By the end of this module the Clinical Scientist in HSST will analyse, synthesise, evaluate and apply the knowledge required to develop, undertake and interpret rigorous dosimetry protocols, calculate patient risk and apply the principles of justification, optimisation and dose reference levels to their own area of Medical Physics practice consistent with the roles and responsibilities of a Medical Physics Expert to ensure the safety and efficacy of medical radiation exposures for patients.
Knowledge and understanding
By the end of this module the Clinical Scientist in HSST will be able to analyse, synthesise, critically evaluate and apply knowledge, and will:
- Critique the international, EU and national legislation and institutional requirements for the radiation risks from ionising radiation and the requirements for dosimetry, including:
- the statutory and institutional requirements of Medical Physics services with respect to dosimetry measurements (including non-ionising radiations as appropriate);
- relevant international, EU, national and local legislation, recommendations and documentation regarding risk from ionising radiations and other physical agents with the purpose of hazard prevention and emergency preparedness in the healthcare environment with regard to patient safety/risk management;
- the function of the main national, European and international organisations concerned with protection of patients from ionising radiations and other physical agents (e.g. ICRP, ICNIRP, IAEA, EC, WHO, UNSCEAR).
- Evaluate the underpinning dosimetric quantities for ionising radiation in their own area of Medical Physics practice, including:
- the definition of patient dosimetric quantities for each clinical procedure in their own area of Medical Physics practice and the methods used for their measurement/calculation.
- Explain and critically evaluate the principles of internal dosimetry, including:
- methods for determining patient-specific organ masses, including the respective errors, and explain the difference between morphological and functional volume of organs or lesions;
- the principles of tumour dosimetry;
- the fundamental limitations of dosimetry at the organ level, for instance in deriving tumour dosimetry, taking into account activity and density heterogeneities;
- the application and use of techniques for the estimation of dose at the sub- organ, voxel and cellular level;
- where practice relates to unsealed sources, the medical internal radiation dose (MIRD) scheme, its development and the fundamental characteristics and limitations of the formalism, and how this governs its usage;
- the role of the International Commission on Radiological Protection (ICRP) in the development of the dosimetric formalism, including use of the ICRP reference phantom;
- how standard geometric models may be made patient-specific by scaling to individual body mass, organ volume/mass and tissue density;
- how the main types of computer codes used for dose calculation can be used for dose optimisation.
- Justify the choice of dosimeter for the monitoring of patient radiation dose, including:
- the structure, operation and advantages/disadvantages of the various types of patient and personal dosimeters and area monitors available for the various types of ionising radiation, including criteria for selection (e.g. accuracy, precision, uncertainties, linearity, any dose rate/energy/directional dependence, spatial resolution, physical size, read out convenience and convenience of use), management, calibration, traceability (including international traceability framework) and user protocols;
- the principles of biological monitoring of radiation exposure using genetic or metabolic changes in biological samples;
- the requirements for, and the practical implementation of, appropriate systems for the monitoring of doses to patients from ionising radiations and other physical agents in own area of medical physics practice.
- Explain the possible impact of human factors with regard to patient safety in the use of medical devices that use ionising radiation or radioactive materials.
Technical and clinical skills
By the end of this module the Clinical Scientist in HSST will be able to critically apply their knowledge and understanding to develop and evaluate investigative strategies/procedures/processes that take account of relevant clinical and scientific evidence and other sources of information and would be expected to critically reflect on their performance and apply in practice a range of clinical skills and will be able to:
- Maintain and develop dosimetry services in their area of medical physics practice through:
- selecting and using instruments for the measurement of dosimetric quantities for the various types of ionising radiations and other physical agents for patients;
- developing rigorous dosimetry protocols;
- maintaining the calibration and traceability of dosimetry instruments;
- implementing cross-calibration procedures for dosimetry
- Critically apply their understanding of dosimetric quantities by:
- carrying out an ionising radiation and other physical agent dose audits with respect to patient safety in their own area of Medical Physics practice;
- undertaking dosimetric investigations and the supervision of dosimetry measurements;
- converting dosimetric quantities measured in air or other medium to relevant dosimetric quantities in tissue;
- interpreting the results of dosimetry measurements;
- advising on the establishment and use of appropriate reference levels with respect to risks from ionising radiations and other physical agents.
- Where practice relates to unsealed sources, critically apply their understanding of internal dosimetry related to unsealed sources by:
- distinguishing between the requirements for radiation protection dosimetry and the need for patient-specific dosimetry;
- designing optimal dosimetry protocols and calculation procedures for unsealed sources;
- assessing the requirements for quantitative imaging and/or other measurements for dosimetric purposes;
- assessing the risk to the public following procedures relating to unsealed sources, including therapeutic procedures;
- developing methods for ensuring reproducibility of dosimetry assessments;
- performing dosimetric calculations using the MIRD formalism;
- using the appropriate method for calculating dose factors (e.g. point-kernel versus Monte-Carlo).
- Critically apply their understanding of the risks from ionising radiation by:
- calculating patient risk from measurement data of the dosimetry quantities used to assess adverse biological effects for the various types of ionising radiations and other physical agents;
- assessing patient risks from given procedures in their own area of Medical Physics practice from measured patient dose data and dose-effect relationships;
- applying the principles of justification (risk/benefit assessment) and optimisation (including As Low As Reasonably Practicable (ALARP) to protect the patient from unnecessary risk from ionising radiations and other physical agents;
- applying the various means of dose reduction and dose optimisation (appropriate source strengths, exposure time, distance, shielding) in protocol optimisation;
- calculating risks to the unborn child in the case of exposure to ionising radiations and other physical agents.
Attitudes and behaviours
By the end of this module the Clinical Scientist in HSST would be expected to demonstrate the attitudes and behaviours necessary for the role of a Medical Physics Expert working within the limits of professional competence and will be able to:
- Apply evidence-based personal and team professional practice placing the patient at the centre of care:
- act in accordance with the principles and practice of patient-centred care regularly reflecting on your practice and revising judgements and changing behaviour in light of new evidence and feedback;
- critically assess and evaluate personal and team-related performance in the context of evidence-based patient care, identifying areas of good practice and make improvements where necessary.
- Display a professional commitment to ethical practice consistently operating within national and local ethical, legal and governance requirements:
- accept professional ethical standards and encourage informed debate and critical reflection within healthcare teams;
- seek advice of peers, legal bodies and regulators in the event of ethical dilemmas, which could include disclosure and confidentiality;
- respect requests from patients that information should not be shared unless this puts the patient or others at risk of harm;
- share and discuss information about patient care with the patient unless they have expressed a wish not to receive such information.
- Apply the principles of Good Scientific Practice and the professional standards performing to the highest standards of personal behaviour in all aspects of professional practice:
- lead by example, setting high standards of personal behaviour and acting with openness, fairness and integrity, listening to the views of others;
- work and act in accordance with the requirements for professional regulation;
- promote professional attitudes, values and behaviours at all times;
- be truthful and admit to and learn from errors;
- inform the statutory regulator if they are cautioned, charged with a criminal offence, suspended or have restrictions placed on their own scientific, clinical, or professional practice.
- Consistently operate in accordance with relevant current national legislation, policy and practice:
- identify and assess the implications of national legislation, policy and advice for service organisation, and delivery of high-quality services;
- consult with peers and service users as part of obtaining agreement to align services with national legislation, policy and advice.