Teaching PET/CT to medical students under the COVID-19 lockout: Implementing a new freeware client server PET/CT viewer in the university network

Aim/Introduction: Since 2017, medical students in the third and the fifth years at the University of Bergen are taught PET/CT 'hands-on' by mandatory exercises in the university's learning management system (LMS) paired to a diagnostic client-server viewing system in the hospital [1] Following the COVID-19 pandemic, students were barred access to the hospital To give students continued access to PET/CT studies in native format including interactive image fusion, a separate client server system based on the university network had to be established at short notice Materials and Methods: All 77 fifth-year students participating in the course 'Nuclear Medicine in Oncology' were requested to install the open source multiplatform Fiji viewer with Beth Israel PET/CT plugin (http://petctviewer org/) on their personal computers Anonymized DICOM images are hosted by the public domain orthanc server (https://orthanc-server com) running under a virtual CentOS Linux host behind the university's firewall Students connect via virtual private network (VPN) with individual logon Transport Security Layer (TSL/https) encryption is provided by apache2 acting as a reverse proxy Detailed end user documentation was provided by screencasts on https://www uib no/en/radioweb/nuclear and inside the LMS Results: The new client-server solution was online with complete user documentation after just six days on 19 April 2020 Regulatory approval was obtained on 21 April 2020, in time for the electronic Team-Based Learning (TBL) session on 22 April 2020 Before the TBL, we performed in-depth usability testing with the first five student adopters, four of whom had been exposed to earlier practical teaching of PET/CT as part of their objective structured Clinical Examination (OSCE) at the end of their third year [1] All five expressed their satisfaction with the new solution Within ten days after the TBL, 25 % of the students (19/77) passed the course's introductory PET/CT tutorial, and none requested support Conclusion: The freeware Fiji/orthanc PET/CT-viewer has made it possible for medical students to receive hands-on PET/CT training even when they have no access to the hospital infrastructure We plan a detailed student survey at the conclusion of our course to determine if these changes, which were necessitated by the pandemic crisis, provide a benefit to our teaching that should be made permanent