IR(ME)R in radiotherapy Flashcards
In which aspects of the radiotherapy pathway do most CQC reportable incidents occur? Why is this?
- Treatment and delivery.
- IT processes and planning.
- There is the most opportunity for error in delivery and planning due to a patient coming for treatment a large number of times or the large number of steps in the planning process.
Who is typically the referrer duty holder in radiotherapy? Who is the practitioner?
- Referral is likely to come from a general cancer MDT.
- The oncologist taking the recommendation of the MDT will act as the referrer.
- This oncologist will often also be the practitioner and will decide whether or not to proceed with the treatment.
Are the therapeutic and planning/verification CT exposures referred by the same individual? Is the practitioner the same in both cases?
- Typically, the oncologist will refer for all exposures. However, treatment planners/radiographers could refer for verification exposures, for example. Registrars, radiographers or physics may refer for additional planning CT scans.
- Again, the practitioner would likely be the oncologist. However, trainee oncologists may be permitted to justify staging or planning scans, for example.
What do radiotherapy referral guidelines typically include?
- Information for the referrer on when it would be appropriate to refer a patient for radiotherapy (e.g. histology report indicating staging of a disease).
- Radiation dose associated with all prescription options, including for associated planning and verification CT exposure.
What are the practitioners responsibilities in radiotherapy?
- The justification of an exposure (i.e. determining whether there is a net benefit).
- Other aspects of an exposure such as optimisation (e.g. minimising normal tissue dose) or setting dose constraints for research exposures.
Who is the operator in radiotherapy?
Many ‘operators’ are apparent in radiotherapy as there are many supporting functions to carrying out an exposure e.g.:
- Oncologist defining OARs.
- Radiographer performing exposures or calculating required patient movement given image matching.
- Medical physicist performing QC.
What is the difference between justification and authorisation? Who is responsible for authorisation in radiotherapy? How is the authorisation process typically undertaken?
- Justification indicates the decision to treat whereas authorisation indicates readiness to deliver a treatment.
- The practitioner (typically the oncologist) is usually responsible for authorisation. Operators (e.g. trainee oncologists, radiographers, dosimetrists, physicists etc.) may be permitted to authorise.
- The authorisation process typically involves an electronic signature.
Who is typically responsible for authorising the imaging exposures in the radiotherapy process?
The radiographer.
What are the specific optimisation requirement for radiotherapy, as per IR(ME)R?
- All therapeutic exposures of target volumes must be individually planned.
- Doses to non-target volumes should be kept ALARP in line with the therapeutic purpose of the exposure.
What considerations are required for pregnant or potentially pregnant radiotherapy patients? What about for paediatric patients?
- The urgency of the exposure - may proceed promptly, use a technique with different fractions or a lower dose bath or wait until after the pregnancy.
- A pregnancy test may be appropriate when pregnancy status is unknown.
- Children are at greater risk of developing cancer later in life after RT (more radiosensitive and longer life expectancy) so care must be taken to minimise dose to normal tissues. Organs are also closer together in a child.
What are some examples of clinical evaluation in radiotherapy?
- The extent of the disease and treatment plan created from planning CTs.
- Therapy exposures delivered and their consistency with the prescribed dose.
- Patient reviews regarding whether therapy is working and any side effects.
What might the written IR(ME)R protocols for radiotherapy treatment contain?
- Dose regimes.
- Dose constraints.
- Verification techniques.
- The type of treatment to use (e.g. VMAT, IMRT, brachy) for different diseases.
What are the differences between an MPE for diagnostic radiology and radiotherapy?
DR:
- Less direct involvement in each individual exposure.
- Typically provide advice for multiple hospitals/trusts.
RT:
- More closely involved in every type of exposure due to the high doses involved.
- Typically embedded within a department and work closely with managers, oncologists, radiographers and maintenance engineers.
- More work involved with preparing and validating radiation delivery equipment and patient dose modelling equipment.
- Need to accurately know doses to specific tissues, including in the case of incidents where treatments may have to be modified.
What kinds of radiotherapy SAUE are notifiable to the CQC?
- Therapeutic dose significantly less than intended (may result in failure of intended therapy).
- Specific levels of overexposure to target volumes or OARs.
- Geographical misses.
- Certain levels of additional verification images (whether intended or in error).
What constitutes a clinically significant exposure in radiotherapy? Who asseses this?
- An incident with a measurable effect on the patient’s tumour control, toxicity or quality of life.
- The practitioner will assess this.
