IRMER Flashcards
What is the role of a referer?
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
Where do RT referals tend to come from?
Come from and MDT - often oncologists are a referer and practitioner
Who can be a referer?
Anyone who is agreed upon by the employer and healthcare professionals at the local level - usually oncologist
Who decides the referal criteria?
The employer - often in clinical protocals
What is the role of a practitioner?
Responsible for the justification of a medical exposure and such other aspects of a medical exposure as provided in IRMER
What exposures need to be justified?
Therapeutic and any concomitant doses - often linked
Need proof of compliance in MDT meeting record
Clinical protocols should show justification of all exposures
Are subsequent exposures justified if an unexpected finding is found on a planning CT?
No
Who can be a practitioner?
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)
What is the role of the operator?
Anyone that conducts the practical aspects of an exposure - covers many areas - can be oncologist, radiographer, technologist/physicist, treatment planner
What aspects of the exposure lead the oncologist to being an operator?
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
What aspects of the exposure lead the planner to being an operator?
Produce plan
Outline targets or OARs
Check plan
Calculate treatment MUs
What aspects of the exposure lead the technologist to being an operator?
Adjust machine output
Calibrate treatment couch
What aspects of the exposure lead the radiographer to being an operator?
Set up patient Construct delivery sequence in V&R Acquire verification image Calculate required patient moves Deliver therapeutic exposures
Which operator should be used for each task?
Operators may only perform the functions and responsibilities that are outlined in the standard operating procedures
Who authorises an exposure?
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
Why is authorisation required?
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
What is the requirement for optimisation in IRMER?
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
What optimisation is done in clinic?
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
What is the practitioner responsible for in optimisation?
Select appropriate planning for target volume
Consider normal tissue ALARP - consistent with intent
What is the operator responsible for in optimisation?
Select appropriate methods/equipment
Ensure adherence to dose constraints
Ensure appropriate QC
Assess doses
Why is optimisation even more important for children?
Have much longer time for latent effects to show
Organs closer together
More radiosensitive
What optimisation methods are used for children?
Have a paediatric specialist
Use child-specific dose protocols and CT protocols
Use child specific OAR constraints
What optimisation methods are used for pregnancy?
Consider avoiding the abdomen
Consider delaying treatment until after birth
What is the regulation for clinical review?
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
What is required for every standard radiological practice?
Written protocol - can e consultant and equipment specific
What are the requirements of an MPE?
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
When do incidents need to be reported?
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.
When are research exposures allowed?
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
When are DRLs needed in RT?
RT planning exposures
What are the responsibilities around DRLs?
The employer must set DRLs and review them regularly
The employer must investigate when DRLs are consistently exceeded
What are required of QA programs?
Review procedures regularly
Identify indicators of quality and measure performance against them regularly
Adopt a recognised system ie iso9000, Towards safer RT, peer review
