External Beam Radiotherapy Techniques —
Training activity: 4

Details

Perform routine quality assurance for a treatment unit and its associated imaging equipment

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

• Safe operation of treatment machines
• Data recording
• Interpreting results
• Escalate faults, including clinical consequences and impact
• Making recommendations
• Remedial action
• Documentation
• Legislation
• Working effectively with other staff groups when working on treatment machines
• Clinical handover with radiographers
• Handover to and from engineers
• Communication of relevant issues and clinical impact
• Handover documentation

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 routine quality assurance for a treatment unit and its associated imaging equipment? What are the specific requirements and expected outcomes for this QA activity, as outlined in the curriculum or discussed with your Training Officer? How will you know if the QA has been performed accurately and effectively, ensuring the unit is suitable for clinical use?

• What is your prior experience with routine quality assurance of radiotherapy equipment? What do you already know about the procedures, equipment, and safety protocols involved? What potential challenges might arise during the QA process (e.g., unexpected readings, equipment malfunctions), and how do you plan to address them? When would you need to seek advice or help, and from whom, if you encounter something outside your scope of practice during this QA? How do you feel about embarking on this specific quality assurance activity?

• What specific skills related to equipment operation, data interpretation, or quality control do you aim to develop or refine? What specific insights do you hope to gain regarding the importance of routine QA and its impact on patient safety?

• What additional considerations do you need to make before performing this routine QA? Are there any actions identified from previous QA experiences (yours or others’) that you need to consult or implement? What important information, such as specific QA protocols, safety guidelines, or equipment manuals, do you need to review before starting?

In action

• Does anything unexpected occur during the activity? e.g.
  • Unusual readings outside expected tolerances.
  • Unexpected equipment behaviour or error messages.
  • Challenges with the imaging quality or alignment tests.
  • A deviation from the standard QA protocol.
• Are you considering how this specific experience compares with previous experiences of similar activities. Is this type of unexpected event common or rare?
• How do you react to the unexpected development?
  • Do you respond appropriately (e.g., do you stop the process, re-run a test, or check a specific component)?
  • Do you adapt or change your approach to the QA procedure in real-time?
  • Does it affect your ability to undertake the activity independently (e.g., do you immediately recognise the need to consult a supervisor or senior colleague)?
• Do you find it difficult to adapt? Do you feel confident in your immediate decision-making?
  • Does it affect your confidence in your knowledge of the equipment or procedure?
  • Do you feel positive you can reach a successful conclusion, or do you feel out of your depth?
• How do you work within your scope of practice to address the unexpected development?  Do you know when to intervene and when to escalate? What do you  learn in the moment as a result of the unexpected development (e.g., a specific troubleshooting step, a nuance of equipment behaviour, or a critical parameter)?

On action

• Begin by summarising the key points of your experience performing routine quality assurance for a treatment unit and its associated imaging equipment. Consider specific events, actions, or interactions which felt important during the QA process, including your own feelings at the time. Include any ‘reflect-in-action’ moments where you adapted to the situation as it unfolded during the QA process.
• Identify what learning you can take from this experience of performing routine QA e.g., what strengths did you demonstrate? What skills and/or knowledge gaps were evident? Compare this experience against previous engagement with similar QA activities – were any previously identified actions for development achieved? Has your practice improved in performing this type of routine QA? Identify any challenges you experienced while performing the QA 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 specific QA activity e.g., did you need to seek advice or clarification regarding the treatment unit or imaging equipment? 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 the routine QA.
• Identify the actions / ‘next steps’ you will now take to support the assimilation of what you have learnt from performing routine QA, including from any feedback you have received e.g., what will you do differently next time you perform this activity? Has anything changed in terms of what you would do if you were faced with a similar QA situation again? Do you need to practise any aspect of performing routine QA further?

Beyond action

• Have you reviewed the actions you identified for improvement from your prior reflections on this activity? For instance, what specific steps did you plan to take to enhance your efficiency, accuracy, or understanding of troubleshooting in QA? Have you completed these actions, and are you now ready to consistently demonstrate this new learning in your QA practice? Has analysing these situations with others changed your view or understanding of the processes, potential issues, or best practices?
• Reflect on how the learning gained from multiple QA activities will support you in preparing for observed ‘in-person’ assessments related to equipment quality. Consider how your practice in performing routine QA has developed and evolved over time. Do you now more readily recognise when a situation or outcome during QA is beyond your scope of practice, requiring escalation or external advice?

Relevant learning outcomes

#	Outcome
# 2	Outcome Perform required measurements to establish a treatment machine is suitable for clinical use; interpret results and instigate corrective action where required.
# 3	Outcome Apply appropriate guidance, regulations and codes of practice to ensure patient safety in all elements of practice.