Imaging and Diagnostic Nuclear Medicine —
Training activity: 7

Details

Use image analysis software to extract quantitative information from clinical studies

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

• Assumptions informing analysis software
• Methods to accurately extract quantitative data:
  • Quantitation of in vivo activity concentration including calibration methods
  • Extraction of semi-quantitative measures (e.g. SUV and myocardial perfusion scoring)
  • Extraction of physiological parameters (e.g. kinetic analysis/compartmental modelling)

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 the successful extraction of quantitative information, and how will you ensure that you correctly identify regions of interest (ROIs), apply necessary correction factors (e.g., for decay, attenuation, or scatter), and accurately document results such as SUV, GFR, or blood volume?
  • Have you discussed this specific task with your training officer to gain a clarity of understanding regarding the measurements required, the acceptable margin of error, and how these results will be used to influence clinical decision-making?
• What is your prior experience of this activity?
  • Thinking about your prior experience —such as those involving tracer kinetics or reconstruction methods—how familiar are you with the specific quantitative tools within the analysis software?
  • What possible challenges do you anticipate—such as defining ROIs accurately in the presence of noise or artefacts, or ensuring data calibration—and how have you planned to handle these technical issues?
  • Do you clearly recognise the scope of your own practice, specifically knowing when a result falls outside the expected range or when a complex case requires seeking advice from a supervisor or medical physics expert?
  • How do you feel about embarking on this quantitative analysis?
• What do you anticipate you will learn from the experience?
  • What specific skills do you want to develop, such as improving your ROI definition technique, deepening your understanding of the underlying quantitative models, or increasing your proficiency with software corrections?
  • What specific insights do you hope to gain regarding how varying acquisition or reconstruction parameters affect the final values, or the potential sources of error in clinical quantification?
• What additional considerations do you need to make?
• • Have you consulted the actions for improvement identified from your previous experiences, such as points you noted while observing earlier quantitative analyses or performing manual calculations?
  • Have you reviewed all important information before starting, including the patient’s clinical history, the required software inputs (e.g., administered activity, patient weight), and the relevant departmental SOPs for quantitative studies?

In action

• Are you noticing anything surprising or different from what you anticipate during the process of using image analysis software to extract quantitative information?
  • Are you encountering situations such as:
    • The software produces unexpected quantitative results e.g., very high or low SUV values, abnormal clearance rates
    • Difficulty accurately defining the required region(s) for quantitative measurement
    • The software displays an error message during the calculation or extraction process
    • Problems with calibrating the system or inputs required for quantitative analysis e.g., injected dose, time points
    • The inability to export or save the quantitative data in the required format
    • The software freezes or crashes during the analysis
  • 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 within your authority, or do you need support because it is beyond your current scope (for example, having to discard results or report a software issue)?
  • 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 software error, the correct way to handle discrepancies in input data, or the importance of double-checking specific quantitative outputs?
• 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 stopping the analysis?
    • Are you checking the input parameters e.g., patient weight, injected activity, acquisition time?
    • Are you trying repeating the steps in the software?
    • Are you consulting the software manual or departmental SOPs for quantitative analysis?
    • Are you seeking advice from a supervisor or colleague?
    • Are you making a note of the error or unexpected result?
  • 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?

On action

• Begin by summarising the key points of the experience of using image analysis software to extract quantitative information.
  • Describe the specific steps you undertook using the software, including inputs and outputs.
  • 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 software produced unexpected results or you encountered an error message?
  • 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 quantitative analysis 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 specific quantitative metrics (e.g., SUV calculations), required input parameters (e.g., injected dose, calibration factors), defining regions for quantitative measurement, or troubleshooting software issues?
  • What strengths did you demonstrate during the activity? Were there specific skills or knowledge (e.g., understanding tracer kinetics, software proficiency, attention to detail with data entry) you applied effectively?
  • What skills and/or knowledge gaps were evident? Was there anything about the underlying principles of the quantitative analysis, software operation, or interpreting the numerical results 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 quantitative analysis been achieved? Has your practice in this area improved?
  • 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 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, colleague, or Radiation Safety Adviser (RWA) regarding input data, software settings, or unexpected results? Or did you need to escalate something (e.g., questionable quantitative results or a software issue) 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 using software for quantitative image analysis?
• 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 use image analysis software for quantitative information extraction? Will you change your approach to verifying input data, defining regions of interest for calculation, or checking the validity of the results?
  • 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 unusual results or software errors?
  • Do you need to practise any aspect of the activity further? Are there specific quantitative analysis techniques, software functions, or principles you want to develop further, drawing upon this experience?

Beyond action

• Have you revisited your previous reflections for this specific activity (using image analysis software to extract quantitative information)?
  • 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 the correct software parameters, defining regions of interest (ROIs), applying correction factors (e.g., for attenuation or scatter), understanding the output units (e.g., SUV), validating results, or handling software errors?
  • 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?
  • Have you discussed your experiences of quantitative image analysis with peers, near peers, or colleagues? Has discussing these experiences with others changed your view or understanding of common challenges, variability in results, or the clinical interpretation of quantitative metrics?
• 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 extracting quantitative information developed and evolved over time across multiple instances of undertaking this training activity?
  • Can you identify specific examples of improvement or increased confidence in selecting appropriate software tools, interpreting quantitative results, or ensuring reproducibility?
  • Based on your experiences, how has your ability to recognise when something related to quantitative image analysis is beyond your scope of practice improved?
  • Do you have a clearer understanding of when and from whom (e.g., supervisor, clinical scientist, software vendor support) you need to seek advice or clarification regarding complex quantification tasks, validation issues, or novel software features?

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.