STP IACC Domain 3 – Clinical Practice example

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STP Assessment
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While being on the ‘Radiation Safety’ rotation, new criteria for a Significant Accidental or Unintended Exposure (SAUE) were published. To investigate the impact of the new guidance on the number of externally reportable radiation incidents, I reviewed and analysed past errors covering a period of 16 months (SPE102:24). That experience has taught me the importance of understanding newly introduced guidance/regulations and the impact they may have on the clinical practice. Moreover, I used the same data to further identify the causes of these incidents. The results unambiguously revealed human errors as the most common source of mistakes, strengthening my belief that introducing in clinical practice simple tools like checklists (e.g. PAUSED in radiotherapy) can significantly reduce the occurrence of such incidents. On the same rotation, I was also involved in the investigation of radiation incidents (SPE102:25). In addition to showing the challenges with performing an accurate dose assessment based on assumptions, this exercise also highlighted the relevance of rehearsing the contingency plans in maintaining a safe work environment.

Since the beginning of my training, I have had a particular interest in external beam treatment planning. So far, I have been clinically signed off as competent to plan IMRT breast, VMAT prostate and VMAT prostate bed treatments (SPE103:15). Throughout this time, I significantly improved my ability to work in a multidisciplinary team (SCC110:8) and enhanced my communication style through continuous contact with other physicists, dosimetrists, and clinical oncologists. I have also developed a sense of confidence allowing me to make independent decisions regarding the best dose optimisation strategy and occasionally, if it lies within my scope of practice, to provide advice. However, more than ever I have learnt to acknowledge my limitations and ask for the input of my senior colleagues whenever necessary, as treatment planning is rarely a black-and-white process. On the other hand, the nature of treatment planning has made me very aware of how easy it is to start focusing more on just meeting the dose constraints rather than achieving the best possible solution for the specific patient. Hence why, before the pandemic, I spent a day at an outpatient breast clinic. Furthermore, through the case-based discussions related to treatment planning I have learnt the importance of radiobiology in the process (SPE157c2:CBD9) and how crucial protocols, work instructions and checklists are in maintaining the high quality and safety of provided services (SPE103:CBD4). Participating in patient-specific (SPE157c1:11) and in-vivo dosimetry measurements (SPE157c2:11-13) has brought to my attention another important aspect of treatment planning – patient safety – and the role of radiotherapy physicists in its maintenance.

Over the course of the STP, I have found the dosimetry and treatment equipment aspect of my training to be one of the most challenging ones due to the complexity of scientific concepts and the initial lack of regular practical experience. It was reflected in my 18-month multi-source feedback (MSF:MSF-1) which highlighted the need to give more emphasis on training in routine quality assurance measurements. Since then, I have been much more involved in routine quality checks performed especially on linacs (SPE157c1:5) and brachytherapy equipment (SPE158c3:2). Attending these sessions has made me realise that the key to growing confidence in undertaking equipment testing is an in-depth understanding of the equipment operation and simply practice. It has also demonstrated the importance of accurate recording of the results and knowing the course of action when results are out of tolerance.

My understanding of regular QA testing procedures has significantly improved throughout the training however, there is still room for further growth, especially in investigating the cause of detected problems. Over the next few months, I am planning to increase my exposure to these processes and achieve clinical competence in performing regular linac monthly testing. I have also observed head and neck treatments being planned, so soon will start working toward expanding my clinical expertise and getting signed off as competent to plan such cases.

Last updated on 19th May 2022