Module - Radionuclide Therapy

Work-based learning outcomes

  1. Advise on the choice of radiopharmaceutical for radionuclide therapy in terms of the physical properties of the radionuclide, the physiological properties of the radiopharmaceutical and the clinical context of the procedure
  2. Advise on and perform practical aspects of the administration of radionuclide therapy to patients
  3. Specify, and explain to the patient, the post-therapy behavioural restrictions placed on them
  4. Specify the facilities required for radionuclide therapy
  5. Implement and advise on the principles of management of radiation safety associated with radionuclide therapy administrations and patients
  6. Undertake practical radiation safety tasks required to deliver a service, including the effective communication of risk, decontamination procedures and radioactive waste management
  7. Specify and perform the radiation monitoring of inpatients to determine their point of release
  8. Implement the principles of internal radiation dosimetry, patient-specific dosimetry protocols and their requirements for data acquisition and analysis

Work-based Competencies

Learning outcome Title Knowledge
1 2,3,4,7

Generate or critically review the design of suitable equipment and facilities for patient therapies-
  • Design of inpatient rooms for radiation protection, including fixed and/or portable room shielding, aqueous waste management and minimisation of contamination
  • Shielding, eg for internal transport, administration, waste containment
  • The patient experience and needs of patients including those with physical or language difficulties
2 1,2

Advise on the appropriateness of requests for the administration of radionuclide therapy
  • Clinical applications of radionuclide therapy
  • Relevant requirements under IRMER, IRR99, MDGN, revision of local rules
  • Requirements of radiopharmaceutical regarding route of administration and radiation protection
  • Risks for patients, staff and the public
  • Information needs of patients associated with radionuclide therapy
3 1,2,3

Prepare or critically review a radiation risk assessment for the administration of a particular form of radionuclide therapy
  • Clinical applications of radionuclide therapy
  • Relevant requirements under IRMER, IRR99, MDGN, revision of local rules
  • Requirements of radiopharmaceutical regarding route of administration and radiation protection
  • Risks for patients, staff and the public
  • Information needs of patients associated with radionuclide therapy
4 2,3,5

Write or critically review standard operating procedures for the administration of particular form(s) of radionuclide therapy, incorporating the results of the risk assessment
  • Clinical applications of radionuclide therapy
  • Relevant requirements under IRMER, IRR99, MDGN, revision of local rules
  • Requirements of radiopharmaceutical regarding route of administration and radiation protection
  • Risks for patients, staff and the public
  • Information needs of patients associated with radionuclide therapy
5 2,3

Perform a tailored radiation risk assessment and instructions for those in contact with an individual radionuclide  therapy outpatient
  • Radiopharmaceutical retention and route(s) of excretion, IRR99
  • Effective written and oral communication with regard to radiation protection
6 2,3,4,5,7

Prepare or review written instructions for staff on the management of inpatients receiving a particular radionuclide therapy, and give advice to staff in accordance
  • Requirements of local rules to address the delivery of this service
  • Systems of work for good and safe practice
  • Contingency planning staff needs for information and advice
  • Support available for staff who support inpatients
  • Inpatient needs in relation to information, advice and support
7 2,6

Actively contribute to the administration of a range of radionuclide therapies, including at least iodine-131 for thyroid cancer and benign thyroid disease
  • Appropriate radiation protection advice, including monitoring programmes, design and testing of customised radiation shielding, and radioactive waste management under EPR
  • Training of non-specialist clinical staff in radiation protection as applied to their role
  • The patient experience of administration of oral radiopharmaceuticals and their need for information and support
8 2,6

Assist and advise medical practitioners in the administration of non-oral radionuclide therapies, eg by intravenous infusion
  • Appropriate radiation protection advice, including monitoring programmes, design and testing of customised radiation shielding, and radioactive waste management under EPR
  • Training of non-specialist clinical staff in radiation protection as applied to their role
9 3

Advise patients and their carers on appropriate post-therapy behavioural restrictions
  • Requirements for behavioural restriction in outpatient and inpatient contexts, and with reference to the specific radionuclide and radiopharmaceutical, and relevant individual patient circumstances
10 7

Actively participate in the monitoring of inpatients to determine effective half-life and/or residual activity and managing the criteria for release of inpatients based on the results of this monitoring
  • Physical properties of radionuclide(s) used, and retention and route(s) of excretion of radiopharmaceuticals used
  • The appropriate selection, operation, calibration and quality assurance of radiation monitors/detectors
  • Relevant requirements under IRMER, IRR99, MDGN
  • Patient engagement in the monitoring process
11 6

Perform contamination monitoring and decontamination of a treatment room post radionuclide therapy administration
  • Radiopharmaceutical retention and route(s) of excretion
  • Ionising Radiations regulations 1999 (IRR99), Environmental Permitting Regulations (EPR)
  • Selection and operation of contamination monitors, including detectors, decontamination measures and radioactive waste management under EPR
  • Implications of ineffective monitoring and decontamination for patients, staff and public
12 6

Record, store and dispose of radioactive waste produced as a result of radionuclide therapy
  • EPR requirements for management of radiation waste and detailed compliance with EPR conditions
13 1-8

Participate in clinical audit of radionuclide therapy
  • Awareness of appropriate metrics to audit and awareness of the audit process, including audit loop
14 7,8

Actively participate in acquisition of imaging data and/or data from radiation detectors/monitors
  • Data acquisition protocols optimised for the acquisition of quantitative data collected to determine organ, tumour and/or whole body retention for patient-specific dosimetry protocols
15 8

Actively participate in calculating absorbed radiation doses to target and non-target tissues for therapy protocols guided by patient-specific dosimetry
  • The principles of internal radiation dosimetry for determining patient specific organ/whole body and tumour radiation doses
  • The importance of tumour (target) dose and critical normal organ/whole body doses in the planning and management of patient- specific radionuclide therapies
  • Protocols for the patient-specific determination of tumour and/or normal organ/whole body radiation dose

Work-based assessment

Complete 1 Case-Based Discussion(s)
Complete 1 of the following DOPS and/or OCEs
Type Title
DOPS Monitor a patient in the therapy room
DOPS Administer a therapy for benign thyroid disease, under supervision
DOPS Set up under supervision a therapy infusion
DOPS Decontaminate a therapy room once the patient has left
DOPS Analyse the monitoring data to calculate the activity remaining in a therapy patient when they leave hospital.
DOPS Prepare instructions for a therapy patient on leaving hospital.
DOPS Calculate the total activity administered to a patient by calculating activity of waste. Record results and store waste appropriately.
DOPS Perform a tailored risk assessment for a patient undergoing out-patient therapy.
OCE Explain details of a therapy administration to a patient
OCE Explain precautions to a patient who has had Radioiodine therapy for benign thyroid disease
OCE Explain precautions to a patient who has had Radioiodine therapy for thyroid cancer.
OCE Explain monitoring procedure to a therapy patient
OCE Give a presentation about the shielding requirements of different types of radionuclide therapy.