Physical Sciences and Biomedical Engineering: Medical Physics Technology … › networks › nhs-networks › msc... · 2011-11-18 · Division: Physical Sciences and Biomedical

Healthcare Science

Practitioner Training Programme Training Manual 2011/12

Physical Sciences

and Biomedical Engineering: Medical Physics Technology

Specialisms: • Radiotherapy Physics • Radiation Physics • Nuclear Medicine

CONTENTS Page No Section 1.0 Healthcare Practitioner Training Programme in Medical Physics Technology 1.1 Introduction 3 1.2 Role of a Healthcare Science Practitioner 4 1.3 Good Technical Practice 4 1.4 Overall Aim of the Training Programme 4 Section 2.0 Programme Overview 2.1 Generic Modules 6 2.2 Division Modules 6 2.3 Specialist Modules 6 Section 3.0 Work-based Training Modules 3.1 Introduction 8 3.2 Year 1 8 3.3 Year 2 and 3 for Radiotherapy Physics 11 3.4 Year 2 and 3 for Radiation Physics 15 3.5 Year 2 and 3 for Nuclear Medicine 17 Section 4.0 Assessment 4.1 Assessment 21 4.2 Competency Log Book 22 4.3 Generic Module 23 4.4 Division /Theme Modules 24 4.5 Radiotherapy Physics 25 4.6 Radiation Physics 37 4.7 Nuclear Medicine 51 Appendices Appendix 1 Direct Observation of Practical/Procedural Skills Template 75 Appendix 2 Case Based Discussion Template 77

2 BSc Medical Physics Technology

Practitioner Training Programme Training Manual: 2011/12 updated Nov 11

Section 1.0 Healthcare Science Practitioner Training Programme (PTP) in Medical Physics Technology

1.1 Introduction This manual provides an overview of the integrated 3-year BSc (Hons) in Healthcare Science and a more detail description of the structure and function of the work-based learning outcomes that form an integral part of the training programme for Healthcare Science Practitioners (HCSP) in Medical Physics Technology specialising in Radiotherapy Physics, Radiation Physics and Nuclear Medicine. This training manual must be used in conjunction with the course handbook provided by the Higher Education Institution with whom each student is registered. The BSc (Hons) programme has been developed to provide the knowledge, skills and experience that underpins the role and function a Healthcare Science Practitioner is expected to successfully perform at the end the programme. The concept of this programme is shown in the diagram below.

5

Year 2Techniques & Methodologies

Year 3Application to Practice

Year 1Scientific Basics

Academic

Increasing specialisation & supporting science

Academic learning to support workplace skil ls development

Special ism: one of:

•Radiotherapy Physics•Radiation Physics •Nuclear Medicine

PRACTITIONER TRAINING PROGRAMME [PTP] – Medical Physics

Workplace-based

Clinical Experience(15 weeks)

Cl inical Experience (25 weeks)

andResearch Project

Divisional Focus – Medical Physics

Introductory Block across Heal thcare Science

Increasing experient iallearning

BSc (Hons) in Healthcare Science (Specialism)

Work placements(10 weeks)



1.2 Role of a Healthcare Science Practitioner A Healthcare Science Practitioner (HCSP) will have the necessary expertise in applied scientific techniques underpinned by theoretical knowledge within a division or related specialism and will work in a range of healthcare settings:

• with a defined technologically based role in the delivery and technical reporting of quality assured tests, investigations and interventions on patients, samples or equipment;

• in a number of specialisms, HCSP will provide therapeutic

interventions, some of which may be specialist. 1.3 Good Technical Practice Good Technical Practice sets out, for the profession and the public, the standards of behaviour and practice that must be achieved and maintained as a Healthcare Science Practitioner. One of the ways to help set the benchmark for professionals and their practice is to use the standards of professional regulators. This curriculum therefore:

• broadly uses the generic Health Professions Council (HPC) Standards of Proficiency and HPC Standards of Conduct, Performance and Ethics, but contextualises these for Healthcare Science.

The Domains of Good Technical Practice are; 1. Professional 2. Scientific 3. Clinical 4. Technical 5. Investigation and reporting 6. Quality 7. Working with colleagues 8. Research and development 9. Probity 10. Leadership 11. Training and developing Others 1.4 Overall Aim of the Training Programme The overall aim of this HCSP training and education programme is to prepare the student to fulfil the function of a HCSP working in a clinical healthcare setting in Radiotherapy Physics, Radiation Physics and Nuclear Medicine and the programme has been designed to have a strong patient and clinical focus.



The programme combines and integrates both academic and work-based learning. Within the first year it is expected that the experiential component will start broad with short ‘tasters’ across Medical Physics Technology with some exposure to other aspects of the patient pathways for example a clinic, patient education programme, medical records and other areas of healthcare science. This will give the student a wide appreciation of the many specialisms within Healthcare Science and a more holistic view of the areas, which contribute to high-quality care. At the end of the programme the student should be able to fulfil the role of a Healthcare Science Practitioner. The diagram below depicts the broad framework around which all BSc (Hons) degree programmes in Healthcare Science being implemented as part of the Modernising Scientific Careers (MSC) Programme are structured. Each of the three divisions within the MSC Programme (Physical Sciences and Biomedical Engineering, Life Sciences and Physiological Sciences) have interpreted and adapted this framework. Further refinement has been undertaken by each Higher Education Institution to develop and deliver BSc (Hons) programmes that enable students to meet the learning outcomes of the course.

HIGH LEVEL FRAMEWORK INTEGRATED BSc (Hons) IN HEALTHCARE SCIENCE

Year 1 Scientific

Basics

Scientific Basis of Healthcare Science - Integrated Module

across Body Systems will usually include informatics,

maths and statistics [60]

Professional Practice

[10]

Work-based Training

10 weeks

Generic Curriculum

Year 2 Techniques & Methods

Generic Curriculum


[10]

Specialism Specific Curriculum

Work-based Training

15 weeks

[10]

Work-based Training

25 weeks [20]


[10]

Division/Theme Specific Curriculum

Scientific Basis of Healthcare Science

[60]

Research Methods

[10]

Scientific Basis of Healthcare Science Specialism

[60]

Principles of Scientific

Measurement

[30]

Division/Theme Specific Curriculum

Scientific Basis of Healthcare Science

[50]

Generic Curriculum

*36 wks

*40 wks

*46 wks

Practice Based Project

[30]

Specialism

Year 3 Application to Practice

Generic Modules: Common to all divisions of Healthcare Science

Division/Theme Specific Modules: Life Sciences; Physical Sciences and Biomedical Engineering (Medical Physics Technology; Clinical Engineering); Physiological Sciences (Cardiovascular, Respiratory and Sleep Sciences; Neurosensory Sciences)

Specialist Modules: Specific to a specialism Section 2 provides an overview of the structure of the Generic, Division and Specialist modules for students following the Medical Physics Technology BSc.



Section 2.0 Programme Overview 2.1 Generic Modules The 3-year degree has been designed with three key curriculum strands. The Generic Curriculum depicted in blue will be followed by all students undertaking Healthcare Science Practitioner BSc (Hons) degree and has three modules: Year 1, 2 & 3 Professional Practice Year 1 Scientific Basis of Healthcare Science Year 2 Research Methods The professional practice module is a vertical theme running from Year 1 to Year 3. In Year 1 all students will also study the Scientific Basis of Healthcare Science with integrated work-based training and in Year 2 Research Methods. 2.2 Division/Theme Modules This BSc (Hons) programme in Medical Physics Technology has six Division specific modules namely: Year 1 Informatics, Maths and Statistics Year 1 Scientific Basis of Medical Physics including Work-based training Year 2 Medical Imaging Year 2 Radiation Governance Year 2 The Medical Equipment Life Cycle Year 2 Principles of Scientific Measurement 2.3 Specialist Modules The specialism specific curriculum, depicted in orange, will be followed by students undertaking the Radiotherapy Physics specialism and has four modules: Year 3 Cancer, Radiobiology, and Clinical Radiotherapy Physics Year 3 Practice of Radiotherapy Physics Years 2 & 3 Work-based training Year 3 Research Project The specialism specific curriculum, depicted in orange, will be followed by students undertaking the Radiation Physics specialism and has four modules: Year 3 Framework of Radiation Governance and Risk Management Year 3 Practice of Radiation Physics Years 2 & 3 Work-based training Year 3 Research Project



The specialism specific curriculum, depicted in orange, will be followed by students undertaking the Nuclear Medicine specialism and has four modules: Year 3 Physics and Instrumentation Year 3 Clinical Indication, Pathology and Patient Care Years 2 & 3 Work-based training Year 3 Research Project Further details of the indicative content and high level learning outcomes for each module of the BSc in Healthcare Science (Medical Physics Technology), including the work-based training, will be provided by the Higher Education Institution in the Student Handbook.



Section 3.0 Work-based Training Modules 3.1 Introduction The BSc (Hons) programme integrates knowledge, skills and experience and a series of work-based placement enables students to gain the skills and attitudes to practice as a Healthcare Science Practitioner. This section describes the learning outcomes across knowledge, skills, experience and professionalism that a student should gain during work-based training. The professional practice module runs vertically throughout the programme and many of the learning outcomes will be achieved in the workplace. Work-based learning should equate to a minimum of 10 weeks in Year 1 and a minimum of a further 40 weeks across Year 2 and 3. The work-based placement in Year 1 exposes the student to the clinical environments across Medical Physics and specifically within the Radiotherapy Physics, Radiation Physics and Nuclear Medicine pathways. It is expected that the student will gain an understanding of how departments function, the range of investigations undertaken, the professional and inter-professional relationships, which exist, and a wider understanding of the NHS. Section 3.2 Division: Physical Sciences and Biomedical Engineering Theme: Medical Physics Technology Year 1: Work-based Training The overall aim of the work-based learning within Year 1 is to provide the student with a broad appreciation of the range of work undertaken within Healthcare Science. Students will begin the process of the development of the skills and attitudes relevant to the Healthcare Science Practitioner building on learning in the academic environment including practical sessions, clinical skills sessions, reflection on development etc. Additionally it should help students learn in the context of practice and real life experience and have a motivational element as they work towards a career in the NHS. This module will provide a foundation from which the student will build their knowledge, skills, experience and attitudes throughout the three year programme of study and transfer these skills to employment in healthcare science. It is expected that this period of initial work-based training will provide the opportunity to begin to integrate and embed many of the professional practice learning outcomes and enable the student to practice safely in the workplace Students will be expected to begin to maintain a portfolio of evidence and achievement in the relevant sections of the Training Manual.



Learning Outcomes: Knowledge and Understanding On successful completion of this module the student will: 1. Describe the roles undertaken by a Healthcare Science Practitioner relevant to

each area of their placements. 2. Explain the range of technologies and procedures relevant to their placements. 3. Describe the work of the healthcare science workforce and explain how it

contributes to the patient pathways relevant to each area of their placement. 4. Explain the need to ensure that the needs and wishes of the patient are central

to their care. 5. Explain the importance of developing and maintaining the patient-professional

partnership. 6. Explain the procedures relevant to the use of chaperones. 7. Explain the impact of adverse incidents on patients, carers and healthcare

professionals. 8. Describe the procedures and need for evaluation of adverse incidents. 9. Recognise the relevance of a Dress Code policy in the modern clinical

environment. 10. Recognise the standards of professional behaviour expected of a Healthcare

Science Practitioner. 11. Explain why responsibility for infection control is a shared responsibility. 12. Explain the structure of the organisation and inter-relationship of primary care,

outpatient and inpatient services. Learning Outcomes: Practical Skills On successful completion of this module the student will demonstrate: 1. Safe working in the clinical environment relevant to each area of their

placement. 2. The six stage hand-washing technique. 3. Basic Life Support in accordance with current Resuscitation Council (UK)

guidelines. 4. Appropriate professional practice at all times. 5. Effective communication within the work-based environment and clinical team. 6. In accordance with local health and safety regulations, the ability to undertake

routine investigations as defined in this training manual. Learning Outcomes: Associated Personal Qualities and Behaviours (Professionalism) On successful completion of this module the student will: 1. Behave in a professional manner in matters of attendance, appearance,

maintaining confidentiality and infection control. 2. Respect and understand individuals’ beliefs and ways of coping with illness.



3. Value social diversity and its relationship to service provision in healthcare. 4. Demonstrate the ability to work safely within each environment. 5. Demonstrate the ability to treat patients with respect. 6. Communicate effectively with the healthcare environment and clinical team and

develop appropriate interpersonal skills. 7. Seek to adapt their communication style to meet the varying needs of different

peers, colleagues and patients in different contexts. 8. Adopt a range of techniques to overcome barriers to communication. 9. Develop and maintain professional relationships and effective team working. 10. Discuss and demonstrate safe and effective practice in a healthcare

environment. 11. Begin to develop a balance between reflective practice and active exploration in

personal learning. 12. Take responsibility for personal learning.

Indicative Content and Suggested Experience

• Observe the work of a range of Healthcare Science departments, technologies and procedures

• Observe the process for handling work requests from the receipt of the request to completion

• Observe the patient journey from admission to discharge • Gain an understanding of the skills required to work safely in the

clinical/laboratory/workshop/radiation environment • Record keeping, data protection, confidentiality • Gain an appreciation of how the NHS is structured • Team working and the role of multi-disciplinary team meetings • Meaning and role of professionalism and professions in healthcare • Roles of different professional groupings in Healthcare Science • Human and social diversity and its implications for relationships, behaviours and

service provision in healthcare • Types of effective communication in the context of healthcare. Barriers to

effective communication and strategies to overcome them • Interpersonal skills related to dealing with patients, carers and healthcare

professionals • The skills needed to work as part of a team • Management and evaluation of adverse incidents • Data management (paper and electronic) • Infection control • Basic Life Support • Reflective practice and its application



Section 3.3 Division: Physical Sciences and Biomedical Engineering Theme: Medical Physics Technology Specialism: Radiotherapy Physics Years 2 & 3: Work-based Training [30 Credits]

The overall aim of this module is to give the student experience of Radiotherapy Physics that ensures that the student can undertake the full breadth of practice expected of a newly qualified healthcare science practitioner in Radiotherapy Physics. This is delivered through work placements in Years 2 and 3 of the degree course. Important Note: Work-based training does not have to be confined only to the work-base but elements may be taught in other environments, e.g. a clinical skills laboratory, simulation centre or science laboratory.

Learning Outcomes: Knowledge and Understanding On successful completion of this module the student will: 1. Demonstrate increased knowledge, understanding and confidence in

application of the core skills in clinical, patient identification, communication skills and management, and quality assurance.

2. Demonstrate competence for routine tasks and situations in Radiotherapy Physics including treatment planning, dose measurement, quality assurance, calibration and operation of equipment, patient interventions and immobilisation techniques.

3. Critically review and evaluate departmental protocols in relation to the core skills in health and safety, human rights, patient identification, communication skills and management, quality assurance.

4. Critically review and evaluate routine tasks in relation to treatment planning, dose measurement, quality assurance, calibration and operation of equipment, and patient interventions.

5. Produce a ‘Professional Portfolio’ which cumulatively records / provides evidence of the skills, knowledge and attitudes gained.

Learning Outcomes: Practical Skills

On successful completion of this module the student will: 1. Produce a range of Radiotherapy dose treatment plans using imaging data,

defined treatment parameters, dose calculations and simulation. 2. Undertake processes to assist in the safest and most effective treatment being

delivered to the patient. 3. Make safe and appropriate immobilisation devices in accordance with local



protocols. 4. Participate in the preparation and delivery of Brachytherapy treatment

procedures. 5. Undertake quality control procedures for Radiotherapy Systems. 6. Demonstrate the ability use a wide range of dosimeters for a variety of dose

measurements types in accordance with established procedures. 7. Apply a professional approach to all activities undertaken within the

radiotherapy department.

Learning Outcomes: Associated Personal Qualities and Behaviours (Professionalism) On successful completion of the module the student will: 1. Present complex ideas in simple terms in both oral and written formats. 2. Challenge discriminatory behaviour and language. 3. Adapt communication style and language to meet needs of listeners. 4. Respect and uphold the rights, dignity and privacy of patients. 5. Establish patient-centred rapport. 6. Consistently focus on professional duty of care. 7. Reflect and review own practice to continuously improve personal performance. 8. Consistently operate within sphere of personal competence and level of

authority. 9. Manage personal workload and objectives to achieve quality of care. 10. Actively seeks accurate and validated information from all available sources. 11. Select and apply appropriate analysis or assessment techniques and tools. 12. Evaluate a wide range of data to assist with judgements and decision making. 13. Contribute to and co-operates with work of multi disciplinary teams. 14. Act in a calm and reassuring manner. Indicative Content • Isodose charts and how they are used • Percentage Depth Doses and Tissue Maximum Ratios • Factors affect the dose distribution along the central axis of the beam • Back-scatter • Build-up Effect • Field sizes are defined • Output factors and normalisation • Calculation of equivalent squares • Older methods of volume transfer onto planning outline (e.g. orthogonal film

mark-up) • Other imaging modalities used in Planning Target Volume (PTV) localisation. • Possible pros and cons of using a single outline to generate a treatment plan • Planning algorithms used by the Treatment Planning System (TPS)



• Benefits of using a 3 Dimensional Treatment Planning System that uses Computerised Tomography (CT) electron densities

• Need and techniques used to limit the dose to sensitive structures, e.g. rectum, eyes, brain stem etc

• Concepts of International Commission on Radiological Units (ICRU) Guidance and the concept of margin growing

• Department checking procedure following local protocols • Advanced planning techniques • Dose volume histograms and their production • Dosimetric characteristics of photon, electron and orthovoltage beams • Variety of impression materials and immobilisation devises on the market

and the pros and cons of their use • Requirements for electron mark-ups • Effect of field sizes and stand off corrections • Variety of impression materials and immobilisation devises on the market

and the pros and cons of their use • Health and safety aspects of brachytherapy • Modalities that have taken over from Low Dose Rate Brachytherapy (LDR) for

example High Dose Rate Brachytherapy (HDR) and Pulsed Dose Rate (PDR) Brachytherapy

• Range of treatment sites where brachytherapy can be utilised • All sources used by the department and is aware of why different

sources/isotopes are used for different procedures including; • Type of emitted radiation

o Half life of isotope o Energy

• Record keeping for a given procedure using radioactive sources used clinically

• Attendance and knowledge of theatre and knows how to make sources available for use

• The clinician’s role and the certification needed to practice. • Brachytherapy for gynaecological malignancies • Algorithm used to produce brachytherapy treatment plans, showing an

understanding of units of measurement • Different brachytherapy systems used nationally • Clinical and special waste and equipment, including radiation risks • Effective audit trail and work towards continuous improvement • Rationale for Quality Assurance in Radiotherapy • Departmental protocol in completing radiation dosimetry checks on linac

(photons and electrons) • Procedure for reporting equipment which is out of specified tolerance limits • Appropriate equipment for Quality Control explaining how the instrument

works o Ionisation chamber o Farmer dosimeter o Well chambers

• Variations in temperature and pressure affect machine output • How and why Quality Control frequency differs for different machines • National codes of practice and guidelines



• Use of Thermoluminescent dosimeters (TLD) and semiconductor dosimetry systems in:

o Personal and patient monitoring as appropriate locally o Use of the department’s chosen personal/patient dosimetry system

to calculate dose o Systems for personnel monitoring o Action levels and tolerances o Principles of portal dosimetry

• Need for plan verification. • Clinical use of a variety of verification techniques • Newer verification technologies (e.g. Image Guided Radiation Therapy

(IGRT), Tomotherapy) and impact of these technologies on the patient experience and clinical workload

• Fundamentals of random and systematic errors • Appropriate use of 2 dimensional, 3 dimensional, kilo-voltage (kV) and

Mega-voltage (MV) imaging techniques • Concomitant dose requirements for the different imaging processes • Radiation protection legislation

o Ionising Radiation Regulations 1999 o Ionising Radiation (Medical Exposure) Regulations 2000 o Environmental Permitting Regulations 2010 o MARS o Control of Substances Hazardous to Health o Health and Safety

• Radiotherapy related information technology in particular: o Hospital Information Systems o Oncology Information Systems o Radiology Information Systems and their role in Radiotherapy o Digital Imaging and Communications in Medicine (DICOM)

• Quality systems o ISO9000 o Quality Assurance in Radiotherapy (QART) o Error reporting o Audit

• Quality Assurance processes for a range of radiotherapy equipment following standard departmental protocols.



Section 3.4 Division: Physical Sciences and Biomedical Engineering Theme: Medical Physics Technology Specialism: Radiation Physics Years 2 & 3: Work-based Training [30 Credits]

The overall aim of this module is to give the student experience of Radiation Physics that ensures that the student can undertake the full breadth of practice expected of a newly qualified healthcare science practitioner in Radiation Physics. This is delivered through work placements in years 2 and 3 of the degree course. Important Note: Work-based training does not have to be confined only to the work-base but elements may be taught in other environments, e.g. a clinical skills laboratory, simulation centre or science laboratory.


application, of the core skills in communication skills and management, and quality assurance.

2. Demonstrate competence for routine tasks and situations in Radiation Physics including dose measurement, quality assurance, calibration and operation of equipment that uses ionising and non-ionising radiation.

3. Critically review and evaluate departmental protocols in relation to the core skills in health and safety, communication skills, management and quality assurance.

4. Critically review and evaluate routine tasks in relation to legislative compliance, dose measurement, equipment evaluation and commissioning, quality assurance and the calibration and operation of equipment that uses ionising and non-ionising radiation.

5. Produce a ‘Professional Portfolio’, which cumulatively records and provides evidence of the skills, knowledge and attitudes gained.


On successful completion of this module the student will: 1. Perform a full range equipment life cycle procedures as an equipment user. 2. Measure and record levels of radiation. 3. Calibrate a range of radiation measuring devices. 4. Safely use and transport radioactive sources. 5. Perform a range of tasks in the personal dosimetry service. 6. Perform commissioning and routine Quality Assurance tests on a range of

ionising and non-ionising equipment.



7. Participate in patient dosimetry procedures for both ionising and non-ionising applications.

8. Perform Radiation Surveys for ionising and non-ionising installations.


authority. 9. Manage personal workload and objectives to achieve quality of care. 10. Actively seek accurate and validated information from all available sources. 11. Select and apply appropriate analysis or assessment techniques and tools. 12. Evaluate a wide range of data to assist with judgements and decision making. 13. Contribute to and co-operate with work of multi disciplinary teams. 14. Act with a calm and reassuring manner. Indicative Content • Work safely in all radiation areas • Undertake an assessment of image quality • Participate in the evaluation of a range of new equipment, including X-ray and

Ultrasound • Participate in the acceptance testing and commissioning of a range of new

equipment including X-ray and Ultrasound • Measure and report image quality • Promote safe and effective working practices in areas which may be affected by

ionising and non-ionising radiation • Optimise practices involving radiation • Quality assure and calibrate a range of equipment and radiation sources,

including X-ray, Laser, UltraViolet and Ultrasound • Audit areas where ionising and non-ionising radiation is used • Investigate and report on legislative aspects of use of ionising and non-ionising

radiation at a departmental level • Co-ordinate storage, disposal and transfer of radioactive substances • Collect, monitor and record radioactive waste • Monitor and decontaminate areas where radioactive materials have been used • Audit and report environmental radiation monitoring results



• Audit and report staff dosimetry and workplace monitoring results • Provide a personnel monitoring service for staff working in radiation areas • Measure or calculate radiation doses to members of the public • Measure and report patient radiation dose • Measure and record levels and characteristics of radiation Section 3.5 Division: Physical Sciences and Biomedical Engineering Theme: Medical Physics Technology Specialism: Nuclear Medicine Years 2 & 3: Work-based Training [30 Credits] The overall aim of this module is to give the student experience of Nuclear Medicine that ensures that the student can undertake the full breadth of practice expected of a newly qualified Healthcare Science Practitioner in Nuclear Medicine. This is delivered through work placements in years 2 and 3 of the degree course. Important Note: Work-based training does not have to be confined only to the work-base but elements may be taught in other environments, e.g. a clinical skills laboratory, simulation centre or science laboratory.


application, of the core skills in clinical, patient identification, communication skills and management, and quality assurance.

2. Demonstrate competence for routine tasks / situations in Nuclear Medicine including imaging, non-imaging and therapeutic interventions, preparation of radiopharmaceuticals, quality assurance, and the operation of equipment.

3. Critically review and evaluate departmental protocols in relation to the core skills in health and safety, human rights, patient identification, communication skills and management, quality assurance.

4. Critically review and evaluate routine tasks in relation to imaging, non-imaging and therapeutic patient interventions, preparation of radiopharmaceuticals, quality assurance, and the operation of equipment.

5. Produce a ‘Professional Portfolio’ which cumulatively records / provides evidence of the skills, knowledge and attitudes gained.


On successful completion of this module the student will: 1. Demonstrate competence for routine tasks and situations in Nuclear Medicine

including imaging, non-imaging and therapeutic patient interventions, preparation of radiopharmaceuticals, quality assurance, and the operation of



equipment. 2. Demonstrate the ability to work safely within the legislative and policy

framework around the safe use of ionising radiation within a hospital environment.

3. Be able to use a dose calibrator in the preparation and measurement of radioactivity.

4. Perform a full range equipment life cycle procedures as an equipment user. 5. Be able to set up, optimise and operate imaging equipment safely so as to be

able to produce the highest quality results for interpretation across a range of nuclear medicine investigations.

6. Be able to perform all aspects of the preparation required including providing relevant information and instructions to the patient/carer to ensure the Nuclear Medicine Investigations and Treatment is successful.

7. Be able to administer Radiopharmaceuticals whilst observing all safety, control of infection and radiation protection governance requirements.

8. Be able to perform full range of common Acquisition and Recording techniques used when carrying out Diagnostic Imaging procedures.

9. Be able to perform a range of Nuclear Medicine Therapy procedures used in the clinical treatment pathway of patients.

10. Be able to work in a Radio-pharmacy safely and within the legislative and statutory framework to prepare and dispense radiopharmaceuticals for use in the diagnosis or treatment of patients.

11. Be able to apply quality control procedures within the Radiopharmacy to establish and maintain a safe environment, which meets all legislative and medicine inspectorate requirements.

12. Demonstrate the ability to perform In-Vitro procedures in Nuclear Medicine. 13. Demonstrate the ability to perform Tracer Methodology procedures in Nuclear

Medicine investigations.


authority. 9. Manage personal workload and objectives to achieve quality of care. 10. Actively seek accurate and validated information from all available sources. 11. Select and apply appropriate analysis or assessment techniques and tools. 12. Evaluate a wide range of data to assist with judgements and decision making. 13. Contribute to and co-operate with work of multi disciplinary teams.



14. Act in a calm and reassuring manner. Indicative Content • Anatomy and Physiology which needs to be considered in the planning and

interpretation of radionuclide tests • Immunology • Infection

o Acute, chronic, pus, abscess, differential diagnosis between abscess, cyst and tumour

• Neoplastic disease o Tumours, primary and secondary, (metastases), benign and malignant

tumours, assessing the extent of malignant involvement • Nursing and Emergency Procedures • Administration of Radioactivity • Adverse Incident Reporting Procedures • Radiation Protection for Nuclear Medicine • Radiopharmaceuticals used in Nuclear Medicine

o The design of the radiopharmacy o Good Manufacturing Practice o The types of preparation o Sterilisation techniques o The operation of the radiopharmacy o Maintaining and monitoring the pharmaceutical environment o Waste disposal

• Radiochemistry and Quality Control o The chemistry of technetium o Radiochemical techniques o Production of radiopharmaceuticals o Labelling of blood products o Selection of appropriate radiopharmaceutical

• Perception of the Image • In Vivo Non-imaging Techniques • Techniques requiring the Assay of Radioactive Samples • The Application of Nuclear Medicine in Diagnosis. For radionuclide tests in

common use this should include knowledge of: - o The radiopharmaceutical used, activity administered and route of

administration, half life, beta energy o The preparation of the patient o The views/samples which must be obtained, dynamic protocols o The use of any special data handling techniques or display mode o Any special features of the study o Possible artefacts o Setting up the equipment – energy windows, collimation etc. o The clinical context in which radionuclide tests may be of value, and the

influence of the test results on patient management.



o The radiation dose to the patient and the risks and benefits of the particular radionuclide test to a particular patient.

o New developments in Nuclear Medicine, and the changing role of Nuclear Medicine in the diagnosis and treatment of disease and the relevant imaging modalities used in reaching a diagnosis

• Nuclear Medicine services applied to: o Skeletal Imaging o Central Nervous System o The Endocrine System o The Cardiovascular System o The Respiratory System o The Renal Tract o The Gastrointestinal System

• Therapeutic Applications of Radionuclides in Nuclear Medicine



Section 4.0 Assessment

4.1 Assessment

The responsibility for designing and assessing student learning lies with the Higher Education Institution and will be explained in the Course Handbook. However, there will also be continuous assessment across the 3-year training period in the work-base, using a series of Directly Observed Procedures / Direct Observation of Practical Skills (DOPs), Case Based Discussions (CbDs) and Mini Clinical Examinations (mini-Cex). Examples of CbDs, DOPS and mini-Cex can be found in Appendix 1 and 2. Direct Observation of Practical Skills (DOPS) is the observation and evaluation of a procedural/technical or practical skill performed by a student in a live environment. Case Based Discussions (CbDs) are designed to provide structured teaching and feedback in a particular area of clinical or technical practice by evaluating decision making and the interpretation and application of evidence. They also enable the discussion of the context, professional, ethical and governance framework of practice, and in all instances, they allow students to discuss why they acted as they did. CbDs are used throughout training and should encourage a reflective approach to learning. Mini Clinical Examinations (mini-Cex) are a short snapshot of practitioner/patient interaction. They are designed to assess the clinical skills, attitudes and behaviours of students essential to providing high quality care. All DOPS, CbDs and mini-Cex have the potential to be completed electronically and analysed on a central database. Each student will be required to complete a portfolio in which a record of these will be kept, further detail can be found overleaf. The table below indicates the suggested number of formal work-based assessments that should be completed by the student in Year 1, Year 2 and Year 3.

Year 1 Year 2 Year 3 2 DOPS 1 CBD Competencies

4 DOPS 1 CBD 1 Mini-Cex Competencies

4 DOPS 2 CBD 2 Mini-Cex Competencies

It is the responsibility of the student to maintain their own portfolio and ensure all assessments are completed on time.



4.2 Competency Log Book The competencies form the foundation of the work-based training programme and they are an important part of the portfolio and the student’s record of competence. Competencies are transferable across learning outcomes and do not need to be undertaken twice where they are repeated. Reference should be made to the point at which this competency has been completed. Competencies are cumulative and as such not all competencies have to be completed within the relevant module. All competencies should be completed by the end of the training programme. This manual provides examples of areas of application or evidence required to demonstrate competence. Students are expected to utilise different tools, resource and media within the local laboratory to demonstrate each area of competence. Some competencies are exit competencies. These are described as such in the recognition that they require longer time and experience to acquire and therefore cannot be limited to one specific module or individual learning outcome.



Section 4.3 Generic Module Year 1: Work-based Training Learning Outcome 1 Performs the generic skills, demonstrates adherence to health and safety, professional behaviour and the knowledge and understanding defined in the work-based module for Year 1. Competency The student will be able to:

Reviewer Date Comments/Evidence

Demonstrate the six stage hand-washing technique.

Demonstrate basic life support skills.

Demonstrate effective communication skills within the healthcare environment.

Demonstrate safe working practice in the workplace.

Demonstrate the standards of dress and professional behaviour required in the workplace.



Section 4.4 Division: Physical Sciences and Biomedical Engineering Theme: Medical Physics Technology Year 1: Work-based Training Learning Outcome 2 Demonstrate the ability to observe, assist and perform under direct supervision, some basic routine procedures whilst working in accordance with local rules and safety regulations. Competency The student will be able to:


Assist in the preparation of Nuclear Medicine equipment prior to a scanning procedure.

Observe and assist in routine Nuclear Medicine scans.

Perform basic contamination monitoring.

Perform basic radiation dose measurements.

Observe and assist in measuring the performance characteristics of an X-ray tube.

Observe and assist in the production of a radiotherapy treatment plan.

Observe and assist in the production of an immobilisation device.



Section 4.5 Division: Physical Sciences and Biomedical Engineering Theme: Medical Physics Technology Specialism: Radiotherapy Physics Years 2 & 3: Work-based Training Learning Outcome 3 Demonstrate the ability to perform a full range equipment life cycle procedures as an equipment user. Competency The student will be able to:


Critically appraise equipment, accessories or consumables as to whether they are fit for purpose.

Participate in the procurement of equipment, accessories or consumables.

Perform visual inspection of equipment prior to use to ensure it is safe to use.

Perform risk assessments on equipment and its use.

Operate the equipment inventory system (written or electronic) in order to save or retrieve equipment information.



Identify equipment inventory information such as serial numbers model numbers etc.

Identify the cleaning / decontamination process for a range of equipment within the specialist area and then applies these processes to clean the equipment.

Identify the maintenance requirements of a range of equipment used in the department and perform user maintenance.

Follow the procedure to obtain local or manufacturer assistance in maintenance or repair.

Perform user decontamination procedures on a range of equipment of equipment.

Demonstrate the process for the disposal of equipment, accessories and consumables in a safe and appropriate manner.



Learning Outcome 4 Dose planning and virtual simulation: Demonstrate the ability to produce a range of Radiotherapy dose treatment plans using imaging data, defined treatment parameters, dose calculations and simulation processes to assist in the safest and most effective treatment being delivered to the patient. Competency The student will be able to:


Manually add opposed fields dose distribution.

Calculate monitor units from the treatment prescription for the opposed field’s distribution.

Identify and contour organs at risk and taking into account their dose tolerance limits.

Demonstrate competence in using department’s treatment planning system.

Produce and critically evaluate an opposed field pelvis plan including sparing organ at risk following local protocols.

Produce and critically evaluate a multi field treatment plan for a bladder or prostrate patient including sparing organ at risk following local protocols.

Produce and critically evaluate an opposed fields plan for a larynx including sparing organ at risk following local protocols.



Produce and critically evaluate a Breast/Chest wall plan including sparing organ at risk following local protocols.

Check Planning Target Volume margins against clinical protocols as per diagnosis.

Demonstrate the ability to define treatment field parameters for simple treatment techniques using virtual simulation software.

Demonstrate the ability to define appropriate isocentre.

Demonstrate the ability to conform treatment fields using multi-leaf collimators etc.



Learning Outcome 5 Mould room: Demonstrate the ability to make safe and appropriate immobilisation devices in accordance with local protocols. Competency The student will be able to:


Prepare the clinical area for the procedure.

Check the patients’ identity and that the request is appropriate to the clinical history provided.

Empathise with the patient and assess their ability to undergo the procedure specified by the request.

Prepare the patient according to the radiotherapy request form.

Give instructions and explain the procedure to the patient and other relevant persons’.

Complete the necessary documents for set-up reproduction.

Use hand and machine tools safely and effectively during procedures associated with the mould room.

Demonstrate good health and safety practice when performing mould room procedure.

Position the patient as appropriate to the procedure.

Take the relevant measurements and impressions.



Manufacture immobilisation devices to meet the specification required to deliver treatment.

Select the appropriate thickness of lead shielding.

Produce a lead mask or cut-out that meets the department’s quality standard.

Produce a tissue equivalent substance (bolus) to meet the treatment specification requirements.



Learning Outcome 6 Brachytherapy: Demonstrate the ability to participate in the preparation and delivery of Brachytherapy treatment procedures.

Competency The student will be able to:


Check and calculate the activity of sealed sources.

Perform standard sealed source calculations using the department’s planning programmes. (e.g. standard High Dose Rate Brachytherapy insertion)

Explain the principles of prostate brachytherapy and observation of the procedure.

Discuss and apply understanding of volume coverage and treatment plan analysis.

Clean and sterilise applicators after use in accordance with departmental rules.

Produce brachytherapy treatment plans.

Perform routine quality control of any brachytherapy equipment.



Learning Outcome 7 Quality Control of Radiotherapy: Demonstrate the ability to undertake quality control procedures for Radiotherapy Systems. Competency The student will be able to:


Perform routine quality control programme of orthovoltage treatment units.

Perform under supervision, routine quality control programme of megavoltage units.

Follow departmental protocol in completing radiation dosimetry checks on linac (photons and electrons).

Perform, under supervision, quality control procedures for other radiotherapy treatment units. (eg High Dose Rate Brachytherapy, Tomotherapy units).

Perform routine strontium testing of therapy level dosimeters.

Perform routine output measurements of treatment units. (Orthovoltage – in air measurements, MegaVoltage X-ray and electron measurements).

Perform under supervision routine quality control programme of Computed Tomography and simulators.

Perform under supervision routine quality control programme of treatment planning systems.



Learning Outcome 8 Dose Measurement: Demonstrate the ability to use a range of dosimeters for a variety of dose measurements types in accordance with established procedures. Competency The student will be able to:


Describe the use of Thermoluminescent Dosimeters (TLD) and semiconductor dosimetry systems in: personal and patient monitoring according to local protocols.

Prepare Thermoluminescent Dosimeters for patient monitoring according to local protocols.

Explain the principles portal dosimetry.



Learning Outcome 9 Image Guidance: Demonstrate the ability to use image guidance to check and modify treatment plans following local protocols. Competency The student will be able to:


Explain the justification of departmental localisation tolerances.

Check verification images against planning Digitally Reconstructed Radiographs following local protocols under supervision.

Produce Digitally Reconstructed Radiographs encompassing relevant anatomy to assist the image matching process.

Apply the limitations of cone beam soft tissue matching analysis.

Explain the appropriate use of different Fiducial markers for a number of treatment sites.

Assess criteria required for rescanning, replanning and reimaging patients in according to local protocols or tolerances.



Learning Outcome 10 Radiotherapy Practice: Demonstrate the ability to apply a professional approach to all activities undertaken within the radiotherapy department. Competency The student will be able to:


Comply with all data protection requirements when creating, storing and maintaining valid patient records.

Use computer systems, verification systems and network systems within the radiotherapy department following any local rules.

Work within the legislative frameworks, radiology protection, health and safety standards and clinical governance.

Work within the Quality Assurance systems as applied to radiotherapy and audit.

Comply with the rules relating to Health and Safety, including manual handling.

Communicate with patients and colleagues.

Make radiotherapy judgements and decisions to support effective healthcare delivery.

Practice safely and to the highest professional standards.



Participate as an effective member of the Multidisciplinary Team (MDT) dealing with the delivery of radiotherapy based treatments.



Section 4.6 Division: Physical Science and Biomedical Engineering Theme: Medical Physics Technology Specialism: Radiation Physics Years 2 &3: Work-based Training Learning Outcome 3 Demonstrate the ability to perform a full range equipment life cycle procedures as an equipment user. Competency The student will be able to:


Critically appraise equipment, accessories or consumables as to whether they are fit for purpose.


Perform a visual inspection of equipment prior to use to ensure it is safe to use.

Perform risk assessments on the equipment and its use.





Identify the cleaning /decontamination process for a range of equipment and then applies this process to clean some equipment.



Perform user decontamination procedures on a range of equipment.




Learning Outcome 4 Demonstrate the understanding, skill and ability to measure and record levels of radiation.



Select the appropriate device for the type of radiation to be measured. Ensure the selected equipment is in working order and within calibration. Perform the full range of measurements required e.g. dose rate, contamination checks, output measurements. Record the results accurately and in the correct format. Produce the results and make them available to the appropriate person within specified timescales.



Learning Outcome 5 Demonstrate the ability to calibrate a range of radiation measuring devices. It is expected that calibrations would be performed on a range of instruments that include contamination monitors, dose rate meters, electronic personal dosimeters, radiographer Quality Assurance meters, and dosimeters



Identify the type of device to be tested and select the documentation and equipment appropriate to the test. Check that location provided for tests is appropriate, where calibration is performed away from base. Select the appropriate radiation source(s) for the calibration.

Use the source(s) in an appropriate manner following all procedures put in place to satisfy legislation.

Perform and record the measurements/observations necessary to complete the equipment calibration. Take advice and make appropriate adjustments to the test protocol where the equipment under test prevents a standard procedure from being used. Calculate the equipment calibration factors. Identify any equipment failing to pass calibration and take the appropriate action. Assist with or observe adjustments made to equipment to facilitate a pass, where appropriate.



Produce a written report for the equipment.

Identify equipment that, despite passing calibration, may appear to be failing.



Learning Outcome 6 Demonstrate the ability to safely use and transport radioactive sources. Competency The student will be able to:


Perform all the checks required prior to the removal of source(s) from their base. Complete all the required paperwork prior to the transport of source(s). Transport the source(s) in a manner that satisfies legislatory requirements. Ensure that any source(s) not immediately returned to their base are stored in an appropriate location. Take appropriate action when it is suspected that a source is lost or damaged. Perform source leak tests. Review the results of leak tests and identify any results that may indicate potential source damage. Take the appropriate action where leak tests indicate potential damage. Follow all procedures that were / are put in place to ensure the security of sources. Perform the contamination checks following the use of unsealed sources. Take the appropriate action in the event that contamination is detected. Assist in the maintenance of contamination check records.



Learning Outcome 7 Demonstrate the ability to perform a range of tasks in the personal dosimetry service. Competency The student will be able to:


Provide personal dosimetry services to a range of users.

Assist with the issue of dosimeters to users.

Assist with the processing and reporting of results of returned dosimeters.

Take the appropriate action when assessed doses exceed pre-set action levels or give other cause for concern. Provide basic advice to users.

Assist in the production of routine reports and other documentation for users.

Assist with the record keeping associated with personal dosimetry.



Learning Outcome 8 Demonstrate the ability to perform Commissioning and routine Quality Assurance tests on a range of ionising and non-ionising equipment. Competency The student will be able to:


Perform routine Quality Assurance tests on a range of equipment that utilise both ionising and non-ionising radiations.

Assist with commissioning tests on a range of equipment that utilise both ionising and non-ionising radiations.

Assist with Critical Examinations on diagnostic X-ray equipment installations.

Equipment and Installations include, for example, static & mobile diagnostic X-ray, static & mobile fluoroscopy, dental plus associated equipment such as Automatic Exposure Control (AEC), Dose Area Product (DAP) meters, imaging systems etc. For each survey the student will be able to: Select appropriate equipment and documentation for tests.

Follow appropriate room handover procedures on both arrival and departure.

Competently operate the test equipment being used and identify common equipment faults.

Competently operate the equipment under test and identify all control functions.

Perform all tests required to complete the assessment (see below for equipment specific lists).

Identify any equipment failing to meet remedial or suspension levels or having radiation safety implications.



Assist with assessments of image quality associated with the test.

Accurately record all the measurements made during the test and produce a report for the equipment.

Report the results to an appropriate individual and comment on any issues highlighted by the report.

Below are examples of the tests/measurements/calculations expected for each equipment type under test – full list found in current Institute of Physics and Engineering in Medicine guidance: General radiography: kilo-Voltage (kV), exposure time, focal spot size, Half Value Layer (HVL), filtration, light field alignment, X-ray field-bucky alignment, tube voltage, tube linearity, tube repeatability, tube output.

Intra-oral dental: kilo-Voltage (kV), X-ray beam alignment, Half Value Layer (HVL), filtration, tube voltage, tube linearity, tube repeatability, timer accuracy, measurement/estimation of patient skin dose.

Orthopantomogram (OPG): kilo-Voltage (kV), X-ray beam alignment, Half Value Layer (HVL), filtration, tube voltage, tube linearity, tube repeatability, timer accuracy, dose width product.

Fluoroscopy: kilo-Voltage (kV), input dose (all field sizes & programmes), patient entrance skin dose rate, maximum skin dose, threshold contrast, image size & collimation, spatial resolution, X-ray beam-image intensifier alignment.



Dose area product meter (DAP): calibration accuracy, change in calibration with variation of (i) tube voltage, (ii) field size.

Automatic exposure control (AEC): image receptor dose, repeatability, variation with (i) patient thickness (ii) tube voltage, consistency between chambers.

Computed Radiography (CR) reader: calibration of exposure indicator, system transfer process, system linearity, dark noise, non uniformity, erasure efficiency, threshold contrast, spatial resolution, scaling errors.

Direct digital (DDR): accuracy of detector dose indicator, dark noise, image uniformity, detector indicator reproducibility, system linearity, system transfer property, threshold contrast, scaling errors, spatial resolution, blurring & stitching artefacts.



Learning Outcome 9 Demonstrate the ability to participate in patient dosimetry procedures for both ionising and non-ionising applications. Competency The student will be able to:


Assist with the processing of Dose Area Product (DAP) data to generate local diagnostic reference levels (DRL), where available.

Use national data to identify diagnostic reference levels for different examinations, where Dose Area Product data is not collated locally.

Identify records that would not be included for the purpose of generating diagnostic reference levels.

Assist with patient dose surveys using methods other than Dose Area Product readings to gather data.

Observe the use of equipment output measurements to calculate patient dose following actual, suspected or simulated incidents.

Use patient dosimetry assessments and/or equipment quality Assurance results to identify areas where optimisation of processes and/or equipment settings may be required. Observe the methods used in the assessment of patient dose in UltraViolet therapy.



Observe the methods used to assess patient dose in radiotherapy and nuclear medicine.



Learning Outcome 10 Demonstrate the ability to perform Radiation Surveys for ionising and non-ionising installations. Competency The student will be able to:


Assist with radiation surveys for a range of installations eg. diagnostic x-ray, dental, radiotherapy, brachytherapy, nuclear medicine, laser, ultraviolet (UV) and intense light source (ILS). Assist with radiation surveys for temporary installations (eg. wards, operating theatres).

Assist with the routine testing of protective equipment used in diagnostic X-ray.

For each survey or test the student is able to:

Select appropriate equipment and documentation for assessments.

Follow the appropriate handover procedures on both arrival and departure.

Competently operate the test equipment used and identify common equipment faults.



Assist with all tests/observations/ calculations required to complete the survey e.g. general room assessment (warning lights, emergency isolators, local rules), leakage assessment, scatter measurements, lead equivalence measurements (of barriers, doors, walls and personal protective equipment), assessment of safety features, identify standard tube labelling. Accurately record all measurements/observations during the survey and produce a report. Identify any radiation safety implications. Report the results to an appropriate individual and comment on any issues highlighted by the report. Make recommendations on methods for improvement. Assist with environmental monitoring surveys using dosimeters or survey meters and comment on the advantages/disadvantages of each method.



Section 4.7 Division: Physical Sciences and Biomedical Engineering Theme: Medical Physics Technology Specialism: Nuclear Medicine Years 2 & 3: Work-based Training Learning Outcome 3 Demonstrate the ability to perform a full range equipment life cycle procedures as an equipment user. Competency The student will be able to:


Critically appraise the equipment, accessories or consumables as to whether they are fit for purpose.


Perform a visual inspection of equipment prior to use to ensure it is safe to use.

Perform risk assessments on equipment and its use.





Identify the cleaning/decontamination process for a range of equipment within the specialist area and then apply these processes to clean the equipment.



Perform user decontamination procedures on a range of equipment.




Learning Outcome 4 Demonstrate the ability to set up, optimise and operate imaging equipment safely so as to be able to produce the highest quality results for interpretation across a range of nuclear medicine investigations. Competency The student will be able to:


Perform basic operating features of the imaging equipment and its accessories e.g. Bed operation, gantry movement, collimators, positioning controls, emergency stop etc.

Operate the acquisition control and information processing system.

Use a suitable phantom and acquisition mode, operate equipment to investigate the effect of:

• Collimator selection • Photo Peak • Counts/time statistics • Positioning and orientation • Attenuation • Dual energy acquisition • Image manipulation and

presentation

Perform daily, weekly and monthly Quality Control using an appropriate source using standardised parameters, with an awareness of action thresholds. To include the following:

• Uniformity • Centre of rotation • Linearity • Spatial Resolution • Sensitivity



Be able to select and prepare suitable equipment for the procedure.

Recognise basic image anomalies and errors.

Interpret results so as to be able to recognise normal appearances and normal ranges, common artefacts and the possible causes of abnormal appearances.



Learning Outcome 5 Demonstrate the ability to perform all aspects of the preparation required including providing relevant information and instructions to the patient/carer to ensure the Nuclear Medicine investigations and treatment are successful. Competency The student will be able to:


Identify the roles of • Operator • Practitioner • Referrer

Identify the criteria acceptable for the delegated authority for the authorisation of referrals.

Identify when the practitioner justification is required.

Assist in scheduling appointments with regard to:

• Session arrangements • Radiopharmaceutical

availability • Equipment and room

availability • Staff availability • Patent transport

arrangements • Pre-medication

Ensure patient confidentiality at all times.

Demonstrate environmental cleanliness taking into account infection control requirements.

Check a patient’s identity according to local procedures.

Confirm the patients consent according to local protocol.



Confirm the justification and authorisation for procedures.

Check the study is appropriate to the patients clinical history provided and the study has been justified under local procedures.

Check there are no contraindications to proceeding routinely.

Give instructions and explanation of procedures to patients and/or other relevant persons.

Relay sufficient and accurate, relevant information to other departments to ensure the patient is correctly prepared and available.

Check relevant patient preparation has been undertaken.

Check for possible pregnancy or breast-feeding in women of reproductive capacity.

Be aware of local procedures for identifying non-standard occurrences during the procedure.

Give appropriate information and instructions to the patient to enable them to co-operate fully with procedure, using appropriate language and interpreters if necessary.

Assess patient’s needs and respond appropriately.

Display the ability to preserve a patient’s dignity, privacy, security and confidentiality.

Work within their skills and abilities to be sure the patient is not placed at undue risk or injury with due regard to a patient’s medical condition.



Demonstrate the ability to keep clear and accurate documentation that meets or exceeds the requirements in place through protocols, procedures, guidance, local rules and legislation.



Learning Outcome 6 Demonstrate the ability to Administer Radiopharmaceuticals whilst observing all safety, control of infection and radiation protection governance requirements.



Respond appropriately in the event of an adverse reaction.

Follow the procedure for reporting, in the event of an adverse reaction or extravasation

Complete the accredited training for venous sampling.

Complete the accredited training for Intra-Venous (IV) administration of Radiopharmaceuticals.

Explain the need for administration of adjunct drugs.

Identify adjunct drugs regularly used in Nuclear Medicine and their usual mode of administration.

Explain ‘Patient Group Directions’: • How they work • Who they relate to

Observe and assist with the operation of: • A syringe pump • Giving set



Complete the relevant training to administer radiopharmaceuticals and adjunct drugs via the following routes:

• Oral • Aerosol • Intravenous • Subcutaneous • Intramuscular

Confirm and calculate the patients’ dosage (relevant activity of radioactive material or medical dosage of pharmaceutical product).

Be aware of, and select a suitable site/ route for administration and if difficulties were to occur knows when, how and where to get support.




Learning Outcome 7 Demonstrate the ability to perform a range of Acquisition and Recording techniques used when carrying out Diagnostic Imaging procedures. Examples of typical procedures that might be included are

• Bone Scan (trauma, metastasis, infection, prosthesis), • Brain Scan (perfusion, 123I-Iofluopane (DaTSCAN) • Multiple Gated Acquisition scan (MUGA) • Cell Labelling (White cell 99mTc or 111Indium, Red cell mass) • Endocrine procedures (thyroid, parathyroid) • Gastro-intestinal (Hepatobilary, Oesophageal swallow, Gastric emptying,

Meckels, 23-Seleno-25-homo-tauro-cholate scan (SeHCAT) • In-vitro (procedures e.g. 51Cr-Ethylenediaminetetraacetic acid (EDTA),

Glomerular Filtration Rate (GFR), Schilling test) • Pulmonary (Perfusion, ventilation) • Renal procedures e.g. (Renogram (with & without diuresis), Micturating

cystogram, DiMercaptoSuccinic Acid (DMSA) scan • Positron Emission Tomography (Whole Body, Brain) • Lymph • Limb • Sentinel Node Biopsy



Use techniques appropriate to the patient’s condition to obtain optimal results.

Identify anatomical features and normal and abnormal bio-distributions in the full range of studies (see above).

Use supporting or immobilising equipment.

Select equipment and use relevant standard operating procedure (SOP) for appropriate data acquisition.

Carry out a wide range of imaging procedures according to local standard operating procedures.

For each type of procedure (see above) identify and document the following:

• Patient preparation • Reason for the examination



• Presenting pathology • Radiopharmaceutical

administered • Mode of uptake • Dose administered and the

Administration of Radioactive Substances Advisory Committee (ARSCA) limit

• Protocol used/views acquired • Normal and abnormal

appearances Recognise the possible need for extra views or spect studies as appropriate.

Recognise the need for further intervention (e.g. administration of a diuretic).

Perform basic routine processing and analysis according to protocols e.g. Static studies, dynamic studies, spect and gated studies.

Perform complex processing to include Myocardial Perfusion Imaging and filter choice for Single Photon Emission Computed Tomography.


Observe/assist in the acquisition and recording of Hybrid imaging (e.g. Single Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) and Positron Emission Tomography/Computed Tomography (PET/CT).



Learning Outcome 8 Demonstrate the ability to perform a range of Nuclear Medicine Therapy procedures used in the clinical treatment pathway of patients. Competency The student will be able to:


Assist and observe in the administration of therapy To include at least one of the following:

• 131 I for benign and malignant disease of the thyroid gland

• 90Y • 131 I-MIBG for treatment of

adrenal tumours • 89Sr for the treatment of bone

metastases

For each type of therapy procedure observed:

• Identify the protocol to be used

• Confirm appropriate authorisation and justification

• Identify the practitioner with the specific Administration of Radioactive Substances Advisory Committee (ARSAC) certificate

• Assist in the patient preparation

o Including pre administration checks including medication.

• Explain the differences between radiopharmaceutical administered, mode of uptake and radiation emissions and the impact this may make on the patient

• Assist in delivering specific patient and patient carer information including radiation protection, instructions following administration

• Assist in the disposal of waste according to protocol and monitoring procedures.





Learning Outcome 9 Demonstrate the ability to work in a Radiopharmacy safely and within the legislative and statutory framework to prepare and dispense radiopharmaceuticals for use in the diagnosis or treatment of patients. Competency The student will be able to:


Identify the classification of rooms.

Check and confirm the air handling unit work stations/isolators are working within specification and be aware of action levels.

Be able to explain the classification of rooms and the air handling unit.

Check the environmental integrity (room and cabinet pressures) and be aware of the action levels.

Explain the different types of preparation with respect to open and closed procedures.

Complete the operator tests.

Assist in the radiopharmacy documentation.

Elute a 99mTc generator to include:

• Elution procedure • Carry out the procedure for

Molybdenum breakthrough • First line Quality Control • Measure activity of eluate

Calculate the required volume of individual patient doses based on the required activity and the time of injection. (Taking into account patient factors e.g. paediatrics and patients weight).



Reconstitute a range of commercial kits in accordance with written procedure being aware of the different production techniques involved.

Measure activity of reconstituted kits.

Demonstrate an awareness of the procedure for use of unlicensed products and the roles of those involved.

Identify and explain the procedures to be followed when there are failures of equipment, products or Quality Control Tests.

Identify and explain the procedures to be followed in the event of a recall of products e.g. Quality Control failure, manufacturer recall.

Complete the documentation for the receipt of both active and non-active products.


Be aware of procedures in case of failures of equipment, products or Quality Control Tests.

Perform radioactive contamination monitoring.

Be aware of and perform the procedures for use of unlicensed products to include products, which are purchased as finished products, prepared from unlicensed kits or prepared according to in-house formulae.



Learning Outcome 10 Demonstrate the ability to apply quality control procedures within the Radiopharmacy to establish and maintain a safe environment, which meets all legislative and medicine inspectorate requirements.



Carry out first line Quality Control to include:

• Inspection for particles • Expected activity • PH • Radionuclide concentration • Radiochemical purity

Perform Radiochemical purity (RCP) for a range of radiopharmaceuticals.

Participate in the environmental testing of the radiopharmacy to include:

• Settle plate testing • Particle counting • Contact plates • Observation and recording of

room pressures, fridge temperatures etc.

Be aware of and perform the procedures release / failure of product.

Complete the documentation regarding the results of Quality Control carried out in the radiopharmacy.



Learning Outcome 11 Demonstrate the ability to perform Tracer Methodology procedures in Nuclear Medicine investigations.



Assist/perform Red Cell Volume determination including:

• Labelling blood cells • Preparation of injection • Assisting with the injection

and taking of the blood samples

• Preparation of standards and samples for counting

• Assaying the activity of the samples

• Calculation of the red cell volume.

Assist/perform white cell labelling using either 99mTc or 111In.



Learning Outcome 12 Demonstrate the ability to use a dose calibrator in the preparation and measurement of radioactivity.



Explain the construction of the dose calibrator.

Use the dose calibrator to measure the activity of radiopharmaceuticals.

Measure the changes in readings of activity when a radioactive sample is positioned at different depths.

Measure changes in readings of activity when samples are in different volumes.

Measure the linearity over the range of activities used in practice.

Demonstrate readings obtained from the same activity in different containers e.g. syringe, bottle and vial.

Perform Quality Control in accordance with local procedures and be aware of the procedure for reporting any deviations.



Learning Outcome 13 Demonstrate the ability to perform In-Vitro procedures in Nuclear Medicine. Competency The student will be able to:


Perform or confirm routine Quality Control procedures on monitoring or measuring equipment.

Use preventative measures when dealing with potential microbiological or radiation hazards.

Pipette a series of samples, weighing the sample each time Calculate the accuracy of pipetting.

Prepare samples for counting in an auto gamma counter.

Operate an auto gamma counter in accordance with a pre-defined protocol to produce a single energy spectrum.

Count a mixture of two radionuclides. Calculate cross channel contribution to demonstrate the need for cross channel correction in a sample of more than one radionuclide.

Prepare a standard stock solution according to a written protocol.



Process data produced by an auto gamma counter in accordance with pre defined protocol.

Perform a Glomerular Filtration Rate (GFR) determination to include:

• Preparation of injection • Assisting with the

administration of the radiopharmaceutical and taking of blood samples

• Preparation of standards and samples for counting

• Assaying activity of samples• Calculation of results

After in-vitro testing, safely dispose of all waste materials, clean the area and monitor for radioactive contamination as per written protocols.



Learning Outcome 14 Demonstrate the ability to work safely within the legislative and policy framework around the safe use of ionising radiation within a hospital environment. Competency The student will be able to:


Identify the designated areas of the department noting the features and restrictions for each area.

Identify the areas where radioactive materials are stored, handled and disposed of.

Identify the survey meters used in the department, and be aware of which meter to use for which application.

Check the meters are working correctly in routine use, by checking the power supply and background levels.

Perform reference source checks and understand the need for reporting deviations from the norm.

Be aware of and have basic understanding of National legislation, European Directives and National & International recommendations on radiation safety.



Identify the limits set out in the departmental certificate for receipt, storage and disposal of radioactive materials issued by the environment agency.

Identify the department’s Radiation Protection Adviser (RPA) and Radiation Protection Supervisor (RPS) and explain their roles.

Work according to the department’s local rules, procedures and protocols.

Work in accordance with the departments protocols for

• Acceptance • Storage • Handling • Waste disposal • Labelling • Packaging • Transporting of radioactive

materials.

Use gloves, shielding, distance and speed to reduce exposure and contamination.

Use equipment used to contain spillage.

Identify the location and confirm the contents of the department’s decontamination kit.

Document a radiation incident.

Carry out and document personal and environmental monitoring for radioactive contamination in accordance with local protocol.



Apply local protocols for the disposal of radioactive waste including:

• Segregation and labelling of different types of radioactive waste

• Estimation of storage activity

• Estimation of disposal activity

• Record keeping.

Package and label radioactive materials for transport in accordance with local procedures.

Assist in giving instructions to other personnel and patients to include:

• Doses given and hazards to patients

• Hazards arising from patients to staff/family/carers

• Appropriate care to be given following a Nuclear Medicine procedure

• Instructions for pregnant or breastfeeding patients.

Identify procedures for pregnant or breastfeeding staff to minimise radiation dose.

Perform a risk assessment in the clinical environment.

Participate actively in Clinical Audit including appropriate statistical analysis.



Participate in preparing and tidying areas where radioactive materials are handled or used so as to ensure present no unexpected risk.

Perform radioactive contamination monitoring.



Appendix 1

Direct Observation of Practical/Procedural Skills

Template: Medical Physics Technology

Clinical context:

Insert Module Title

Insert Module Title Insert Module Title

Procedure: Trainee identification data

Assessor’s Name: Assessor’s position:

Insert Insert

Difficulty of the procedure: Low Average High

Number of times procedure performed by student: 1-4 5-9 >10

Please grade the following areas using the scale below

Bel

ow

expe

ctat

ions

Bor

derli

ne

Mee

ts

expe

ctat

ions

Abo

ve

expe

ctat

ions

Una

ble

to

com

men

t 1

1. Understands scientific principles of

procedure including basic science underpinning it

2. Has read, understands and follows the appropriate SOP’s, risk and COSHH assessments, and any other relevant H&S documentation

3. Understands and applies the appropriate internal and external quality control associated with the procedure

4. Understands the risks associated with items of equipment and uses them appropriately



5. Accurately completes associated documentation

6. Output meets accepted laboratory/professional standards

7. Carries out the procedure within appropriate time frame

8. Is aware of the limitations of the test

9. Demonstrates awareness of the limits of responsibility and when to seek advice

10. Professionalism

1 Please mark this if you have not observed the behaviour

FEEDBACK AND DOCUMENTATION OF LEARNING NEEDS

AGREED ACTION

Outcome Satisfactory

Unsatisfactory Date of assessment

Time taken for assessment:

Signature of Assessor

Signature of Student

Time taken for feedback:



Appendix 2

Case Based Discussion Template for PTP in Medical Physics Technology

Student identification data

Module: Insert Title Insert Title Insert Title Complexity

of the scenario:

Low Average High

Brief description of output and

focus of scenario discussed:

Assessor’s Name: Assessor’s position:

Please grade the following areas using the scale below

Bel

ow

expe

ctat

ions

B

orde

rline

Mee

ts

expe

ctat

ions

Abo

ve

expe

ctat

ions

Una

ble

to

com

men

t 1

1. Understands clinical and/or

scientific principles relevant to scenario

2. Can discuss relevant health and safety issues

3. Can discuss the procedures used to obtain the results

4. Can discuss the quality control procedures to ensure the result is accurate

5. Demonstrates a knowledge of relevant ‘Best Practice’ guidelines and other policies relevant to the scenario

6. Can discuss the significance of routine patient results with reference to the reason for referral





7. Is aware of, and can use as required, appropriate resources to aid in the interpretation of results

8. Is aware of importance of audit trail and can complete audit trail accurately

9. Demonstrates awareness of the limits of responsibility and when to seek advice

10. Professionalism

1 Please mark this if you have not observed the behaviour

FEEDBACK AND DOCUMENTATION OF LEARNING NEEDS

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Outcome Satisfactory Unsatisfactory

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Physical Sciences and Biomedical Engineering: Medical Physics Technology … › networks › nhs-networks › msc... · 2011-11-18 · Division: Physical Sciences and Biomedical