Graduation Date

Fall 12-15-2023

Document Type


Degree Name

Doctor of Philosophy (PhD)


Medical Sciences Interdepartmental Area

First Advisor

Bryce M. Abbey, Ph.D.

Second Advisor

Ryan C. Splittgerber, Ph.D.

Third Advisor

Laura D. Bilek, Ph.D.

Fourth Advisor

Kendra K. Schmid, Ph.D.


Optimal radiographic image quality is critical because it affects the accuracy of the radiologist’s interpretation. Radiologic technologists are obligated to obtain diagnostic images while minimizing patient radiation. However, repeated images due to technologist error have increased in recent years. This study aimed to evaluate the effectiveness of non-immersive virtual reality (VR) simulation on first-year students’ image evaluation of common positioning errors on routine knee and lumbar spine protocols. Research questions were 1) Does guided instruction using non-immersive radiographic positioning simulation software lead to improved image evaluation scores? 2) How well do participants describe evaluation of positioning errors after guided instruction using radiographic positioning simulation software? 3) What are student perceptions of using non-immersive radiographic positioning simulation software for image evaluation instruction? Crossover intervention design was used to deliver radiographic image evaluation instruction through traditional lecture and guided simulation using non-immersive VR to 33 first-year radiography students at a single academic institution located across four geographic program locations. Pre- and post-test knowledge assessments examined rate of confidence and ability to recognize positioning errors on multiple choice and essay questions. A survey collected student perceptions through Likert scale and essay questions. There was no difference in image evaluation performance by instructional method. Guided simulation instruction was as effective as traditional lecture. VR was favorably received by participants and was shown to increase confidence. VR strengths were reported as producing a resultant image, unlimited exposures without the use of radiation, and practice opportunities; limitations included software and time restrictions. Findings support existing literature stating that VR simulation is as, or more, effective than traditional methods. Virtual reality simulation is not a replacement for clinical placement but may accelerate skill development and optimize placement time by allowing students to focus on learning experiences that can only be gained in complex, real-world clinical environments. Virtual reality radiographic positioning simulation can effectively bridge the theory-practice gap found in radiography education and assist educators in producing stronger radiologic technologists capable of delivering safer and higher quality patient care.


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