Formative / Summative Assessment of Palliative Radiotherapy Treatment Delivery

Learning Outcomes

• Knowledge
  • Principles of effective communication  & basic patient care
  • General anatomical terminology
    - Surface anatomy
    - Planes and regions
  • Principles of the treatment delivery workflow to include:
    - Initial patient immobilisation
    - Positioning to skin surface coordinates
    - Couch position translations to treatment field isocentre
  • Awareness of Linear Accelerator mechanical movement capability & limitations (e.g. gantry rotation, couch movements)
  • Awareness of radiation safety legislation for patients and staff

• Skills
  • Patient preparation:
    - 3 point positive ID check
    - Assess patient condition
    ​- Consent to proceed
  • Interprets patient positioning information
  • Demonstrates a logical step-wise approach to patient positioning
  • Interpretation and application of translational couch movements from initial positioning to final treatment field position
  • Application of clinical and technical skills

• Attitudes/Behaviours
  • Communication skills
  • Patient care
  • Safe working
    - workflow & process
    - set-up accuracy
    - pre and post procedure checks including equipment parameters, room safety,  dose, prescription and MUs

Scenario Environment

Initial Simulation Setup

Initial Preparation

Students will have had an introduction to VERT and up to six facilitated sessions to practice positioning skills prior to placement 1.

At the start of Semester 2 (mid-January), post placement 1 and following consolidation workshops, the module lead will randomly allocate a patient scenario and treatment related parameters (treatment site, field sizes, patient position, dose prescription etc.) to each student to facilitate their preparation of a bespoke radiotherapy treatment sheet.

In a scheduled workshop, at least one week prior to assessment and working in pairs, students will independently develop their own treatment sheet and cross check their partners dose calculations and treatment data. Upon satisfactory completion, each student will then pre book an assessment time (30 minute duration).

Initial VERT Set-Up:

On the scheduled assessment day, the lead assessor will switch on VERT v. 5.0 and preload “Sample Plan 1, Pelvis, Prostate IMRT”.  They will ensure that skin marks are visible and lower the treatment couch to an appropriate height for patient “on load” prior to admitting each student to the VERT suite.

Case Introduction

The student:

• must check patient (actor) ID and general condition
• confirm the required position and immoblisation from their treatment sheet
• use couch controls and skin marks (positioning coordinates) to align virtual patient with the aid of the Linear Accelerator optical indicators (lasers, field light, distance indicator)
• then use couch controls to apply shifts (references to positioning coordinates) to align patient at the required field position
• set and checks all relevant treatment parameters (filed size, SSD, couch height etc.) and confirm they are happy with the set-up
• will then proceed to explain the procedure for leaving the room and the checking processes to be carried out in the control area prior to and during “beam on”
• demonstrate the process for treating additional fields
• conduct a final patient check and answer any patient questions before discharging the patient from the room

Available Collateral Information

N/A

Instructions for Personnel

Lead Assessor - prepares the room / software prior to each assessment according to the instructions in the assessor guidelines and completes the assessment checklist

Second Assessor - acts as moderator / second marker and as patient actor if required

Evaluation Strategy

Ongoing (Assessment format was introduced in January 2021), Qualitative “first impressions” and verbal reflections are collected on the day and used as feedforward actions for students and quantitative performance data collection will continue