Guide For STP Trainees : Imaging With Ionising Radiation .
Guide for STP Trainees : Imaging with Ionising Radiation - SpecialismDOPSDOPS (Note that not all of the DOPS in the LearningGuide are listed)Prepare a phantom for SPECT QCPerform monthly QC on gamma camera according toDepartmental proceduresProcess a renogramPerform a SPECT or SPECT/CT reconstructionPerform quality control procedures on intraoperative probeCompetencies which may share evidencewith this DOPSDiscussion of radiation protection and practical skillsIIR-C-1,2,3,54Short reportIIR-C-2Practical observations and analysis of resultsIIR-C-5,6,8Practical observations/discussion of reconstruction parametersIIR-C-5,6,8Short reportIIR-C-12, 13Analysis of measurementsIIR-C-33Demonstration of dealing with radioactive spills. Decontamination of therapy roomafter treatmentIIR-C-34, 35, 54Practical observations and analysis of results.IIR-C-42Practical observations and analysis of resultsIIR-C-42Practical observations and analysis of resultsIIR-C-42Practical observations and analysis of resultsIIR-C-43, 44Set up a radionuclide calibrator to measure I-123 using acopper filterPractical observations and analysis of resultsIIR-C-43, 44Monitor radioactive waste and dispose where appropriate.Keep records of storage and disposalPractical observations and analysis of resultsIIR-C-35, 57Test leakage of an X-ray tubePractical observations and analysis of resultsIIR-C-66Measure the image quality for a mammography unit using avariety of test objectsPractical observations and analysis of resultsIIR-C-68Short reportIIR-C-71, 72Practical observationsIIR-C-87Examples of possible evidenceCompetencies which may share evidencewith this CbDMonitor a patient in the therapy roomDecontamination of areasPerform a molybdenum breakthrough test and analyse theresultPerform a chemical purity test and analyse the resultElute a Tc-99m generatorIIR DOPSExamples of evidence which may relate to this DOPSPerform a linearity measurement on a RadionuclidecalibratorAnalyse and interpret data from a multislice CT phantomUndertake a range of system administration tasks on anuclear medicine or diagnostic radiology systemCbDExamples of possible subjects for CbD. Note that these are notprescribed within the Learning GuideImaging clinical case studiesNon-imaging clinical case studiesRadionuclide therapy case studyTechnetium generatorsIIR CbDEPR waste limitsLocal rules in a particular areaDiscussion of particular imaging, e.g. brain imaging including any post processingand image analysisDiscuss clinical requirements of a non-imaging test, e.g., SeHCAT, includingpurpose, equipment necessary, results calculations and implications of resultsExplain procedure to a patient and discuss possible post-treatment restrictions.Further discussion of practical issues surrounding MRTShort report showing understanding of Technetium generators. Discussion of issuessurrounding Technetium generatorsDiscussion demonstrating understanding of different types of waste and limits.Analysis of aqueous waste limit trendsWrite/critically appraise local rules and discussIIR-C-5IIR-C-19, 20IIR-C-30, 32IIR-C-35, 57IIR-C-48, 49General requirements of quality assurance and commissioning on arange of equipmentShort reports on QA/commissioning of equipmentIIR-C-1, 2, 65, 66, 67, 68, 69, 70, 71, 72Reporting radiation incidents, including information on calculatingdoses and risksShort report demonstrating example calculationsIIR-C-83, 84CT DRLsDiscussion of CT DRLs. Perform an audit or analyse audit results. Discuss radiationrisksRadiation risk and effect variations in relation to the type of radiation, Short report showing understanding of the principles. Discussion of risk and effectpatient age, sex and pregnancy status, and the body part irradiatedvariations in relation to differing exposure circumstancesDose risk assessment as performed in MPE statement in IRAS formsDose risk assessment, letter of advice, discussion of outcome of assessment(e.g. DR, radionuclide, hybrid imaging)IPEM STP Guide - Imaging with Ionising Radiation Specialism F7IIR-C-80IIR-C-61, IIR-C-38, IIR-C-83 and 84IIR-C-83 and 84Page 1
dionuclide ImagingPerform planar gamma camera commissioning tests andparticipate in the commissioning tests of Single-photonIIR-C-1 emission computed tomography (SPECT)/ ComputedTomography (CT) and Positron emission tomography(PET)/ (CT) scanners Report of commissioning tests on new system if appropriate Repeat acceptance tests, comment on results and compare to those at acceptanceIIR-C-2Make comprehensive quantitative routine performancemeasurements on imaging equipment Evidence of participation in QC on gamma cameras, SPECT-CT, PET-CT (nameon log, statement from supervisor etc.)IIR-C-3Critically review quality assurance programmes forradionuclide imaging Review present QC programme and update to reflect equipment changes Evidence that trainee has taken an active part in assisting on the imaging rota andInstigate corrective action based on an evaluation of quality undertaking QCIIR-C-4control results Case report of corrective action taken when QC results have been outsideacceptable limits e.g. acquire new uniformity correctionIIR-C-5Understand the wider clinical situation relevant to patientspresenting to the modality Review a selection of current scanning protocols (in terms of latest guidance,Develop and evaluate protocols for the optimal acquisition,departmental requirements etc.)processing and display of clinical images Review and update scanning protocols for new equipmentWrite standard operating procedures for radionuclideIIR-C-7 Write SoP for a new procedureimaging Become familiar with processing scans and provide evidence (e.g. name on log,statement from supervisor)Use sophisticated image analysis software to extractIIR-C-8 Case studies where complicated or unusual processing is requiredquantitative information and enhance diagnostic utility Perform dosimetry for therapy patients using sequential imagingModify and develop image acquisition and analysissoftwareExplain the cause and effect of a range of artefacts and ofIIR-C-10 equipment performance limitations on the interpretation ofclinical imagesIIR-C-11Participate in the clinical audit of radionuclide imaging innuclear medicineIIR-C-12Make comprehensive quantitative performancemeasurements on non imaging IR-C-18IIR-C-19Plan and perform commissioning tests on beta and gammacounters and gamma spectrometersCritically review quality assurance programmes for theequipment used for non-imaging diagnostic testsInstigate appropriate corrective action based on anevaluation of test resultsChoose appropriate tissue – equivalent phantoms forquantitative in-vivo uptake measurementsDevelop and critically evaluate the optimal acquisition andprocessing of dataWrite standard operating procedures (SOPs) for nonimaging testsParticipate in a range of non-imaging in-vivo and ,4IIR-C-6,7IIR-C-6,7 Review of possible artefacts including bookwork (IAEA atlas), artefacts on CT,local experience Clinical audit report. Possible audits could be checking DRLs, audit of particularexaminations (e.g. renograms, software/processing on different systems)IIR-C-12, 13, 14, 15 Report describing QC tests and commissioning tests on non-imaging equipment.This should include a review of the QA programme against current guidance Example equipment: Gamma counter, Calibrators, balance, contamination monitors,gamma probeIIR-C-12, 13, 14, 15IIR-C-12, 13, 14, 15IIR-C-12, 13, 14, 15 Report on optimisation of patient non-imaging test mini-project. To include testoptimisation, SOP, phantom measurements, patient test results and clinicalimplications, issues with artefacts and the limitations of the tests Examples: SeHCAT, GFR, Thyroid uptake Short report on observations of non-imaging patient tests Examples: SeHCAT, GFR, Thyroid uptakeIIR-C-16, 17, 18, 19, 20, 21, 22IIR-C-16, 17, 18, 19, 20, 21, 22IIR-C-16, 17, 18, 19, 20, 21, 22IIR-C-16, 17, 18, 19, 20, 21, 22IIR-C-16, 17, 18, 19, 20, 21, 22 Report on optimisation of patient non-imaging test mini-project. To include testExplain the cause and effect of a range of artefacts, and of optimisation, SOP, phantom measurements, patient test results and clinicalIIR-C-21 equipment performance limitations and patient relatedimplications, issues with artefacts and the limitations of the testsfactors on the interpretation of results Examples: SeHCAT, GFR, Thyroid uptakeAdvise on the clinical appropriateness of non-imagingIIR-C-22diagnostic testsPerform clinical audit of non-imaging diagnostic nuclearmedicineIIR-C-1,2,3,4 Report on project work to develop softwareGenerate results and assist in the interpretation ofIIR-C-20diagnostic tests, including the use of reference rangesIIR-C-23Other competencies which may be demonstratedby this evidence Report on patients' pathway through the nuclear medicine department Case reports for a selection of patient studies Attend MDT and write a brief reportIIR-C-6IIR-C-9Non-Imaging Radionuclide TestsExamples of evidenceIIR-C-16, 17, 18, 19, 20, 21, 22IIR-C-16, 17, 18, 19, 20, 21, 22 Short report on a clinical audit of a non-imaging patient test. Examples: SeHCAT, GFR, Thyroid uptakeIPEM STP Guide - Imaging with Ionising Radiation Specialism F7Page 2
IIR-C-24Generate or critically review the design of suitableequipment and facilities for patient therapies Report/presentation on the design of the equipment, rooms and facilities for patienttherapies including suggested changes/improvements Short Review of the risk assessment available for the room/procedureIIR-C-25Advise on the appropriateness of requests for theadministration of radionuclide therapy Written confirmation of discussion on appropriateness of therapies for differentpatient circumstances Write an individual patient risk assessment for a patient with difficult social/clinicalcircumstancesPrepare or critically review a radiation risk assessment forIIR-C-26 the administration of a particular form of radionuclidetherapy Risk assessment for room/procedure Risk assessment for individual patientIIR-C-24, 25Write or critically review standard operating procedures for SOP for therapy based on previously written risk assessmentIIR-C-27 the administration of particular form(s) of radionuclide Short report reviewing current SOPs and if any alterations are necessary due to risktherapy, incorporating the results of the risk assessmentassessmentsPerform a tailored radiation risk assessment andIIR-C-28 instructions for those in contact with an individualradionuclide therapy outpatient Radiation risk assessment for staff, family, friend or work colleagues forradionuclide therapy outpatient Example: for benign thyroid diseaseRadionuclide TherapiesPrepare or review written instructions for staff on the Instructions for staff for radionuclide inpatient therapiesIIR-C-29 management of inpatients receiving a particular Short report reviewing current staff instructions and if any alterations are necessaryradionuclide therapy, and give advice to staff in accordance Presentation detailing instructions to be presented to ward staffIIR-C-53Actively contribute to the administration of a range ofIIR-C-30 radionuclide therapies, including at least iodine-131 forthyroid cancer and benign thyroid disease Written confirmation of active contribution to radionuclide therapiesIIR-C-30, 31, 32, 33Assist and advise medical practitioners in theIIR-C-31 administration of non-oral radionuclide therapies, e.g. byintravenous infusion Written confirmation of active contribution to radionuclide therapies given byintravenous infusion Written confirmation of discussion on appropriateness of therapies (administeredvia intravenous infusion) for different patient circumstances Example therapies: 90Y-Dotatate, 177Lu-Dotatate, 131I-mIBG, 223Ra-dichlorideIIR-C-30, 31, 32, 33 Written confirmation of active contribution on providing patients/carers on posttherapy restrictions including 131I and one other radionuclideIIR-C-32Advise patients and their carers on appropriate posttherapy behavioural restrictionsIIR-C-33Actively participate in the monitoring of inpatients to Written confirmation of active monitoring of inpatientsdetermine effective half-life and/or residual activity and Spreadsheet showing activity and effective half-life calculationsmanaging the criteria for release of inpatients based on the Short report detailing case studyresults of this monitoring.IIR-C-34Perform contamination monitoring and decontamination ofa treatment room post radionuclide therapy administrationIIR-C-35Record, store and dispose of radioactive waste produced as Written confirmation of active participation in waste disposala result of radionuclide therapy Short report describing waste disposal proceduresIIR-C-36 Participate in clinical audit of radionuclide therapy Written confirmation of active participation in decontamination procedures Short report describing decontamination procedures Written confirmation of active monitoring of inpatients Spreadsheet showing activity and effective half-life calculations Short report detailing case study including any imaging performedActively participate in acquisition of imaging data and/ordata from radiation detectors/monitorsIIR-C-38Actively participate in calculating absorbed radiation dosesto target and non-target tissues for therapy protocols guided Report/spreadsheet with organ dosimetry calculationsby patient-specific Attend dosimetry training if not performed at current centredosimetryIIR-C-39Advise colleagues on the use ofradiopharmaceuticals Presentation to peers on the use of radiopharmaceuticals Short report on the production of radiopharmaceutical including guidanceIIR-C-40Access sources of information on the design requirementsfor the production of radiopharmaceuticals Summary of requirements including relevant guidance Table showing information sources e.g. GMP, MHRA, National and InternationalguidanceIIR-C-42Comply with relevant quality assurance requirementsassociated with radiopharmaceuticalsIIR-C-30, 31, 32, 33, 52IIR-C-30, 31, 32, 33, 37IIR-C-35IIR-C-34, 57 Audit report Examples: patient experience questionnaire, administered activities, patientdischarge levelsIIR-C-37Critically review environmental and personal monitoringIIR-C-41 including which tests are performed and frequency oftestingRadiopharmacyIIR-C-30, 31, 32, 33IIR-C-32, 33 Review environmental and personal monitoring procedures Present audit of environmental/personal monitoring and comment on results Results of Quality assurance tests on radiopharmaceuticals and evidence of signoff for patient use Details of quality system used in radiopharmacy, possibly in the form of a tablelisting requirementsIIR-C-43 Perform commissioning tests on radionuclide calibrators Report of commissioning tests performed in accordance with NPL guidanceIIR-C-43, 44Perform periodic quality control tests on radionuclideIIR-C-44 calibrators and recommend procedures for optimisation ofmeasurements Review of calibrator QC protocols Results of QC tests, including daily QC, monthly QC and linearityIIR-C-43, 44IIR-C-45Use radionuclide calibrators for the measurement oftherapeutic activities of radionuclides Evidence of participation in measurement of therapeutic radiopharmaceuticals (e.g.name on log, statement from supervisor) Therapy case studiesIIR-C-46Review compliance of radiopharmacy procedures againstrelevant radiation regulations and guidance Table linking procedures with relevant regulations and guidance Report of RPA/RWA audit of RadiopharmacyIPEM STP Guide - Imaging with Ionising Radiation Specialism F7Page 3
IIR-C-47Undertake risk assessment for a range of radiation facilitiesand a range of radiation hazards, to include external and Risk assessments covering external and internal, low energy and high energy, Xinternal, lowray, gamma, beta and positronenergy and high energy, X-ray, gamma, beta and positronIIR-C-48Write local rules for a diagnostic imaging area, includingcontingency planning Local rules for a new facility or new protocol Short review of current local rulesIIR-C-49Write local rules for nuclear medicine facilities andservices, including contingency planning Local rules for a new facility or new protocol Short review of current local rulesIIR-C-50Critically appraise IRMER procedures for a radiationfacility. Review IR(ME)R documentation Perform IR(ME)R auditRadiation ProtectionReview the results of whole body and extremity radiationIIR-C-51 dose monitoring of staff and take remedial action asappropriateIIR-C-50, 58, 59 Short report of an audit of hand and foot monitoring Short report reviewing badge results detailing any actions takenIIR-C-52Give advice to diagnostic and therapy patients on theprecautions that they should follow on their return home,with particular regard to the safety of children, unbornfoetuses and breast-fed infants Written confirmation of active contribution on providing patients/carers on posttherapy restrictions including 131I and one other radionuclide Written confirmation of active contribution on providing patient restrictions todiagnostic patientsIIR-C-32IIR-C-53Give radiation safety advice to a range of healthcare staffin connection with nuclear medicine patients. Instructions for staff for radionuclide inpatient therapies Short report reviewing current staff instructions and if any alterations are necessary Presentation detailing instructions to be presented to staffIIR-C-29IIR-C-54Deal with a spillage of liquid radioactive material andperform subsequent decontamination measures Written confirmation of practical skills in dealing with a spillageDOPCalibrate contamination monitors for measuring the surface Report/spreadsheet showing procedure and results from contamination monitoractivity of a range of radionuclides, including technetiumIIR-C-55calibrations and regular QC99m, iodine-131 and Critical appraisal of QC procedures for monitoring equipmentpure beta emitterIIR-C-56 Report/spreadsheet showing procedure and results from contamination monitorcalibrations and regular QC Critical appraisal of QC procedures for monitoring equipmentIIR-C-55IIR-C-56Manage a quality assurance programme for radiationmonitorsIIR-C-57Participate in the management of the storage, disposal and Written confirmation of active participation in waste disposalrecord keeping of radioactive waste Short report describing waste disposal proceduresIIR-C-58 Perform radiation protection audits for nuclear medicineIIR-C-59Critically review policies and procedures for regulatorycomplianceCollect data for the calculation of estimated absorbed,IIR-C-60 equivalent and effective doses to patients, and effectivedoses to staff and the publicIIR-C-61IIR-C-35 Participate in and prepare reports for IRR, EPR, IR(ME)R auditsIIR-C-50, 58, 59 Short report reviewing policies related to e.g., IRR, EPR, IR(ME)R - this can bedone as part of the audit process or preparation for an inspectionIIR-C-50, 58, 59 Personal dosimetry report Patient dose auditCalculate estimated radiation dose and radiation risk where Radiation dose incident report e.g. skin doserelevant in relation to a particular incidentIPEM STP Guide - Imaging with Ionising Radiation Specialism F7Page 4
Diagnostic Radiology Equipment PerformanceDecide on appropriate tests to apply to the assessment ofIIR-C-62 the measuring device to ensure that it is performingaccording to its specified standard Cross calibration work instruction Familiarisation with manufacturers recommendations and instructions for measuringdevice if appropriateUndertake and/or arrange for tests to be carried out in anIIR-C-63 environment, and with facilities, that are appropriate andtraceable to national standards Cross calibration of equipment
Practical observations and analysis of results IIR-C-68 Analyse and interpret data from a multislice CT phantom Short report IIR-C-71, 72 Undertake a range of system administration tasks on a nuclear medicine or diagnostic radiology system Practical observations IIR-C-87 CbD Examples of possible evidence Competencies which may share evidence
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