ACPSEM. Diagnostic Imaging Medical Physics. Clinical Training Guide

Transcription

1 ACPSEM Diagnostic Imaging Medical Physics Clinical Training Guide Version 5.0 Approved by the PSB on 9/5/2018

2 THE ACPSEM The ACPSEM mission is to advance services and professional standards in medical physics and biomedical engineering for the benefit and protection of the community. In following this mission, the ACPSEM Clinical Training Guide (CTG) has been developed by many experienced medical physicists over many years. It represents a pathway for registrars to follow in order to acquire the knowledge and skills expected of a qualified diagnostic imaging medical physicist (DIMP). ACKNOWLEDGEMENTS This clinical training program was originally developed using training guides by the Regional Co-operative Agreement (RCA), under the auspices of the International Atomic Energy Agency (IAEA), as its basis. The ACPSEM gratefully acknowledge the approval of the RCA/IAEA for the use of their guides in the development of the TEAP documentation. The ACPSEM acknowledges and thanks the many members who have contributed to the development of the DIMP TEAP Program and hence to the advancement of the medical physics profession.

3 Contents THE ACPSEM... i ACKNOWLEDGEMENTS...ii 1. INTRODUCTION COMET elearning System DIMP TEAP TRAINING MODULES Module Classification Module Categories Module Codes Module Rating Core Modules Speciality Modules Nuclear Medicine Speciality Modules Diagnostic Radiology Optional Modules COMPETENCY ASSESSMENT Levels of competency assessment Evidence of Training Competency Assessment Methods Assessment by Observation Assessment of Written Evidence Assessment by Question and Answer Recognition of Prior Learning (RPL) Formal Assessments undertaken by ACPSEM... 10

4 1. INTRODUCTION This Clinical Training Guide (CTG) for training in Diagnostic Imaging Medical Physics (DIMP) is one of currently three guides that conform to the ACPSEM TEAP for medical physicists and Radiopharmaceutical scientists. This document outlines the training plan to lead to certification as a medical physicist, either in Diagnostic Radiology or Nuclear Medicine or both. The decision to combine the training in medical physics for diagnostic radiology and nuclear medicine was taken historically In order to address current and ongoing needs of medical imaging facilities in Australia and New Zealand, with the ultimate aim of developing medical physicists who, as well as being competent in their chosen specialty, will also be familiar with the basic and shared elements of the other specialty (especially those relating to radiation safety). In order to achieve this, the program takes advantage of commonality in related areas of both specialties. Dual certification is encouraged and possible with one extra year of study. In line with the ACPSEM TEAP document, this guide describes a training pathway that can be undertaken by registrars, who are generally early entry practitioners to medical physics, and experienced professionals who may wish to expand their competencies and or seek certification in a new specialty, or may be required to take this path to qualify for registration (see Registration document). The enrolment requirements for registrars and experienced professionals are detailed in the ACPSEM TEAP document. While the pathway is essentially the same for both categories of participants, experienced professionals might be expected to have accelerated progression through the program as a result of prior knowledge and experience which would be recognised through standard competency based assessment of modules (see later). With the above proviso, for the remainder of this document the term registrar will be used to cover both entry practitioners and experienced professionals. Certification with specialization in either diagnostic radiology or nuclear medicine is achieved in approximately three years (additional time is required for registrars concurrently undertaking required MSc study) and dual certification can be achieved with approximately one further year of training. In essence, registrars seeking a single specialty will complete the training modules related to their chosen specialty, along with other modules necessary to achieve the core competencies required in a multi-modality medical imaging facility. The ACPSEM DIMP Training Program includes four types of training modules, which are described in section 2. The modular nature of the Training Program allows registrars to undertake a number of training modules concurrently and the selection of these modules is related to their progress through the program, dual or single speciality goal and the clinical opportunities available to undertake some optional modules. Each module involves attainment of levels of competence (see section 4.1) and it is common, and indeed often beneficial, for multiple modules to progress in parallel. All DIMP registrars are required to complete the core modules. Core modules include modules with competencies relating to both diagnostic radiology and nuclear medicine, as well as modules with competencies predominantly relating to one single specialty that have however been deemed essential for the expanded role for a certified DIMP. Modules can be taken in any order, or concurrently, to suit the requirements of the registrar and his/her employer. It should be noted, that prerequisites are suggested for some modules where the competencies build on those acquired from working through other modules. In these cases the suggested level of achievement for the prerequisite module would normally be at level 1, however higher levels of achievement may be specified by a supervisor as required. DIMP Clinical Training Guide Page 1 of 10 V5.0, PSB approved 9/5/18

5 As detailed in the ACPSEM TEAP document, registrars are required to have a suitable publication to be eligible for certification. It is recommended that registrars prepare early with the selection of a research area to complete this requirement. The basic textbooks recommended for the DIMP TEAP are: Diagnostic Radiology Physics: A Handbook for Teachers and Students (IAEA). Nuclear Medicine Physics: A Handbook for Teachers and Students(IAEA) Bushberg, Seibert, Leidholt and Boone. The Essential Physics of Medical Imaging, Third Edition. Cherry, Sorenson and Phelps. Physics in Nuclear Medicine, Fourth Edition Martin, CJ and Sutton, DG: Practical Radiation Protection in Healthcare, Oxford University Press, McRobbie, D.W., Moore, E.A., Graves, M.J., Prince, M.R., MRI From Picture to Proton, 3rd edn, Cambridge University Press, Cambridge (2017). The IAEA texts will be distributed to DIMP registrars following their successful enrolment in the program. Additional recommended texts and resources are given in the detailed specification for each training module. 2. COMET elearning System ACPSEM s elearning system is called COMET. All TEAP resources including the TEAP Program document, Clinical Training Guide, Assessment Guideline along with various other resources, forms and training activities can be accessed through this platform. COMET also contains the clinical training modules themselves and is utilised for uploading evidence of training, supervisor grading, feedback and progress tracking. 3. DIMP TEAP TRAINING MODULES 3.1 Module Classification Full lists of the training modules are given later in this section. Core modules are mandatory for registrars undertaking either specialty, or both. Specialty-specific modules are mandatory for registrars enrolled in that specialty and other modules are optional. Modules have defined knowledge-based and skills-based competencies. It should be noted that most modules should be able to be completed (under supervision) as part of the registrar s normal allocated duties. The training program includes four types of modules: 1. Core Modules: In these modules the registrar acquires the knowledge that is required for training and work in a clinical environment. For some core modules, the successful completion of the coursework component of an ACPSEM accredited Medical Physics MSc course will be the basic foundation for completion of these modules. However, often this knowledge needs to be put into clinical context and this is facilitated as the registrar progresses in his/her training. Other modules relate to the registrar s clinical and professional work environments. DIMP Clinical Training Guide Page 2 of 10 V5.0, PSB approved 9/5/18

6 An important component of the core modules are the radiation protection and basic dosimetry competencies which are routinely undertaken in most large medical imaging facilities. On completion of these modules, the registrar should be capable of handling most radiation safety situations. The Part 1 written examination covers work from core modules. Registrars are encouraged to sit for this exam once they have completed these modules (with some exceptions) to competency level Nuclear Medicine Speciality Modules: These more advanced training modules build on the knowledge acquired in the core modules but relate to nuclear medicine specifically. The Part II written examination covers work from one selected specialty. Registrars are encouraged to sit for this exam once they have completed all required modules up to competency level Radiology Speciality Modules: These more advanced training modules build on the knowledge acquired in the core modules but relate to diagnostic radiology specifically. The Part II written examination covers work from one selected specialty. Registrars are encouraged to sit for this exam once they have completed all required modules up to competency level Optional Modules: There are 16 designated optional modules to choose from, although single-specialty registrars may also choose modules from the alternate specialty. 9 points are required from the optional/alternate specialty list. Full details of the assessments are specified in a separate TEAP Assessment Procedures for Registrars in DIMP document, available on COMET. 3.2 Module Categories Modules are separated into six broad categories: Introductory (1); Radiation safety (2); Dosimetry and detriment (3); Performance testing (4); Clinical (5); and Therapy (6, NM only). A module s category can be easily identified by the third character (first number) in the module code (see next section). 3.3 Module Codes The module code is designed to describe the module attributes in some detail, specifically: Whether it is Core, Specialty-specific or Optional (C, S or O); Who is considered qualified to be the assessor of the registrar s competence, a Radiology physicist, an NM physicist, requires Both or Either (R, N, B or E); DIMP Clinical Training Guide Page 3 of 10 V5.0, PSB approved 9/5/18

7 Which category it falls into (1-6, see previous section); and Module number within that category. So, a module with the code CB2.6 is a core module, requires assessment by both a qualified DR and NM physicist, is a radiation safety module (category 2) and is number 6 within that category. A module with the code SR4.2 is a specialty-specific module, requires a qualified radiology physicist to grade it, is a performance testing module (category 4) and is module number 2 within that category. 3.4 Module Rating Modules are classified as one of the following: 1 (low), 2 (moderate) and 3 (high) in terms of how much time needs to be invested to complete them. The competency level currently assigned (1, 2 or 3) is the multiplier applied to the module rating to determine the number of points achieved at each stage of competency. So, modules rated 1, 2 and 3 are worth 3, 6 and 9 points at completion (L3), respectively. Because the majority of the program is mandatory, the primary purpose of the rating system is simply to provide more accurate progress tracking. The ratings do have significance when choosing optional modules though because one, two or three modules may need to be completed, depending on the ratings of the modules chosen. 3.5 Core Modules There are 22 core modules, all of which are mandatory for both DR and NM specialisation. These are as follows: Core Modules Module Code Module Description Rating CE1.1 Anatomy and physiology for diagnostic imaging medical physicists 1 CE1.2 Radiation biology and epidemiology 1 CE1.3 Diagnostic imaging technology 3 CE1.4 Imaging informatics 1 CE1.5 Clinical activities and factors that affect patient care 1 CE1.6 Professional awareness 1 CE1.7 Communication 1 CE1.8 Teaching 1 CE2.1 Radiation protection legislation, principles, control methods and operational considerations 3 CE2.2 Monitoring radiation levels, including personal dose monitoring 2 CN2.3 Exposure from unsealed sources and the risk of contamination 1 CN2.4 Radiation risk assessment and advice to staff, carers and general public in diagnostic nuclear medicine 1 DIMP Clinical Training Guide Page 4 of 10 V5.0, PSB approved 9/5/18

8 CE2.5 Sources of exposure, incidents and emergencies 1 CB2.6 Radiation shielding for diagnostic imaging facilities 3 CN2.7 Areas designated for the use of unsealed sources and associated waste management 2 CB3.1 Basic patient and fetal dose and detriment from diagnostic imaging procedures 2 CE3.2 Radiation risk to the patient in diagnostic radiology 1 CE4.1 Performance testing of display and hardcopy devices 1 CN5.1 Physiological basis and protocols for diagnostic nuclear medicine procedures I 1 CE5.2 Clinical audit 2 CE5.3 Life cycle of imaging equipment 3 CN6.1 Principles of radionuclide therapy Speciality Modules Nuclear Medicine There are 14 mandatory modules associated with the nuclear medicine specialty. These are as follows: Nuclear Medicine Specialty Modules Module Code Module Description Rating SN3.6 Formalism and application of internal dosimetry 2 SN3.7 Patient specific dosimetry for radionuclide therapeutic procedures 2 SN4.8 PET/CT Performance testing and quality control of dose calibrators 2 SN4.9 Performance testing of gamma cameras 2 SN4.10 Performance testing of PET scanners 2 SN4.11 Performance testing of CT for hybrid imaging 1 SN5.7 Physiological basis and protocols for diagnostic nuclear medicine procedures II 2 SN5.8 The physiological basis of PET imaging 1 SN5.9 Common artefacts in clinical images 2 SN5.10 Computer imaging processing techniques 1 SN5.11 Quantitative nuclear medicine imaging 2 SN5.12 Optimisation processes in nuclear medicine 2 SN6.2 Applications of therapeutic radionuclides 1 SN6.3 Treatment procedures and radiation safety precautions for therapy using unsealed radionuclide sources 2 DIMP Clinical Training Guide Page 5 of 10 V5.0, PSB approved 9/5/18

9 3.7 Speciality Modules Diagnostic Radiology There are 12 mandatory modules associated with the diagnostic radiology specialty. These are as follows: Diagnostic Radiology Specialty Modules Module Code Module Description Rating SR3.3 Ionising radiation dosimetry and principles of measurement 2 SR3.4 Patient dosimetry in diagnostic radiology 2 SR3.5 Foetal dose estimation 2 SR4.2 Performance testing of general radiography equipment 2 SR4.3 Performance testing of computed radiography and digital radiography equipment 2 SR4.4 Performance testing of fluoroscopy and interventional equipment 2 SR4.5 Performance testing of computed tomography equipment 2 SR4.6 Performance testing of mammography equipment 2 SR4.7 Performance testing of dental radiography equipment 1 SR5.4 Patient dose audit 2 SR5.5 Assessment of image quality 2 SR5.6 Optimisation processes in diagnostic radiology Optional Modules The following modules are optional; however, 9 points must be attained by completing a selection of these (or modules from the non-chosen specialty for registrars seeking a single certification). One, two or three modules may need to be completed, depending on the ratings of the modules chosen. Modules rated 1, 2 and 3 are worth 3, 6 and 9 points once completed (to Level 3), respectively. Optional Modules Module Code Module Description Rating OE2.10 Laser Safety 2 OE4.12 Performance testing of dual-energy x-ray absorptiometry (DEXA) Equipment 1 OE5.16 Image analysis in a high level programming language (advanced) 1 ON3.10 Use of traceable standards for radioactivity measurements 1 ON3.11 Patient-specific dosimetry 2 ON4.13 Performance testing and quality control of scintillation probes and well counters 1 ON5.15 Image reconstruction, registration and fusion and tracer kinetic modelling 2 DIMP Clinical Training Guide Page 6 of 10 V5.0, PSB approved 9/5/18

10 ON5.17 Analysis of common clinical studies and sources of error 1 ON5.18 Developing clinical protocols for the estimation of patient dosimetry 1 OR2.8 Department design 1 OR2.9 Safety in MRI imaging 2 OR3.9 Dosimetry system calibration 1 OR4.14 Performance testing of magnetic resonance imaging equipment 2 OR4.15 Performance testing of ultrasound equipment 1 OR5.13 Magnetic resonance imaging technology 2 OR5.14 Magnetic resonance imaging applications 2 4. COMPETENCY ASSESSMENT Competency assessment will be based on the degree to which the knowledge-based and skillsbased competencies specified for each module have been achieved. Both acquired knowledge and practical skills are to be considered. 4.1 Levels of competency assessment Three levels of competency can be achieved. Level 3 designates a completed module and MUST ultimately be achieved. Level 1: Registrar has demonstrated most of the knowledge-based learning outcomes. Level 2: Registrar has demonstrated all of the knowledge-based learning outcomes and some of the skills-based learning outcomes. Level 3: Registrar has demonstrated all of the knowledge-based learning outcomes, the ability to perform all of the skills-based learning outcomes and is able to perform the competencies independently. To address the cognitive competencies (for example an understanding of ) the registrar should be able to satisfy oral assessment on the items listed under the knowledge learning outcomes for the specific module under assessment. The listed knowledge sources in that module should contain the needed reference material to give the required cognitive competencies. The recommended elements of training are related to the skill based competencies and are divided into highly recommended training and other recommended training. A supervisor may reduce or change this list according to local clinical conditions, however, there would normally be a good reason why a highly recommended activity is not completed. Supervisors grade their registrars in the grading section of COMET, based on their assessment of the registrar s competence. DIMP Clinical Training Guide Page 7 of 10 V5.0, PSB approved 9/5/18

11 4.2 Evidence of Training Registrars are required to keep records of the training activities that facilitated the competency assessments (grading) to be made by their supervisor. This evidence will be available to External Assessors for their Annual Progress Reviews (APRs) and to ACPSEM Examiners at the final oral exam stage. Evidence of training may take many forms and may include written feedback from their supervisor, department reports, QA assessment documents, procedures, presentations prepared/delivered, etc. As a general rule, higher quality evidence is required at the higher levels of competency. Some suggested examples of suitable training evidence for individual competencies are included in Table 1. Table 1. Examples of some forms of Evidence of Training used to assign competency levels LEVEL 1 LEVEL 2 LEVEL 3 Logbook notes, showing registrar participation in an activity Observation by the supervisor of registrar participation Tutorial notes MSc course notes Dot point summaries of theory Evidence of attendance at TEAP training days, workshops and seminars Reports (verbal or written) from others about what they have done with the registrar Experimental records showing registrar participation Minutes showing attendance at meetings CPD records Evidence of professional contributions by the registrar MSc assessment tasks Observation by supervisor of a registrar carrying out a task under general supervision. Experimental records showing registrar completion of a task. Q&A session with supervisor covering core knowledge. Internal reports on minor projects carried out by the registrar Written answers to o assignments o training day questions o past exam questions Summaries of key protocols or physics principles Moodle quiz results Registrar trains other staff in routine tasks Practical tasks carried out under mock exam conditions, including Q&A. Internal reports on major projects carried out by registrar (e.g. acceptance testing a new item of equipment, performing a shielding design/ assessment). Critical reviews of departmental procedures in comparison with published protocols. Procedures developed or substantially revised by the registrar Registrar trains other registrars or non-physics staff. Registrar is rostered to work under minimal supervision. 4.3 Competency Assessment Methods There are five key competency assessment methods: Assessment by observation; Assessment of written evidence; Question and answer oral sessions; Recognition of prior learning (RPL); and Formal assessments (progress reviews, examinations, etc) undertaken by ACPSEM Assessment by Observation Assessment by observation is the ideal way to assess practical skills. The assessor DIMP Clinical Training Guide Page 8 of 10 V5.0, PSB approved 9/5/18

12 observes the registrar carrying out a practical task, which may be either real work or a simulated task, such as a mock exam. Ideally, the assessment by observation should be supplemented by some questions to test registrar comprehension. Regular practice with performing practical tasks under observation and answering questions is essential to help registrars prepare for their Oral examination Assessment of Written Evidence Assessment of written evidence is valuable for assessing high level analysis skills, such as the ability to carry out complex calculations, to critically evaluate a process or to make recommendations. Assessors may consider all kinds of written evidence, such as those listed in Table 1. Looking at written evidence such as reports and experimental notes is helpful for assessing work carried out outside the assessor s direct observation. Ideally, assessment of written evidence should be supplemented by questions to test registrar comprehension Assessment by Question and Answer Assessment by questioning the registrar is very useful for testing the registrar s comprehension of theory and how it applies in practice, and for identifying gaps in knowledge. It has the advantage of being much faster than other assessment methods. Questioning allows the assessor to explore a range of scenarios that may not be achievable in routine clinical practice, such as what to do when accidents occur or results are out of tolerance. Regular practice with answering questions verbally is essential to help registrars prepare for their final Oral Examination Recognition of Prior Learning (RPL) When assessing competency, assessors can take a registrar s prior learning into account. The registrar may have evidence of competency gained prior to starting their clinical training in TEAP. Examples include: University coursework or research Participation in other medical physics training programs Prior work experience in diagnostic radiology and/or nuclear medicine medical physics Prior work experience in other disciplines TEAP is a competency based learning program. It doesn t matter how or when the registrar achieved a particular competency, provided it can be demonstrated that they have achieved it. This means that TEAP does not require registrars to repeat training that has been undertaken elsewhere so long as it is established that the required competency has been attained. Assessors should recognize relevant prior learning when assessing competencies. However, the assessor (see 3.3 for information on who is a qualified assessor for particular modules) must decide whether the prior learning is relevant to the competency under consideration. The assessor should require the registrar to provide evidence of their prior learning, to satisfy the specific module learning outcomes where possible, and this should be supplemented through oral assessment to test whether the registrar s knowledge and skills are currently at the level DIMP Clinical Training Guide Page 9 of 10 V5.0, PSB approved 9/5/18

13 expected for TEAP, and that the registrar has retained and understood the material previously learnt Formal Assessments undertaken by ACPSEM Formal assessments of the registrar s progress will, of course, be undertaken by the College at regular intervals, culminating in written and oral examinations as the registrar approaches the end of his/her training. Details of the College s assessment procedures are given in the DIMP TEAP Assessment Procedures document. DIMP Clinical Training Guide Page 10 of 10 V5.0, PSB approved 9/5/18