Developing guidance for the appropriate use of computed tomography within a hybrid imaging environment “CT Competencies”

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Developing guidance for the appropriate

use of computed tomography within a

hybrid imaging

environment-“CT Competencies”

Simon King

Programme Leader MSc Nuclear Medicine, Faculty of Health & Applied Sciences,

Dept. of Allied health Professions

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Overview

•

Why this is so important? The need to get it right..

•

Current position of CT within NM

•

Impact of CT on NM environment and working

practices

•

Learning and development

•

Evidence to support the development of CT

competencies

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Current position

• _{CT in Nuclear Medicine may be utilised for a number of}

clinical reasons:

1. Attenuation correction (e.g. cardiac imaging)

2. Localisation/registration (e.g. skeletal imaging, neuroendocrine imaging, sentinel node imaging)

3. “Stand-alone” diagnostic imaging (e.g. brain imaging, contrast enhanced imaging)

• _{(IRMER, 2000) - CNMPs must now possess the appropriate}

skills, competencies and evidence of appropriate training to safely utilise CT within hybrid imaging in modern practice.

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Impact of MSCT

hybrid systems

• Hybrid systems (SPECT/CT, PET/CT) within clinical practice capable of providing full diagnostic CT parameters.

1. Exposure optimisation (scan length, scan time, tube rotation time & pitch, kV, mAs, slice thickness)

2. Patient preparation / potential use of contrast agents

3. Dose modulation (DOM) / automatic exposure control + DOM (AEC+DOM)

4. CT reconstruction kernels / WLs, WWs and post processing

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Impact on NM physical

environment

•

New ‘physical barriers’- CT control room with lead

glass screen and intercom.

•

Reshaping the way the CNMP interacts with the

patient.

•

Greater emphasis on development of

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Environmental

considerations

• _{Noise within the clinical imaging}

room (aircon for CT unit)

• _{Additional workstations}

• _{New language and imaging}

protocols

• _“_{Draw up the juice}_” • _“_{Punch the tube}_” • _“_{How many clicks}_?”

• _“_{Pend, suspend, activate,}

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Current agendas and

drivers for change

•

Current pressures impacting the NHS

(financial/govt. agenda)

driven-• _{Change working practices}

• _{Increased emphasis on high quality care} • _{Greater clinical effectiveness}

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New skills and knowledge

• _{CT practicalities}_{(image acquisition/processing,}

instrumentation, use of remote injection pumps?)

• _{Radiation protection and patient dose minimisation}

techniques

• _{Cross sectional anatomy}

• _{Patient counselling and support skills}_{(increase in the amount}

of oncology patient referrals, especially with patients who are newly diagnosed with cancer)

• _{Increased decision making capabilities}_{(identification of}

incidental findings on patients’ images and subsequent actions)

• _{Service improvement and innovation}_{(provision of a ‘one stop}

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Emergence of a new

workforce

• _{New language / symbols / working}

practices / rituals

• _{Complexity of software / ‘}_movement_’

of digital data / impact on patient contact

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Learning and development

SCoR

position-• _{In the interest of the patient, a professional responsible}

for the episode of care is able to undertake all aspects of that episode of care safely and competently.

• _{An understanding of CT technology is now a core}

competence of NM practice.

• _{All CNMPs should receive competency based induction}

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Learning and development

•

Employers who are delivering CT as part of the NM

service should ensure local training for the

workforce which is documented.

•

Examples of training/education:

1. Locally designed ‘in-house’ informal course in consultation with med phys expert for CT

2. Mentoring by local CT qualified radiographers

3. Consultation with local senior CT department staff with regards acquisition protocols

4. Formal post graduate education

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50 60 10 15 35 Apps training In-house training Competency based training University training Other

Current education/training position

Does your department currently have hybrid imaging capabilities e.g. SPECT/CT, PET/CT, PET/MRI?

Yes = 170 No = 49

If yes, what training have you had?

Other?

Thought most things had been

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Evidence to support the

development of CT

competencies

Do you feel that additional training in relation to hybrid imaging might prove beneficial to your current clinical practice?

N/A Unsure No Yes

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Evidence to support the

development of CT

competencies

So what training / education are the workforce after?

Activity Number

Cross sectional anatomy 13

CT optimisation 11

Manipulation of imaging parameters 9

Diagnostic CT and contrast 6

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Aims of a CT competency

framework

1. Equip the CNMP with necessary skills needed to optimise imaging techniques

2. Provide evidence of appropriate training/experience

3. Support CNMPs using CT within multi-professional environment

• Raise awareness of modality

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Formulation of CT

competency framework

Enable CNMPs to develop and create professional identity with emerging roles and responsibilities

• _{Framework for CNMPs who are required to develop their practical} understanding, skills and competencies.

• _{Current and future needs analysis necessary- how will CT will be} utilised and at what level?

• _{Good working relationship with CT Radiographers –}

• help develop practical understanding, skills and competencies • _{provide problem solving experience and quality control}

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CT Competencies: Pre-Learning

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CT Competencies: Reflections of Learning

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Summary and Future

Developments

• _{Subsequent production of any competency framework will}

not be fit for all clinical departments.

• _{Departments will need to adopt accountability for local}

implementation of new imaging protocols.

• _{Any competency framework can only be used in an advisory}

capacity.

• _{Work between professional bodies/organisations and}

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Please feel free to let me know your thoughts, feelings, comments…