracavitary brachytherapy for both commercial electronic brachytherapy units in the setting of accelerated partial-breast irradiation. To demonstrate the methodology to extend an existing risk analysis for a different application, the task group modified the analysis for the case of post-hysterectomy, vaginal cuff irradiation for one of the devices. RESULTS: The analysis illustrated how the TG-100 methodology can lead to interventions to reduce risks and improve quality for each unit and procedure addressed. CONCLUSION: This report provides a model to guide facilities establishing a quality management program for electronic brachytherapy.

Considerations for developing chronic care system for traumatic brain injury based on comparisons of cancer survivorship and diabetes management care.

Experts in traumatic brain injury (TBI) rehabilitation recently proposed the framing of TBI as a chronic disease rather than a discrete event. Within the framework of the Chronic Care Model (CCM), a systematic comparison of three diseases - cancer survivorship, diabetes management and TBI chronic care - was conducted regarding chronic needs and the management of those needs. In addition, comparisons of these conditions require comparative evaluations of disease management characteristics and the survivor concept. The analysis found diabetes is more established within the CCM, where care is integrated across specialists and primary care providers. No single comparison provides a full analogue for understanding the chronic care health delivery system for TBI, indicating the need for a separate model to address needs and resources for TBI survivors. The findings from this research can provide practitioners with a context to develop a robust continued care health system for TBI. Practitioner Summary: We examine development of a chronic care system for traumatic brain injury. We conducted a systematic comparison of Chronic Care Model elements of decision and information support. Development of capabilities using a benchmark of diabetes care, with additional insights from cancer care, provides insights for implementing TBI chronic care systems.

Community health integration through pharmacy process and ergonomics redesign (CHIPPER).

As the expansion and utilisation of community pharmacy systems increases, so does the risk for an adverse drug event to occur. In attempts to mitigate this risk, many community pharmacies implement health information technology (IT); however, there are challenges in integrating the wider systems components necessary for a successful implementation with minimal unintended consequences. The purpose of this paper is to introduce a Community Health Integration through Pharmacy Process and Ergonomics Redesign (CHIPPER) framework, which explores the multiple angles of health IT integration to support medication delivery processes in community pharmacy systems. Specifically, CHIPPER identifies the information flows that occur between different parts of the system (initiation, upstream, midstream and downstream) with varying end-users and tasks related to medication delivery processes. In addition to the justification and presentation of the CHIPPER model, this paper reviews several broad applications for CHIPPER and presents two example studies that demonstrate the CHIPPER framework. Practitioner Summary: Most medication delivery in the US occurs through outpatient-based community pharmacy practice. Community pharmacies are challenged by inconsistent and incomplete information flow and technology integration between providers, pharmacy practitioners and patients. This paper presents a framework for improved healthcare systems engineering analysis of pharmacy practice, with case study examples.

AAPM and GEC-ESTRO guidelines for image-guided robotic brachytherapy: report of Task Group 192.

In the last decade, there have been significant developments into integration of robots and automation tools with brachytherapy delivery systems. These systems aim to improve the current paradigm by executing higher precision and accuracy in seed placement, improving calculation of optimal seed locations, minimizing surgical trauma, and reducing radiation exposure to medical staff. Most of the applications of this technology have been in the implantation of seeds in patients with early-stage prostate cancer. Nevertheless, the techniques apply to any clinical site where interstitial brachytherapy is appropriate. In consideration of the rapid developments in this area, the American Association of Physicists in Medicine (AAPM) commissioned Task Group 192 to review the state-of-the-art in the field of robotic interstitial brachytherapy. This is a joint Task Group with the Groupe Européen de Curiethérapie-European Society for Radiotherapy & Oncology (GEC-ESTRO). All developed and reported robotic brachytherapy systems were reviewed. Commissioning and quality assurance procedures for the safe and consistent use of these systems are also provided. Manual seed placement techniques with a rigid template have an estimated in vivo accuracy of 3-6 mm. In addition to the placement accuracy, factors such as tissue deformation, needle deviation, and edema may result in a delivered dose distribution that differs from the preimplant or intraoperative plan. However, real-time needle tracking and seed identification for dynamic updating of dosimetry may improve the quality of seed implantation. The AAPM and GEC-ESTRO recommend that robotic systems should demonstrate a spatial accuracy of seed placement ≤1.0 mm in a phantom. This recommendation is based on the current performance of existing robotic brachytherapy systems and propagation of uncertainties. During clinical commissioning, tests should be conducted to ensure that this level of accuracy is achieved. These tests should mimic the real operating procedure as closely as possible. Additional recommendations on robotic brachytherapy systems include display of the operational state; capability of manual override; documented policies for independent check and data verification; intuitive interface displaying the implantation plan and visualization of needle positions and seed locations relative to the target anatomy; needle insertion in a sequential order; robot-clinician and robot-patient interactions robustness, reliability, and safety while delivering the correct dose at the correct site for the correct patient; avoidance of excessive force on radioactive sources; delivery confirmation of the required number or position of seeds; incorporation of a collision avoidance system; system cleaning, decontamination, and sterilization procedures. These recommendations are applicable to end users and manufacturers of robotic brachytherapy systems.

Delays and user performance in human-computer-network interaction tasks.

OBJECTIVE: This article describes a series of studies conducted to examine factors affecting user perceptions, responses, and tolerance for network-based computer delays affecting distributed human-computer-network interaction (HCNI) tasks. BACKGROUND: HCNI tasks, even with increasing computing and network bandwidth capabilities, are still affected by human perceptions of delay and appropriate waiting times for information flow latencies. METHOD: Conducted were 6 laboratory studies with university participants in China (Preliminary Experiments 1 through 3) and the United States (Experiments 4 through 6) to examine users' perceptions of elapsed time, effect of perceived network task performance partners on delay tolerance, and expectations of appropriate delays based on task, situation, and network conditions. RESULTS: Results across the six experiments indicate that users' delay tolerance and estimated delay were affected by multiple task and expectation factors, including task complexity and importance, situation urgency and time availability, file size, and network bandwidth capacity. Results also suggest a range of user strategies for incorporating delay tolerance in task planning and performance. CONCLUSION: HCNI user experience is influenced by combinations of task requirements, constraints, and understandings of system performance; tolerance is a nonlinear function of time constraint ratios or decay. APPLICATION: Appropriate user interface tools providing delay feedback information can help modify user expectations and delay tolerance. These tools are especially valuable when delay conditions exceed a few seconds or when task constraints and system demands are high. Interface designs for HCNI tasks should consider assistant-style presentations of delay feedback, information freshness, and network characteristics. Assistants should also gather awareness of user time constraints.

Tools for developing a quality management program: human factors and systems engineering tools.

During the past 10 years, there has been growing acceptance and encouragement of partnerships between medical teams and engineers. Using human factors and systems engineering descriptions of process flows and operational sequences, the author's research laboratory has helped highlight opportunities for reducing adverse events and improving performance in health care and other high-consequence environments. This research emphasized studying human behavior that enhances system performance and a range of factors affecting adverse events, rather than a sole emphasis on human error causation. Developing a balanced evaluation requires novel approaches to causal analyses of adverse events and, more importantly, methods of recovery from adverse conditions. Recent work by the author's laboratory in collaboration with the Regenstrief Center for Healthcare Engineering has started to address possible improvements in taxonomies describing health care tasks. One major finding includes enhanced understanding of events and how event dynamics influence provider tasks and constraints. Another element of this research examines team coordination tasks that strongly affect patient care and quality management, but may be undervalued as "indirect patient care" activities.

Knowledge sharing and expertise coordination of event response in organizations.

This paper provides an overview of opportunities and challenges for expert coordination, knowledge sharing, and task performance using advanced information and communication technologies. Evolving in part from [Hendrick, H., 1991. Ergonomics in organizational design and management. Ergonomics 34(6), 743-756] discussion of macroergonomics, this paper describes the author's framework for systems engineering analysis of information flow and performance at team and organizational units of analysis. Work in the author's research lab has focused on several aspects of information technology use and team interactions to support shared understandings, task demands, and effective responses in responses to events. Multiple empirical studies are summarized describing evaluations of technology use, task cycles and expert knowledge coordination in several settings, including aerospace, healthcare, and project management.

Augmenting team cognition in human-automation teams performing in complex operational environments.

There is a growing reliance on automation (e.g., intelligent agents, semi-autonomous robotic systems) to effectively execute increasingly cognitively complex tasks. Successful team performance for such tasks has become even more dependent on team cognition, addressing both human-human and human-automation teams. Team cognition can be viewed as the binding mechanism that produces coordinated behavior within experienced teams, emerging from the interplay between each team member's individual cognition and team process behaviors (e.g., coordination, communication). In order to better understand team cognition in human-automation teams, team performance models need to address issues surrounding the effect of human-agent and human-robot interaction on critical team processes such as coordination and communication. Toward this end, we present a preliminary theoretical framework illustrating how the design and implementation of automation technology may influence team cognition and team coordination in complex operational environments. Integrating constructs from organizational and cognitive science, our proposed framework outlines how information exchange and updating between humans and automation technology may affect lower-level (e.g., working memory) and higher-level (e.g., sense making) cognitive processes as well as teams' higher-order "metacognitive" processes (e.g., performance monitoring). Issues surrounding human-automation interaction are discussed and implications are presented within the context of designing automation technology to improve task performance in human-automation teams.

Multi-team dynamics and distributed expertise in imission operations.

The evolution of space exploration has brought an increased awareness of the social and socio-technical issues associated with team performance and task coordination, both for the onboard astronauts and in mission control. Spaceflight operations create a unique environment in which to address classic group dynamics topics including communication, group process, knowledge development and sharing, and time-critical task performance. Mission operations in the early years of the 21st century have developed into a set of complex, multi-team task settings incorporating multiple mission control teams and flight crews interacting in novel ways. These more complex operational settings help highlight the emergence of a new paradigm of distributed supervisory coordination, and the need to consider multiple dimensions of expertise being supported and exchanged among team members. The creation of new mission profiles with very long-duration time scales (months, rather than days) for the International Space Station, as well as planned exploration missions to the Moon and Mars, emphasize fundamental distinctions from the 40 yr from Mercury to the Space Shuttle. Issues in distributed expertise and information flow in mission control settings from two related perspectives are described. A general conceptual view of knowledge sharing and task synchronization is presented within the context of the mission control environment. This conceptual presentation is supplemented by analysis of quasi-experimental data collected from actual flight controllers at NASA-Johnson Space Center, Houston, TX.

Analysis and modeling of information flow and distributed expertise in space-related operations.

Evolving space operations requirements and mission planning for long-duration expeditions require detailed examinations and evaluations of information flow dynamics, knowledge-sharing processes, and information technology use in distributed expert networks. This paper describes the work conducted with flight controllers in the Mission Control Center (MCC) of NASA's Johnson Space Center. This MCC work describes the behavior of experts in a distributed supervisory coordination framework, which extends supervisory control/command and control models of human task performance. Findings from this work are helping to develop analysis techniques, information architectures, and system simulation capabilities for knowledge sharing in an expert community. These findings are being applied to improve knowledge-sharing processes applied to a research program in advanced life support for long-duration space flight. Additional simulation work is being developed to create interoperating modules of information flow and novice/expert behavior patterns.

Analysis of treatment delivery errors in brachytherapy using formal risk analysis techniques.

PURPOSE: To identify hazardous situations in treatments, analyze the nature of errors committed, and assess the value of several analysis techniques. MATERIALS AND METHODS: The study applied several risk analysis techniques to brachytherapy events (misadministrations) reported to the U.S. Nuclear Regulatory Commission and the International Atomic Energy Agency. RESULTS: (1) Events usually have multiple causes. (2) Failure to consider human performance in the design of equipment led to a large fraction of the events. (3) Verification procedures often were ineffectual. (4) Many events followed the failure of persons involved to detect that the situation was abnormal, often even though many indications pointed to that fact. Once the event was identified, the response often included actions appropriate for normal conditions, but inappropriate for the conditions of the event. (5) Events tended to happen most with actions having the least time available. (6) Lack of training and procedures covering unusual conditions frequently contributed to events. (7) New procedures or new persons joining a case in the middle present increased hazards. CONCLUSIONS: Risk analysis tools common in industry provide useful information for error reduction in medical settings, although not as effectively, and modification of such techniques could improve their efficacy.

Describing functional requirements for knowledge sharing communities.

Human collaboration in distributed knowledge sharing groups depends on the functionality of information and communication technologies (ICT) to support performance. Since many of these dynamic environments are constrained by time limits, knowledge must be shared efficiently by adapting the level of information detail to the specific situation. This paper focuses on the process of knowledge and context sharing with and without mediation by ICT, as well as issues to be resolved when determining appropriate ICT channels. Both technology-rich and non-technology examples are discussed.