The Quest for Quality: Principles to Guide Medical Radiation Technology Practice

Competencies of therapeutic radiographers working in the linear accelerator across Europe: A systematic search of the literature and thematic analysis

“…"perform risk and hazard analysis in the workplace", "analyse errors and near-misses and ensure prevention of future events", among others). This phenomenon of decomposing competencies into its sub-dimensions was discussed by Adams et al and Gillan et al 33,34 23,27,44 Verify prescription e Interpret treatment prescriptions e Verify treatment prescription and report discrepancies e Compare the plan with the prescription 23,24,28 Data transfer e Carry out necessary data transfer checks 24 Positioning and immobilisation Critically assess immobilisation e Confirm appropriate immobilisation considering aim of treatment and patient condition 24 Reproduce immobilisation e Position the patient according to planning and simulation 24 Accuracy e Ensure accuracy in positioning 24,49 Patient comfort e Promote patient comfort, as much as possible 24 Delivery of treatment Choice of devices e Choose the appropriate therapeutic, imaging and ancillary devices 19,27 Parameters check e Check if appropriate treatment parameters were selected 23 Treatment administration e Administer treatment accurately and safely e Apply best practice at all times e Interrupt treatment, if required, in an emergency 24,27,28 Patient observation e Constantly observe the patient during treatment 42 Avoid treatment gaps e Avoid radiotherapy treatment gaps 44…”

“…Quality and risk management Risk management e Perform risk and hazard analysis in the workplace e Reduce risks and hazards for patients and staff e Ensure appropriate workload for safe practice e Report incidents and near-misses 23,24,27,33,34,38e42 Quality improvement e Contribute to the continuous improvement of practice e Analyse errors and near-misses and ensure prevention of future events e Develop technology and its application into practice 19,27,28,33,34,41,43e45 Radiation protection e Recognise the radiation hazards in the workplace e Ensure protection of staff and public against radiation e Ensure protection of patients against radiation e Adhere to the use of personal dosimeters e Know and adhere to legislation regarding radiation protection 19,23,24,27,28 Justification e Be able to select a suitable treatment, based on own analysis e Critically question radiological referrals e Refuse to carry out an exposure which, in one's professional opinion, is inadvisable 19,23,24,27 Optimisation e Maintain ALARA principle e Minimise dose to normal tissues 19,23,27 Carry out audits e Develop and implement audit programmes 27,46 Evidence-based practice e Apply relevant scientific evidence into practice e Take decisions based on scientific evidence e Apply results of research into practice 19,23,24,27,28,34,41 Individual professional development e Continuously assess their own competencies, knowledge and skills e Ensure their own professional development 19,27,34,41e43,45 Development of the profession e Contribute to the profiling of the profession e Contribute to the content-related development of the profession 27 Protocols, standards, guidelines and regulations e Implement professional standards into professional practice e Adhere to legal regulations e Follow national and international guidelines e Implement institutional protocols into practice 19,23,24,27,38,41 ...…”

“…Image acquisition e Select the appropriate image modality e Acquire planar (2D) images e Acquire volumetric (3D) images 19,24,27 Image interpretation e Analyse verification images: Analyse planar (2D) verification images a Analyse volumetric (3D) verification images a e Make decisions regarding the action to take following image analysis, within the protocols e Follow patient setup verification protocols e Develop patient setup verification protocols e Analyse images to evaluate the result of radiotherapy treatments 19,24,27,28,34,44,47,49,53 Equipment quality assurance Perform QA e Perform daily QA of the linear accelerator e Perform QA of imaging systems e Carry out in vivo dosimetry 19,23,24,39,41 Evaluate and report results of QA e Evaluate results of QA procedures e Take corrective actions in view of QA results e Report inconsistencies in QA procedures 23,24,39 a The sub-theme "Image interpretation" was further divided to include two sub-themes: Analysis of 2D and 3D images. The literature does not provide information regarding which competencies are developed in the individual European countries.…”

“…Certain general competencies can be broken into more specific competencies. 33 An example given by Gillan et al 34 is that the competency of "practising based on evidence" would only be achieved by performing a series of other specific competencies, namely, "questioning practice, evaluating ideas, critically analysing the evidence, and applying the learning achieved to future practice" 34(pp430e431) ; the former is a general competency and the latter are specific competencies. This complexity may be another reason for the variation observed between the existing benchmarking documents.…”

Creating a Culture of Continuous Improvement in a Radiation Therapy Planning Department: A Pilot Initiative Using Quality Conversations

“…Radiation therapy is linked to practices relating to clinical and technical aspects that provide care to patients. Within the practice of radiation therapy, prevailing views of quality have predominately been focused on planning, treatment delivery, and quality control of equipment [10]. Recently, there has been an addition to these concepts, a shift toward engagement of the team to discuss, implement, and guide conversations related to quality and improvements [11].…”