Diagnostic Radiology Physics —
Training activity: 15

Details

Perform equipment performance testing, under supervision, on fluoroscopy equipment, and analyse and report results to clinical users.

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 learning outcomes help you focus on the specific technical requirements for assessing fluoroscopy equipment performance?
• In what ways will this activity help you develop the practical skills needed to conduct QA and/or commissioning tests on dynamic x-ray systems as required by the curriculum?
• How will you ensure you can effectively identify the link between the clinical requirements of a fluoroscopy suite and the technical image quality characteristics you are measuring?
• What is the importance of being able to not only perform the tests but also analyse and communicate findings to clinical users in a way that informs safe clinical practice?
• How will this activity help you understand the legislative and governance frameworks that underpin equipment testing and reporting in diagnostic radiology?

What do you anticipate you will learn from the experience?

• What specific insights do you hope to gain regarding the construction and operation of x-ray image intensifiers or digital receptors used in fluoroscopy?
• How do you anticipate this experience will improve your ability to interpret test results—such as dose rates and spatial resolution—against national recommendations and local tolerances?
• What do you expect to learn about modality-specific artefacts in fluoroscopy, and how the technical parameters you measure relate to their appearance in clinical images?
• In what ways do you anticipate this experience will prepare you for the high-level analytical and interpretive responsibilities required of a Clinical Scientist when determining if a system is suitable for clinical use?
• What insights do you hope to gain regarding the limitations of x-ray image quality (e.g., noise, contrast degradation, and MTF) in the context of a dynamic imaging system?

What actions will you take in preparation for the experience?

• How will you discuss the level of supervision and the specific suite of performance tests with your Training Officer to ensure clarity of your role?
• Which national recommendations (e.g., IPEM), local work instructions, and QA protocols will you review beforehand to ensure your testing methodology is robust?
• What steps will you take to familiarise yourself with the physics principles and potential failure modes unique to fluoroscopy and digital subtraction angiography (DSA)?
• How will you prepare to handle potential challenges, such as encountering an unexpected ‘Level A’ QA fail that requires immediate equipment restriction and communication?
• Which resources or image atlases will you use to prepare for identifying and suggesting rectifications for common fluoroscopic artefacts?
• How do you feel about the responsibility of assessing complex, high-dose equipment that is used for interventional procedures?
• How might acknowledging feelings of uncertainty regarding technical precision or reporting help you focus your preparation on the areas where you need the most support?
• Does the weight of responsibility regarding patient safety and equipment suitability influence how you plan to approach your collaboration with the clinical team?

In action

What are you doing?

• Which specific fluoroscopy performance tests—such as dose rate measurements, spatial resolution, or digital subtraction angiography (DSA) consistency—are you currently performing?
• Why are you performing these tests in this particular order, and how does this ensure the efficient use of the clinical suite?
• How are you using the measurement devices (e.g. ionisation chambers or test phantoms) and what steps are you taking to ensure their correct operation in a dynamic imaging environment?
• What decisions are you making regarding data collection and real-time analysis as the fluoroscopic images are generated?
• Which aspects of this procedure feel intuitive based on your current knowledge of x-ray physics, and which require more conscious attention to local protocols or guidance from your supervisor?

How are you progressing with the activity?

• Are the tests proceeding as expected, or are you encountering unexpected readings or ‘Level A’ failures that require immediate investigation?
• How effective are your actions in obtaining the necessary data to appraise the quality assurance of the system?
• What challenges are you facing in interpreting the results against national recommendations and local departmental tolerances?
• What are you learning about the practicalities of fluoroscopy QA—such as the construction and operation of the x-ray image intensifier or digital receptors—as the activity unfolds?
• How does this activity reinforce your understanding of the scientific principles of dynamic x-ray imaging technology and the limitations of image quality?

How are you adapting to the situation?

• If you identify a common image artefact, such as lag or distortion, what visual cues are you using, and how are you adapting your testing to investigate the root cause?
• What recommendations for rectification are you formulating in the moment, and are they practical for the clinical setting?
• What support or guidance do you find yourself needing from your supervisor regarding the interpretation of complex results or the use of specialised software?
• How are you adapting your communication style to ensure that your findings will be clear, concise, and actionable for the clinical users when you report the results?
• Are you ensuring that all real-time decisions, particularly those regarding equipment suitability for clinical use, remain strictly within your defined scope of practice?

On action

What did you notice?

• How would you summarise the key procedural steps you took to perform the performance testing, such as setting up dosimetry equipment or image quality test phantoms for the fluoroscopy system?
• What specific parameters were assessed—for example, dose rates, spatial resolution, or digital subtraction angiography (DSA) consistency—and were the results within national recommendations and local tolerances?
• Were any common image artefacts identified during the session, and what were the significant features or data patterns that led to their identification?
• What did you notice about the process of analysing and interpreting the results before they were compiled into a report?
• How was the final report received by the clinical users, and what information did you prioritise to ensure the findings were clear and actionable?
• In what ways did the supervised nature of the activity influence your technical approach or your confidence in evaluating the equipment’s suitability for clinical use?

What did you learn from the activity?

• What new knowledge did you develop regarding Learning Outcome 2 and your ability to appraise quality assurance results for dynamic x-ray systems?
• What did you learn about the scientific principles of fluoroscopy technology, such as the operation of the x-ray image intensifier or digital receptors and the limitations to image quality like noise and contrast degradation?
• How has this experience improved your ability to identify modality-specific artefacts and provide scientifically sound recommendations for rectification?
• In what ways did your reflection-in-action—the real-time decisions you made regarding phantom alignment or data collection—influence the accuracy of the final performance assessment?
• What did you learn about the practical challenges of performing QA in a clinical environment, such as managing time constraints in a busy interventional suite?
• How does the ability to perform and report these technical tests relate to the high-level interpretive and professional responsibilities you will hold as a post-programme Clinical Scientist?

What will you take from the experience moving forward?

• How will you apply the learning from this activity to your routine practice, particularly when investigating a Level A QA fail or commissioning new fluoroscopy equipment?
• What specific areas for continued development have been identified, such as a need to better understand complex x-ray fluoroscopy or hybrid imaging technologies?
• What ‘next steps’ will you now take—such as reviewing the latest IPEM guidelines or attending a reporting session with a Radiologist—to support the assimilation of what you have learned?
• What support or resources, such as specialist mentoring or access to national dose audits, would be beneficial for your ongoing development in fluoroscopy physics?

Beyond action

Have you revisited the experiences?

• How has your understanding of performing and appraising quality assurance matured since you first completed this supervised testing on fluoroscopy equipment?
• When evaluating this experience have you revisited your initial analysis of dose rates and spatial resolution in light of subsequent experiences or updated national recommendations?
• How has engaging in professional storytelling with senior physicists or clinical colleagues regarding complex dynamic imaging or digital subtraction angiography (DSA) results changed your perspective on troubleshooting?
• As part of a holistic review of the Diagnostic Radiology Physics module, what specific interpretive behaviours—such as linking fluoroscopic image intensifier operation to clinical image quality—have you now successfully assimilated?
• Have you compared your reflections from this training activity with relevant Observed Training Activities (OTAs) to identify how your technical approach to quality assurance has been influenced by your previous experience of observing the practice of others?

How have these experiences impacted upon your current practice?

• How has this hands-on experience of performing fluoroscopy QA influenced your current ability to critically appraise technical results or identify potential equipment failures in your routine work?
• In what ways has your proficiency in identifying and rectifying image artefacts improved your confidence when advising interventional radiographers on image quality issues?
• How has this experience supported your preparation for formal observed assessments, such as the DOPS: ‘Perform image quality tests for a… fluoroscopy system’ or the OCE: ‘Feedback to users as to whether a diagnostic radiology system is suitable for clinical use’?
• Can you identify specific instances where your reporting skills have improved, particularly in communicating technical limitations or Level A failures to non-technical clinical users?
• How has this activity enhanced your appreciation for the teamwork required with medical physics colleagues to ensure the safe operation of complex, high-dose interventional equipment?

How might these experiences contribute towards your future practice?

• Which transferable skills developed through this activity—such as complex data analysis, technical troubleshooting, and risk assessment—will be most essential for your future role as a Clinical Scientist?
• How will your ability to appraise QA results and recommend rectifications for artefacts contribute to maintaining high standards of patient safety and diagnostic quality in your future career?
• What clear actions for continued development have you identified, such as mastering the performance testing of emerging technologies like hybrid imaging or complex interventional platforms?
• How has the mastery of these technical skills 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 be responsible for the commissioning of new fluoroscopy suites or leading quality improvement initiatives within a wider healthcare organisation?

Relevant learning outcomes

#	Outcome
# 2	Outcome Perform and appraise quality assurance on equipment across a range of diagnostic radiology modalities.
# 3	Outcome Identify common image artefacts and make recommendations for rectification.