Diagnostic Radiology Physics —
Training activity: 10

Details

Carry out a patient dose audit for at least two x-ray imaging modalities

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.

Considerations

• Patient dose parameters and their calibration
• Measurement and calculation techniques including assessment of uncertainties
• Patient dose surveys
• Electronic dose data collection
• Typical doses and risks in diagnostic radiology
• Local and national DRLs

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 for this activity?
  • Identify what is expected of you in relation to performing a patient dose audit.
  • Discuss with your training officer to gain clarity on the scope of the audit (e.g., number of patients, specific projections/procedures), data collection methods, and the format for interpreting results and making recommendations.
• What is your prior experience of patient dose audits or data analysis related to dose?
  • Think about what you already know about patient dose parameters and their calibration, measurement and calculation techniques, or electronic dose data collection.
  • Have you previously extracted data from PACS or RIS systems, or performed any statistical analysis of patient dose data?
  • Consider possible challenges you might face during the audit, such as data completeness, identifying outliers, ensuring data anonymisation, or interpreting typical doses and risks in diagnostic radiology in the context of your audit findings. Think about how you might handle them.
  • Do you know when you will need to seek advice or help, and from whom (e.g., IT for data access, a medical physicist for complex dose calculations or radiologists for clinical context)?
  • Are you comfortable with data handling and the ethical considerations of patient data?
• Consider the specific skills you want to develop, drawing upon previous experiences with data analysis or quality assurance.
  • This could include skills in database querying, statistical analysis of dose data, identifying optimisation opportunities, or preparing audit reports.
  • Identify the specific insights you hope to gain from engaging with this activity. For example, do you hope to understand the variability in patient doses for different modalities, the factors influencing dose, or the practical steps involved in formulating effective optimisation strategies?
• What additional considerations do you need to make before carrying out the patient dose audit?
• • Consult actions identified following previous experience of data collection, analysis, or audit processes. Are there any specific departmental policies or national guidelines for patient dose audits that you need to follow?
  • Identify important information you need to consider, such as ethical approvals for data access, the chosen methodology for data extraction and analysis, the specific x-ray imaging modalities you will audit, and the timeline for reporting.

In action

• Are you noticing anything surprising or different from what you anticipate during the process of carrying out the patient dose audit?
  • Are you encountering situations such as:
    • A new or unusual trend in patient dose data that defies initial expectations, particularly when compared to national diagnostic reference levels (DRLs) or local benchmarks.
    • Unexpected data inconsistencies or missing information within the dose data collection system.
    • Conflicting data points that make critical evaluation or statistical analysis difficult.
    • An anticipated cause for higher doses (e.g., protocol deviation) that turned out to be incorrect during your analysis.
  • How does this experience compare with previous experiences of similar activities, such as any prior observations of patient dose discussions or image quality optimisation efforts?
• How is any unexpected development being resolved as you progress during the activity?
  • How are you working within your scope of practice?
  • Are you successfully managing the situation yourself, or do you need support because it is beyond your current scope (for example, if the data analysis requires advanced statistical methods you’re unfamiliar with, or if proposing significant changes to clinical protocols)?
  • What are you learning in this moment as a result of any unexpected development? For example, are you learning a new approach to data extraction from the PACS, or a more robust method for identifying the root causes of dose variations?
• How is this impacting your actions? For example, are you responding to the situation appropriately?
  • Are you adapting or changing your approach to the audit, such as focusing on a different subset of data or a particular procedure? Is it affecting your ability to undertake the activity independently?
  • Consider the steps you are taking in the moment, such as:
    • Are you re-checking data sources, filters, or calculation methods immediately?
    • Are you consulting relevant local imaging protocols or national DRLs more thoroughly than planned?
    • Are you seeking advice from your training officer, a statistician, or clinical leads to understand the anomaly or to interpret complex data?
    • Are you changing your initial approach to developing optimisation recommendations based on new insights or feedback?

On action

• Begin by summarising the key points of the patient dose audit experience for the chosen modalities, from data collection to initial analysis.
  • Consider any specific events, actions, or interactions that felt important, including your own feelings during the experience.
  • Include any ‘reflect-in-action’ moments where you adapted to the situation as it unfolded. For example, recall if you noticed a new or unusual trend in patient dose data that defied initial expectations, or if there were unexpected data inconsistencies or conflicting data points. How did you respond to these in the moment (e.g., re-checking data sources, consulting relevant protocols)?
• Identify what learning you can take from this experience.
  • What strengths did you demonstrate during the dose audit, and what skills and/or knowledge gaps were evident (e.g., data analysis techniques, understanding national diagnostic reference levels (DRLs))?
  • Compare this experience against previous engagement with similar activities, such as any prior observations of patient dose discussions or image quality optimisation efforts. Were any previously identified actions for development achieved?
  • Has your practice improved in areas like interpreting dose trends or identifying root causes of variations?
  • Identify any challenges you experienced (e.g., incomplete data, interpreting complex statistical findings) and how you reacted to these. Did this affect your ability to deal with the situation, and were you able to overcome the challenges?
  • Identify anything significant about the activity. Did you need to seek advice or clarification from your training officer, a statistician, or clinical leads to understand an anomaly or to interpret complex data? Or did you need to escalate to ensure that you were working within your scope of practice if the analysis required advanced statistical methods you were unfamiliar with, or if proposing significant changes to clinical protocols?
• Identify the actions / ‘next steps’ you will now take to support the assimilation of what you have learnt, including from any feedback you have received. For example, what will you do differently next time to extract data more efficiently from the PACS or to identify the root causes of dose variations more robustly?
  • Has anything changed in terms of what you would do if you were faced with a similar situation again, such as a different approach to developing optimisation recommendations based on new insights?
  • Do you need to practise any aspect of the activity further, such as presenting the audit results and suggestions for optimisation to a team?

Beyond action

• Have you revisited the experiences?
  • Have you reviewed your actions from your previous reflections for carrying out patient dose audits?
  • What actions did you identify you would need to take to improve your practice (e.g., data collection efficiency, statistical analysis skills, or formulation of optimisation recommendations)?
  • Have you completed these actions, and are you ready to demonstrate this new learning into practice?
  • Consider if your view of the situation has changed because of analysing this with others. For example, has discussing challenges in data interpretation or engaging with a clinical team on optimisation strategies offered new insights into the audit process or communication?
• How have these experiences impacted upon current practice?
  • Consider how the learning from carrying out patient dose audits will support you in preparing for observed ‘in-person’ assessments for the module.
  • Consider how your practice in conducting patient dose audits and contributing to optimisation has developed and evolved over time.
  • Have you become more proficient in identifying trends in dose data, more confident in making evidence-based recommendations, or better at recognising when patient dose issues are complex and require multi-disciplinary discussion beyond your immediate scope of practice?

Relevant learning outcomes

#	Outcome
# 6	Outcome Perform a patient dose audit, interpret the results and make recommendations for optimisation strategies.