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Nuclear Medicine GRI – Placement details - Weeks are interchangable Week 1 Week 2 1.1 General Introduction to 2.1 Thyroid clinic Monday imaging 2.2Therapies Friday including 1.2 Sample films program radiation protection precautions 1.3 Daily QC of calibrator and Tues-Thurs drawing up 2.3 Bone Lung and Renograms and follow patient pathway Week 5 Week 6 GGH- M-W SGH – M VIC – Th-F GRI-Tu-F 5.1 PET/CT 5.2 Beta counting – breath tests 6.1 MUGA/RNVG + specialist brain 5.3 Stress/Rest myocardial perfusion + reporting 6.2 White cell labelling 6.3 GFR preparation and calculation 6.4 Investigate spectra Week 9 Week 10 10.1 Geometry of samples for counting 10.2 Radionuclide calibrator geometry/I123 counting 10.3Tumour imaging including SPECT CT and attenuation correction (octreotide/mibg/parathyroid) WIG Tu-Th 9.1 Radiopharmacy (3 days) GRI- Th-F 9.2 Infection control audit 9.3 Handwashing audit 9.4 Fire audit 9.5 H&S management manual Week3 3.1 Renogram analysis 3.2 DMSA 3.3 Gastric (including meal preparation) 3.4 Hida – include analysis and check at least one manually Week 7 7.1 IRR99 – Local rules and contingency 7.2 IRMER 7.3 RSA 7.4 ARSAC 7.5 Audit doses/DRLs for week 1-4 of placement including SPECT CT 7.6 Include seeing waste disposal 7.7 Staff dose monitoring 7.8 Review a Datix incident Week 4 4.1 QC of gamma cameras and other equipment – uniformity, sensitivity count rate etc 4.2 Image artefacts Week 8 8.1 Williams phantom and SPECT phantom acquisition parameters and collimators Throughout: Observe bone, brain and lung studies if possible – make sure this includes SPECT reconstruction and SPECT CT Observe sentinel node study if possible Attend reporting sessions, Attend staff meetings Find out how data is archived, Undertake contamination monitoring at the end of the day – or if there has been a spill under the direction of the RPS Generate workload figures for weeks 1-8 of placement and use these to calculate liquid waste disposal for this period Competency/Learning Outcome mapping for Training Plan Key Competences STP work based Training task from plan above – knowledge and skills Learning learning guide Outcomes IR1 Perform routine quality control measurements on gamma cameras, Single-photon emission computed tomography (SPECT/ Computed Tomography (CT)) scanners and Positron emission tomography (PET)/CT scanners if available. 4.1 QC of gamma cameras and other equipment – uniformity, sensitivity count rate etc 5.1 PET/CT 2.1 Thyroid clinic Monday 2.2Therapies Friday including radiation protection precautions 2.3 Bone Lung and Renograms and follow patient pathway 3.1 Renogram analysis 3.2 DMSA 3.3 Gastric (including meal preparation) 3.4 Hida – include analysis and check at least one manually 4.2 Image artefacts 5.3 Stress/Rest myocardial perfusion + reporting 6.1 MUGA/RNVG + specialist brain Good Scientific Practice Comptence Throughout all 1.1 Professional Practice competencies should be covered, in addition 1.2.4, 1.2.5 and all of 1.3 Working with Colleagues – this will be assessed by supervisors and feedback given where appropriate 2.1.1, 2.3.1, 2,3,4 2.1.2 10.3 Tumour imaging including SPECT CT and attenuation correction (octreotide/mibg/parathyroid) Undertake a written review of a chosen patient pathway – e.g. Thyroid patient 3.1.10, 3.2.3 IR1 Investigate the effects of acquisition parameters and post- acquisition processing and display on planar image. This should include planar, SPECT, SPECT/CT and/or PET/CT imaging if available. 1.1 General Introduction to imaging 1.2 Sample films program 8.1 Williams phantom and SPECT phantom acquisition parameters and collimators 5.1 PET/CT 2.1 Thyroid clinic Monday 2.2Therapies Friday including radiation protection precautions 2.3 Bone Lung and Renograms and follow patient pathway 3.1 Renogram analysis 3.2 DMSA 3.3 Gastric (including meal preparation) 3.4 Hida – include analysis and check at least one manually 4.2 Image artefacts 5.3 Stress/Rest myocardial perfusion + reporting 6.1 MUGA/RNVG + specialist brain 10.3 Tumour imaging including SPECT CT and attenuation correction (octreotide/mibg/parathyroid) 2.1.3, 2.1.4 IR2 Establish appropriate operating conditions for sample counters, 6.3 GFR preparation and calculation 6.4 Investigate spectra 2.1.5, 2.1.6 including energy calibration and choice of energy. IR2 Perform routine quality control measurements on sample counters and associated equipment, e.g. centrifuges 6.3 GFR preparation and calculation 6.4 Investigate spectra IR2 Investigate the effect on measured count-rate of factors such as energy window setting, sample volume and source– detector geometry for in-vitro and in-vivo counters. 10.1 Geometry of samples for counting 10.2 Radionuclide calibrator geometry/I123 counting IR2 Prepare radioactive samples and 6.3 GFR preparation and calculation standards for counting. 6.4 Investigate spectra 2.2.4 IR2 Assist in routine patient investigations using uptake counters, gamma spectrometers, manual and automatic beta and gamma sample counters correctly and safely, and, where possible, other equipment such as whole body counters demonstrating patient-centred, safe practice 2.2.6 6.3 GFR preparation and calculation 6.4 Investigate spectra 5.2 Beta counting – breath tests 6.2 White cell labelling 2.2.1 and the effect of equipment settings and counting geometry on measured count-rates. IR2 Control of infection risks pre, during and post investigations and actions taken to manage these. 9.2 Infection control audit 9.3 Handwashing audit IR2 Analyse data from non-imaging tests to give quantitative physiological information. 6.3 GFR preparation and calculation 2.2.2 2.2.6 2.2.7 2.2.8 2.3.4 3.1.17 2.2.1 IR3 Measure and record air pressures in the rooms of a radiopharmacy. 9.1 Radiopharmacy 2.3.1, 2.3.2 IR3 Perform QC testing of the Tc99m generator eluate, including yield, radionuclide purity and chemical purity. 9.1 Radiopharmacy 2.3.1, 2.3.2 IR3 Prepare a technetium-99m radiopharmaceutical kit. 9.1 Radiopharmacy 2.3.1, 2.3.2 IR3 Measure the radiochemical purity of a technetium-99m 9.1 Radiopharmacy 2.3.1, 2.3.2 labelled radiopharmaceutical. IR3 Perform routine quality assurance measurements on a radionuclide calibrator 1.3 Daily QC of calibrator and drawing up 2.3.1, 2.3.2 IR4 Handle sealed and unsealed radioactive sources, demonstrating the application of the principles of time, distance and shielding to minimise radiation dose. 1.3 Daily QC of calibrator and drawing up 2.3.1, 2.3.2 IR6 Measure or calculate patient doses for a range of examinations, including the estimation of foetal dose. 3.1.17 IR6 Calculate the risks and the risk factors associated with patient doses 7.1 IRR99 – Local rules and contingency 7.2 IRMER 7.3 RSA 7.4 ARSAC 2.2Therapies Friday including radiation protection precautions 7.1 IRR99 – Local rules and contingency 7.2 IRMER 7.3 RSA 7.4 ARSAC 2.2Therapies Friday including radiation protection precautions 9.4 Fire audit 9.5 H&S management manual 3.1.17 RP1 Undertake risk assessment for a radiation facility. 7.1 IRR99 – Local rules and contingency RP2 Calibrate and test equipment that measures radiation and obtain measurements required and the safety features to be tested as part of the critical examination. 1.3 Daily QC of calibrator and drawing up 2.3.1, 2.3.2 ,2.3.3 RP2 Confirm acceptability of radiation levels within the defined area or distance from the source. 7.1 IRR99 – Local rules and contingency 2.3.4 RP3 Undertake a simple audit of an area where radiation is used according to local standard operating procedures 7.2 IRMER 7.5 Audit doses/DRLs for week 1-4 of placement including SPECT CT 2.3.4, 3.1.17 RP3 Report findings; specify degree of compliance, recommendations for further action and date of follow-up review. 7.2 IRMER 7.5 Audit doses/DRLs for week 1-4 of placement including SPECT CT Report at weekly staff meeting 2.3.4 RP4 Participate in, or review, patient 7.5 Audit doses/DRLs for week 1-4 of placement 2.3.4, 3.1.17 dose audit data to assess including SPECT CT optimisation including the use of diagnostic reference levels RP7 Critically appraise contingency plans within local rules. 7.1 IRR99 – Local rules and contingency 7.3 RSA 7.4 ARSAC 2.2.7, 2.3.1 RP7 Identify and plan an exercise to rehearse contingency plans (e.g. contamination incident, loss of source). 7.1 IRR99 – Local rules and contingency 7.3 RSA 7.4 ARSAC 7.6 Include seeing waste disposal 2.2.7, 2.3.1 RP7 Analyse recent radiation incidents and summarise the types and causes of incidents 7.1 IRR99 – Local rules and contingency 7.2 IRMER 7.3 RSA 7.4 ARSAC 7.8 Review a Datix incident 2.2.7, 2.3.1 Appendix 1 For reference : Extract from STP Work based practice – learning outcomes for Imagine with ionising radiation and Radiation safety physics MODULE TITLE Imaging with IR (IIR) 3.6.1 COMPONENT Rotation AIM To introduce the trainee to a range of equipment and techniques used in Nuclear Medicine and Diagnostic Radiology and understand the effects of image acquisition parameters and post processing. SCOPE On completion of this module the trainee will be able to operate a range of equipment for equipment performance evaluation, patient dose measurement and clinical imaging. LEARNING OUTCOMES On successful completion of this module the trainee will: Radionuclide Imaging IR1. Demonstrate safe practice when working with sources of ionising radiation, including X-ray equipment, sealed and unsealed radioactive material. Non-Imaging Radionuclide Tests IR2. Assist in routine patient investigations using uptake counters, gamma spectrometers, manual and automatic beta and gamma sample counters correctly and safely, and, where possible, other equipment such as whole body counters, demonstrating patient-centred, safe practice and the effect of equipment settings and counting geometry on measured count-rates. Radiopharmacy IR3. Perform a range of procedures in the radiopharmacy correctly and safely, including quality assurance tests of facilities, products, equipment and radionuclide calibrators. Radiation Protection IR4. Handle sealed and unsealed radioactive sources safely and use safe practice when working with X-ray equipment. Diagnostic Radiology Equipment Performance IR5. Operate radiographic and fluoroscopic equipment for the purpose of performance testing and undertake performance tests on a basic range of Xray equipment. Patient Dose Measurements IR6. Make and collate patient dose measurements, calculating patient doses for a range of examinations, including the calculation of foetal dose. CLINICAL EXPERIENTIAL LEARNING The clinical experiential learning for this module is: Observe and describe a range of common nuclear medicine scans, undertake analysis of the results and discuss with your training officer how the clinical scans contribute to the diagnosis and management of patients. Observe and participate in the performance of a range of non-imaging in-vivo and in-vitro tests, including measurements of volume, uptake and clearance, and discuss the evidence base underpinning these procedures with your training officer. Observe the routine production of radiopharmaceuticals and participate in routine quality assurance procedures within the radiopharmacy and describe the role of the radiopharmacy in patient care. Participate in the performance assessment of a range of common X-ray imaging equipment and discuss the evidence base underpinning these measurements with your training officer. Audit and calculate patient doses from a range of procedures and discuss the evidence base underpinning these calculations with your training officer. All of these experiences should be recorded in your e-portfolio. The following section details the competence and knowledge and understanding each trainee must gain. Each competence is linked to the relevant learning outcomes and trainees must demonstrate achievement of each competence for each linked learning outcome. PROFESSIONAL PRACTICE Trainees should ensure they refer to the professional practice learning framework and continue to achieve the professional practice competences alongside the competences defined in this module. MODULE TITLE Radiation Safety Physics (RADS) 3.6.1 COMPONENT Rotation AIM To introduce the trainee to legislation, policies, procedures and the practical implementation of radiation safety in healthcare. SCOPE On completion of this module, the trainee will have undertaken a range of assessments, measurements and tests based on understanding of the requirements, standards and policy for radiation safety. They will have participated in a range of radiation measurement and audit activities, including quality assurance, the optimisation of practices and the design of new facilities. LEARNING OUTCOMES On successful completion of this module the trainee will: RP1. Produce a design specification for planned new facilities or services requiring a radiation risk assessment, which includes essential control features. Facility Safety Assessment RP2. Calibrate and test equipment that measures radiation and perform a safety assessment of a radiation facility. Radiation Safety Audits RP3. Undertake a simple audit of an area where radiation is used according to local standard operating procedures. Optimisation RP4. Use the results of patient dose audit to assess and interpret the optimisation of practices. RP5. Participate in measurements of image quality and patient dose for the same practice. Measure Radiation Levels RP6. Select and use appropriate instruments and test equipment to measure and record levels and characteristics of radiation. Contingency Plans RP7. Assist in implementing safe and effective working practices in radiation areas, including response to radiation incidents and contingency planning. Policy and Procedures RP8. Critically appraise the content of local rules against legislative requirements for ionising and non-ionising radiation settings.