Training activity information
Details
Carry out a patient dose audit for at least two x-ray imaging modalities, in each case compare to relevant local & national diagnostic reference levels and make recommendations including establishment of LDRLs and areas of possible optimisation.
Type
Entrustable training activity (ETA)
Evidence requirements
Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion.
Reflection at multiple timepoints on the trainee learning journey for this activity.
Reflective practice guidance
The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.
Before action
What does success look like?
- How will reviewing the relevant learning outcomes help you focus on the requirement to establish local diagnostic reference levels (LDRLs) and identify areas for optimisation?
- In what ways will this activity develop your ability to audit adherence to radiation safety legislation (such as IRMER and IRR) within a clinical imaging environment?
- How will you ensure you gain the detailed practical knowledge required to accurately compare patient dose data against national diagnostic reference levels (NDRLs) to draw valid conclusions about practice?
- What steps will you take to apply the principles of optimisation to ensure your recommendations effectively improve patient protection while maintaining diagnostic image quality?
- How will this training activity prepare you to demonstrate the interpretive skills necessary to discuss potential changes to DRLs with clinical staff and other healthcare professionals?
What is your prior experience of this activity?
- What is your current level of understanding regarding the collection, analysis, and interpretation of patient dose audit data and the concept of DRLs?
- What previous experience do you have with statistical tools or software that will be necessary for identifying trends and anomalies in the datasets from your two chosen modalities?
- What potential challenges do you anticipate—such as difficulties in data extraction, managing outliers, or accessing up-to-date national DRLs—and how do you plan to handle them?
- How do you honestly feel about embarking on this task, particularly regarding the responsibility of formulating legislative advice that could impact local clinical protocols?
- Do you clearly recognise the scope of your own practice for this activity, and do you know at what point you should seek advice from a medical physicist or clinical lead?
What do you anticipate you will learn from the experience?
- What specific analytical and data management skills do you want to develop by conducting this audit across different imaging modalities?
- What insights do you hope to gain regarding the practical application of IRMER and IRR in the routine monitoring of patient protection?
- How do you expect this experience to improve your ability to identify specific areas for clinical optimisation beyond simply meeting reference levels?
- In what ways do you anticipate this activity will prepare you for the high-level analytical and reporting responsibilities required for your future role as a Clinical Scientist?
What actions will you take in preparation for the experience?
- How will you discuss the scope of this audit with your Training Officer to clarify which imaging modalities will be used and how you will access the relevant dose data?
- Which employer’s procedures and local protocols governing dose auditing will you review beforehand to ensure your methodology is compliant?
- What national guidelines and NDRL databases will you gather to support your comparative analysis and ensure your recommendations are evidence-based?
- How will you familiarise yourself with the reporting requirements for audit findings to ensure your advice on legislative compliance is clear and actionable for clinical staff?
In action
What are you doing?
- As you begin the extraction of patient dose data for your two chosen modalities, what specific regulatory requirements from IRMER or IRR are you focusing on, and why have you prioritised them in your audit workflow?
- What is your rationale for the statistical methods you are using to identify outliers or skewed distributions within the dose datasets?
- What decisions are you making regarding the integrity of the records you are reviewing, and how are you determining if the data is sufficient to establish a valid Local Diagnostic Reference Level (LDRL)?
- Which aspects of performing this legislative audit feel intuitive to you, and which parts—such as identifying specific areas for optimisation beyond simple compliance—require more conscious effort?
- How are you approaching the comparison between local and national DRLs to ensure your real-time findings will address the requirement to improve clinical practice?
How are you progressing with the activity?
- How effective is your current analytical approach in identifying discrepancies between local practice and national standards?
- What challenges or ambiguities are you facing as the data analysis unfolds—such as managing incomplete records, resolving data extraction errors, or interpreting complex statistical trends?
- In what ways are you applying the principles of quality assurance to verify that the audit findings are robust before you begin formulating recommendations?
- What are you learning about the practical limitations of the current dose recording systems or local protocols as you actively engage with the data?
- How does the information you are currently auditing connect to your existing knowledge of radiation protection legislation and the principles of patient protection?
How are you adapting to the situation?
- Based on your immediate observations of the data, are there alternative statistical approaches or additional data cleaning steps you should consider to ensure the accuracy of your LDRL establishment?
- How are you adapting your communication style in the moment to ensure your findings and recommendations for optimisation will be clear and actionable for clinical staff?
- What support or guidance—such as consultation with a medical physicist or your Training Officer—do you find yourself needing to resolve uncertainties regarding legislative nuances or complex data anomalies?
- Are you confident that your real-time decisions and interpretations regarding legislative compliance remain strictly within your defined scope of practice?
- If you encounter resistance or unexpected questions from clinical staff during the audit process, how are you adjusting your approach to maintain a good radiation safety culture?
On action
What did you notice?
- How would you summarise the key procedural elements and steps you took to perform the patient dose audit for your two chosen x-ray imaging modalities?
- What specific parameters or data patterns did you focus on while comparing local dose data to relevant national diagnostic reference levels (NDRLs)?
- How did you evaluate the integrity of the data—including the identification of outliers or inconsistencies—to draw valid conclusions before formulating your recommendations for local diagnostic reference levels (LDRLs)?
- What did you notice about the way you communicated your audit findings and proposed optimisation strategies to clinical staff? Were you able to justify the legislative requirements clearly and effectively?
- Were there any unexpected challenges during the data extraction or analysis process, such as issues with data integrity or software limitations, and how did you identify them?
What did you learn from the activity?
- What new knowledge did you develop regarding the performance of audits against legislation and the formulation of advice on compliance?
- How has this experience improved your ability to identify specific areas of possible optimisation to improve clinical practice and patient protection?
- In what ways did your reflection-in-action—the decisions you made while handling data discrepancies or interacting with staff in real-time—influence the final recommendations you generated?
- What did you learn about the practical limitations of current dose recording systems and how these impact your ability to establish robust LDRLs?
- How does this specific experience in auditing and legislative advice relate to the high-level analytical and professional responsibilities required for your future role as a Clinical Scientist?
What will you take from the experience moving forward?
- What specific areas for continued development have you identified in your statistical analysis capabilities or your ability to navigate complex legislative nuances (e.g., IRMER or IRR)?
- How can you apply the learning from this activity to your routine practice, particularly regarding the ongoing monitoring and establishment of diagnostic reference levels?
- What specific ‘next steps’ will you now take—such as mastering advanced statistical software or reviewing the latest national DRL updates—to support the assimilation of what you have learned?
- What support or resources, such as specialist mentoring from a medical physicist, would be beneficial for your ongoing development in dose auditing and optimisation?
- How has your learning from this activity directly supported your preparation for observed assessments, such as the Observed Communication Event (OCE) focused on discussing changes to diagnostic reference levels with clinical staff?
Beyond action
Have you revisited the experiences?
- How has your understanding of performing audits against legislation and formulating advice on compliance evolved since you first engaged with patient dose auditing, especially as you have encountered different imaging modalities or complex datasets?
- Have you reviewed your actions from your previous ‘reflect-on-action’ sessions for this activity, specifically revisiting your notes regarding challenges encountered during data extraction or analysis, such as data integrity issues or outliers?
- What specific actions did you identify you would need to take to improve your practice in DRL audits—such as mastering advanced statistical analysis techniques or specialised software—and have you successfully completed these?
- How has professional storytelling with peers or senior medical physicists regarding the management of resistance from clinical staff during DRL discussions changed your perspective on effective recommendation formulation?
- As you revisit this module holistically, how effectively have you acted upon your previous identified ‘next steps’ regarding the comparison of local and national diagnostic reference levels?
How have these experiences impacted upon your current practice?
- How have these experiences enhanced your ability to perform audits against legislation and make recommendations to improve practice in a way that is robust and defensible?
- In what ways has the learning from your DRL audits supported your preparation for the observed ‘in-person’ assessments, specifically the Observed Communication Event (OCE): ‘Discuss changes to diagnostic reference levels with clinical staff’?
- How has your proficiency in interpreting complex patient dose data and formulating clear recommendations for optimisation supported your contribution to broader radiation safety management within your department?
- How has your understanding of when something is beyond your scope of practice become clearer, particularly concerning highly specialised statistical interpretations or the legislative implications of audit findings under IRMER or IRR?
- How do you now approach seeking advice or escalating situations where clarification from a senior medical physicist or Training Officer is needed regarding the establishment of LDRLs?
How might these experiences contribute towards your future practice?
- Which transferable skills developed through this activity—such as the critical evaluation of data, statistical analysis, and the communication of legislative advice—will be most essential in your future role as a Clinical Scientist?
- How will your ability to accurately interpret and report on dose audits contribute to more effective patient protection and risk management in more complex future clinical scenarios?
- What clear actions for continued development have you identified, such as staying updated on advancements in dose monitoring technologies or participating in national audits to refine your expertise?
- How has the learning from this activity provided the necessary foundation for the high-level analytical and interpretive responsibilities you will hold in post-programme professional practice?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 3 |
Outcome
Perform audits against legislation and make recommendations to improve practice. |
| # 4 |
Outcome
Formulate advice on compliance with aspects of legislation. |