Module - Imaging with Ionising Radiation (SPE101)

STP

Aim of this module

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.

Work-based learning outcomes


  1. Demonstrate safe practice when working with sources of ionising radiation, including X-ray equipment, sealed and unsealed radioactive material.
  2. 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.
  3. Perform a range of procedures in the radiopharmacy correctly and safely, including quality assurance tests of facilities, products, equipment and radionuclide calibrators.
  4. Handle sealed and unsealed radioactive sources safely and use safe practice when working with X-ray equipment.
  5. Operate radiographic and fluoroscopic equipment for the purpose of performance testing and undertake performance tests on a basic range of X-ray equipment.
  6. Make and collate patient dose measurements, calculating patient doses for a range of examinations, including the calculation of foetal dose.

Work-based Competencies


Learning outcome Title Knowledge
1 1

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.

  • Principles of quality assurance and equipment quality control.
  • The purpose of the different types of test.
  • How to operate imaging equipment, the factors that affect dose and image quality, and the intended use of the equipment.
  • The range of suitable tests to carry out on equipment to establish safe, consistent and expected operation.
  • How to analyse data, estimate errors and perform statistical analyses.
  • The risks and consequences of poor results.
  • Current guidelines and legislative requirements for imaging equipment testing.
  • The performance and limitations of test equipment.
  • The key performance parameters for evaluation.
  • The impact of differences in performance on clinical purpose.
  • Implications for dose and image quality introduced by different equipment options.
  • Appropriate specifications for different clinical requirements.
  • How a range of common clinical scans are acquired, including planar bone, planar kidney, SPECT myocardial perfusion and PET tumour imaging.
  • Performance criteria, including remedial and suspension levels, for a broad range of imaging equipment.
  • Principles and techniques of measurement and assessment.
2 1

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.

  • Principles of quality assurance and equipment quality control.
  • The purpose of the different types of test.
  • How to operate imaging equipment, the factors that affect dose and image quality, and the intended use of the equipment.
  • The range of suitable tests to carry out on equipment to establish safe, consistent and expected operation.
  • How to analyse data, estimate errors and perform statistical analyses.
  • The risks and consequences of poor results.
  • Current guidelines and legislative requirements for imaging equipment testing.
  • The performance and limitations of test equipment.
  • The key performance parameters for evaluation.
  • The impact of differences in performance on clinical purpose.
  • Implications for dose and image quality introduced by different equipment options.
  • Appropriate specifications for different clinical requirements.
  • How a range of common clinical scans are acquired, including planar bone, planar kidney, SPECT myocardial perfusion and PET tumour imaging.
  • Performance criteria, including remedial and suspension levels, for a broad range of imaging equipment.
  • Principles and techniques of measurement and assessment.
3 2

Establish appropriate operating conditions for sample counters, including energy calibration and choice of energy.

  • The range of radionuclides, radioactivity administered and radiation dose in relation to clinical studies.
4 2

Perform routine quality control measurements on sample counters and associated equipment, e.g. centrifuges.

  • The range of radionuclides, radioactivity administered and radiation dose in relation to clinical studies.
5 2

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.

  • The range of radionuclides, radioactivity administered and radiation dose in relation to clinical studies.
6 2

Prepare radioactive samples and standards for counting.

  • Correct use of associated equipment, e.g. pipettes, centrifuges, etc.
  • The objectives of the work involving the use of radiation.
  • Current working practices within the organisation.
  • Lines of communication within the organisation.
  • Accepted standards of working practice in the field of radiation use.
7 2

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.

  • The relevant health and safety regulations specific to each investigation.
  • How to communicate with patients in a way that respects their dignity, rights, privacy and confidentiality.
  • The importance of checking patient identity, explaining the procedure to the patient and gaining informed consent.
  • The information needs of patients, common questions and concerns of patients about investigations pre, during and post investigation.
  • The authority level for provision of information to patients.
  • Process of notifying patients of the results.
  • The relevant procedures and requirements for patient conformance.
  • Clinical indications for, contraindications to, risks and benefits of each investigation.
  • Principles, guidance and law with respect to informed consent and trust governance procedures.
8 2

Control of infection risks pre, during and post investigations and actions taken to manage these.

  • Protocols and requirements for hygiene and infection control related to the relevant range of investigations, including preparation, conduct and completion of investigation.
  • Protocol for hand washing and how effective hand washing contributes to control of infection.
9 2

Analyse data from non-imaging tests to give quantitative physiological information.

  • The range, purpose, principles, capabilities and limitations of technology to be evaluated.
  • Relevant performance parameters and their significance to clinical requirements.
  • The range of existing evaluation methodologies and their application to new technology.
  • Methods of measurement of image quality, acquisition, processing and display.
  • Methods of measurement of dose and the implications of the results.
10 3

Measure and record air pressures in the rooms of a radiopharmacy.

  • Good Manufacturing Practices (GMP) requirements and associated guidelines for standards of working environment.
  • Physical and chemical properties of radiopharmaceuticals used for diagnostic and therapeutic nuclear medicine.
  • How to identify and comply with relevant national and international legislation and guidelines.
  • The range of relevant standard operating procedures.
  • Radiation protection guidelines and their application including local rules, environmental permitting, RSA93 (Scotland) and associated documentation for correct handling of radioactive materials.
11 3

Perform QC testing of the Tc-99m generator eluate, including yield, radionuclide purity and chemical purity.

  • Good Manufacturing Practices (GMP) requirements and associated guidelines for standards of working environment.
  • Physical and chemical properties of radiopharmaceuticals used for diagnostic and therapeutic nuclear medicine.
  • How to identify and comply with relevant national and international legislation and guidelines.
  • The range of relevant standard operating procedures.
  • Radiation protection guidelines and their application including local rules, environmental permitting, RSA93 (Scotland) and associated documentation for correct handling of radioactive materials.
12 3

Prepare a technetium-99m

  • Good Manufacturing Practices (GMP) requirements and associated guidelines for standards of working environment.
  • Physical and chemical properties of radiopharmaceuticals used for diagnostic and therapeutic nuclear medicine.
  • How to identify and comply with relevant national and international legislation and guidelines.
  • The range of relevant standard operating procedures.
  • Radiation protection guidelines and their application including local rules, environmental permitting, RSA93 (Scotland) and associated documentation for correct handling of radioactive materials.
13 3

Measure the radiochemical purity of a technetium-99m labelled radiopharmaceutical.

  • Good Manufacturing Practices (GMP) requirements and associated guidelines for standards of working environment.
  • Physical and chemical properties of radiopharmaceuticals used for diagnostic and therapeutic nuclear medicine.
  • How to identify and comply with relevant national and international legislation and guidelines.
  • The range of relevant standard operating procedures.
  • Radiation protection guidelines and their application including local rules, environmental permitting, RSA93 (Scotland) and associated documentation for correct handling of radioactive materials.
14 3

Perform routine quality assurance measurements on a radionuclide calibrator.

  • Methods for both radiation and microbial contamination monitoring.
  • The type, nature and implications of possible contaminants.
  • Procedures relating to operational capacity and contingency planning.
  • Control measures applicable to prevention and removal of all types of contamination.
  • How the mo-99/TC generator is used in radiopharmacy.
  • The range of standard environmental monitoring tests and their purpose.
  • The importance of physical environmental monitoring and the required testing frequency.
  • Expected performance, limitations and calibration of equipment, including dose calibrators and isolators, and range of tests to be undertaken.
  • Requirements for storage, handling and disposal of radioactive medicinal products.
  • Aseptic techniques and their application.
  • Radiation protection guidelines and their application, including local rules.
  • Administration of Radioactive Substances Advisory Committee (ARSAC) Diagnostic Reference Levels..
  • Use of appropriate diluents, limitations and consequences of over- dilution and use of unsuitable containers.
  • The range of equipment and facilities, purpose and correct use.
  • Corrective action to be taken in the event of spillage, breakage or contamination.
  • Your own level of responsibility relating to each part of this standard.
  • Methods for identifying high-risk procedures and obtaining suitable approval.
  • Sampling and pipetting techniques.
15 4

Handle sealed and unsealed radioactive sources, demonstrating the application of the principles of time, distance and shielding to minimise radiation dose.

  • The types and quantities of radiation being used in the various locations within the organisation.
  • Application of relevant legislation and guidance to protect patients, staff and the public in nuclear medicine and diagnostic radiology.
  • Measures that are taken to ensure that radiation doses are as low as reasonably achievable (ALARA), with particular reference to children, and to pregnant and breast-feeding patients.
  • Legislation and sources of advice relevant to the practice of Nuclear Medicine and Diagnostic Radiology, distinguishing between acts, regulations, codes of practice and guidance.
  • Radiation safety information that should be given to patients following the administration of diagnostic and therapeutic radiopharmaceuticals.
  • How to minimise contamination and decontamination procedures.
  • The importance of Environment Agency (EA)/ Scottish Environment Protection Agency (SEPA) application and approval, and the purpose of such application.
  • The requirements and limitations of the organisation’s certificates permitting the acquisition, storing and disposal of radioactive waste.
  • The criteria for safe storage and disposal of radioactive materials.
  • The requirements of various items of legislation that govern the management of radioactive materials and waste.
  • The legislative requirements for packaging, labelling and transport of radioactive material.
  • Methods of monitoring for radioactivity and contamination, and the appropriateness of each method to a given scenario.
  • Requirements for monitoring f records of radioactive materials in store.
  • Requirements for annual reporting on transfer and disposal of radioactive substances.
  • The hazards associated with and protection measures required to work safety in a radiation area.
  • Precautions that should be followed by diagnostic and therapy patients on their return home.
  • Contraindications to and adverse effects of performance of therapy, including allergies, medical conditions, drug interactions or previous diagnostic investigations.
  • Clinical features that may influence the procedure.
  • Specific requirements of ‘comforters and carers’.
  • Range of protocols and how they may be adapted to meet patient need.
  • Significance of previous results on the performance of planned procedures.
  • Range of special needs that may require adaptation of procedure.
16 4,5

Operate a range of quality control equipment, including ionisation chambers, solid state dosimeter an electrometer and a kV meter.

  • Choice of test equipment used in performance measurements in diagnostic radiology application of image quality indicators.
  • Methods of assessing and measuring image quality.
  • Factors that affect image quality.
  • Standards for image quality.
  • How images are formed and displayed.
  • Methods and effects of data processing compression and transfer.
  • Image artefacts.
  • How to choose and use appropriate test equipment.
17 4,5

Change image acquisition parameters and review the effect on the measurements made using quality control equipment.

  • Factors that affect image quality and patient dose.
  • How to analyse data, estimate errors and perform statistical analysis.
18 5

Undertake cross-calibration of an ionisation chamber or solid state dosimeter.

  • Interpretation of quality assurance tests results and identification of required remedial actions.
19 4,5

Operate a basic range of radiographic and fluoroscopic X- ray equipment under supervision and perform quality assurance tests.

  • Performance criteria, including remedial and suspension levels for X-ray equipment.
20 4,5

Undertake image quality tests on a radiographic or fluoroscopic system.

  • Performance criteria, including remedial and suspension levels for X-ray equipment.
21 5

Measure the parameters of an automatic exposure

  • Performance criteria, including remedial and suspension levels for X-ray equipment.
22 6

Undertake a patient dose audit and present the results, including reference to appropriate dose reference

  • Choice of method for measuring patient dose in Diagnostics Radiology.
  • The types of radiation involved in medical exposure.
  • Risks and the risk factors associated with patient doses.
  • The operation of the equipment or processes used to deliver radiation to the patient.
  • Equipment, procedural and patient-related factors that affect dose received.
  • The range of suitable dosimeters available and their limitations and applicability.
  • How the dosimeter works and factors that affect the response of dosimeters.
  • The quantities used as dose descriptors.
  • How to translate measured values of dose into other dose quantities, including effective dose.
  • How to set and apply dose reference levels.
  • The requirements of the applicable radiation legislation and how it is applied to X-ray patient dosimetry.
23 6

Measure the performance characteristics of a dose area product meter against a calibrated reference ionisation chamber.

  • Choice of method for measuring patient dose in Diagnostics Radiology.
  • The types of radiation involved in medical exposure.
  • Risks and the risk factors associated with patient doses.
  • The operation of the equipment or processes used to deliver radiation to the patient.
  • Equipment, procedural and patient-related factors that affect dose received.
  • The range of suitable dosimeters available and their limitations and applicability.
  • How the dosimeter works and factors that affect the response of dosimeters.
  • The quantities used as dose descriptors.
  • How to translate measured values of dose into other dose quantities, including effective dose.
  • How to set and apply dose reference levels.
  • The requirements of the applicable radiation legislation and how it is applied to X-ray patient dosimetry.
24 6

Measure or calculate patient doses for a range of examinations, including the estimation of foetal dose.

  • Choice of method for measuring patient dose in Diagnostics Radiology.
  • The types of radiation involved in medical exposure.
  • Risks and the risk factors associated with patient doses.
  • The operation of the equipment or processes used to deliver radiation to the patient.
  • Equipment, procedural and patient-related factors that affect dose received.
  • The range of suitable dosimeters available and their limitations and applicability.
  • How the dosimeter works and factors that affect the response of dosimeters.
  • The quantities used as dose descriptors.
  • How to translate measured values of dose into other dose quantities, including effective dose.
  • How to set and apply dose reference levels.
  • The requirements of the applicable radiation legislation and how it is applied to X-ray patient dosimetry.
25 6

Calculate the risks and the risk factors associated with patient doses.

  • Choice of method for measuring patient dose in Diagnostics Radiology.
  • The types of radiation involved in medical exposure.
  • Risks and the risk factors associated with patient doses.
  • The operation of the equipment or processes used to deliver radiation to the patient.
  • Equipment, procedural and patient-related factors that affect dose received.
  • The range of suitable dosimeters available and their limitations and applicability.
  • How the dosimeter works and factors that affect the response of dosimeters.
  • The quantities used as dose descriptors.
  • How to translate measured values of dose into other dose quantities, including effective dose.
  • How to set and apply dose reference levels.
  • The requirements of the applicable radiation legislation and how it is applied to X-ray patient dosimetry.

Work-based assessment


Complete 1 Case-Based Discussion(s)
Complete 1 of the following DOPS and/or OCEs
Type Title
DOPS Carry out a centre of rotation test on a SPECT system
DOPS Prepare samples and standards for GFR measurement
DOPS Measure the radionuclide purity, molybdenum breakthrough, for technetium 99m eluate
DOPS Draw up radioactivity and prepare phantom for QC studies
DOPS Operate and perform QA measurements on a radiographic imaging system
DOPS Undertake calibration check on a dose area product meter