Module information
Module details
- Title
- Advanced Radiotherapy Techniques
- Type
- Specialist
- Module code
- S-RP-S3
- Credits
- 20
- Phase
- 3
- Requirement
- Compulsory
Aim of this module
The aim of this module is to provide trainees with an understanding of advanced treatment techniques used in radiotherapy.
Work-based content
Training activities
| # | Learning outcome | Training activity | Type | Action |
|---|---|---|---|---|
| # 1 | Learning outcome 1,8 |
Training activities
Participate in correction of a mechanical aspect of an external beam treatment machine |
Type DTA | Action View |
| # 2 | Learning outcome 1,8 |
Training activities
Participate in correction of the dose output calibration of an external beam treatment machine |
Type DTA | Action View |
| # 3 | Learning outcome 1,2,4,7 |
Training activities
Perform and check measurements to characterise the dosimetry of small photon fields |
Type DTA | Action View |
| # 4 | Learning outcome 2,8 |
Training activities
Perform radiobiological calculations and discuss options with the clinician for treatment gaps and re-treatments, considering the risks, benefits and individual needs of the patient |
Type DTA | Action View |
| # 5 | Learning outcome 3,4,5 |
Training activities
Process image data and generate a treatment plan for a patient having undergone a 4DCT scan |
Type DTA | Action View |
| # 6 | Learning outcome 4,5,7 |
Training activities
Review a local approach to motion management and make recommendations |
Type DTA | Action View |
| # 7 | Learning outcome 4,5,7 |
Training activities
Analyse IGRT data to evaluate the CTV-PTV margin for a clinical site and relate to the clinical objective |
Type DTA | Action View |
| # 8 | Learning outcome 2,4,5,7 |
Training activities
Review the dose constraints for a clinical site. Make recommendations considering safety, efficacy, outcomes and the suitability and impact on the patient |
Type DTA | Action View |
| # 9 | Learning outcome 2,5,7 |
Training activities
Calculate the concomitant dose for a patient and justify the use of imaging through risk benefit analysis |
Type DTA | Action View |
| # 10 | Learning outcome 2 |
Training activities
Perform manual calculations for static field treatment plans and compare with the treatment planning system |
Type ETA | Action View |
| # 11 | Learning outcome 3,4,5,7,8 |
Training activities
Undertake a treatment plan adaption strategy for at least one patient and critically appraise its efficacy and impact on the patient |
Type DTA | Action View |
| # 12 | Learning outcome 4,5,6,8 |
Training activities
Draft a commissioning plan for a specialist or a new technology or technique |
Type DTA | Action View |
| # 13 | Learning outcome 4,5,6,7,8 |
Training activities
Summarise and discuss the potential impact on current practice of a radiotherapy clinical trial |
Type DTA | Action View |
| # 14 | Learning outcome 6,7 |
Training activities
Undertake commissioning and/or upgrades of clinical software |
Type DTA | Action View |
| # 15 | Learning outcome 1,4,5,6,7,8 |
Training activities
Assist in the commissioning or re-validation of treatment equipment or techniques |
Type DTA | Action View |
| # 16 | Learning outcome 7,8 |
Training activities
Perform an audit focusing on a clinical aspect of radiotherapy and communicate the findings and recommendations to the multidisciplinary team |
Type DTA | Action View |
| # 17 | Learning outcome 4,7 |
Training activities
Appraise departmental treatment planning quality assurance protocol and make recommendations |
Type DTA | Action View |
| # 18 | Learning outcome 7,8 |
Training activities
Write, or review a quality system document considering patient and organisational requirements |
Type DTA | Action View |
| # 19 | Learning outcome 3,7,8 |
Training activities
Assess the impact of an error in patient treatment delivery, write an incident report and recommend a strategy for correction |
Type DTA | Action View |
| # 20 | Learning outcome 1,4,7,8 |
Training activities
Assist in troubleshooting issues with treatment equipment and plan a strategy to resolve the issue |
Type DTA | Action View |
| # 21 | Learning outcome 3,4,7,8 |
Training activities
Assist in troubleshooting issues with a patient’s treatment and plan a strategy to resolve the issue |
Type DTA | Action View |
Assessments
Complete 4 Case-Based Discussions
Complete 4 DOPS or OCEs
Direct Observation of Practical Skills Titles
- Perform an image registration for the purpose of adaptive planning, evaluating the outcome for its potential clinical use.
- Perform measurements as part of clinical trial dosimetry and/or planning audit.
- Calculate patient dose from a kV imaging system to be able to assess the associated dose given to patients.
- Calculate biological effective doses for different fractionation regimes for tumours and organs at risk, including compensation strategy for gaps in treatment.
- Calculate the dose given to a patient after a radiotherapy error and make recommendations based on the findings.
Observed Clinical Event Title
- Communicate results of an audit to a multidisciplinary team.
- Discuss the outcome of radiobiological calculation for a patient re-treatment with a healthcare professional, appropriately communicating the risks.
- Present a new technique or clinical trial and discuss the impact on the department and patient care.
- Summarise a case discussed at a multidisciplinary team meeting and discuss the treatment options and rationale in the context of the patient’s history with another healthcare professional.
Learning outcomes
| # | Learning outcome |
|---|---|
| 1 | Perform required measurements to establish whether a treatment machine is suitable for clinical use and apply corrective actions where required. |
| 2 | Perform dosimetric and radiobiological calculations. |
| 3 | Generate, adapt and evaluate treatment plans using complex techniques. |
| 4 | Critically appraise the application of radiotherapy treatments and techniques and make recommendations considering safety, efficacy, outcomes and the suitability and impact on the patient. |
| 5 | Evaluate the application of novel and evolving techniques and treatments in radiotherapy. |
| 6 | Plan for adoption and validation of new techniques and equipment in radiotherapy. |
| 7 | Assess the quality of practice and make recommendations for improvements. |
| 8 | Practice effectively as part of a multidisciplinary team to provide safe, patient centred radiotherapy treatments. |
Clinical experiences
Clinical experiences help you to develop insight into your practice and a greater understanding of your specialty's impact on patient care. Clinical experiences should be included in your training plan and you may be asked to help organise your experiences. Reflections and observations from your experiences may help you to advance your practice and can be used to develop evidence to demonstrate your awareness and appreciation of your specialty.
Activities
- Observe a 4D CT scan and observe the treatment being delivered to appreciate the role in the patient pathway.
- Observe a discussion with a patient about radiotherapy consent or giving consent for entry into a clinical trial.
- Attend a meeting where quality and departmental radiation incidents are discussed.
- Attend a multidisciplinary meeting where a new technique is introduced or a new clinical site is being proposed and/or being discussed.
Academic content (MSc in Clinical Science)
Important information
The academic parts of this module will be detailed and communicated to you by your university. Please contact them if you have questions regarding this module and its assessments. The module titles in your MSc may not be exactly identical to the work-based modules shown in the e-portfolio. Your modules will be aligned, however, to ensure that your academic and work-based learning are complimentary.
Learning outcomes
On successful completion of this module the trainee will be able to:
- Explain the physical principles of imaging equipment and image processing, including limitations and uncertainties.
- Critically evaluate the role of different imaging modalities in all stages of the radiotherapy pathway.
- Apply integrative knowledge of approaches to treatment verification, motion management and adaptive planning.
- Discuss the radiobiological basis of radiotherapy and formulate appropriate recommendations for clinical scenarios.
- Critically appraise the requirements for safe working in radiotherapy, applying the relevant legislation and guidance governing radiation safety and describe the underpinning quality framework.
- Demonstrate a critical awareness of the purpose of clinical trials and outline the main elements of a clinical trial quality assurance programme.
Indicative content
| Imaging in Radiotherapy | |
| Dicom in RT | Dicom RT files, DICOM tags, terminology, connectivity and inter-operability, troubleshooting |
| CT imaging for RT | CT protocol configuration, dose optimisation and concomitant dose, image quality, national reference levels |
| Planar imaging | kV, MV |
| Image data manipulation | Viewing clinical images, image processing, image fusion, registration algorithms, image quality |
| MRI for RT | MRI scanner design and requirements for RT, clinical use of MR in RT, artefacts, quality assurance for MRI in RT, diffusion, perfusion, fMRI scans |
| PET-CT, PET-MR, Ultrasound | Clinical use in RT, SUV levels, limitations in RT planning |
| Motion management
|
Active and passive motion management, 4DCT, gating, DIBH |
| Treatment verification | IGRT, online and offline protocols, verification techniques, sources of error – random and systematic uncertainties, PTV margin calculations. Justification, optimisation and dose limitation for IGRT
|
| Adaptive radiotherapy | Terminology, rationale, levels of adaptation, adaptive planning techniques and equipment |
| SGRT | |
| Radiation safety in Radiotherapy | |
| IR(ME)R for Radiotherapy | IRMER roles and responsibilities, justification and optimisation, guidance notes, enforcement, SAUE |
| Patient incidents | Incident investigations, legislation and guidance, examples and learning points |
| IRR | IRR roles and responsibilities, dose limits, radiation sources, radiation surveys, radiation risk assessment, designation of controlled and supervised areas, local rules, staff and patient protection, ACOP, reportable incidents |
| Room design for RT facilities | Room design and construction (linacs, superficial machines, brachytherapy), shielding calculations, neutrons |
| Radioactive materials | Management and security, legislation, transport and disposal |
| Radiobiology | |
| TCP and NTCP | Cell cycle, 5 R’s, Cell survival and the LQ model, alpha/beta ratio, TCP, NTCP, principles of fractionation, incomplete repair, BED, EUD, organ/complication architecture |
| Radiobiological data | Sources of data, dose limits, uncertainties |
| Retreatments and treatment gap compensation | Accelerated repopulation, modelling treatment gaps, compensation strategies, RCR recommendations, retreatments |
| Secondary cancer induction | Definitions and modelling |
| Effects of oxygen/hypoxia, dose rate, LET, genetic variation in radiosensitivity | |
| Radiobiology of particle therapy | LET and RBE |
| Radiobiology of brachytherapy | |
| Development of other key skills | |
| IT and networking | Networking and network environment, hospital systems (PACs etc), interoperability (DICOM, HL7), legislation, systems management, data protection, GDPR, health informatics, emerging technologies (basic concepts of machine learning, AI, big data)… |
| Quality management | Quality assurance and quality control, audit, quality improvement, quality management systems, national legislation and accreditation |
| Change management | Commissioning, upgrades, risk assessment, end to end testing, document control |
| Clinical trials | Impact on UK practice, RCTs and hierarchy of evidence. Accreditation, patient consent, data anonymisation, trial quality assurance, documentation |