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Year 3: Radiation protection for RT > IRMER > Flashcards

IRMER Flashcards

1
Q

What is the role of a referer?

A

Supply the practitioner with sufficient medical data relevant to the medical exposure requested to allow the practitioner to decide if there is a net benefit to the patient

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2
Q

Where do RT referals tend to come from?

A

Come from and MDT - often oncologists are a referer and practitioner

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3
Q

Who can be a referer?

A

Anyone who is agreed upon by the employer and healthcare professionals at the local level - usually oncologist

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4
Q

Who decides the referal criteria?

A

The employer - often in clinical protocals

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5
Q

What is the role of a practitioner?

A

Responsible for the justification of a medical exposure and such other aspects of a medical exposure as provided in IRMER

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6
Q

What exposures need to be justified?

A

Therapeutic and any concomitant doses - often linked
Need proof of compliance in MDT meeting record
Clinical protocols should show justification of all exposures

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7
Q

Are subsequent exposures justified if an unexpected finding is found on a planning CT?

A

No

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8
Q

Who can be a practitioner?

A

Anyone who is agreed upon by the employer and healthcare professionals at the local level - usually oncologist (consultant for therapy, SpR for pre-treat imaging, can be superintendent radiographer for extra exposures due to verification or weightloss)

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9
Q

What is the role of the operator?

A

Anyone that conducts the practical aspects of an exposure - covers many areas - can be oncologist, radiographer, technologist/physicist, treatment planner

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10
Q

What aspects of the exposure lead the oncologist to being an operator?

A 
Check patient ID
Check potential pregnancy
Outline target and OARs
Insert I-125 prostate seeds
Insert gynae applicator
Mark up electron patient
Decide treatment position in mould room
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11
Q

What aspects of the exposure lead the planner to being an operator?

A

Produce plan
Outline targets or OARs
Check plan
Calculate treatment MUs

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12
Q

What aspects of the exposure lead the technologist to being an operator?

A

Adjust machine output

Calibrate treatment couch

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13
Q

What aspects of the exposure lead the radiographer to being an operator?

A 
Set up patient 
Construct delivery sequence in V&R
Acquire verification image
Calculate required patient moves
Deliver therapeutic exposures
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14
Q

Which operator should be used for each task?

A

Operators may only perform the functions and responsibilities that are outlined in the standard operating procedures

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15
Q

Who authorises an exposure?

A

The practitioner justifies and authorises an exposure
Operators can authorise an exposure if it is not practicable for a practitioner to authorise the exposure and it is within protocol

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16
Q

Why is authorisation required?

A

It allows operators to make technical decisions about individual exposures without the practitioner there - can allow concomitant doses to be given in a different way or by a different person

17
Q

What is the requirement for optimisation in IRMER?

A

A practitioner shall ensure that exposure to the target volumes are individually planned, taking into account that doses to non-target volumes and tissues shall be as low as reasonably practicable and consistent with the intended radiotherapeutic purpose of the exposure

18
Q

What optimisation is done in clinic?

A

Planned patients have dose constraints set for non-target tissues - normal tissue doses ALARP
Less effort for palliative patients
Unplanned radical patients have margins as small as possible
Consider imaging doses

19
Q

What is the practitioner responsible for in optimisation?

A

Select appropriate planning for target volume

Consider normal tissue ALARP - consistent with intent

20
Q

What is the operator responsible for in optimisation?

A

Select appropriate methods/equipment
Ensure adherence to dose constraints
Ensure appropriate QC
Assess doses

21
Q

Why is optimisation even more important for children?

A

Have much longer time for latent effects to show
Organs closer together
More radiosensitive

22
Q

What optimisation methods are used for children?

A

Have a paediatric specialist
Use child-specific dose protocols and CT protocols
Use child specific OAR constraints

23
Q

What optimisation methods are used for pregnancy?

A

Consider avoiding the abdomen

Consider delaying treatment until after birth

24
Q

What is the regulation for clinical review?

A

The employer must take steps to ensure that a clinical evaluation of the outcome of each medical exposure is recorded in accordance with the employer’s procedures, or where the employer is currently the practitioner or operator, shall so record a clinical evaluation including factors relevant to patient dose

25
Q

What is required for every standard radiological practice?

A

Written protocol - can e consultant and equipment specific

26
Q

What are the requirements of an MPE?

A

Employer shall ensure that an MPE shall be involved in every medical exposure - closely involved in every radiotherapeutic practice - in practice they write protocols and are available on site

27
Q

When do incidents need to be reported?

A

If the employer has reason to believe or knows an incident has occured that resulted in a dose much greater than intended to the patient then they must undertake a preliminary investigation and notify the relevant authority, along with planning a fuller investigation, unless it shows no overexposure occurred.

28
Q

When are research exposures allowed?

A

Approved by local research ethics committee
Employer’s procedures provide that:
Individual participated voluntarily
Individual informed about the risk prior to exposure
Dose constraint is adhered to
Target levels of doses are planned by the practitioner to give net therapeutic or diagnostic benefit

29
Q

When are DRLs needed in RT?

A

RT planning exposures

30
Q

What are the responsibilities around DRLs?

A

The employer must set DRLs and review them regularly

The employer must investigate when DRLs are consistently exceeded

31
Q

What are required of QA programs?

A

Review procedures regularly
Identify indicators of quality and measure performance against them regularly
Adopt a recognised system ie iso9000, Towards safer RT, peer review

Year 3: Radiation protection for RT (5 decks)

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