Imaging and Diagnostic Nuclear Medicine —
Training activity: 5

Details

Perform and evaluate an image registration task

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

• Application of registration software
• Assumptions informing analysis software
• Impact of mis-registration
• Use of normal templates and databases

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 a successful image registration task, specifically regarding the achievement of accurate spatial alignment between different sets like PET/CT or SPECT/CT?
  • Have you discussed the required level of accuracy and the clinical context for this particular task with your training officer to ensure a clarity of understanding?
•  What is your prior experience of this activity?
  • Thinking about your prior experience – such as those involving combining images from different modalities—how familiar are you with the image registration principles and the specific software to be used?
  • What possible challenges do you anticipate—such as patient motion artefacts, anatomical changes between scans, or software limitations—and how have you planned to handle these if they arise?
  • Do you clearly recognise your scope of practice for this task, specifically knowing exactly when you must seek advice or help from a supervisor or reporting clinician regarding complex cases or difficult registrations?
  • How do you feel about embarking on this image registration task?
• What do you anticipate you will learn from the experience?
  • What specific skills do you want to develop through this activity, such as improving your proficiency with registration software, understanding different algorithms, or enhancing your ability to visually assess registration quality?
  • What specific insights do you hope to gain, such as understanding how acquisition parameters affect registration accuracy or the broader clinical importance of accurate image fusion?
• What additional considerations do you need to make?
  • Have you consulted actions for improvement identified from your previous experiences, such as points you noted while observing registration tasks or related image processing?
  • Have you reviewed all important information required before starting, including the patient’s details, the types of images involved, the clinical question being addressed, and any known issues with the datasets?

In action

• Are you noticing anything surprising or different from what you anticipate during the process of performing and evaluating an image registration task?
  • Are you encountering situations such as:
    • The software fails to automatically register the images correctly
    • Manual adjustment of the registration proves difficult or does not yield a good alignment
    • Unexpected anatomical differences or patient movement artefacts make registration challenging
    • The images have different fields of view or resolutions than anticipated
    • There is a technical issue with the software or workstation
    • The required anatomical landmarks for registration are unclear or distorted
  • How does this experience compare with previous experiences of similar activities?
• 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, deciding the registration is clinically unacceptable)?
  • 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 common registration error, the importance of checking image parameters before starting, or when it is necessary to seek help with a complex case?
• 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?
  • Consider the steps you are taking in the moment, such as:
    • Are you pausing the registration process?
    • Are you trying a different registration algorithm or method within the software?
    • Are you consulting departmental procedures or guidelines for image registration?
    • Are you seeking advice from a supervisor or colleague?
    • Are you documenting the issue or difficulty immediately?

On action

• Begin by summarising the key points of the experience of performing and evaluating the image registration task.
  • Describe the specific steps you undertook using the software.
  • Consider specific events, actions, or interactions that felt important during the activity, including your own feelings during the experience. For example, how did you feel when the automatic registration failed or manual adjustment was challenging?
  • 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 during the registration process, 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 different registration algorithms, manual adjustment techniques, handling specific image artefacts during registration, or the importance of evaluating registration quality?
  • What strengths did you demonstrate during the activity? Were there specific skills or knowledge (e.g., anatomical knowledge, software proficiency) you applied effectively?
  • What skills and/or knowledge gaps were evident? Was there anything about image registration techniques, software features, or evaluation criteria you were unsure about or struggled with?
  • Compare this experience against previous engagement with similar activities (if any). Have any previously identified actions for development related to image registration been achieved? Has your practice in this area improved?
  • Identify any challenges you experienced (beyond unexpected events already noted in ‘reflect-in-action’) and how you reacted to these. Did these challenges affect your ability to deal with the situation independently? Were you able to overcome the challenges?
  • Identify anything significant about the activity. Did you need to seek advice or clarification from a supervisor or colleague regarding the registration process or outcome? Or did you need to escalate something (e.g., a registration you couldn’t achieve acceptably within your scope) to ensure you were working within your scope of practice?
  • Acknowledge any changes in your own feelings now that you are looking back on the experience. Do you feel more confident in performing image registration tasks?
• Identify the actions / ‘next steps’ you will now take to support the assimilation of what you have learnt. This includes learning from any feedback you have received.
  • What will you do differently next time you perform and evaluate an image registration task? Will you change your approach to selecting control points, evaluating fusion images, or troubleshooting issues?
  • Has anything changed in terms of what you would do if you were faced with a similar situation again, particularly regarding handling unexpected developments like poor initial registration or difficult anatomy?
  • Do you need to practise any aspect of the activity further? Are there specific registration techniques or software functions you want to develop further, drawing upon this experience?

Beyond action

• Have you revisited your previous reflections for this specific activity (performing and evaluating image registration)?
  • When reviewing these past reflections, what actions for improvement did you previously identify you would need to take to improve your practice related to selecting appropriate registration methods, using software effectively, evaluating the quality of registration, or troubleshooting issues?
  • 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 challenges and nuances of combining images from different modalities?
• 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 performing and evaluating image registration developed and evolved over time across multiple instances of undertaking this training activity?
  • Can you identify specific examples of improvement or increased confidence in handling challenging registration tasks or selecting appropriate parameters?
  • Based on your experiences, how has your ability to recognise when something related to image registration is beyond your scope of practice improved?
  • Do you have a clearer understanding of when and from whom (e.g., supervisor, senior colleague, software expert) you need to seek advice or clarification?

Relevant learning outcomes

#	Outcome
# 3	Outcome Use appropriate software to extract quantitative and qualitative information from nuclear medicine images and combine images from different modalities.