Basic Original Report Effect of Simulation-Based Training and Neurofeedback Interventions on Radiation Technologists’ Workload, Situation Awareness, and Performance Lukasz M. Mazur, PhD, a,b,c, * Robert Adams, EdD, a Prithima R. Mosaly, PhD, a,b,c Joseph Nuamah, PhD, a Karthik Adapa, MBBS, MPP, MPH, a,c and Lawrence B. Marks, MD a a Department of Radiation Oncology, b School of Information and Library Sciences, and c Carolina Health Informatics Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Received 29 June 2020; revised 17 August 2020; accepted 19 August 2020 Abstract Purpose: Our purpose was to assess the effect of a combined intervention e simulation-based training supported by neurofeedback sessions e on radiation technologists’ (RTs’) workload, situation awareness, and performance during routine quality assurance and treatment delivery tasks. Methods and Materials: As part of a prospective institutional review board approved study, 32 RTs previously randomized to receive versus not receive simulation-based training focused on patient safety were again randomized to receive versus not receive a 3-week neurofeedback intervention (8 sessions of alpha-theta protocol) focused on stress reduction as well as conscious precision, strong focus, and ability to solve arising problems. Perceived workload was quantified using the NASA Task Load Index. Situation awareness was quantified using the situation awareness rating technique. Performance score was calculated using procedural compliance with time-out components and error detection. Results: RTs randomized to simulation-based training followed by neurofeedback sessions demonstrated no significant changes in perceived workload or situation awareness scores, but did have better performance compared with other study groups (P < .01). Conclusions: This finding is encouraging and provides basis for using neurofeedback as means to possibly augment performance improvements gained during simulation-based training. Ó 2020 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved. Introduction Radiation technologists (RTs) play a critical role in ensuring patient safety in that they act as one of the last lines of defense to catch upstream errors before radiation treatment delivery. 1 RTs have relatively demanding jobs as they conduct somewhat repetitive tasks approximately every 15 minutes for 8 to 10 hours per day. 2,3 These Sources of support: The research was supported by the grant number R18HS025597 from the Agency for Healthcare Research and Quality. Disclosures: none. Research data are stored in an institutional repository and will be shared upon request to the corresponding author. * Corresponding author: Lukasz M. Mazur, PhD; E-mail: lmazur@ med.unc.edu https://doi.org/10.1016/j.prro.2020.08.005 1879-8500/Ó 2020 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved. Practical Radiation Oncology ® (2020) xx, e1-e10 www.practicalradonc.org