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PLOS One logoLink to PLOS One
. 2026 Feb 12;21(2):e0323153. doi: 10.1371/journal.pone.0323153

An online training platform for SPECT imaging technology utilizing three-dimensional modeling

Lihua Qiao 1,#, Hongzhi Wang 2,#, Xiaorui Guo 3, Xinkun Lei 3, Hua Shang 3, Ruibin Zhao 1, Tian Xia 4, Ruiping Qin 1, Zikun Fang 1, Luqi Shou 1, Yiwen Qin 1, Dandan Shang 5,¤,*
Editor: Alexandre Bonatto6
PMCID: PMC12900319  PMID: 41678459

Abstract

Objective

The provision of nuclear medicine experimental classes within universities poses significant challenges due to the high risk, substantial cost, and large size of the requisite equipment. To address the bespoke training needs of students majoring in imaging technology in this new medical era, our team has developed an online training platform specifically for SPECT imaging technology, a key aspect of nuclear medicine.

Method

This platform utilises advanced technologies such as Unity3D to create six three-dimensional scene modules of SPECT imaging and seven typical disease examination operation processes. As a result, we have achieved a human-computer interactive three-dimensional virtual system. The aforementioned teaching strategy has been implemented in our institution’s instructional practice across five semesters, in addition to being adopted by three other medical colleges.

Results

Training data reveals that the overall sample score distribution aligns with a normal distribution, suggesting that the platform’s structure is logically and effectively designed. Furthermore, the linear fit slopes of individual sample scores are consistently positive, indicating that the frequency of training sessions yields a positive feedback effect on students’ bespoke training. The innovative nature of this platform is protected through computer software copyrights.

Conclusion

Our online training platform enhances course structure and student training objectives, effectively accommodating the requirements of nuclear medicine teaching for personalized student training, innovative thinking, and the “early clinical” mindset.

Introduction

Single Photon Emission Computed Tomography (SPECT) is a crucial technique in nuclear medicine examinations, significantly impacting the diagnosis and treatment of various human diseases. As the training requirements for students specializing in medical imaging techniques and clinical technicians in emerging medical fields become increasingly stringent, the importance of implementing teaching experiments to familiarize students with SPECT examinations, encourage clinical thinking, and prepare them for future roles as clinical technicians is profound. However, the radioactivity of nuclear medicine drugs, coupled with the high cost, intensive consumption, and irreversible nature of these experiments, pose significant challenges to conducting nuclear medicine experiments [1]. Consequently, many medical schools do not include these experiments in their curriculum. In order to effectively address this pedagogical challenge, a departure from conventional teaching methodologies is imperative. However,VR has clear benefits such as ease of controlling repetition, feedback, and motivation, as well as overall advantages in safety, time, space, equipment, cost efficiency, and ease of documentation [2]. The development of a distributed medical imaging virtual simulation platform has the potential to steer the application of VR towards a more scientifically rigorous, digitally advanced, and information-rich direction [3].

This educational reform is rooted in the “student-centered” pedagogical approach, emphasizing the principles of “solidifying foundations, adequate practice, respecting individuality, and seeking truth and practicality” to implement innovative teaching designs. Our team developed a three-dimensional model educational training platform using Unity3D technology for SPECT virtual experiments. This platform hosts three-dimensional scene models and process models, facilitating human-computer interaction functions for seven distinct examination projects. Students can thus operate with a comprehensive understanding of the principles and technical know-how. The entire experimental process encompasses learning principles, understanding equipment, operating examination procedures, and diagnosing typical diseases. This enables students to acquire SPECT-related knowledge in a more coherent and systematic manner. The integration of research feedback into teaching presents an innovative strategy for nuclear medicine education, addressing the personalized training needs of students.

Methods

Content reconstruction

The process of reconstructing teaching content effectively converts the initial modular teaching approach into a chain teaching methodology. This integration amalgamates knowledge from the fields of medicine, engineering, and science, thereby consolidating theoretical understanding and reinforcing foundational principles. SPECT is an integral component of nuclear medicine within the realm of medical imaging principles. The subject matter of nuclear medicine is typically taught in a modular fashion across various related courses. For instance, a course in medical physics elucidates the physical foundations of nuclear medicine, while a course on medical imaging principles explores its imaging mechanisms. Similarly, courses on medical imaging equipment, examination technology, image processing, and diagnostics delve into their respective areas within the field of nuclear medicine. Traditional pedagogy presents nuclear medicine technology across several related modular courses, employing what has been termed “modular teaching.” This pedagogical reformation employs a virtual experimental platform to transition from modular to chain teaching. In this approach, knowledge pertaining to nuclear medicine is presented in a sequential manner within the imaging principle course. While the primary focus remains on the imaging principles of nuclear medicine, the course also provides brief overviews of its corresponding physical bases, as well as detailed descriptions of relevant imaging equipment, examination technology, image processing techniques, and typical medical case diagnoses. Consequently, individual knowledge points of nuclear medicine imaging technology are interconnected in a sequential chain-like manner. This facilitates a comprehensive reconstruction and integration of the teaching content. This method enables students to more systematically master the theoretical aspects of the subject matter. The reconstruction schematic is shown in Fig 1.

Fig 1. Content reconstruction diagram.

Fig 1

Horizontal teaching refers to a modular approach, whereas vertical teaching alludes to a chain methodology.

Platform construction

Medical virtual simulation experiments leverage virtual reality software development tools to replicate abstract and highly practical medical experimental content within a virtual simulation system [46]. Over the past decades, several authors [710] have championed and implemented virtual experiments, thereby accelerating the educational process. The use of medical virtual simulation experiments in medical education compensates for the shortcomings of experimental teaching conditions, overcomes the limitations of time and space, and circumvents the various risks associated with physical experimental operations [5,6]. Consequently, the rapid development of virtual simulation experiments [1119] has been observed across diverse fields such as X-CT [2023], anatomy [2426], and dentistry [27].

For the aforementioned reasons, our team has pioneered the development of a nuclear medicine (SPECT) examination technology simulation software, equipped with AI assistant functionalities. Notably, this system is the first of its kind, both domestically and internationally. This innovative tool effectively bridges the gap between theoretical knowledge and practical application. The sophisticated three-dimensional scene rendering offers an engaging virtual environment for students, while the human-computer interactive operations enable them to emulate the roles of nuclear medicine technologists. Furthermore, the integrated AI assistant function facilitates an autonomous learning teaching mode. This flexible platform empowers students to practice at their own pace, free from constraints related to time, location, or frequency.

This model is primarily designed with three key aspects in mind: data acquisition and processing prerequisites, the computer simulation of human-computer interaction within a three-dimensional virtual system, and feedback optimization. The conceptual design framework for this model is depicted in Fig 2.

Fig 2. Model design concept diagram.

Fig 2

Prerequisites, human-computer interaction, and feedback optimization.

The conceptual design diagram illustrates the theoretical foundation as the cornerstone, computer numerical simulation as the technical means, and clinical experimental data as both the support and verification. By integrating computer software and hardware, a three-dimensional system of human-computer interaction is achieved. The formative evaluation of the operator can be relayed to the background, thereby optimizing the system model further.

The system’s development technology employs Unity3D to construct 3D scenes and formulate interactive logic, which are then displayed and interacted with via a web browser using HTML5 technology. The AI assistant function was created utilizing the Python language and the Kouzi platform. Visual Studio, serving as the development environment, offers robust code editing and debugging capabilities. Concurrently, the Access database is employed for server-side data storage and management. The successful development and deployment of the online experimental simulation system were achieved through the synergistic use of these tools and technologies. Technical details are provided in Table 1.

Table 1. Details of the developed techniques.

Technology Tools Quality Image Refresh Time Pixel Language Database
3D simulation, animation technology, WebGL technology, large model technology Unity, Visual Studio, Buckle platform 1080p 60fps 1024 × 960 C#,

python
Access, Mysql

Model structure.

  • (1)

    AI Assistant Module

The study’s model system incorporates an AI assistant module, depicted in Fig 3. Students have the opportunity to engage with this AI assistant in two modalities: text and voice. Throughout the experimental procedure, students can utilize the AI assistant to address any queries they may have, thereby accommodating their individual learning requirements.

Fig 3. AI assistant.

Fig 3

The AI assistant is represented by an icon of a small monkey.

  • (2)

    Six Major Scenario Modules

The system comprises six primary scenario modules: the lobby, pre-examination preparation room, injection room, waiting room, scanning room of SPECT, and Operation room of SPECT. These modules are designed to offer students a comprehensive understanding of various scenarios and examination processes, thereby providing them with foundational knowledge of the environment and procedures for subsequent clinical practice. This approach addresses the challenge of gaining only observational experience with limited hands-on practice. Please refer to Fig 4 for further details.

Fig 4. Six major scenario modules.

Fig 4

Each box represents a scene module. Blue arrows depict the patient’s route, while yellow arrows denote the nuclear medicine technologist’s pathway.

① The hall features a triage desk, waiting chairs, landmarks, and simulated individuals, among other elements. As illustrated in Fig 5. ② The pre-examination preparation roomis outfitted with a consultation desk, a consultation chair, a number calling button, a dialogue button, an inspection form, and a weighing scale, among other equipment. As illustrated in Fig 6. ③ The injection room is equipped with a lead protective cover, radioactive drugs, needles, and lead recycling buckets, as illustrated in Fig 7. ④ The waiting room is equipped with chairs for patients and features landmarks, as illustrated in Fig 8. ⑤ The scanning room of SPECT is equipped with both examination and supporting apparatuses. ⑥ The operation room of SPECT is equipped with a technician’s console, a call button, a computer monitor, a keyboard, among other tools. This can be illustrated as depicted in Fig 9.

Fig 5. Virtual interface of the hall.

Fig 5

The patient remains in the waiting hall, which is equipped with waiting desks and landmarks.

Fig 6. The pre-examination preparation room.

Fig 6

In the image, a yellow call button is located on the left side of the consultation desk, while a weighing scale is situated on the right side.

Fig 7. The injection room.

Fig 7

The lead box, containing the radioactive drug, is situated on one side, while the patient waits on the opposite side of the lead protective cover for injection with the medication.

Fig 8. The waiting room.

Fig 8

(A) The patient is entering the waiting room. (B)The patient is sitting in the waiting chair and waiting to be called.

Fig 9. The operation room.

Fig 9

Nuclear medicine technologists conduct image acquisition on patients by remotely operating the equipment from within a shielded compartment.

  • (3)

    Process model

The system encompasses seven distinct disease examination procedures,: thyroid static imaging, gated static myocardial tomography/stress myocardial tomography (also known as dynamic myocardial imaging), ectopic gastric mucosa imaging, hepatobiliary dynamic imaging, renal dynamic phenomenon, and whole-body bone imaging. The nuances in these examination differences are elucidated in Table 2.

Table 2. The seven major inspection details.
Check name Injected drug Injected dose (mCi) Mode of injection Empty stomach
Whole body bone imaging 99mTc-MDP 15-25 Administering injections to patients in the designated injection room. No
Thyroid static imaging 99mTcO4- 2--5 Administering injections to patients in the designated injection room. No
Renal dynamic phenomenon 99mTc-DTPA 3--10 Administer medication beside the bed No
Hepatobiliary dynamic phenomenon 99mTc-PMT or 99mTc-EHIDA 5--10 Administer medication beside the bed Yes
Resting gated myocardial imaging 99mTc-MIBI 20--25 Administer medication beside the bed Yes
Load gated myocardial imaging 99mTc-MIBI 20-25 Administer medication beside the bed Yes
Ectopic gastric mucosa imaging 99mTcO4- 10 Administer medication beside the bed Yes

The examination procedure comprises eight stages: Introduction to the Principle--Calling the Number--Medical History Collection--Weighing--Injection in the Injection Room (required for static collection)--Calling the Number--Positioning (for dynamic collection, an additional bedside medication step is needed)--Image Collection. An operational design of this examination process is illustrated in Fig 10.

Fig 10. SPECT operation flowchart.

Fig 10

The examination procedure comprises eight stages: Introduction to the Principle--Calling the Number--Medical History Collection--Weighing--Injection in the Injection Room (required for static collection)--Calling the Number--Positioning (for dynamic collection, an additional bedside medication step is needed)--Image Collection.

The virtual experiment described herein requires a laboratory equipped with internet access and computers. The procedure is divided into eight steps, wherein students assume the dual roles of nuclear medicine technologists and patients, navigating the SPECT examination process through human-computer interaction. The theoretical introduction section provides explanations and exercises focused on the imaging principle of SPECT, thereby deepening the students’ comprehension through a combination of learning and practice testing. The ‘call out’ and medical history collection sections are dedicated to the selection of examination forms and the completion of pre-examination precautions. The weighing section finalizes the allocation of the radiopharmaceutical injection dose. For static acquisition examinations, the radiopharmaceutical is administered in a separate injection room; the patient then waits in a designated waiting area until called out for the examination. In contrast, dynamic acquisition examinations proceed directly to the SPECT examination room after patient call out, where they recline on an examination bed and receive medication. Meanwhile, Nuclear medicine technologists conduct image acquisition on patients by remotely operating the equipment from within a shielded compartment. Finally, it is the students’ responsibility to diagnose the collected images as either normal or abnormal and, through human-computer dialogue, inform patients of post-examination precautions. This concludes the experiment.

The process model’s characteristics primarily encompass five facets. ① The model comprises a training and an assessment mode. The training mode accommodates multiple tests to cater to students with diverse learning paces, enabling repeated practice. In contrast, the assessment mode is a one-time event, designed to encourage students to engage in frequent practice to attain their personalized learning objectives. ② The platform incorporates a role-playing feature, wherein students assume roles such as nuclear medicine technicians and patients, with the ability to switch between roles. ③ The system features a “level-up mode”, demanding accurate operations for progression, thereby showcasing the system’s hierarchical structure. ④ In instances of operator error, the “operation hint box” offers corrective suggestions, catering to the self-learning preferences of students. ⑤ Lastly, the system supports dynamic evaluation throughout the process, permitting educators to monitor and provide real-time feedback on students’ learning progress.

Teaching practice

The simulation system has been employed for instructional purposes across five academic cycles at Hebei Medical University, benefiting a total of 550 students. The participants were second-year university students, with an average age range of 18–20 years and a gender ratio of 57.1% (36,3% male and 63,6% female). Given that this SPECT virtual experiment constituted the inaugural instance at the institutional level, the participating students lacked prior exposure to such virtual simulations involving SPECT methodologies. Detailed statistics are provided in Table 3. Practice data for all students is provided in S1 Text.

Table 3. Details of teaching practice.

Time Courses Classes Laboratory hours number of students
2021-2022-1 Nuclear medicine equipment and examination techniques Grade 2019 Medical Imaging Technology Major 3 102
2021-2022-2 Principles of medical imaging Grade 2020 Medical Imaging Technology Major 3 146
2023-2024-1 Principles of medical imaging Grade 2022 Smart Medical Engineering 3 30
2023-2024-2 Principles of medical imaging Grade 2022 Medical Imaging Technology Major 3 143
2024-2025-2 Principles of medical imaging Grade 2023 Medical Imaging Technology Major 3 129

In the second semester of 2024–2025, we established an intelligent course named “Principles of Medical Imaging” and integrated it with SPECT virtual simulation experiments to construct a ternary classroom. The ternary classroom approach encompasses pre-class guidance, in-class mutual learning, and after-class research. By offering teaching resources in a phased and tiered manner, this methodology caters to the individualized training requirements of students.

“Pre-class guidance” refers to the practice of providing students with the opportunity to conduct preliminary previews of the course material. This can be achieved through a variety of both online and offline resources, including knowledge maps, artificial intelligence (AI) assistants, and other digital materials.

The term “interactive learning during the course” pertains to the utilization of the SPECT virtual simulation experimental platform and interactive comments within nuclear medicine technologist classrooms. This approach facilitates a comprehensive range of learning activities, from theoretical study and equipment overview to examination procedures and image diagnosis. It employs a phased teaching methodology that enables students to systematically organize knowledge points and draw connections between problems. In essence, the entire classroom teaching process is structured in a phased, layered, and goal-oriented manner. This methodology effectively enhances students’ knowledge, abilities, and overall academic performance.

After-school research learning primarily pertains to students’ utilization of reference books, academic literature, AI assistants, and digital resources post-class, enabling them to delve deeper into their studies and reach advanced levels of understanding.

Results

Comparative analysis of pre-class and post-class test scores

In contrast to the conventional teaching model, the pre-class test administered prior to the implementation of the SPECT inspection technology online training platform serves as a gauge of students’ knowledge acquisition within the traditional pedagogical framework. Conversely, the post-class test, administered following the integration of this online platform, evaluates students’ understanding within the innovative teaching paradigm of this study. Specifically, data from the 2023 cohort of medical imaging technology students was analyzed, as depicted in Fig 11. The mean score of the pre-class test was 85.98 (Fig 11.A), while the post-class test yielded an average score of 94.92 (Fig 11.B). This comparison reveals a 8.94% increase in knowledge acquisition by students utilizing the online training platform compared to their counterparts who did not. Furthermore, the post-class test of utilizing the online training exhibits a larger median and a smaller variance compared to the pre-class test. Please refer to Table 4 for more details.

Fig 11. Pre-class and post-class test.

Fig 11

The pre-class test and post-class test quantify the students’ performance before and after utilizing the online practical training platform, respectively. A: Pre-class test scores; B: Post-class test scores.

Table 4. Details of pre-class test and post-class test.

Grade category Pre-class test Post-class test
Number of Students 129 129
Average value 85.9845 94.9225
Median 88.0000 100.0000
Mode 100.00 100.00
Standard Deviation 15.288 8.733
Variance 233.719 76.263
Skewness −0.946 −1.656
Standard Error of Skewness 0.213 0.213
Kurtosis −0.211 2.363
Standard Error of Kurtosis 0.423 0.423
Range 52.00 42.50
Total Sum 11092.00 12245.00
Percentile 10 60.0000 80.0000
20 72.0000 85.0000
30 88.0000 100.0000
40 88.0000 100.0000
50 88.0000 100.0000
60 88.0000 100.0000
70 100.0000 100.0000
80 100.0000 100.0000
90 100.0000 100.0000

Evaluation of overall sample performance distribution

The statistical analysis presented in Table 5 is derived from the teaching practice results of the 2023-2024-2 and 2024-2025-2 semesters. It evaluates the performance of 272 samples, which were subjected to both the training mode (including the first training) and the assessment mode. The findings are subsequently elaborated upon in the ensuing paragraph.

Table 5. Results of training and assessment mode.

Grade category First training result Multiple training average Assessment results
Number of Students 270 (2 missing) 270 (2 missing) 272
Average value 85.1222 91.3922 95.2390
Median 89.5000 93.8333 100.0000
Mode 100.00 92.00 100.00
Standard Deviation 15.137 7.997 8.562
Variance 229.126 63.947 73.304
Skewness −2.236 −2.353 −3.02
Standard Error of Skewness 0.148 0.149 0.148
Kurtosis 8.491 6.382 12.132
Standard Error of Kurtosis 0.295 0.296 0.294
Range 100.00 49.00 65.00
Total Sum 22983.00 24584.51 25905.00
Percentile 10 66.0000 81.8000 88.0000
20 74.0000 88.2000 91.0000
30 82.0000 91.2857 96.0000
40 85.4000 92.6364 98.0000
50 89.5000 93.8333 100.0000
60 93.0000 95.0000 100.0000
70 93.0000 95.7143 100.0000
80 97.0000 96.6250 100.0000
90 100.0000 97.5714 100.0000

The distribution of initial training scores for the entire sample predominantly aligns with the normal distribution, as depicted in Fig 12.A. This suggests that the question formulation on the platform is relatively appropriate.

Fig 12. Overall sample performance distribution.

Fig 12

The dispersion of student grades across 272 total samples for the 2023-2024-2 and 2024-2025-2 academic year’s second semesters is detailed.A: First training result.B:Multiple training average.C:Assessment results.

The mean score of the initial training session was 85.12 points, exhibiting a standard deviation of 15.137, as evidenced by Fig 12.A. Subsequent to numerous training sessions, the mean score rose to 91.39 points, with a reduced standard deviation of 7.997, as evidenced by Fig 12.B, suggesting that repeated training significantly enhances student performance. Following these multiple training sessions, the mean sample score for the assessment was noted at 95.24 points, showcasing a standard deviation of 8.562, as evidenced by Fig 12.C. The distribution of assessment scores post-training demonstrated an exponential increase. This resulted in a more concentrated distribution of assessment scores in the high-score area, as evidenced by Fig 12.C.

Evaluation of individual sample performance outcomes

Three students’ scores were randomly selected as research samples, and the distribution of their multiple training scores was analyzed. The results are presented in Fig 13.

Fig 13. Individual sample grade distribution.

Fig 13

Three distinct samples were arbitrarily chosen for examination. The horizontal axis indicates the frequency of training sessions, while the vertical axis denotes performance. A: Sample 1.B:Sample 2.C:Sample 3.

The statistical analysis reveals a significant positive correlation between the increase in training session numbers and sample scores. This suggests that the training model substantially enhances performance metrics, thereby affirming its value.

In Sample 1 (Fig 13.A), corresponding to Student ID 22011220011, the subject underwent seven training sessions, yielding an average score of 98.86. The slope of the linear fit of these scores is 0.7500.

Sample 2 (Fig 13.B) pertains to a student identified as ID 22011220013, who underwent eight training sessions, yielding an average score of 96.88. The slope of the linear fit of these scores is 1.35.

Sample 3 (Fig 13.C) pertains to a student identified by ID 22021070017, who underwent eight training sessions, yielding an average score of 94.63. The linear fit slope of the scores is notably 2.71.

The impact of personalized training times on student assessment performance

The data presented in Fig 14 demonstrates a marked improvement in assessment scores compared to pre-training values. It is evident that, after five sessions of training, scores can attain a high level.

Fig 14. The effect of training frequency.

Fig 14

The horizontal axis represents the number of training sessions, while the vertical axis represents the assessment results.

Course satisfaction survey

Course satisfaction was evaluated using a survey question administered through Wjx: “Are you satisfied with the teaching methods used in the ‘Principles of Medical Imaging’ course?” Statistical analysis revealed that 94.64% of students expressed satisfaction with the pedagogical approaches employed,as illustrated in Fig 15.

Fig 15. Course satisfaction survey.

Fig 15

Different colors denote varying degrees of satisfaction.

Discussion

Comparative analysis of pre-class and post-class test scores

An analysis of pre-class test scores (traditional mode) and post-class test scores (reformed mode) indicates that the online training platform enhances students’ learning efficacy, thereby achieving the anticipated research objectives.

Evaluation of overall sample performance distribution

The comprehensive statistical analysis reveals that the score distribution from the initial training session (Fig 12.A), along with the average scores across multiple training sessions (Fig 12.B), align closely with a normal distribution. This suggests that the quantity and difficulty of questions posed by the platform are relatively balanced and appropriate.

After multiple training sessions, the average score of students increased by 6.27, indicating that repeated training is beneficial for the improvement of student performance. Post-training, there was a marked exponential increase in the distribution of test scores, suggesting that repeated training rounds significantly enhance test performance. Furthermore, there was a heightened concentration of test scores in the upper range, as depicted in Fig 12.C.

The average score of the initial training session was 85.12 points. This can be attributed to the fact that foundational procedural tasks, such as selecting an injection method and removing foreign objects, are relatively simple assessments and thus do not significantly differentiate participants. Furthermore, these basic functional capabilities do not necessitate prolonged training. However, more advanced capabilities cannot be met without appropriate training.

The differentiation is primarily evident in tasks such as bedside injection operations and scan positioning, which necessitate a high level of knowledge mastery. These tasks not only reflect the proficiency in inspection techniques but also enhance it through training. This component is the heart of inspection technology, suggesting that skills can only be honed through meticulous practice and instruction. This underscores the value of this assessment system, as it effectively differentiates core skill proficiency.

Evaluation of individual sample performance outcomes

Upon analyzing the results of individual samples, it was discovered that, the statistical analysis reveals a significant positive correlation between the increase in training session numbers and sample scores. This suggests that the training model substantially enhances performance metrics, thereby affirming its value.The lesser slope exhibited by Sample 1 (Fig 13.A) can be attributed to the robust foundation and strong practical skills of this sample, which yielded high yet somewhat variable scores. Nevertheless, the positive slope of the score indicates that the training regime also contributes to maintaining score stability. The score curve for Sample 2 (Fig 13.B) shows more pronounced fluctuations. This is primarily due to the system’s training mode, which employs a random extraction method; thus, the content and operational procedures differ with each inspection. Consequently, the same learner might encounter variations in their scores. However, as they become more familiar with diverse inspections, the score distribution evens out. Sample 3 (Fig 13.C) initially displayed lower scores, but demonstrated considerable improvement after fewer training sessions, resulting in a steeper score slope. This suggests rapid mastery of the learning or training techniques.

The impact of personalized training times on student assessment performance

The personalized training times have a positive feedback effect on student assessment scores. This indicates that the design of training and assessment modes is reasonable and can meet the individual learning needs of students.

Course satisfaction survey

The data of 94.64% satisfaction strongly suggests that the teaching model is highly regarded by students. Consequently, this pioneering model accommodates the requisites of student progression and pedagogical transformation.

Conclusion

Compared to traditional theoretical instruction, the online training platform for SPECT examination technology developed by our team enhances practical teaching of SPECT within the academic setting. This virtual practice is radiation-free and not constrained by time or space, allowing for an integrated theory-practice pedagogical approach. Data from pre- and post-class assessments demonstrate that this method has significantly improved students’ understanding. Furthermore, the model leverages virtual simulation technologies to restructure educational content, facilitating a comprehensive review of nuclear medicine technology. It caters to individualized training needs, bolsters the systematic nature of students’ knowledge acquisition, and refines the educational framework. By incorporating modern digital tools like AI assistants and knowledge graphs, we have achieved a profound integration of digital technology and educational instruction.

The platform’s application has thus far been confined to the domain of PET imaging (Further details are provided in S2 Text). However, over the course of the next five years, its utilization is anticipated to expand to SPECT/CT imaging. Further advancements are expected in the subsequent decade, with potential integration into the SPECT/MR imaging field. The platform, currently extended to three additional medical colleges (Further details are provided in S2 Text), has garnered significant commendation from peer institutions. Looking ahead, it is projected that within five years, the platform will facilitate the training of undergraduate students across ten medical colleges and residents in affiliated hospitals. Within a decade, this figure is expected to rise to encompass 50 medical colleges or affiliated hospitals. Notably, continual iterative updates will be made to the platform to bolster its functionality. For instance, there will be an increase in the number of cases to strengthen students’ early clinical job competencies [2834]. Additionally, the platform aims to optimize the natural interaction between patients and technicians, thereby fostering students’ communication skills, emotional intelligence, and psychological development [3540]. Furthermore, a voice guidance function will be incorporated to assist students with reading disabilities, such as those with poor eyesight, in navigating the platform [41]. In conclusion, teaching innovation represents not just the convergence of theory and practice, technology and science, but also the forefront of medical advancement and human health protection. In our teaching reform, we steadfastly adhere to the principle of “having levels, having connotation, having goals”, with the ultimate objective of nurturing students into a new generation of technically proficient medical imaging professionals who “know the principles, understand technology, and can create”.

Supporting information

S1 Text. Dataset.

Practice data for all students.

(ZIP)

pone.0323153.s001.zip (72.5KB, zip)
S2 Text. Supporting information.

(PDF)

pone.0323153.s002.pdf (254KB, pdf)

Acknowledgments

We would like to express our gratitude to the Second Hospital of Hebei Medical University for providing us with valuable clinical data. Furthermore, we acknowledge the technical support provided by Shanghai Peiyun Educational Technology Co., Ltd.

Data Availability

All relevant data are within the manuscript and its Supporting Information files.

Funding Statement

This research was facilitated through the generous support of the following projects:Research and Practice on Innovation and Entrepreneurship Education and Teaching Reform in Universities of Hebei Province in 2023 (2023cxcy068), Medical Science Research Project of Hebei Province in 2022 (20220971), Research and Practice on Higher Education Teaching Reform in Hebei Province (2022GJJG149), Educational and Teaching Research Project of Hebei Medical University (2022YBZD-4, 2022YBPT-8, 2024CHYB-48), and University Student Innovation Experiment Plan Project of Hebei Medical University in 2023 (USIP2023337).But, The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The author(s) received no specific funding for this work.

References

  • 1.Yu Y, Yang N, Ren QQ, Li ZX, Lin JT. Exploration on the construction of medical imaging virtual simulation experimental platform. Digital Technology and Applications. 2018;36(12):193–5. doi: 10.19695/j.cnki.cn12-1369.2018.12.107 [DOI] [Google Scholar]
  • 2.Haar S, Sundar G, Faisal AA. Embodied virtual reality for the study of real-world motor learning. PLoS One. 2021;16(1):e0245717. doi: 10.1371/journal.pone.0245717 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3.Sun Q, Hu JF, Shi WY, Xiao XW, Wu X. Design of medical image virtual simulation training platform based on MNSS. Computer Measurement & Control. 2019;27(7):227–30. doi: 10.16526/j.cnki.11-4762/tp.2019.07.049 [DOI] [Google Scholar]
  • 4.Wei Q. Problems and countermeasures in college laboratory equipments management. Value Engineering. 2010;11:213–4. doi: 10.14018/j.cnki.cn13-1085/n.2010.11.067 [DOI] [Google Scholar]
  • 5.Zhang MK. Research on the innovative application of virtual reality technology in college teaching. Office Informatization. 2025;30(5):96–8. [Google Scholar]
  • 6.Ma TC, Ren P, Liu P, Li XN, Zhou J. The application of hybrid virtual simulation experiment teaching mode in basic medical experiment basic skills course. Chinese medicine modern distance education of China. 2025;23(1):43–6. doi: 10.3969/j.issn.1672-2779.2025.01.014 [DOI] [Google Scholar]
  • 7.Cooper J, Vik JO, Waltemath D. A call for virtual experiments: accelerating the scientific process. Prog Biophys Mol Biol. 2015;117(1):99–106. doi: 10.1016/j.pbiomolbio.2014.10.001 [DOI] [PubMed] [Google Scholar]
  • 8.Tao SN, Huang H. Application of virtual laboratories in experiment teaching of nuclear medicine. Chinese Educational Technology and Equipment. 2016;(24):61–2. doi: 10.3969/j.issn.1671-489X.2016.24.061 [DOI] [Google Scholar]
  • 9.Meyer OA, Omdahl MK, Makransky G. Investigating the effect of pre-training when learning through immersive virtual reality and video: A media and methods experiment. Computers & Education. 2019;140:103603. doi: 10.1016/j.compedu.2019.103603 [DOI] [Google Scholar]
  • 10.Lawson AP, Mayer RE. Effect of Pre-Training and Role of Working Memory Characteristics in Learning with Immersive Virtual Reality. International Journal of Human–Computer Interaction. 2024;41(4):2523–40. doi: 10.1080/10447318.2024.2325176 [DOI] [Google Scholar]
  • 11.Delgado CY, Mayer RE. Implementing Pretraining to Optimise Learning in Immersive Virtual Reality. Computer Assisted Learning. 2024;41(1). doi: 10.1111/jcal.13099 [DOI] [Google Scholar]
  • 12.Pflieger LCJ, Hartmann C, Bannert M. Enhancing knowledge construction in emerging technologies: the role of imagination training in immersive virtual reality environments. Discov Educ. 2024;3(1). doi: 10.1007/s44217-024-00154-2 [DOI] [Google Scholar]
  • 13.Aziz F, Li C, Khan AU. Immersive learning in virtual worlds: A two-step analysis SEM and NCA for assessing the impact of Metaverse education on knowledge retention and student collaboration. Technology in Society. 2025;81:102871. doi: 10.1016/j.techsoc.2025.102871 [DOI] [Google Scholar]
  • 14.Boel C. Perceptions of Higher Education Students on Immersive Virtual Reality for Communication Skills Training. The Bodyswaps Case. Communications in Computer and Information Science. Springer Nature Switzerland. 2025. 142–55. doi: 10.1007/978-3-031-80475-5_10 [DOI] [Google Scholar]
  • 15.Wang Y, Pan L. Immersive virtual reality in education: impact on the emotional intelligence of university students. Educ Inf Technol. 2024;30(4):5283–99. doi: 10.1007/s10639-024-13013-2 [DOI] [Google Scholar]
  • 16.Caratachea M, Monty Jones W. Making in virtual reality environments: a case study of K-12 teachers’ perceptions on the educational affordances of virtual reality for maker-centered learning. Education Tech Research Dev. 2023;72(1):155–80. doi: 10.1007/s11423-023-10290-5 [DOI] [Google Scholar]
  • 17.Phuttawong M, Chatwattana P. The Educational Guidance Platform via Artificial Intelligence Chatbot to Promote Vocational Aptitude for Vocational Students. HES. 2024;15(1):128. doi: 10.5539/hes.v15n1p128 [DOI] [Google Scholar]
  • 18.Alarcon-Urbistondo P, Perez-Aranda J, Casado-Molina A. Key determinants of intention to use virtual reality in medical training. Virtual Reality. 2024;28(2). doi: 10.1007/s10055-024-00990-5 [DOI] [Google Scholar]
  • 19.Lin W, Chen L, Xiong W, Ran K, Fan A. Measuring the sense of presence and learning efficacy in immersive virtual assembly training. International Journal of Mechanical Engineering Education. 2025. doi: 10.1177/03064190241308659 [DOI] [Google Scholar]
  • 20.Laha B, Sensharma K, Schiffbauer JD, Bowman DA. Effects of immersion on visual analysis of volume data. IEEE Trans Vis Comput Graph. 2012;18(4):597–606. doi: 10.1109/TVCG.2012.42 [DOI] [PubMed] [Google Scholar]
  • 21.Yanof J, Haaga J, Klahr P, Bauer C, Nakamoto D, Chaturvedi A, et al. CT-integrated robot for interventional procedures: preliminary experiment and computer-human interfaces. Comput Aided Surg. 2001;6(6):352–9. doi: 10.1002/igs.10022 [DOI] [PubMed] [Google Scholar]
  • 22.Troville J, Guo C, Rudin S, Bednarek DR. Methods for object tracking and shadowing in a top-down view virtual reality scattered radiation display system (SDS) for fluoroscopically-guided procedures. In: Medical Imaging Conference, 2020. 113123C. doi: 10.1117/12.2548469 [DOI] [Google Scholar]
  • 23.Zhao Z, Zhou X-P. Rapid uniaxial compressive strength assessment by microstructural properties using X-ray CT imaging and virtual experiments. ArchivCivMechEng. 2021;21(2). doi: 10.1007/s43452-021-00191-w [DOI] [Google Scholar]
  • 24.Ail G, Freer F, Chan CS, Jones M, Broad J, Canale GP, et al. A comparison of virtual reality anatomy models to prosections in station-based anatomy teaching. Anat Sci Educ. 2024;17(4):763–9. doi: 10.1002/ase.2419 [DOI] [PubMed] [Google Scholar]
  • 25.Luursema J-M, Verwey WB, Kommers PAM, Annema J-H. The role of stereopsis in virtual anatomical learning. Interacting with Computers. 2008;20(4–5):455–60. doi: 10.1016/j.intcom.2008.04.003 [DOI] [Google Scholar]
  • 26.Wainman B, Pukas G, Wolak L, Mohanraj S, Lamb J, Norman GR. The Critical Role of Stereopsis in Virtual and Mixed Reality Learning Environments. Anat Sci Educ. 2020;13(3):401–12. doi: 10.1002/ase.1928 [DOI] [PubMed] [Google Scholar]
  • 27.Bevizova K, Falougy HE, Thurzo A, Harsanyi S. Is virtual reality enhancing dental anatomy education? A systematic review and meta-analysis. BMC Med Educ. 2024;24(1):1395. doi: 10.1186/s12909-024-06233-0 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28.Zeng Y, Yang J, Zhang J-W. Post competency training in standardized training of resident physicians and integrated postgraduates. World J Clin Cases. 2024;12(29):6250–4. doi: 10.12998/wjcc.v12.i29.6250 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 29.Chow J, Al-Duaij L, Last N, Sheth U, Rehman M, Azim A, et al. Transformational learning and professional identity formation in postgraduate competency-based medical education. Med Educ. 2025;59(4):409–17. doi: 10.1111/medu.15553 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30.Birman NA, Vashdi DR, Miller-Mor Atias R, Riskin A, Zangen S, Litmanovitz I, et al. Unveiling the paradoxes of implementing post graduate competency based medical education programs. Med Teach. 2025;47(4):622–9. doi: 10.1080/0142159X.2024.2356826 [DOI] [PubMed] [Google Scholar]
  • 31.Fu Y, Zhao G, Shan J, Zeng L. Study on a job competence evaluation system for resident physicians (including integrated postgraduates) receiving standardized training. BMC Med Educ. 2023;23(1):834. doi: 10.1186/s12909-023-04833-w [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32.Yu Y, Wu L, Li M, Xu B, Yin X, Huang X, et al. Application of BOPPPS in the Standardized Training of Resident Doctors in Surgery of Traditional Chinese Medicine. CE. 2021;12(06):1215–21. doi: 10.4236/ce.2021.126091 [DOI] [Google Scholar]
  • 33.Wang C, Yao Y, Chen Y, Chen J. The impact of evidence-based medicine curricula on information literacy among clinical medical undergraduates and postgraduates in China. BMC Med Educ. 2025;25(1):520. doi: 10.1186/s12909-025-07125-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 34.Zafošnik U, Cerovečki V, Stojnić N, Belec AP, Klemenc-Ketiš Z. Developing a competency framework for training with simulations in healthcare: a qualitative study. BMC Med Educ. 2024;24(1):180. doi: 10.1186/s12909-024-05139-1 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35.Razumnikova O, Davidov A, Bakaev M. Brain Networks that Experience Virtual Nature: Cognitive Pre-tuning Due to Emotional Intelligence. Studies in Computational Intelligence. Springer Nature Switzerland. 2025. p. 232–43. doi: 10.1007/978-3-031-80463-2_21 [DOI] [Google Scholar]
  • 36.Al Yahyaei A. Reserving the human touch in nursing education while integrating virtual reality and simulation. J Prof Nurs. 2024;54:36–8. doi: 10.1016/j.profnurs.2024.06.005 [DOI] [PubMed] [Google Scholar]
  • 37.Sharp J, Kelson J, South D, Saliba A, Kabir MA. Virtual reality and artificial intelligence as psychological countermeasures in space and other isolated and confined environments: A scoping review. Acta Astronautica. 2025;232:666–77. doi: 10.1016/j.actaastro.2025.04.002 [DOI] [Google Scholar]
  • 38.Laovoravit V, Manon W, Inchamnan W, Swangarom P. The Learning Achievement of Airline Business Students on the Virtual Experience during the Pre-flight Emergency Equipment Check Procedures on the Airbus A320 Series Aircraft. Asia Social Issues. 2023;16(4):e255791. doi: 10.48048/asi.2023.255791 [DOI] [Google Scholar]
  • 39.Zhao M. The influence of virtual reality on improving emotional expressiveness in vocal performance. Acta Psychol (Amst). 2025;255:104969. doi: 10.1016/j.actpsy.2025.104969 [DOI] [PubMed] [Google Scholar]
  • 40.Scoresby J, Shelton BE. Visual perspectives within educational computer games: effects on presence and flow within virtual immersive learning environments. Instr Sci. 2010;39(3):227–54. doi: 10.1007/s11251-010-9126-5 [DOI] [Google Scholar]
  • 41.Passig D. The Impact of Immersive Virtual Reality on Educators’ Awareness of the Cognitive Experiences of Pupils with Dyslexia. Teachers College Record: The Voice of Scholarship in Education. 2011;113(1):181–204. doi: 10.1177/016146811111300105 [DOI] [Google Scholar]

Decision Letter 0

Alexandre Bonatto

20 May 2025

Dear Dr. Shang,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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Academic Editor

PLOS ONE

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Research and Practice on Innovation and Entrepreneurship Education and Teaching Reform in Universities of Hebei Province in 2023 (2023cxcy068),, Medical Science Research Project of Hebei Province in 2022 (20220971), Research and Practice on Higher Education Teaching Reform in Hebei Province (2022GJJG149), Educational and Teaching Research Project of Hebei Medical University in 2022 (2022YBZD-4, 2022YBPT-8), and University Student Innovation Experiment Plan Project of Hebei Medical University in 2023 (USIP2023337).

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Additional Editor Comments :

Dear Author,

Thank you for submitting your manuscript. After careful review, I am pleased to offer acceptance pending minor revisions: please address the reviewers’ comments and resubmit within 45 days. As optional enhancements, you may include an Author Contributions statement, streamline your reference list to the most pertinent sources, and adjust paragraph structure to improve readability. I look forward to receiving your revised manuscript.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Yes

Reviewer #2: Yes

**********

2. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #1: I Don't Know

Reviewer #2: Yes

**********

3. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #1: No

Reviewer #2: Yes

**********

4. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: No

Reviewer #2: Yes

**********

Reviewer #1: Hello, respected authors, and thank you for this interesting article. Although for various reasons I was against rejection, I think the authors can be given another chance.

A strange and thought-provoking point is the presence of more than ten authors for the article. Please justify that this number of authors is really necessary? And where did they contribute?

How interesting and interesting the topic is, but I offer a few points to improve your article that I hope will be useful and useful:

Reduce old references and do not exceed 20.

Do not write paragraphs that are too long or too short, try to maintain order.

Your statement of the problem is a little weak. Explain in one paragraph why this research is important and necessary.

Why did you choose Vietnam?

Your article is international. Can you achieve some generalization in the findings from a limited number of countries and individuals? Explain this a little bit about this issue as well.

Completely and several times to strengthen the structure of the journal and observe all its issues.

Explain whether the sample is sufficient for the research population and can it be strengthened?

In my opinion, strengthen the qualitative section of the article because it will provide readers with the existing attractions.

The limitations of the research are not included in the conclusion.

Add a section titled Discussion and compare all the research with previous research.

There needs to be some direct promise in the article, which has made the text very sweet, but it is more literary than scientific.

The sixth research did not study new research in this field and this makes your article look like an old article.

The article is too short, or you were in a hurry, or you could not spend the time as much as you would like.

Ten references are not enough for an original article, I think you should increase it to 40.

Please provide a timeline of the research process.

Best wishes

Reviewer #2: This is a well written manuscript that showcases the development and use of SPECT training, combining 3D modeling, AI assistance, and multimodal instructional strategies. The study presents both group-level and individual-level performance data, the “three-element classroom” (pre-class, in-class, and post-class) design is aligned with active learning best practices.

It would have been good if the authors could elaborate why a control group was not used or comparative data against traditional teaching methods was done.

While quantitative performance is analyzed, student perceptions, satisfaction, and engagement are only briefly mentioned. Please elaborate on these findings as well.

The manuscript would benefit from English editing to simplify the writing. Some sections (e.g., tables, explanations of AI functionality) are overly verbose or technically dense for a general readership.

What extent the platform could be generalized to other imaging modalities or clinical areas?

**********

what does this mean? ). If published, this will include your full peer review and any attached files.

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Reviewer #1: Yes: Amir Karimi

Reviewer #2: No

**********

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PLoS One. 2026 Feb 12;21(2):e0323153. doi: 10.1371/journal.pone.0323153.r002

Author response to Decision Letter 1


2 Jul 2025

Response to Reviewers

Dear Editor and Reviewers:

Thank you for your insightful feedback on this article. I will address the concerns of the article sequentially from the perspectives mentioned below.

1 Editor's queries

Question 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming.

Answer: The manuscript has been revised to conform to the style guidelines specified by "PLOS ONE". Please refer to the " Revised Manuscript with Track Changes" or " Manuscript -New " for further details.

Question 2. Please ensure that you have an ORCID iD and that it is validated in Editorial Manager.

Answer:The ORCID iD of the corresponding author has been duly added and verified in "Editorial Manager".

Question 3. Please state what role the funders took in the study. If the funders had no role, please state: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."If this statement is not correct you must amend it as needed.Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf.

Answer:①The primary supporting project for this article is the "Research and Practice of Innovation and Entrepreneurship Education and Teaching Reform in Hebei Province's Universities in 2023 (2023CXCY068)". The project content aligns seamlessly with this article, focusing on the development and operation of a virtual experimental platform for nuclear medicine. This platform is designed to enhance the innovation and entrepreneurship training of professionals specializing in medical imaging technology. The findings of this article will be derived from the outcomes of the project.② The research concepts and program code for this study were supplied by the "Hebei Province Medical Science Research Project in 2022 (20220971)".③ This article's teaching innovation design and practice are founded on the project titled "Research and Practice of Higher Education Teaching Reform in Hebei Province (2022GJJG149)", a 2022 Education and Teaching Research Project from Hebei Medical University (2022YBZD-4, 2022YBPT-8). ④ Data analysis for this article is provided by the project "2023 College Students' Innovation Experiment Plan of Hebei Medical University (USIP2023337)".Consequently, all the aforementioned elements are pivotal to the content of this article and should be preserved.

Question 4. Please amend either the title on the online submission form (via Edit Submission) or the title in the manuscript so that they are identical.

Answer: Modified the title on the online submission form (by editing the submission) or in the manuscript, such that it is identical to the title in the revised manuscript.

Question 5. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly.

Answer: The supporting information file's title and content are provided at the conclusion of the manuscript, as outlined on page 34 of the " Revised Manuscript with Track Changes" within the "Supporting Information" section.

Question 6. Please review your reference list to ensure that it is complete and correct.。

Answer�The references have been meticulously reviewed, and both the format and quantity of references have been appropriately revised in the "Revised Manuscript with Track Changes " on page 28, within the "References" section.

2 Questions Raised by Reviewer 1

Question 1. Please justify that this number of authors is really necessary? And where did they contribute?

Answer :The online training platform for SPECT imaging technology, developed by our research team, represents a collaborative effort among universities, hospitals, and private enterprises. University instructors Shang Dandan, Qiao Lihua, Zhao Ruibin, and Qin Ruiping brought innovative concepts, pragmatic solutions, course execution, and authored articles to the project. Hospital nuclear medicine technologists Guo Xiaorui, Lei Xinkun, and Shang Hua supplied clinical data, constructed scenes, and designed cases. Wang Hongzhi, a professor at East China Normal University and chairman of Shanghai Peiyun Educational Technology Co., Ltd., alongside enterprise engineer Xia Tian, offered technical assistance, including system debugging and maintenance. Current students Fang Zikun, Shou Luqi, and Qin Yiwen contributed to the analysis and feedback on teaching practice data. In essence, this research encompassed the efforts of various stakeholders, including multiple institutions, educators, students, and company staff, spanning from development to instructional implementation. Consequently, every author has played a pivotal role. Please refer to the“Author Contributions”section, which has been added on page 28 of the“Revised Manuscript with Track Changes”.

Question 2. Reduce old references and do not exceed 20.

Answer�The number of outdated references has been suitably reduced to a maximum of 20, while the overall quantity of references has been augmented to 41, as indicated on page 28 "References" in the " Revised Manuscript with Track Changes ".

Question 3. Do not write paragraphs that are too long or too short, try to maintain order.

Answer�Paragraphs of lesser length were amalgamated and excessively long sentences were judiciously excised. This can be observed in the "Six Major Scenario Modules" section on pages 9-11, the "Process model" section from pages 11-12, and in the " Revised Manuscript with Track Changes " where longer paragraphs have been condensed on pages 11 and 14.

Question 4. Your statement of the problem is a little weak. Explain in one paragraph why this research is important and necessary.

Answer�The online training platform developed by our team for SPECT imaging technology addresses the high risks and costs associated with SPECT equipment, as well as the challenges of implementing experimental classes on campus. This platform offers a departure from traditional teaching constraints, allowing students to engage in educational practice without the limitations of time, space, or frequency, thereby accommodating their individualized needs. The platform's design is supported by training data which indicates that the overall sample score distribution aligns with a normal distribution. Furthermore, the positive slopes of individual sample scores suggest that the frequency of training sessions has a beneficial impact on students' personalized development. The integrated dynamic evaluation system provides constructive feedback on teaching outcomes, thereby achieving the objectives of nuclear medicine education in terms of personalized student cultivation, innovative thinking, and the development of an "early clinical" mindset.

Question 5. Why did you choose Vietnam?

Answer�It appears to be an operational error; the study was conducted in the People's Republic of China instead of Vietnam as originally intended.

Question 6. Your article is international. Can you achieve some generalization in the findings from a limited number of countries and individuals? Explain this a little bit about this issue as well.

Answer�An online training platform for Single-Proton Emission Computed Tomography (SPECT) examination technology, incorporating AI assistant functions and featuring seven typical disease examinations, could not be located in international data sets. This absence is consistent with the computer software copyright associated with this study. The comprehensive teaching innovation model, from the conceptualization and development of the online training platform to its implementation in pedagogical practice, has not been previously observed in related SPECT teaching methodologies. Thus, this study possesses significant originality.

Question 7. Completely and several times to strengthen the structure of the journal and observe all its issues.

Answer�The paper has been restructured in accordance with your request and is now presented within the " Revised Manuscript with Track Changes ".

Question 8. Explain whether the sample is sufficient for the research population and can it be strengthened?

Answer�To date, over 550 students from our institution have engaged in teaching practice on this platform, fully addressing the research objectives. This practice is executed in a phased manner, with class-specific instruction. Owing to space constraints within the article, data analysis was confined to students from a particular class in a specific semester. Furthermore, three additional universities are utilizing this platform. For further details, please see Attachment 2.

Question 9. In my opinion, strengthen the qualitative section of the article because it will provide readers with the existing attractions.

Answer�The "Abstract" on page 3 and the "Discussion" on page 23 of the " Revised Manuscript with Track Changes " have been revised by incorporating qualitative speech.

Question 10. The limitations of the research are not included in the conclusion.

Answer�The limitations have been excised from the conclusion section and relocated to the " Revised Manuscript with Track Changes " in the " Conclusion " section on page 25.

Question 11. Add a section titled Discussion and compare all the research with previous research.

Answer�A "Discussion" section has been incorporated on page 23 of the " Revised Manuscript with Track Changes ". Additionally, a comparative analysis with previous research has been included. The data relevant to this comparison is presented on page 17 and 23 of the " Revised Manuscript with Track Changes " within the Comparative Analysis of Pre-class and Post-class Test Scores.

Question 12. There needs to be some direct promise in the article, which has made the text very sweet, but it is more literary than scientific.

Answer�In the " Revised Manuscript with Track Changes ", we have incorporated future planning commitments and application expansion commitments into the “Conclusion” section on page 25.

Question 13. The sixth research did not study new research in this field and this makes your article look like an old article.

Answer�This study has secured a copyright for the computer software utilized in the research, as outlined in Appendix 1(S1 File), underscoring the novelty of the project. The development and implementation of an online training platform, specifically designed for educational purposes, represents the most comprehensive and systematic teaching system globally for conducting SPECT virtual experiments within an academic setting. Consequently, this study is both innovative and of significant practical value.

Question 14. The article is too short, or you were in a hurry, or you could not spend the time as much as you would like.

Answer�The supplementary content is comprehensively outlined in the " Revised Manuscript with Track Changes ": on page 2 within the "Abstract" section; page 15, where "Table 3" now includes data for "2024-2025(2)"; page 17 and 23, which features an added section titled "Comparative Analysis of Pre-class and Post-class Test Scores"; page 18, showcasing updated "Table 4" data; and page 22 and 25, where three new subsections have been introduced: "(4) The influence of customized training sessions on student evaluation scores", "Course Satisfaction Survey", and page 25" Conclusion".

Question 15. Ten references are not enough for an original article, I think you should increase it to 40.

Answer�The quantity of references has been augmented to a total of 42, as indicated within the "References" section on page 28 of the " Revised Manuscript with Track Changes ".

Question 16. Please provide a timeline of the research process.

Answer�June 2020 - December 2020: The university, enterprise, and hospital collaborated to sign an agreement, determining the research plan, including platform design, data collection, virtual experimental scenario modules, and operational process module design, etc.

January 2021 - February 2022: The initial development of the SPECT examination technology online training platform was completed, and it was piloted during the 2021-2022 (1) semester.

March 2022 - July 2022: The SPECT inspection technology online training platform was officially developed and completed, and was approved for computer software copyright, officially being put into educational practice.

August 2022 - July 2023: Iterative optimization of the SPECT examination technology online training platform, organization and analysis of teaching practice data.

August 2023 - December 2023: A provincial first-class undergraduate virtual simulation experimental teaching course based on this platform was applied for and approved.

Jan 2024–Mar 2025: Writing of papers related to the study, completion and submission of articles..

3 Questions Raised by Reviewer 2

Question 1. It would have been good if the authors could elaborate why a control group was not used or comparative data against traditional teaching methods was done.

Answer�In this study, a control group was not established, given the potential for individual students to attribute their performance outcomes either to the prohibition of using the training platform or its utilization. Instead, the research employed a comparative approach, examining the difference in knowledge mastery between pre-class and post-class assessments. Refer to page 17 and 23, "Comparative Analysis of Pre-class and Post-class Test Scores" in the " Revised Manuscript with Track Changes " for detailed insights, particularly Figure 9 data. In this context, the pre-class assessment serves as a proxy for traditional teaching methodologies, whereas the post-class evaluation represents innovative teaching approaches. Consequently, the study does incorporate control data.

Question 2. While quantitative performance is analyzed, student perceptions, satisfaction, and engagement are only briefly mentioned. Please elaborate on these findings as well.

Answer�The data from the satisfaction survey has been incorporated into the "Revised Manuscript with Track Changes " on page 23 and 25, within the section titled "Course Satisfaction Survey." This can be seen in Figure 13.

Question 3. The manuscript would benefit from English editing to simplify the writing. Some sections (e.g., tables, explanations of AI functionality) are overly verbose or technically dense for a general readership.

Answer�The section titled "Check point" in Table 2 (page 12) has been deleted, and the section labeled "Check name" in Table 3 (page 15) has been modified. Additionally, the feature 2 of "AI " on page 11 has been removed.All of them can be seen from the "Revised Manuscript with Track Changes ".

Question 4. What extent the platform could be generalized to other imaging modalities or clinical areas?

Answer�①The platform is currently integrated with imaging fields such as PET and CT (refer to Annex 2 for specifics). It is projected that within the subsequent five years, it will be extendable to the SPECT/CT imaging field, and within a decade, to the SPECT/MR and other related imaging fields.② Currently, the platform is not only being used by our own institution but has also been expanded to three other medical colleges (see Attachment 2 for details). Within the next five years, it is expected that the platform will cater to undergraduate or standard-training students from 10 medical colleges or affiliated hospitals. Within a decade, the target is to extend this service to 50 medical colleges or affiliated hospitals. This application promotion has been added to the "evised Manuscript with Track Changes " on page 25 in the "Conclusion" section.

These are my comprehensive responses. I eagerly await your feedback.

Best wishes!

Dandan Shang

2025.6.29

Attachment

Submitted filename: Response to Reviewers.docx

pone.0323153.s004.docx (28.4KB, docx)

Decision Letter 1

Alexandre Bonatto

3 Sep 2025

Dear Dr. Shang,

Please submit your revised manuscript by Oct 18 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

  • A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.

  • A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.

  • An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols .

We look forward to receiving your revised manuscript.

Kind regards,

Alexandre Bonatto

Academic Editor

PLOS ONE

Journal Requirements:

If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #3: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions??>

Reviewer #3: Partly

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3. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #3: No

**********

4. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #3: No

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #3: Yes

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Reviewer #3: The paper reports several aspects of an online platform aimed to help the training of students on SPECT imaging technology. Half of the paper is devoted to the evaluation of the platform based on its use in the training of more than 500 students. Results are presented in the form of descriptive statistics, and the authors conclude that the platform contributed positively to a better performance of the students in learning the contents of the courses where it has been applied.

I was not a reviewer of the previous version, but I noticed that several questions from the previous reviewers were answered by the authors. However, even after the changes and answers, I think that the paper is not ready for acceptance in its present form.

First of all, the text needs to be restructured and improved.

1. The introduction is too short. The text in the “Platform construction” subsection would be better as part of the introduction. It does not explain the methods used by the authors.

2. I think that Figure 2 needs an improvement and probably a correction. Is the “User experience feedback” the evaluation part? I did not understand the sentence “The formative evaluation of the operator can be relayed to the background, thereby optimizing the system model further.” Is the operator the student? Is the formative evaluation the assessment of the knowledge acquired by the student? These are aspects that should be in the conceptual design framework.

3. Figure 4 is described in the text, referring to numbers for each module. However, the figure itself does not contain the numbers used to identify each module. Also, some expressions are confusing: what is “chairs of landmarks”? Could you use a more specific case for a body weight detector, or are there different such devices? It would be interesting to have images of all modules. What is a ”calling button”?

4. As for Table 2, is “The injection room is filled of medicine” really a “Mode of Injection”?

5. The description starting at line 222 and figure 8 is very confusing. There is no description of Figure 8. Only the list of the stages. Since this is an example, it should be complete and described as a usage scenario. Then, there is a description of the characteristics of the process model, which seems to be out of place. Probably it would be better to move this text to the conceptual design framework section because it is the design rationale of the platform.

The second aspect that deserves profound changes is the “Teaching practice” section, which contains the description of the platform evaluation through its use across time by students.

When assessing the use of a new tool, one usually describes the protocol adopted for composing or inviting the participants, the procedure (i.e., how participants used the tool), the data collected, the data analysis methods, and the results. In the paper, the authors presented the teaching practice in an unstructured way. Please refer to a paper presenting a user study for a better way of reporting such user experiments. Plos One has papers with correct ways of reporting user studies (see, for example, https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0245717)

Moreover, I have some other concerns.

1. If 550 students used the platform, why present only data from 2023-2024?

2. Are the differences between pre-test and post-test scores statistically significant? The authors report only means and standard deviation.

3. As far as I understood, the students followed the three-element classroom approach presented from lines 263-286. The authors mention that the pre-test was applied before the tool was used. So, the students have already engaged in the “pre-class guidance”. On the other hand, the post-test was applied right after the use of the training tool. It is not clear how many times they could perform the simulation during the “interactive learning phase”, and if all students performed the same number of times the simulation tasks.

As a minor comment, please check lines 283-284. What are “Wanqianxing” and “Rain Classroom”?

**********

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Reviewer #3: No

**********

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PLoS One. 2026 Feb 12;21(2):e0323153. doi: 10.1371/journal.pone.0323153.r004

Author response to Decision Letter 2


2 Oct 2025

Dear Editor and Reviewers:

Thank you for your insightful feedback on this article. I will address the concerns of the article sequentially from the perspectives mentioned below.

1 Editor's queries

Question 1. Please include the following items when submitting your revised manuscript:A 'Response to Reviewers'.A 'Revised Manuscript with Track Changes'.A 'Manuscript'.

Answer: The initial draft has been thoroughly revised in accordance with the requested modifications. Please refer to the “Response to Reviewers-2“� " Revised Manuscript with Track Changes-2" and " Manuscript-2" for further details.

Question 2. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter.

Answer: I have included a statement of financial disclosure in “cover letter-2”.

Question 3.While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, PACE helps ensure that figures meet PLOS requirements.

Answer:I have upload my figures files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool. I have resubmitted the figure files.

Question 4.The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction.

Answer: All experimental data have been placed in file 2,“Practice data for all students” . Protocols.io has been alerted, and they are currently generating laboratory protocols. If the experimental designs and all associated data are must to be deposited with Protocols.io, these newly generated protocols will supersede file 2 in due course.

2 Questions Raised by Reviewer 3

Question 1. The introduction is too short. The text in the “Platform construction” subsection would be better as part of the introduction. It does not explain the methods used by the authors?

Answer: The content from the subsection titled "Platform construction" has been incorporated into the introduction, and the references suggested by the review experts have been included. This can be found in lines 46-72 of the “Revised Manuscript with Track Changes-2”.

Question 2. I think that Figure 2 needs an improvement and probably a correction. Is the “User experience feedback” the evaluation part? I did not understand the sentence “The formative evaluation of the operator can be relayed to the background, thereby optimizing the system model further.” Is the operator the student? Is the formative evaluation the assessment of the knowledge acquired by the student? These are aspects that should be in the conceptual design framework.

Answer: Figure 2 has been updated�as depicted in Fig 2. "User experience feedback" refers to the evaluation section where operators, which could include students or teachers, participate in a virtual experiment. The data presented in this article is a statistical analysis derived from a population of students within a school setting who have had the opportunity to experience the experiment. The formative assessment focuses on evaluating the students' acquisition of knowledge and their ability to correctly and proficiently operate the experiment. It is also an evaluation of the platform functions, which helps the platform optimize iterations.

Question 3. Figure 4 is described in the text, referring to numbers for each module. However, the figure itself does not contain the numbers used to identify each module. Also, some expressions are confusing: what is “chairs of landmarks”? Could you use a more specific case for a body weight detector, or are there different such devices? It would be interesting to have images of all modules. What is a ”calling button”?.

Answer:. Figure 4 has been updated to incorporate numerical labels for each module, and the module identifiers within the figure have been harmonized with those used in the text. There are no “chairs of landmarks” in the article, only “waiting chairs” and “landmarks”. The weight detector is a standard scale (not a specialised medical one), as can be seen in the following Figure 6. It has been changed to " a weighing scale", as can be seen at line 159 of the “Revised Manuscript with Track Changes-2”. The “mumber calling button” is the button pressed by the doctor to call out the next patient number in the waiting room, as can be seen in Figure 6.The figure 6 has been incorporated at line 169 of the of the “Revised Manuscript with Track Changes-2”. Furthermore, the manuscript incorporates "Figure 8. The waiting room" to facilitate a more intuitive presentation of the content within this platform�as shown at line 174 of the “Revised Manuscript with Track Changes-2”.

Figure 6 The pre-examination preparation room

Question 4. As for Table 2, is “The injection room is filled of medicine” really a “Mode of Injection”?.

Answer: The translation provided is inaccurate. The correct interpretation should be "administering drugs to patients in an injection room," which refers to an "injection mode" of administration that is intravenous. Changes have been made to Table 2, line 184 of the “Revised Manuscript with Track Changes-2”.

Question 5. The description starting at line 222 and figure 8 is very confusing. There is no description of Figure 8. Only the list of the stages. Since this is an example, it should be complete and described as a usage scenario. Then, there is a description of the characteristics of the process model, which seems to be out of place. Probably it would be better to move this text to the conceptual design framework section because it is the design rationale of the platform.

Answer: The operating environment of the original Fig. 8 (now Fig. 10) is elaborated, and the contents in the operating process are elaborated and sorted out, as shown in lines 185 to 214 of the “Revised Manuscript with Track Changes-2”. In addition, this part of the content was added to the conceptual design framework section, as shown in Fig. 2.

Question 6. If 550 students used the platform, why present only data from 2023-2024?

Answer: The SPECT platform undergoes annual optimizations and iterative updates, resulting in minor variations in statistical data collection each year. During its pilot phase, the system solely included training mode data, omitting assessment mode data. By the 2023-2024-1 semester, although data for both training and assessment modes was available, the platform only computed average scores for the training mode, excluding scores from the inaugural training session, thus rendering the data statistics incomplete. It was only in the 2023-2024-2 semester that the platform achieved optimal performance, leading to more comprehensive data statistics. Consequently, the original manuscript chose data from the most recent year as a benchmark. Nevertheless, following expert recommendations, statistical analyses were performed on data from the two latest semesters, specifically 2023-2024-2 and 2024-2025-2. These datasets, derived from the platform's latest iteration and boasting identical data formats, are apt for synchronous analysis. Refer to lines 285-306 and Figure 12 for further details�as in “Revised Manuscript with Track Changes-2”. It is important to note that, due to the lack of a mandatory requirement for the training mode, there were data omissions identified in the records of two students who may have bypassed the training phase and proceeded directly to the assessment phase. As a result, the total amount of data collected from the training mode is slightly less than that gathered from the assessment mode, accounting for the missing data from these two students.

Question 7. Are the differences between pre-test and post-test scores statistically significant? The authors report only means and standard deviation.

Answer: The difference between the pre-class and post-class tests is notable, with the average score of the latter increasing by 12.45%. Furthermore, the post-class test exhibits a larger median and a smaller variance compared to the pre-class test. Please refer to Table 4 for more details. This table has been newly incorporated. see lines 282 of the “Revised Manuscript with Track Changes-2”. Here, in addition, with the optimization of the teaching reform model, only the 2024-2025-2 semester has introduced the ternary classroom of intelligent course teaching. Therefore, the pre-class test and post-class test raw data only contain the data of 129 people in this semester. The reason for this data is also explained in the text, see lines 240 to 242 of the “Revised Manuscript with Track Changes-2”

Question 8. As far as I understood, the students followed the three-element classroom approach presented from lines 263-286 of the “Revised Manuscript with Track Changes-2”. The authors mention that the pre-test was applied before the tool was used. So, the students have already engaged in the “pre-class guidance”. On the other hand, the post-test was applied right after the use of the training tool. It is not clear how many times they could perform the simulation during the “interactive learning phase”, and if all students performed the same number of times the simulation tasks.

Answer: The simulation training is not constrained by a set number of attempts; therefore, during the interaction phase, students may undertake as many training sessions as they require based on their individual needs. This continues until the students feel they have thoroughly mastered the SPECT operation skills and knowledge points. As a result, the frequency of simulation training varies among students. This approach effectively caters to the personalized requirements of the students. This can be seen in lines 117-118 or lines 325 and 380.

Question 9. As a minor comment, please check lines 283-284. What are “Wanqianxing” and “Rain Classroom”?

Answer: “Wanqianxing” and “Rain Classroom” are two distinct teaching tools predominantly utilized for classroom assessments, data analytics, and real-time interactions. This section has been omitted in the latest version,as can be seen in lines 261-265 of the “Revised Manuscript with Track Changes-2”; kindly refer to the most recent draft for precise information.

Furthermore, I have carefully reviewed and revised the unsuitable descriptions present in the text, as outlined in “Revised Manuscript with Track Changes-2”.

These are my comprehensive responses. I eagerly await your feedback.

Best wishes!

Dandan Shang

2025.10.2

Attachment

Submitted filename: Response to Reviewers-2.docx

pone.0323153.s005.docx (244.9KB, docx)

Decision Letter 2

Alexandre Bonatto

19 Nov 2025

Dear Dr. Shang,

  • It was extremely challenging to secure reviewers willing to evaluate this manuscript. Hence, as an exception, I decided to proceed based on a single review (because the reviewer is a specialist on the manuscript's subject).

plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

  • A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.

  • A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.

  • An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols .

We look forward to receiving your revised manuscript.

Kind regards,

Alexandre Bonatto

Academic Editor

PLOS ONE

Journal Requirements:

1. If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise.

2. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #3: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions??>

Reviewer #3: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #3: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #3: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #3: Yes

**********

Reviewer #3: The paper reports several aspects of an online platform aimed at helping the training of students on SPECT imaging technology. Half of the paper is devoted to the evaluation of the platform based on its use in the training of more than 500 students. Results are presented in the form of descriptive statistics, and the authors conclude that the platform contributed positively to a better performance of the students in learning the contents of the courses where it has been applied.

I was a reviewer of the revised version (not of the original version) and posed comments and suggestions that were mostly followed and answered by the authors. I revised them below and added some extra minor suggestions.

1. The Introduction was improved. The authors kept the text in the “Platform construction” subsection, although it does not explain methods.

I suggest eliminating the title “Principles of Construction and Technical Parameters” and keeping the text as part of “Platform Construction”. This small change will make the section “Platform Construction” really about the techniques used to build it.

An additional correction in the section “Platform construction” is to correct the references in the sentence “Over the past decade, several educators and practitioners, including Jonathan Cooper [9], Tao Shaoneng[10], Oliver A. Meyer [11], and Lawson AP [12], …..” These articles have multiple authors. The authors should just write “Over the past decades, several authors [9,10,11, 12] have ….”

2. Figure 2 has been improved a lot. However, you can simplify the caption by replacing the current one with “Model Design Concept Diagram: Prerequisites, human-computer interaction, and feedback optimization. ”

3. Figure 4 has been improved with the numbers, as has its description in the text. However, there still are “chairs of landmarks” in the figure. I think they are waiting chairs as the authors explained in the response letter. So, the figure needs to be corrected.

4. Table 2 has been corrected as advised.

5. Figure 8 has been thoroughly described in the text as suggested.

As a separate comment, in my previous review, I said that the section “Teaching practice” deserved profound changes. I said, “When assessing the use of some new tool, usually one describes the protocol adopted for composing or inviting the participants, the procedure (i.e., how participants used the tool), the data collected, the data analysis methods, and the results. In the paper, the authors presented the teaching practice in an unstructured way. Please refer to a paper presenting a user study for a better way of reporting such user experiments. Plos One has papers with correct ways of reporting user studies (see, for example, https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0245717)”

The authors made some adjustments in the section but did not add demographic information: for example, the reader does not know basic statistics about age, sex and previous experience with VR. These are common data that one usually adds when reporting experiments.

As for my other concerns (three more questions) and comments, the authors addressed them adequately.

**********

what does this mean? ). If published, this will include your full peer review and any attached files.

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Reviewer #3: No

**********

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NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications.

PLoS One. 2026 Feb 12;21(2):e0323153. doi: 10.1371/journal.pone.0323153.r006

Author response to Decision Letter 3


24 Nov 2025

Dear Editor and Reviewers:

Thank you for your insightful feedback on this article. I will address the concerns of the article sequentially from the perspectives mentioned below.

1 Editor's queries

Question 1. Please include the following items when submitting your revised manuscript:A 'Response to Reviewers'.A 'Revised Manuscript with Track Changes'.A 'Manuscript'.

Answer: The initial draft has been thoroughly revised in accordance with the requested modifications. Please refer to the “Response to Reviewers-3“� " Revised Manuscript with Track Changes-3" and " Manuscript-3" for further details.

Question 2. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter.

Answer: There added a fund (2024CHYB-48) in my financial disclosure. The statement of financial disclosure can be seen in “cover letter-3”.

Question 3. 1. If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise.

Answer: The articles recommended by the reviewers were reviewed, confirming their relevance to this study and suitability for citation. See Ref. 2 under "References", as can be seen at lines 50 and 414.

Question 4. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Answer: The references no longer include citations to retracted or controversial articles . That is, references 3 and 4 were removed, as can be seen at lines 50 and 416–420. The citation numbers in existing references have been adjusted accordingly to maintain consistency with the revised numbering system.

Question 5. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results.

Answer: The laboratory protocol has been deposited in protocols.io. Protocol Integer ID:228888.

Private link: https://www.protocols.io/private/7D8871759FCF11F0A1320A58A9FEAC02.

Or practice data for all students is provided in S2 File.

2 Questions Raised by Reviewer 3

Question 1. The Introduction was improved. The authors kept the text in the “Platform construction” subsection, although it does not explain methods.

Answer: The main technical approaches for constructing the platform were incorporated into the “Introduction”. This can be found in lines 55 to 58 of the “Revised Manuscript with Track Changes-3”. Furthermore, the detailed technical methods are presented in lines 126 to 133 and table 1.

Question 2. I suggest eliminating the title “Principles of Construction and Technical Parameters” and keeping the text as part of “Platform Construction”. This small change will make the section “Platform Construction” really about the techniques used to build it.

Answer: The title "Principles of Construction and Technical Parameters" has been deleted and the text is keeping as part of “Platform Construction”.All changes have been completed. This can be found in lines 113 of the “Revised Manuscript with Track Changes-3”.

Question 3. An additional correction in the section “Platform construction” is to correct the references in the sentence “Over the past decade, several educators and practitioners, including Jonathan Cooper [9], Tao Shaoneng[10], Oliver A. Meyer [11], and Lawson AP [12], …..” These articles have multiple authors. The authors should just write “Over the past decades, several authors [9,10,11, 12] have ….”.

Answer: The changes of this sentence have been completed. This can be found in lines 94 to 96 of the “Revised Manuscript with Track Changes-3”.

Question 4. Figure 2 has been improved a lot. However, you can simplify the caption by replacing the current one with “Model Design Concept Diagram: Prerequisites, human-computer interaction, and feedback optimization. ”

Answer: The caption for Figure 2 has been simplified. This can be found in lines 118-120 and 539-541 of the “Revised Manuscript with Track Changes-3”.

Question 5. Figure 4 has been improved with the numbers, as has its description in the text. However, there still are “chairs of landmarks” in the figure. I think they are waiting chairs as the authors explained in the response letter. So, the figure needs to be corrected.

Answer: The “chairs of landmarks” has changed into “Waiting chairs” and “Landmarks”,as can be seen in figure 4.

Question 6. The authors made some adjustments in the section but did not add demographic information: for example, the reader does not know basic statistics about age, sex and previous experience with VR. These are common data that one usually adds when reporting experiments.

Answer: This paper provides comprehensive details regarding the study participants' demographic characteristics (e.g., age range, gender) and prior VR experience. This can be found in lines 219 to 223 of the “Revised Manuscript with Track Changes-3”.

Furthermore, I have carefully reviewed and revised the unsuitable descriptions present in the text, as outlined in “Revised Manuscript with Track Changes-3”.

These are my comprehensive responses. I eagerly await your feedback.

Best wishes!

Dandan Shang

2025.11.21

Attachment

Submitted filename: Response to Reviewers-3.docx

pone.0323153.s006.docx (25.1KB, docx)

Decision Letter 3

Alexandre Bonatto

14 Jan 2026

Dear Dr. Shang,

Please submit your revised manuscript by Feb 28 2026 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

  • A letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.

  • A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.

  • An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols .

We look forward to receiving your revised manuscript.

Kind regards,

Alexandre Bonatto

Academic Editor

PLOS One

Journal Requirements:

1. If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise.

2. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments:

The reviewer asked a single simple change. Once you implement this change, the paper will be accepted.

[Note: HTML markup is below. Please do not edit.]

Reviewer's Responses to Questions

Comments to the Author

Reviewer #3: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions??>

Reviewer #3: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #3: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #3: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #3: Yes

**********

Reviewer #3: The authors have addressed all my suggestions, except for Figure 4, which they addressed partially.

They replaced the text "Chairs of landmarks" with "Waiting chairs" in the "Lobby" part of the figure. However, the text "Chairs of landmarks" in the "Waiting room" still needs to be changed.

**********

what does this mean? ). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy

Reviewer #3: No

**********

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PLoS One. 2026 Feb 12;21(2):e0323153. doi: 10.1371/journal.pone.0323153.r008

Author response to Decision Letter 4


19 Jan 2026

Dear Editor and Reviewers:

Thank you for your insightful feedback on this article. I will address the concerns of the article sequentially from the perspectives mentioned below.

1 Editor's queries

Question 1. Please include the following items when submitting your revised manuscript:a 'Response to Reviewers'.a 'Revised Manuscript with Track Changes'.a 'Manuscript'.

Answer: The manuscript has been comprehensively revised in response to the recommended modifications.Please refer to the “Response to Reviewers-4“� " Revised Manuscript with Track Changes-4" and " Manuscript-4" for further details.

Question 2. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter.

Answer: The financial disclosure statement remains unchanged. The statement of financial disclosure can be seen in “cover letter-4”.

Question 3. 1. If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise.

Answer: The articles recommended by the reviewers were reviewed, confirming their relevance to this study and suitability for citation. See Ref. 2 under "References", as can be seen at lines 50 and 410.

Question 4. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Answer: References 13 and 22, which were retracted or controversial, have been removed and replaced with relevant existing literature. This can be found in lines 442-446 and 474-479 of the “Revised Manuscript with Track Changes-4”. The revised reference list no longer includes "withdrawn or controversial references". Additionally, reference 35 was removed due to its duplication of reference 15, with subsequent reference numbers renumbered accordingly. This can be found in lines 382-384 and 516-518 of the “Revised Manuscript with Track Changes-4”. And more, minor revisions have been made to the format of all references in accordance with the template requirements. This can be found in lines 409-542 of the “Revised Manuscript with Track Changes-4”.

Question 5. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results.

Answer: After discussion with the staff of Platform protocols.io, this experimental protocol is deemed unsuitable for implementation on Platform protocols.io. Therefore, this experimental protocol has not been deployed on Platform protocols.io. However, all raw data generated from this experiment have been fully disclosed within the manuscript as “File S2”.

2 Questions Raised by Reviewer 3

Question 1.They replaced the text "Chairs of landmarks" with "Waiting chairs" in the "Lobby" part of the figure. However, the text "Chairs of landmarks" in the "Waiting room" still needs to be changed.

Answer: The “chairs of landmarks” has changed into “Landmarks” and “Waiting chairs”,as can be seen in the "Waiting room" of figure 4. Furthermore, we have further refined Figure 4 by integrating the pathway for nuclear medicine technologists (depicted by yellow arrows in the diagram) and increase explanatory text in the caption of Figure 4: " Blue arrows depict the patient's route, while yellow arrows denote the nuclear medicine technologist's pathway." This can be found in lines 145-146 and 549-550 of the “Revised Manuscript with Track Changes-4”.

These are my comprehensive responses. I eagerly await your feedback.

Best wishes!

Dandan Shang

2026.1.19

Attachment

Submitted filename: Response to Reviewers-4.docx

pone.0323153.s007.docx (23.6KB, docx)

Decision Letter 4

Alexandre Bonatto

26 Jan 2026

An Online Training Platform for SPECT Imaging Technology Utilizing Three-Dimensional Modeling

PONE-D-25-17893R4

Dear Dr. Shang,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Alexandre Bonatto

Academic Editor

PLOS One

Additional Editor Comments (optional):

Dear Authors,

I am very pleased to inform you that your manuscript has been accepted.

Best regards.

Alexandre Bonatto

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #3: (No Response)

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2. Is the manuscript technically sound, and do the data support the conclusions??>

Reviewer #3: Yes

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3. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #3: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #3: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #3: Yes

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Reviewer #3: The authors have addressed the issue I pointed out while revising version 3 of the manuscript.

They also made changes in the references because they had cited papers that were retracted lately. I'm satisfied with the careful revision.

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Reviewer #3: No

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Acceptance letter

Alexandre Bonatto

PONE-D-25-17893R4

PLOS One

Dear Dr. Shang,

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS One. Congratulations! Your manuscript is now being handed over to our production team.

At this stage, our production department will prepare your paper for publication. This includes ensuring the following:

* All references, tables, and figures are properly cited

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Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Alexandre Bonatto

Academic Editor

PLOS One

Associated Data

    This section collects any data citations, data availability statements, or supplementary materials included in this article.

    Supplementary Materials

    S1 Text. Dataset.

    Practice data for all students.

    (ZIP)

    pone.0323153.s001.zip (72.5KB, zip)
    S2 Text. Supporting information.

    (PDF)

    pone.0323153.s002.pdf (254KB, pdf)
    Attachment

    Submitted filename: Response to Reviewers.docx

    pone.0323153.s004.docx (28.4KB, docx)
    Attachment

    Submitted filename: Response to Reviewers-2.docx

    pone.0323153.s005.docx (244.9KB, docx)
    Attachment

    Submitted filename: Response to Reviewers-3.docx

    pone.0323153.s006.docx (25.1KB, docx)
    Attachment

    Submitted filename: Response to Reviewers-4.docx

    pone.0323153.s007.docx (23.6KB, docx)

    Data Availability Statement

    All relevant data are within the manuscript and its Supporting Information files.


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