Training activity information
Details
Perform checks required before clinical use of inverse and forward planned patient treatments including patient specific quality assurance where appropriate
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
- Deliverability of the treatment plan
- Independent MU checks
- Tolerances and local procedures
- Critical appraisal of results
- Problem solving
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 for performing pre-clinical use checks and patient-specific quality assurance (PSQA)? What are the exact steps and documentation required for verifying the accuracy and deliverability of both inverse and forward planned treatments? How will you ensure that all checks, including PSQA, are meticulously performed to guarantee patient safety before treatment initiation?
- What do you already know about independent monitor unit calculations, PSQA techniques e.g., phantom measurements, EPID dosimetry, and acceptance criteria? What potential challenges might arise during these checks e.g., discrepancies in results, complex field arrangements, and how do you intend to resolve them? When would it be necessary to escalate an issue or seek input from a senior physicist or consultant due to unacceptable PSQA results? How do you feel about the critical responsibility of ensuring the accuracy of patient treatments?
- What specific skills in independent dose calculations, PSQA measurement techniques, data analysis, and critical decision-making do you aim to enhance? What insights do you hope to gain regarding the robustness of different planning techniques and the importance of thorough pre-treatment verification?
- Have you reviewed any previous PSQA reports, non-conformance records, or discussions related to similar treatment types? What important information, such as the treatment plan, patient-specific QA protocol, and reference dosimetry data, should you gather and review?
In action
- You make a note of anything that feels surprising or different from what you anticipate, such as:
- Discrepancies between planned and measured dose values during patient-specific QA.
- Unexpected software errors or calculation inconsistencies during independent checks.
- Issues with the physical setup of the QA phantom or detectors.
- Unforeseen challenges in interpreting complex QA results for inverse planned treatments.
- You consider how this specific experience compares with previous experiences of similar activities. Is this a common issue with a particular treatment technique or a unique discrepancy?
- Do you respond appropriately (e.g., do you re-check calculations, verify plan parameters, or troubleshoot the QA setup)?
- Do you adapt or change your approach to the checks e.g., performing additional measurements, or focusing on specific areas of the dose distribution?
- Does it affect your ability to undertake the activity independently e.g., do you recognise the need to escalate the issue to a senior physicist, or involve the treatment planning team?
- Do you find it difficult to adapt? Do you feel confident in your ability to identify the root cause of discrepancies?
- Does it affect your confidence in the accuracy of the treatment plan or the QA process itself?
- Do you feel positive you can reach a successful conclusion, ensuring patient safety?
- You identify how you work within your scope of practice to address the unexpected development. Is the plan cleared for clinical use, or is further investigation/modification required? What are you learning in the moment as a result of the unexpected development (e.g., a specific troubleshooting step for a QA device, the importance of certain parameters in independent checks, or typical tolerances for different techniques)?
On action
- Begin by summarising the key points of your experience performing checks and patient-specific quality assurance (PSQA) before clinical use of treatments. Consider specific events, actions, or interactions which felt important during the checking and PSQA process, including your own feelings at the time.
- Identify what learning you can take from this experience of performing critical checks and PSQA e.g., what strengths did you demonstrate?
- What skills and/or knowledge gaps were evident? Compare this experience against previous engagement with similar treatment check or PSQA activities – were any previously identified actions for development achieved? Has your practice improved in performing these critical checks and PSQA?
- Identify any challenges you experienced during the checks or PSQA and how you reacted to these e.g., did this affect your ability to deal with the situation? Were you able to overcome the challenges?
- Identify anything significant about this activity of performing checks and PSQA e.g., did you need to seek advice or clarification regarding verification protocols? Or did you need to escalate to ensure that you were working within your scope of practice? Acknowledge any changes in your own feelings now that you are looking back on the experience of performing these checks and PSQA.
- Identify the actions / ‘next steps’ you will now take to support the assimilation of what you have learnt from this activity e.g., what will you do differently next time you perform these checks or PSQA? Has anything changed in terms of what you would do if you were faced with a similar checking or PSQA situation again? Do you need to practise any aspect of these checks or PSQA further?
Beyond action
- Have you reviewed the actions you identified for improvement from your prior reflections on this activity? For example, did you focus on improving your precision in measurements, your speed in data analysis, or your ability to interpret complex patient-specific quality assurance (PSQA) results e.g., gamma analysis? Have you completed these actions, and are you ready to consistently apply this enhanced skill? Has discussing these experiences with others clarified your understanding of machine performance, dosimetry uncertainties, or appropriate actions for non-compliant results?
- Consider how this learning will support you in preparing for observed ‘in-person’ assessments, particularly those related to equipment validation and patient safety. Reflect on how your practice in performing these crucial safety checks has developed and evolved. Do you now have a more comprehensive understanding of the implications of specific results, and do you more readily recognise when a finding warrants immediate escalation to ensure patient safety and compliance with regulations?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 3 |
Outcome
Apply appropriate guidance, regulations and codes of practice to ensure patient safety in all elements of practice. |
| # 6 |
Outcome
Develop and appraise external beam radiotherapy treatment plans for clinical use. |
| # 7 |
Outcome
Practice effectively as part of a multidisciplinary team. |