Diagnostic Radiology Physics —
Training activity: 12

Details

Critically appraise the clinical application of at least two imaging modalities for a given patient cohort/clinical indication, considering their relative limitations and benefits and their impact on the patient pathway.

Type

Developmental training activity (DTA)

Evidence requirements

Evidence the activity has been undertaken by the trainee​.

Reflection on the activity at one or more time points after the event including learning from the activity and/or areas of the trainees practice for development.

An action plan to implement learning and/or to address skills or knowledge gaps identified.

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 are the intended outcomes of the training activity?

• How will reviewing the relevant learning outcome help you focus on the scientific and clinical factors that determine modality selection for a specific patient cohort?
• In what ways will this activity help you develop a critical perspective on the strengths and weaknesses of different diagnostic x-ray modalities, such as projection radiography, fluoroscopy, or CT?
• How will you ensure you can effectively evaluate the crucial link between a specific clinical question and the required image quality characteristics needed for an appropriate modality choice?
• How will this activity develop your understanding of how modality selection directly impacts the patient journey, including diagnosis, treatment planning, and follow-up care?
• What do you need to know about the scientific principles (e.g., spatial resolution, noise, and contrast) that underpin each modality before you begin your appraisal?

What do you anticipate you will learn from the experience?

• What specific insights do you hope to gain regarding the advantages and disadvantages of each modality in terms of diagnostic information, radiation dose, cost, and accessibility?
• How do you anticipate this experience will improve your ability to compare image quality quantitatively and qualitatively between different platforms?
• What do you expect to learn about the evidence base that supports the use of specific modalities for the chosen clinical indication?
• In what ways do you anticipate this experience will prepare you for the high-level interpretive and advisory responsibilities of a Clinical Scientist in justifying modality selection?

What actions will you take in preparation for the experience?

• How will you discuss the training activity with your Training Officer to identify which specific diagnostic x-ray imaging modalities and patient cohorts you will be appraising?
• Which clinical guidelines, local protocols, and research literature will you gather beforehand to ensure your appraisal is evidence-based?
• How will you prepare to evaluate the patient perspective, considering how different imaging experiences might affect their overall pathway and outcomes?
• What are your feelings about developing a more holistic understanding of the role of medical imaging in patient care?
• How might acknowledging feelings of uncertainty regarding the clinical impact of different modalities help you focus your preparation on the patient pathway and outcomes?
• How do you feel about the challenge of critically analysing established clinical practices and modality choices?

In action

What are you doing?

• As you critically appraise these modalities, which specific diagnostic x-ray imaging platforms (e.g., CT, fluoroscopy, or projection radiography) are you currently comparing, and why have you chosen this specific patient cohort?
• What scientific and clinical evidence are you currently prioritising to evaluate the relative benefits and limitations of each modality in the context of the clinical indication?
• How are you analysing the impact on the patient pathway, specifically considering how the choice of modality influences diagnosis, treatment planning, and follow-up?
• Which aspects of this appraisal feel intuitive based on your understanding of technical principles (such as spatial resolution or noise), and which require more conscious effort to understand clinical workflows and patient outcomes?
• What decisions are you making regarding the link between the clinical question being asked and the specific image quality characteristics required from the equipment?

How are you progressing with the activity?

• How effective is your current analytical approach in articulating the strengths and weaknesses of each modality for this specific clinical application?
• What challenges are you facing in obtaining data regarding the patient journey or in quantifying the relative diagnostic effectiveness of the two modalities?
• What are you learning in the moment about the factors that influence the selection of imaging modalities in routine clinical practice?
• How does this investigation connect to your existing knowledge of the limitations to x-ray image quality and the principles of radiation protection (ALARP)?
• As the activity unfolds, are you able to clearly link quantifiable image quality parameters (like the Modulation Transfer Function or Contrast-to-Noise Ratio) to the clinical requirements?

How are you adapting to the situation?

• Are there alternative modalities or clinical scenarios you should consider in your appraisal to ensure your recommendations are comprehensive?
• What support or guidance do you find yourself needing—perhaps from a Radiologist or a senior physicist—to better understand the practical limitations of the equipment in a live clinical setting?
• How are you adapting your communication style in the moment to ensure your appraisal is clear, actionable, and considers the perspectives of the multidisciplinary team?
• Are you ensuring that your critical evaluation remains strictly within your defined scope of practice as a trainee Clinical Scientist?
• Do you need to adjust your focus to better account for cost-effectiveness and accessibility as factors that influence the patient pathway?

On action

What did you notice?

• How would you summarise the key points of the appraisal, specifically identifying which two imaging modalities you compared and the patient cohort or clinical indication you focused on?
• What were the relative limitations and benefits of each modality for this specific cohort, considering factors such as radiation dose, diagnostic information, accessibility, cost, and the patient experience?
• How did you observe these modalities impacting the patient pathway, specifically in terms of speed of diagnosis, treatment planning, or follow-up care?
• Were there specific moments where one modality was clearly superior for the chosen indication, or was the choice more nuanced based on clinical need versus technical limitations?
• What did you notice about the interdisciplinary considerations—such as the input from Radiologists or clinical users—that influenced the appraisal of these modalities?

What did you learn from the activity?

• What new knowledge did you develop regarding the ability to appraise the relative strengths and weaknesses of different diagnostic x-ray modalities in clinical practice?
• How did this experience improve your understanding of the link between a specific clinical question and the required image quality characteristics needed from the equipment?
• In what ways did your reflection-in-action—the real-time decisions you made while comparing technical parameters like spatial resolution and noise—influence your final critical appraisal?
• What did you learn about the practical challenges of balancing the principle of ALARP with the need for high-quality diagnostic images for a specific patient group?
• How does the ability to conduct this type of critical appraisal relate to the high-level interpretive and professional responsibilities you will hold as a Clinical Scientist?

What will you take from the experience moving forward?

• How will you approach discussions about modality selection in the future, particularly when advising referrers or other healthcare professionals on the most appropriate imaging for a patient?
• What specific areas for continued development have you identified, such as a need to better understand the patient experience or the specific impacts of emerging technologies on clinical pathways?
• What ‘next steps’ will you now take—such as attending a reporting session with a Radiologist or reviewing new national guidelines—to support the assimilation of what you have learned?
• How has this experience supported your preparation for observed ‘in-person’ assessments, such as a Case-Based Discussion (CBD) or an Observed Clinical Event (OCE) involving a discussion with an end user?
• What resources or specialist mentoring would be beneficial to help you stay informed about the evolving clinical applications of diagnostic imaging technologies?

Beyond action

Have you revisited the experiences?

• How has your understanding of the clinical utility and limitations of the diagnostic x-ray modalities you appraised evolved since you first completed this activity?
• When evaluating these experiences, how does your appraisal of the chosen patient cohort compare to subsequent encounters with different clinical indications or modalities?
• Have you compared your reflections on this training activities with Observed Training Activities (OTAs), such as observing a reporting session with a Radiologist or Radiographer?
• How has engaging in professional storytelling with peers or senior clinical colleagues about the impact of imaging choices on the patient pathway changed your perspective on modality selection?
• As part of a holistic review of the Diagnostic Radiology Physics module, what specific interpretive behaviours—such as linking image quality parameters like spatial resolution or noise to clinical needs—have you now successfully assimilated into your practice?

How have these experiences impacted upon your current practice?

• How has the experience of critically appraising the limitations and benefits of different modalities influenced the way you currently advise clinical users on equipment or procedures?
• In what ways did this activity support your preparation for the in-person assessments, such as the Observed Clinical Event (OCE): ‘Discuss with an end user the clinical need for image quality’?
• Can you identify specific instances where your communication skills have improved when explaining the trade-offs between diagnostic information and radiation dose to a multidisciplinary team?
• How has your improved ability to evaluate the evidence base for imaging strategies enhanced your current contribution to quality improvement or optimisation initiatives?
• How has this activity influenced your appreciation of how imaging choices directly impact patient management, treatment planning, and overall outcomes?

How might these experiences contribute towards your future practice?

• Which transferable skills developed through this activity—such as critical evaluation of multi-parameter data, clinical collaboration, and informed decision-making—will be most essential in your future role as a Clinical Scientist?
• What clear actions for continued development have you identified, such as staying updated on emerging technologies or changes in national clinical guidelines?
• How will your ability to relate image quality needs to clinical applications contribute to effective imaging strategies and the development of future clinical protocols?
• How has the mastery of these building blocks of learning provided the necessary foundation for the high-level analytical and interpretive responsibilities you will hold in post-programme professional practice?
• How might this experience support your progression towards a specialist role, where you may lead on the implementation of new diagnostic protocols or equipment specifications?

Relevant learning outcomes

#	Outcome
# 7	Outcome Appraise the relative benefits and limitations of diagnostic radiology modalities in clinical practice.