Practical Radiation Protection —
Training activity: 9

Details

Estimate a patient’s effective/organ dose and associated risk due to diagnostic exposures, including:

• General x-ray
• CT
• mammography

fetal dose estimate for one of the above

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

• Tools and information available to assist in and perform calculations
• Concepts of different dose quantities
• Uncertainties and limitations involved in dose/risk quantities and estimates

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 defines a successful estimation of patient effective/organ dose and associated risk, including the evaluation of limitations and uncertainties?
  • Discuss with your Training Officer to gain clarity on the specific scenarios or methods for dose estimation expected, the level of detail required for uncertainty analysis, and the format for communicating estimated doses and risks.
• Reflect on any previous exposure to patient dosimetry, either theoretical or practical.
  • Have you seen dose reports from imaging equipment or discussed patient doses in a clinical context?
  • Consider possible challenges you might face, such as selecting appropriate dose conversion factors, dealing with patient-specific parameters (e.g., body habitus), understanding the complexities of foetal dose estimation, or accurately quantifying uncertainties. How might you handle these challenges?
  • When would you need to seek advice on highly complex dose reconstructions, specific software tools for dose estimation, or communicating difficult risk information to clinicians or patients?
  • Are you confident in your mathematical and physics skills for calculation, or do you feel less confident in interpreting complex dose literature or communicating risk effectively?
• Identify specific skills you want to develop, such as applying dose calculation methodologies for different modalities, understanding the concept of effective dose and organ doses, and accurately quantifying and communicating uncertainties in dose estimates.
  • Identify the specific insights you hope to gain into the clinical relevance of patient dose, the factors influencing dose variation, and the ethical considerations involved in communicating radiation risks.
• What additional considerations do you need to make?
  • Consult actions identified following previous experiences related to data interpretation, mathematical modelling, or risk communication.
  • Identify important information you need to consider, such as typical dose reference levels (DRLs), specific imaging protocols, and the use of relevant dosimetric models or software for calculations.

In action

• Are you noticing anything surprising or different from what you anticipate during the estimation of patient dose and associated risk?
  • Are you encountering situations such as:
    • A new or unusual input parameter (e.g., patient size, exposure factors) that defies initial expectations for dose calculation?
    • An unexpected software error or data input issue in the dose estimation tool?
    • Conflicting data points from different dose calculation methodologies or reference values that make critical evaluation difficult?
    • An anticipated risk level that turned out to be significantly different during your estimation (e.g., unexpectedly high foetal dose)?
  • How does this experience compare with previous experiences of similar dose estimation or risk assessment activities?
• How is any unexpected development being resolved as you progress during the dose and risk estimation?
  • Are you successfully managing the situation yourself, or do you need support because it is beyond your current scope (for example, if interpreting complex dose models or communicating uncertain risks is incomplete or requires senior review)?
  • What are you learning in this moment as a result of any unexpected development? For example, are you learning a new approach to managing uncertainties in dose calculations, or a more robust method for explaining radiation risks to patients or colleagues?
• How is this impacting your actions?
  • Are you responding to the situation appropriately?
  • Are you adapting or changing your method for obtaining patient data or your approach to using dose calculation software? 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 patient parameters or exposure details immediately?
  • Are you consulting relevant dose conversion factors or reference publications for risk estimation more thoroughly than planned?
  • Are you seeking advice from a more experienced colleague or your training officer to understand the dose estimation anomaly or unexpected result?
  • Are you changing your initial approach to presenting the estimated dose and risk based on new insights?

On action

• What happened during the estimation of patient dose and associated risk?
  • Summarise the key points of your experience estimating patient effective/organ dose and risk for diagnostic exposures (e.g., X-ray, CT, mammography, foetal dose).
  • What specific events, actions (e.g., data collection, calculation steps, risk communication), or interactions felt important, including your own feelings during the process?
  • Did you have any ‘reflect-in-action’ moments where you adapted your calculation method or explanation based on a specific patient scenario or data availability?
• How has this patient dose estimation experience contributed to your developing practice?
  • What learning can you take from this experience?
  • What strengths did you demonstrate in accurately calculating doses and assessing associated risks, and in understanding the nuances of different diagnostic modalities?
  • What skills and/or knowledge gaps were evident, particularly regarding complex calculation methods, limitations of dose estimation models, or communicating risk to patients/clinicians?
  • Compare this experience against previous engagements with similar activities. Were any previous identified actions for development achieved? Has your practice in estimating patient doses and risks improved?
  • Identify any challenges you experienced (e.g., incomplete patient data, complex anatomy, uncertainties in dose coefficients, difficulty in explaining risk clearly) and how you reacted to these. Did this affect your ability to accurately estimate the dose or communicate the risk? Were you able to overcome the challenges?
  • Identify anything significant about the activity, such as needing to seek advice or clarification on specific dose factors, risk models, or ethical considerations in risk communication, or needing to escalate a concern about a particularly high dose.
• What will you take from the patient dose estimation experience moving forward?
  • Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learned, including from any feedback received on your calculations or risk assessment.
  • What will you do differently next time you estimate patient doses and associated risks for diagnostic exposures?
  • Has anything changed in terms of what you would do if you were faced with a similar patient dose estimation situation again?
  • Do you need to practise any aspect of dose calculation, risk assessment, or communication further?

 

Beyond action

• Have you reviewed your previous reflections and identified actions for improvement related to estimating patient effective/organ doses and associated risks from diagnostic exposures (general x-ray, CT, mammography, and foetal dose estimates)?
  • What specific steps did you identify to enhance your practice in calculating estimated radiation doses, evaluating limitations, and communicating risks?
  • Have you successfully implemented these actions in subsequent similar dose estimation activities?
  • Are you now confident and prepared to demonstrate this accumulated learning into practice for future instances of patient dose estimation?
  • Did discussing your approach to these estimations and their associated uncertainties with others offer new perspectives or insights that changed your understanding of dose calculation methods, risk communication, or specific challenges like foetal dose estimation?
• How does the learning gained from repeatedly estimating patient doses and risks and reflecting on it support your preparation for observed in-person assessments for the  module, such as CBDs, particularly those focusing on calculating estimated radiation doses, evaluating the limitations and uncertainties of the approach?
  • How has your practice in estimating patient effective/organ doses and associated risks developed and evolved over time through these multiple engagements?
  • Can you identify specific instances where your accuracy in calculation, ability to account for uncertainties, or clarity in communicating risks has improved?
  • How has this holistic reflection helped you better recognise when an aspect of patient dose estimation or risk assessment might be beyond your current scope of practice, and when to seek advice or escalate?

Relevant learning outcomes

#	Outcome
# 4	Outcome Calculate estimated radiation doses, evaluating the limitations and uncertainties of the approach.