Radionuclide Therapies —
Training activity: 2

Details

Prepare, perform checks and administer a radionuclide therapy under supervision

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

• Local SOPs
• Appropriate PPE and radiation protection
• Preparation and/or set up of therapy administration
• Activity assays and checks
• Authorisation checks
• ID checks
• Patient centred care and support
• Pregnancy/breastfeeding checks
• Communication with patients
• Patient consent
• Limits to current practice

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?
  • What is your understanding of what constitutes successful preparation and administration of a radionuclide therapy, and how will you ensure that you accurately perform dose preparation, patient identification checks, and maintain safe techniques throughout?
  • Have you discussed with your training officer the specific level of supervision required and the exact steps you are expected to perform for this particular administration?
• What is your prior experience of this activity?
  • Thinking about your previous experience with diagnostic radiopharmaceuticals or sterile dose preparation, how familiar are you with the specific practical requirements of therapeutic administrations?
  • What potential challenges have you identified—such as difficult venous access, patient anxiety, or contamination risks—and how have you planned to manage these effectively while under supervision?
  • Do you clearly recognise your scope of practice for this activity, specifically understanding which aspects you are expected to perform independently and at what point you must rely on or seek immediate help from your supervisor?
  • How do you feel about embarking on this specific training activity?
• What do you anticipate you will learn from the experience?
  • What specific skills do you want to develop by performing this administration, such as refining your sterile technique, dose verification process, or communication with the patient during the procedure?
  • What specific insights do you hope to gain regarding the real-time application of radiation protection principles when handling high-activity sources?
• What additional considerations do you need to make?
  • Have you consulted the actions for development identified from your previous observations or practice of similar administration skills?
  • Have you reviewed all critical information required before starting, including the patient’s prescription and medical details, the administration route, required PPE, safety equipment, and relevant departmental SOPs?

In action

• Are you noticing anything surprising or different from what you anticipate during the preparation, checks, or administration process?
  • Are you encountering situations such as:
    • Issues with the radiopharmaceutical preparation (e.g., volume, activity, integrity)
    • Problems with administration equipment (e.g., syringe pump, tubing)
    • Unexpected patient reaction or behaviour during administration
    • A check yielding an unexpected result (e.g., dose calibrator reading)
    • Difficulties with personal protective equipment (PPE) or aseptic technique
  • How does this experience compare with previous experiences of similar activities?
• How is this impacting your actions? For example, are you responding to the situation appropriately?
  • Are you adapting or changing your approach to the procedure? Is it affecting your ability to undertake the activity independently (notwithstanding that it’s performed under supervision)?
  • Consider the steps you are taking in the moment, such as:
    • Are you immediately stopping the procedure?
    • Are you consulting your supervisor or other staff?
    • Are you referring to the Standard Operating Procedure (SOP) for the administration?
    • Are you adjusting your handling of the radiopharmaceutical or equipment?
  • How are you feeling in this moment? For example, are you finding it difficult to adapt? Is it affecting your confidence? Are you feeling positive you can reach a successful conclusion?
• How is any unexpected development being resolved as you progress during the activity?
  • How are you working within your scope of practice? Are you managing the initial reaction appropriately before seeking required supervisory input, or does the situation necessitate immediate intervention from your supervisor?
  • What are you learning in this moment as a result of any unexpected development? For example, are you learning a specific troubleshooting step for a piece of equipment or a method for managing patient anxiety during administration?

On action

• Begin by summarising the key points of the experience of preparing, performing checks, and administering the therapy.
  • Describe the specific steps you undertook, including handling the radiopharmaceutical and interacting with the patient.
  • Consider specific events, actions, or interactions that felt important during the activity, including your own feelings during the experience. This might include challenges with preparation steps, performing checks correctly, or the administration process itself.
  • Include any ‘reflect-in-action’ moments, where you adapted to the situation as it unfolded. Recall anything that felt surprising or different from what you anticipated (e.g., difficulty with equipment, an unexpected patient reaction), and how you reacted to that unexpected development in the moment.
• Identify what learning you can take from this experience. For example, what did you learn about the specific preparation steps, the importance of checks, the administration technique, applying radiation safety principles during the procedure, or effective communication with the patient during administration?
  • What strengths did you demonstrate during the activity? Were you effective in following the procedure, maintaining safety, or communicating with the patient?
  • What skills and/or knowledge gaps were evident? Was there anything you were unsure about regarding the preparation, checks, administration technique, or safety protocols?
  • Compare this experience against previous engagement with similar activities (if any). Have any previously identified actions for development been achieved? Has your practice improved in preparing, checking, or administering therapies?
  • Identify any challenges you experienced (beyond unexpected events already noted) and how you reacted to these. Did these challenges affect your ability to deal with the situation? Were you able to overcome the challenges?
  • Identify anything significant about the activity. Did you need to seek advice or clarification from your supervisor during the process? Or did you need to escalate something to ensure you were working within your scope of practice?
• Identify the actions you will now take to support the assimilation of what you have learnt. This includes learning from any feedback you have received, particularly from your supervisor.
  • What will you do differently next time you prepare, check, and administer a radionuclide therapy? Will you change your approach to specific steps or checks?
  • Has anything changed in terms of what you would do if you were faced with a similar situation again, particularly regarding handling unexpected events during preparation or administration?
  • Do you need to practise any aspect of the activity further? Are there specific practical skills related to preparation, checks, or administration you want to develop further, drawing upon this experience?

Beyond action

• Have you revisited your previous reflections (reflect-before-action, reflect-in-action, and reflect-on-action) for this specific activity (preparing, performing checks, and administering a radionuclide therapy under supervision)?
  • When reviewing these past reflections, what actions for improvement did you previously identify you would need to take to improve your practice related to therapy preparation accuracy, performing safety checks, using appropriate Personal Protective Equipment (PPE), or the administration procedure itself?
  • Have you completed these previously identified actions? If not, what are the barriers? If so, how did completing them impact your subsequent performance of this activity?
  • Are you ready to demonstrate this new learning confidently and consistently when performing this task?
  • Has discussing these experiences with others changed your view or understanding of the practical aspects and safety considerations involved?
• Considering your cumulative experiences and reflections on this activity, how will the learning you have gained support you in preparing for relevant observed ‘in-person’ assessments for the module?
  • How has your practice related to preparing, checking, and administering radionuclide therapies developed and evolved over time across multiple instances of undertaking this training activity? Can you identify specific examples of improvement or increased confidence in performing the practical steps accurately and safely?
  • Based on your experiences, how has your ability to recognise when something during preparation or administration is beyond your scope of practice or when you need immediate assistance improved? Do you have a clearer understanding of when and from whom (e.g., supervisor, medical staff) you need to seek advice or clarification?

Relevant learning outcomes

#	Outcome
# 1	Outcome Prepare and administer radiopharmaceuticals for radionuclide therapies, communicating effectively with patients.
# 3	Outcome Apply and advise on, the principles of radiation safety associated with radionuclide therapies.