Training activity information
Details
Calculate the concomitant dose for a patient and justify the use of imaging through risk benefit analysis
Type
Developmental training activity (DTA)
Evidence requirements
Evidence the activity has been undertaken by the trainee.
Reflection on the activity at one or more time points after the event including learning from the activity and/or areas of the trainees practice for development.
An action plan to implement learning and/or to address skills or knowledge gaps identified.
Considerations
- Role of effective doses
- Risks vs benefits
- Optimisation of the imaging protocol
- Use of different IGRT modalities
- Dose reference levels
- Imaging protocols
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 is concomitant dose? How is it calculated?
- What are the risks and benefits of imaging in radiotherapy?
- What patient-specific factors need to be considered?
- Have you discussed the specific patient case and imaging protocols with relevant staff?
- What challenges might you face in quantifying risks and benefits?
- How do you feel about justifying clinical procedures based on this type of analysis?
In action
- How are you calculating the dose delivered to the patient from these imaging procedures?
- What factors are you considering in your risk-benefit analysis (e.g., diagnostic information gained, potential increase in secondary cancer risk)?
- How are you quantifying the risks and benefits to make an informed justification?
- What regulations or guidelines are relevant to this justification?
- Are you able to accurately determine the dose contribution from each imaging modality?
- Are you clearly defining the benefits of the imaging in the context of the patient’s treatment?
- Is your risk assessment comprehensive and considering relevant factors?
- If the risk-benefit analysis suggests that the imaging might not be justified, what alternative strategies are you considering (e.g., reduced imaging frequency, alternative imaging modalities with lower dose)?
- Are you prepared to discuss your findings and recommendations with the clinical team?
On action
- What were the parameters of the treatment plan that influenced the concomitant dose? What imaging modalities and frequencies were being considered or used? What were the estimated doses from both the treatment and the imaging? What risks (e.g., secondary malignancy) were associated with the imaging dose? How were the benefits of the imaging (e.g., improved accuracy) weighed against the risks?
- What did you learn about your skills in performing dose calculations for both therapeutic and imaging exposures, your understanding of the concept of concomitant dose, and your ability to apply risk-benefit analysis in the context of radiation exposure? Do you need to further explore the risks associated with different imaging modalities?
- How will this improve your awareness of concomitant doses from radiotherapy and imaging? How will this enhance your ability to perform risk-benefit analyses for imaging protocols? What further learning in the area of radiation protection and the long-term effects of radiation would be valuable?
Beyond action
- Reflecting on this calculation and justification, how has your understanding of concomitant doses and the principles of risk-benefit analysis in imaging evolved?
- Have you been involved in other discussions or decisions regarding the use of imaging where risk-benefit analysis was important? How did this training activity inform your input?
- How has your understanding of concomitant doses and risk-benefit analysis since contributed to your current practice in ensuring the appropriate use of imaging in radiotherapy?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 2 |
Outcome
Perform dosimetric and radiobiological calculations. |
| # 5 |
Outcome
Evaluate the application of novel and evolving techniques and treatments in radiotherapy. |
| # 7 |
Outcome
Assess the quality of practice and make recommendations for improvements. |