AGENDA FOR CHANGE
NHS JOB EVALUATION SCHEME
1. JOB IDENTIFICATION
Job Title: / Principal Physicist (Radiotherapy Imaging)Reports to: / Consultant Clinical Scientist (Equipment & Dosimetry)
Department, Ward or Section: / Radiotherapy Physics
CHP, Directorate or Corporate Department: / Medical
Job Reference: / SSCANCRAIGRDIO02
No of Job Holders: / 1
Last Update: / 2007
2. JOB PURPOSE
· To provide lead scientific support for all imaging activities used in the planning and verification of radiotherapy treatments.· To assume the legal responsibilities of a Medical Physics Expert, Operator, Referrer and Practitioner as defined under the Ionising Radiation (Medical Exposure) Regulations 2000.
· To contribute to the day-to-day activities of the Radiotherapy Physics Section, providing expert scientific input and specialist knowledge to a broad range of complex radiotherapy procedures, services and developments.
3. DIMENSIONS
The Department of Clinical Oncology at Raigmore Hospital is one of five centres in Scotland with Cancer Centre Status. The department serves a population of approximately 260,000 in the Highland Health Board, Western Isles Health Board and the western part of Grampian Health Board areas, and currently treats in excess of 600 new patients per year. The Radiotherapy Physics Service is provided to the Department of Clinical Oncology by the Radiotherapy Physics Department.
The post holder’s main duties within the department are to provide the lead scientific support for all imaging activities used in the planning and verification of radiotherapy treatments.
Imaging for radiotherapy planning is used to identify which parts of the patient should receive treatment and which parts it is essential to spare from the effects of ionizing radiation. It is therefore essential that imaging modalities are selected and used appropriately, and the post holder will be responsible for providing this advice. The imaging modalities likely to be used most often will be CT, MRI and PET.
Imaging is used during radiotherapy verification to ensure that the radiation fields are delivered accurately to the tumour, and miss any critical structures. The modalities likely to be used include megavoltage portal imaging, fan beam CT and cone beam CT. This is a developing field, and the post holder will take the lead scientific role in the introduction of these techniques.
In addition to these focussed tasks, the post holder contributes at a specialist level to the full range of activities of the Radiotherapy Physics Department, which are described in section 5, including treatment planning, equipment quality control and dosimetry. The department produces approximately 600 treatment plans per year, covering the full range of plan complexity from simple, single field plans to complex, three dimensional, conformal treatment plans.
The postholder operates equipment which has potential to cause serious detriment to life and property, and which therefore requires specialist knowledge and training, and strict adherance to detailed operating and safety procedures.
A significant amount of the work of the section is non-routine, involving evaluation of equipment performance, development work, making changes to treatment techniques, computer program development etc. The post holder contributes to and leads some of this work.
4. ORGANISATIONAL POSITION
5. ROLE OF DEPARTMENT
The Radiotherapy Physics Department provides the only radiotherapy physics service in NHS Highland and one of only five such services in Scotland. It receives referrals for the full range of malignant disease from NHS Highland, NHS Western Isles and from the western part of NHS Grampian. Radiotherapy Physics staff work mostly with staff from the Clinical Oncology Department but work closely and have responsibilities with other Departments including Radiology, Medical Physics and eHealth. The Department provides a fully comprehensive clinical/scientific/technical service working as part of the fully integrated, multidisciplinary Oncology Team; and provides an essential part of the radiotherapy process for all patients. Radiotherapy Physics staff work closely with both Medical and Radiography staff to ensure that all patients receive the optimum customised radiation treatment for their disease, delivered with the highest possible accuracy using complex state of the art equipment.As well as specific physics activities, Department staff work with Government and other Inspectors about the Oncology Department’s compliance with its statutory obligations and accreditation of Quality Management Standards. The Radiotherapy Physics Department has a particular responsibility for quality control, quality assurance and the safety of patients and staff throughout Clinical Oncology. It provides an advisory, teaching and training role; and designs, develops and promulgates policies for use across the organisation. The Department is also highly committed to translating research and development into routine clinical use for all aspects of its work so ensuring that standards are maintained with respect to the rest of the UK. The Radiotherapy Department comprises the four distinct Sections described below:
· Treatment Planning Section - Responsible for the provision of individually designed, optimised treatment plans for each patient, each of which must ensure that the prescribed radiation dose is calculated and correctly targeted on the tumour whilst minimising the radiation dose to surrounding healthy normal tissues and organs at risk.
· Equipment and Dosimetry Section – Responsible for the range of complex Quality Assurance and Calibration Programs required to ensure that the radiotherapy x-ray imaging equipment used to localise the tumours to be treated and the high energy x-ray equipment used to treat each patient are accurately calibrated and precisely configured to high tolerances. This is essential to ensure that the treatment plans designed in the Treatment Planning Section are delivered correctly, accurately and confidently in every case.· Computing Section –Responsible for ensuring the integrity, safe operation and development of the various networked computing, patient information and quality management systems on which the service depends; particularly those used in treatment planning, treatment delivery and electronic document management systems.
· Radiotherapy Technology Section – Responsible for the maintenance, repair and safety of the equipment and facilities used.
All the above Sections are actively involved in the procurement, installation, commissioning and introduction of new radiotherapy equipment, techniques and information systems into safe clinical practice. This is an essential part of the Service’s responsibility for ensuring that the treatments provided by NHS Highland remain up to date, founded on best practice and commensurate with those provided by the other UK Cancer Centres.
6. MAIN TASKS, DUTIES AND RESPONSIBILITIES
· Providing the lead scientific support for all imaging activities used in the planning and verification of radiotherapy treatments.· Contributing to the effective day-to-day operation of the Radiotherapy Physics Section, including assisting with planning and prioritising activity as required to meet the immediate demands on the service.
· Designing optimised radiation treatments for individual patients that will irradiate the tumour and shield critical organs to meet the specific requirements defined by the prescribing Consultant Clinical Oncologist. Identifying anatomical features on patient images generated by CT, MRI, plain X-ray and radiotherapy portal imaging, and assessing their relation to diagnostic and therapeutic radiation beams. Making anatomical measurements on patients and evaluating treatment options. Performing complex calculations to ensure that the dose delivered to the patient will be as specified. Providing information and advice to the mould room regarding blocking of the radiation fields or immobilisation of the patient. Ensuring that treatment plans prepared are checked by an appropriate member of the Radiotherapy Physics Section before simulator verification, final completion and issue. Checking treatment plans prepared by other members of the Radiotherapy Physics Section where appropriate.
· Performing definitive calibrations to a traceable national standard on radiotherapy equipment and test equipment, performing routine constancy calibrations and participating in the design and implementation of quality assurance procedures to satisfy extant radiation safety legislation, departmental procedures, other legislation and national standards, so assisting to ensure that all new and existing equipment is suitable for clinical use.
· Undertaking radiation dosimetry to investigate and rectify equipment performance. Providing essential information on non-routine patient treatments and measuring the radiation doses received by individual patients.
· Undertaking development activity as required in the design of radiation treatments, quality assurance improvements, equipment commissioning, computer applications and radiation dosimetry procedures. Leading projects under the direction of the Head of Radiotherapy Physics or Consultant Clinical Scientist (Equipment and Dosimetry)..
· Participating in other projects specific to the needs of the Department of Clinical Oncology in order to improve the quality of the service for the benefits of patients and users.
· Participating in the development of radiotherapy capital programmes, including assessing the specification and use of equipment, treatment techniques and new technologies.
· Assessing radiation performance of new and modified equipment, measuring requisite test data and integrating it into the treatment planning system. Participating in assessments designed to ensure that radiotherapy equipment meets its original radiation performance specification.
· Ensuring that all work undertaken by the Postholder is adequately documented and checked by an appropriate member of Radiotherapy Physics staff.
· Providing advice to Consultant Clinical Oncologists on non-routine patient treatments, patient radiation dosimetry, design of treatment techniques and patient treatment aids, effect of equipment performance variations on patient treatments and quality assurance issues.
· Participating in the teaching/training of staff, trainees and students.
· Participating in the multidisciplinary approach to radiation treatment in the Department of Clinical Oncology and ensuring good communication with other staff groups.
· Participating in continuous professional development, including publication of scientific papers, and attendance and presentation at national and international conferences.
· Undertaking other work appropriate to the grade of the post if requested to do so by the Head of Radiotherapy Physics or Consultant Clinical Scientist (Equipment and Dosimetry).
7a. EQUIPMENT AND MACHINERY
· Treatment Equipment: Linear accelerators used for radiotherapy with high energy X-rays and electrons (each item around £2M).· Imaging Equipment: CT scanner used for localisation and verification for patients requiring radiotherapy (with value in the range £0.5M to £1.0M per item). Imaging equipment in other areas associated with this post include MRI scanners and PET-CT scanners.
· Computer Equipment: Clinical computer aided design system used for treatment planning (total value approximately £0.8M).
7b. SYSTEMS
· ARIA is a state-of-the-art commercial patient information system, which interfaces to and controls the radiotherapy treatment machines. It integrates and implements the various elements involved in the radiotherapy process, including: safely scheduling and managing all aspects of the patient pathway; allowing treatment planning staff to formulate complex treatment configurations that optimise the distribution of radiation to tumour whilst minimising that to normal tissue through highly specialised techniques in a rapidly developing field; transfer of all planned treatment parameters, and dosimetrically measured characteristics of the treatment machines as required among a department-wide array of computers; use of this data to control the radiotherapy machines to deliver the dose distribution, manage a large number of safety interlocks, and monitor and record all information in real-time; enable the integration of various imaging modalities into the tumour definition and planning process).
· Patient record entries into ARIA
· Frequent use of Word, Excel, PowerPoint etc. to set up presentations, documents and spreadsheets.
· Producing regular reports for management meetings.
· Data analysis relating to incidents and near-misses including DATIX
· Equipment handover documentation to demonstrate the status and safety of radiation equipment.
· Regular review of documentation to ensure continued validity.
8. ASSIGNMENT AND REVIEW OF WORK
The Post holder is accountable to the Consultant Clinical Scientist in Charge of Radiotherapy Physics but day to day management is through the Consultant Clinical Scientist (Equuipment and Dosimetry).The post holder has considerable autonomy when carrying out their duties, particularly in the area of radiotherapy imaging. They will generally prioritise and develop work in this area as they see fit.
The treatment planning workload is generated by the Consultant Clinical Oncologists. This work includes planning radiation treatments for individual patients, undertaking patient dose measurements and providing advice on the radiotherapy physics implications of individual radiation treatments. This may involve some patient contact. This work is undertaken unsupervised. All work is double checked as a requirement of the planning process. When treatment planning has been completed, this work is passed to radiography staff of the Department of Clinical Oncology for patient treatment.
Other work is assigned through the Consultant Clinical Scientist (Equipment and Dosimetry) including project and development activities, some of which the Post holder may lead. Objectives are agreed annually and reviewed at monthly meetings and frequent informal meetings.
The postholder will discuss and agree PDP & R on a regular basis with the Head of Radiotherapy Physics.
The Post holder is accountable to the Consultant Clinical Scientist in Charge of Radiotherapy Physics for ensuring that work undertaken meets the requirements of radiation safety legislation and local quality assurance procedures including, The Ionising Radiations Regulations 1999; The Ionising Radiation (Medical Exposure) Regulations 2000, The Health and Safety at Work Act, 1974, ISO 9000-2000 and the hospital's standing procedures.
9. DECISIONS AND JUDGEMENTS
The post holder has day to day responsibility for the scientific support of radiotherapy imaging and works on his / her own initiative to prioritise the work and develop these services. The post holder will advise the Consultant Clinical Scientist in Charge of Radiotherapy Physics of equipment or resource issues which may affect the smooth running of these services.
The day-to-day clinical work involves treatment planning, machine quality control and dosimetry, and involves making decisions about whether treatment plans are suitable and safe for a patient, and whether equipment is performing correctly, or requires recalibration or adjustment. The post holder is expected to be able to make these decisions unaided. All decisions and judgements in the clinical work can result in serious consequences for a patient’s treatment. Errors in a treatment plan will affect an individual patient. Errors on a treatment machine will affect all patients.
The post holder must be able to answer queries from radiotherapy staff, and make decisions regarding a variety of issues. This requires an in-depth knowledge of the equipment, and the planning and treatment process. The post holder will generally deal with these issues independently.