Advanced Radiotherapy Techniques —
Training activity: 10

Details

Perform manual calculations for static field treatment plans and compare with the treatment planning system

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

• Origin of beam data
• TPS algorithms and calculation methods and their limitations
• Tolerances
• Relevance for patient safety

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

• Consider the broader context of quality assurance and quality control within radiotherapy, as this activity contributes to ensuring accuracy in treatment planning. Confirm with your training officer specific parameters, expected accuracy, and the type of static field treatment plans you are likely to encounter. This conversation can help clarify the specific clinical scenarios and radiobiological basis of radiotherapy that may underpin these calculations.
• Think about what you already know about performing manual calculations and using a TPS  that might be relevant for interpreting TPS data. Have you performed similar calculations in a simulated environment or as part of academic work?
• Consider possible challenges you might face during the activity, and think about how you might handle them: For example, what if your manual calculation significantly differs from the TPS? How will you troubleshoot potential errors? Consider potential issues related to data integrity or the interoperability of systems.
• Recognise the scope of your own practice for this activity. Do you know when you will need to seek advice or help, and from whom, particularly if discrepancies are beyond your immediate ability to resolve?
• Are you confident in your mathematical skills? Do you feel prepared to critically assess the TPS output?
• Consider the specific skills you want to develop – drawing upon previous experiences of the activity. Do you aim to improve your speed and efficiency in performing calculations? Do you want to enhance your ability to identify and troubleshoot subtle differences between manual and TPS outputs?
• Do you hope to gain a deeper understanding of the algorithms used by the TPS, or how different treatment verification techniques relate to plan accuracy?
• Consult actions identified following previous experiences of similar activities: If you have performed any calculations or TPS comparisons before, review your previous reflections. Did you identify any areas for improvement that you can focus on in this attempt?
• Identify important information you need to consider before embarking on the activity: Do you need to review specific departmental protocols for manual calculation checks or TPS validation? Are there specific dose constraints, data tables, or quality assurance protocols that are particularly relevant that you should be aware of?

In action

• Make a note of anything that feels surprising or different from what you anticipated e.g. are your manual calculations for a static field treatment plan differing significantly from the Treatment Planning System (TPS) output?
• Is there an unexpected challenge in accessing or interpreting the DICOM RT files or terminology from the TPS? Are you encountering a calculation error that you didn’t immediately recognise, or was the TPS output different from what you expected?
• Consider how this experience compares with previous experiences of similar activities. Have you encountered similar discrepancies in previous manual calculation checks or TPS validations?
• Was your prior experience with dosimetric and radiobiological calculations sufficient to anticipate the observed outcome?
• Identify how this unexpected development impacts your actions, for instance, are you responding to the situation appropriately? Are you adapting or changing your approach? Is it affecting your ability to undertake the activity independently?
• If there is a discrepancy, how are you attempting to troubleshoot it? Are you re-checking your manual calculations, reviewing the TPS parameters, or seeking to understand potential sources of error Do you recognise when the discrepancy is beyond your immediate ability to resolve and seek advice or help, or are you considering if it needs to be escalated? Are you adapting your method for comparison, perhaps by breaking down the calculation into smaller steps to pinpoint the source of variation?
• Consider how you feel in the moment, for example, do you find it difficult to adapt? Is it affecting your confidence? Do you feel positive you can reach a successful conclusion?
• Is the unexpected outcome challenging your confidence in performing manual calculations? Are you able to successfully identify the reason for any discrepancies between your manual calculations and the TPS, or do you need to escalate it to a more experienced colleague? Do you ensure that the process contributes to the quality assurance and quality control of the treatment plan?
• What specific knowledge or skill are you gaining? Is this experience providing insight into potential patient incidents related to calculation errors or data integrity issues?

On action

• Begin by summarising the key points of the experience of performing manual calculations for a static field treatment plan and comparing them with the Treatment Planning System (TPS).
  • What were the specific treatment plans you worked on?
  • What were the results of your manual calculations, and how did they compare to the TPS output?
  • Did you utilise any specific DICOM RT files or terminology from the TPS during your comparison, and how did they contribute to your understanding?
  • Did you encounter any unexpected discrepancies, and what was your initial reaction?
  • Did you have to troubleshoot a significant deviation between your manual calculation and the TPS? How did you approach identifying the source of the error?
• What strengths did you demonstrate in performing dosimetric and calculations? Were you meticulous, efficient, or particularly adept at identifying errors?
  • What skills and/or knowledge gaps were evident? For instance, did you need to review certain calculation methodologies, specific details of static field planning?
  • Compare this experience against previous engagement with similar activities. Has your practice in performing manual calculations improved?
  • Did facing discrepancies or errors affect your ability to deal with the situation confidently? Were you able to overcome these challenges, perhaps by seeking clarification or systematically troubleshooting?
  • Did you need to seek advice or clarification from your Training Officer or a senior colleague regarding a complex calculation or a significant TPS discrepancy?
  • Did you need to escalate a finding to ensure that you were working within your scope of practice and that patient safety or quality assurance was maintained?
  • Did this experience highlight the importance of specific departmental protocols for quality control or patient incident reporting related to calculation errors?
• Identify the actions / ‘next steps’ you will now take to support the assimilation of what you have learnt.
  • What will you do differently next time when performing manual calculations? For example, will you implement a new checking strategy,, or focus on a particular aspect of the TPS?
  • Has anything changed in terms of what you would do if you were faced with a similar situation again, particularly regarding troubleshooting issues or seeking appropriate support?
  • Do you need to practise any aspect of the activity further, perhaps focusing on a particular type of static field plan or a more complex calculation scenario?

Beyond action

• Have you reviewed your reflections from previous times you performed manual calculations for static field treatment plans ?
• What specific actions did you identify you would need to take to improve your practice in performing these calculations or in understanding discrepancies with the TPS output? Have you completed these identified actions? Are you ready to demonstrate this new learning in practice?
• Consider if your view of situations where manual calculations differed from TPS outputs has changed because of analysing this with others. Has mutual exchange of experiences led to a transformation in your understanding or approach to quality assurance and quality control in treatment planning?
• Consider how the learning from consistently performing and reflecting on this training activity will support you in preparing for observed ‘in-person’ assessments for the module such as calculating patient doses or performing measurements.
• Consider how your practice in performing manual calculations for static field treatment plans has developed and evolved over time.
• Can you now more effectively perform dosimetric calculations ?
• Have you developed a greater ability to recognise when something is beyond your scope of practice in relation to complex calculation discrepancies or TPS issues, and when to seek advice or escalate?
• Reflect on how your consistent engagement with this training activity has enhanced your ability to contribute to the safety, efficacy, and outcomes of radiotherapy treatments.
• How has this continuous reflection contributed to your understanding of the overarching quality management system within radiotherapy, ensuring data integrity and minimising the potential for patient incidents related to calculation errors?

Relevant learning outcomes

#	Outcome
# 2	Outcome Perform dosimetric and radiobiological calculations.