Senior Physicist 8a Radiation Physics

Job Reference Number……P/HC/46……………………………

NHS TAYSIDE – AGENDA FOR CHANGEJOB DESCRIPTION

1. JOB IDENTIFICATION Job Title Senior Physicist 8a Radiation Physics

Department(s)/Location The post will be based principally in Medical Physics at Ninewells, but the post holder will be expected to perform duties at all hospitals, clinics and dental practices throughout Tayside that use Radiological equipment or radionuclides.

Number of job holders 1

2. JOB PURPOSEProvide clinical, scientific and technical Radiation Physics services to NHS Tayside. Provide expert scientific advice in key specialist areas of Diagnostic Radiology, Radiotherapy and Nuclear Medicine radiation protection. Provide support for the radiation protection aspects of two Nuclear Medicine developments and act as lead specialist for radiation protection in the Clinical Research Centre. Undertake research and development.

3. ORGANISATIONAL POSITION


4. SCOPE AND RANGE

The accompanying document outlines the role of the Radiation Physics Service.

The post holder will

1) Act as a clinical scientist in the Radiation Physics Section of the Medical Physics Department and as such

a) Provide scientific support for the provision of a radiation protection service for staff and patients of NHS Tayside.

b) Act as lead specialist for operational radiation protection in the PET/CT development in the NHS Tayside / University of Dundee Clinical Research Centre

c) Provide scientific support to the CT aspects of the PET/CT service and support research and development as required.

d) Provide scientific support for the radiation protection aspects of two Nuclear Medicine developments

e) Provide scientific support for radiation protection in Radiotherapy.

f) Provide scientific support for the provision of a diagnostic radiology physics service to NHS Tayside

g) Act as a Medical Physics Expert for NHS Tayside as required by IR(ME)R 2000.

h) Report to the head of Radiation Physics who is also the Radiation Protection Adviser to NHS Tayside.

i) Supervise physicists working at a lower level, advise and supervise Part I trainee physicists, technical staff and students.

j) .Provide specialist scientific and technical advice to NHS Tayside for procurement of highly specialised radiology equipment such as interventional radiology systems.

2) Timetable and organise his/her own scientific, clinical, research and supervisory work.

3) Perform audits of legislative compliance in diagnostic radiology and in the University Medical School.

4) Operate at a level of expertise where he/she may provide advice on the interpretation and application of legislation and standards at a departmental level within NHS Tayside.

5) Maintain effective communication channels, working relationships and collaborative links with Clinical Radiology and other clinical departments throughout NHS Tayside, liase with a large number of senior managers in different organisations working with ionising and non-ionising radiation, and will interact with senior management in internal and external organisations.

6) Take decisions regarding functioning and optimisation of highly complex ionising radiation imaging equipment, directly affecting radiation dose, image quality and therefore clinical management of patients.

7) Provide the Radiation Physics section with in-depth knowledge and experience across the full range of diagnostic radiology equipment from conventional x-ray and dental systems, to highly sophisticated digital interventional equipment.

The post holder will report to the head of Radiation Physics and to the Director of Medical Physics for scientific matters in terms of legally defined roles.


5 MAIN DUTIES/RESPONSIBILITIES (Note : Notional times are assigned but it should be understood that these are indicative only. The eventualities of the job will mean that from time to time practically 100% of working time will need to be spent on one area of endeavour. For example at critical phases in installation and acceptance of new x-ray installations.

A Clinical, Scientific (60%)

1.1 a) Act as a Medical Physics Expert for NHS Tayside as required by the Ionising Radiation (Medical Exposures) Regulations 2000

b) Deputise for NHS Tayside Radiation Protection Adviser where required

c) Provide scientific support for the radiation protection aspects of two new Nuclear Medicine developments.

d) Provide scientific support for radiation protection in Radiotherapy.

e) Act as lead specialist for the radiation protection aspects of the PET/CT development in the Clinical Research Centre

f) Provide scientific support to the CT aspects of the PET/CT service and support research and development as required.

1.1 Assist with development and provision of radiation protection services offered by the Radiation Physics section.

1.2 Assist with development and provision of the Diagnostic Radiology Physics services offered by the Radiation Physics Section.

1.3 Provide expert advice on radiation protection to NHS Tayside and to other organisations. This will include: providing highly specialised advice to staff on a broad range of radiation protection and measurement procedures; interpretation of legislation and development of working practices; provision of expert radiation safety advice; performance of dosimetry of internally administered radionuclides and the selection of appropriate radiation sources and facilitate the disposal of radioactive waste systems.

1.4 Provide expert technical and scientific advice to aid procurement of highly-complex, patient critical x-ray equipment, (for example develop specification for and evaluate radiological and interventional equipment)

1.5 Design and test radiation safety requirements for rooms in which x-ray equipment will be sited.

1.6 Liase with external inspectors from Regulatory bodies (principally the SEHD, the Health & Safety Executive and SEPA) to facilitate inspections of radiation activities. Analyse requirements and advise departments on appropriate actions to take to achieve compliance with statutory regulations, using a high level of interpersonal skills to achieve understanding of highly complex and sensitive information and acceptance of the need for changes in policies and working practices. Report to NHS Tayside Radiation Safety Committee where appropriate.

1.7 Perform risk assessments and radiation safety audits in Diagnostic Radiology, Radiotherapy, Nuclear Medicine and the Clinical Research Centre, implement codes of practice and other relevant guidance in radiation safety.

1.8 Perform acceptance testing and commissioning on full range of radiation protection and diagnostic radiology equipment.


1.9 Perform and develop quality assurance programmes for Diagnostic Radiology and radiation protection equipment and train junior staff in these techniques.

1.10 Assist in the provision of expert advice to the Tayside Local Research Ethics Committee on all the implications of research projects involving the use of ionising radiation on human subjects.

1.11 Develop software solutions to aid patient dose audit record keeping, Quality Assurance radiation dose and image quality data. This can involve the use of and manipulation of spreadsheets and databases.

1.12 Perform investigations into work practices where predetermined dose levels have been exceeded both for staff and/or patients. Such investigations will require negotiating skills, tact and professional judgement. Analyse outcomes and determine if further action is required. This will involve the use of expert knowledge to determine the magnitude of doses, the attendant risks and consequences and the use of expert judgement to decide on the impact of the incident, report to RPA and on occasion professional judgement required as to whether or not matter need be reported to the appropriate regulatory body.

1.13 Undertake precise calibrations and measurements on radiation monitoring equipment as required.

1.14 Assist with provision of necessary expertise and back-up as required in the event of a major incident involving radiation, including those handled under National Arrangements for Incidents involving Radioactivity (NAIR), CBRN or other emergency schemes. This involves liasing with the counter-terrorism group of the police, SEPA, Health Protection Scotland (HPS) and the SEHD.

1.15 Assist the head of section in formulating responses to governmental and other consultative documents regarding ionising radiation for NHS Tayside and the University of Dundee Medical School.

1.16 Maintain a close working relationship with other members of multi-disciplinary teams in the provision of a patient-carer focussed approach to quality care.

1.17 Advise individual patients on matters relating to radiation risk from diagnostic and therapeutic examinations.

1.18 Participate in and plan radiation protection for novel clinical procedures as required.

1.19 Participate in the voluntary call out service for NHS Tayside to deal with radioactive incidents outside of normal working hours. Where such incidents occur, post holder will be expected to provide lead or sole worker responsibility for radiation protection in extremely unpredictable situations.

1.20 Maintain a close working relationship with other members of multidisciplinary teams in the provision of a patient-carer focussed approach to quality care.

B Managerial (10%)

2.1 Prioritise and manage own work.

2.2 Undertake Continuing Professional Development

2.3 Manage and coordinate the work of junior physicists including performing annual appraisal, training needs and development plans.


2.4 Supervise and take responsibility for the work of other Medical Physicists and Medical Technical staff, trainees and students when they are performing work under the post holder’s direction.

2.5 Manage the infrastructure requirements for all radiation protection aspects of the PET/CT facility and new Nuclear Medicine departments in Perth and Dundee.

2.6 Prioritise Section work in accordance with Departmental and NHS Tayside requirements.

2.7 Ensure equipment is maintained and calibrated. Provide input to business plans in terms of radiation protection test tools and QA equipment.

2.8 Attend management meetings as required and deputise for RPA as required.

2.9 Chair meetings with fellow health professionals.

2.10 Establish and maintain excellent working relationships with medical staff and other health care professionals.

C Teaching, Training & Research (20%)

3.1 Assist with the development and provision of suitable training courses for employees of NHS Tayside and the University Medical School working with radioactive sources.

3.2 Assist in the provision of training courses in radiation safety. This will include the preparation and giving of lectures and tutorials in areas of Radiation Physics to groups of Medical, Scientific, Technical, nursing and ancillary staff; training other medical physics staff in allocated areas of work; and identifying opportunities for establishing new courses where required.

3.3 Provide teaching and training on Radiation Physics and radiation protection on other courses, including external academic teaching to post-graduate and MSc level, and act as an examiner at MSc. level.

3.4 Supervise trainee clinical scientists, and other students, on placement within the Section. Supervise the scientific work of trainees, graduate and postgraduate students, and appropriately qualified research staff working in Radiation Safety.

3.5 Present papers at national and international scientific meetings. Publish in peer reviewed journals.

3.6 Initiate and participate in research and development projects relevant to the scientific and clinical work of Radiation Safety. Manage own research and development projects and supervise R&D work of junior staff.

D Other (10%)

Maintain state registration as a clinical scientist

Keep abreast of the latest technical and scientific developments and their applications in medical and associated fields. Attend suitable seminars and courses as part of personal development and to further the work of the Department.

Provide expert input to Scottish Executive and Department of Health working groups

Participate in working parties set up by professional bodies such as Institute of Physics and Engineering in Medicine (IPEM).

Participate in national committees whose deliberations will impact on NHS Tayside


As member of NHS Tayside Radiation Safety Committee, produce formal minutes and reports to the Medical Director, NHS Tayside.

Participate in annual performance and development reviews.

Participate in appropriate Continuing Professional Development programmes.

The post holder will regularly have to work in patient areas, often when seriously ill patients are undergoing examination or treatment.

6. COMMUNICATIONS AND RELATIONSHIPS

The postholder will liase with senior colleagues and maintain an effective working relationship with them, particularly in the Medical Physics and Clinical Radiology departments, but also throughout NHS Tayside, up to Medical Director level.

The post holder is expected to have excellent written and verbal communication skills and will produce written policies, guidance and reports on a variety of radiation related matters. The post holder will also be expected to convey complicated scientific advice and data to a range of NHS staff with widely varying levels of technical and scientific understanding.

The post holder will be expected to produce scientific reports and publications for dissemination in peer reviewed journals and documents.

The post holder will liase with a number of senior managers in different organisations working with ionising and non-ionising radiation, and will interact with senior management in internal and external organisations.

The post holder will be expected to develop effective working relationships with physicists and medical colleagues elsewhere in the UK as a key member of a major Medical Physics Department within a Teaching Hospital.

The post holder can be expected to have involvement in national professional bodies and committees and to present at national and international conferences and events.

The post holder will be able to communicate complex information at postgraduate level to other professional groups.

The post holder will be able to deal with complex and unpredictable situations and will be expected to investigate practices where radiation incidents have occurred, using good negotiating skills, in dealing with sensitive situations, for example the discovery of pregnancy in patient and/or staff who have undergone exposure to ionising radiation.


7. KNOWLEDGE, TRAINING AND EXPERIENCE REQUIRED TO DO THE JOB

A Qualifications

Scientific 1st or 2nd class Honours degree in a relevant Physics subject

Relevant MSc or higher degree

Corporate Membership of Institute of Physics and Engineering in Medicine (IPEM) PhD or equivalent experience ~ minimum 10 years post- training experience in Diagnostic Radiology and Radiation Protection in a position of responsibility and autonomy.

Registration State registration as a Clinical Scientist ~ minimum 5 years post registration

B Knowledge & Experience

Scientific & Technical

Advanced level of knowledge and extensive experience across the full range of working procedures and practices in Radiation Protection and Diagnostic Radiology physics gained over 10 years experience in a position of responsibility and autonomy for own work, with at least 5 of those years as a state registered Clinical Scientist.

Highly advanced theoretical and practical expert knowledge of the field of Radiation Safety, including the expert knowledge required to deputise for the Radiation Protection Adviser for a large teaching hospital and other academic and commercial organisations.

Expert knowledge in the field of diagnostic radiology physics and digital imaging. Experience of providing expert scientific advice for procurement of highly sophisticated

diagnostic radiology equipment. Scientific and technical knowledge of Mammography systems in terms of radiation safety and

image quality. Advanced knowledge of radiation issues in Nuclear Medicine, sufficient to act as a Medical

Physics Expert as required by IR(ME)R 2000 for Nuclear Medicine Specialist knowledge in other legislative areas such as Road Transport of Radioactive

Materials, Radioactive Substances legislation, Radiation Emergency Preparedness etc. Ability to undertake research and development in areas of specialism of the section. Track record of presentation and publication at national level.

Clinical Highly specialised knowledge of clinical issues and their implications for external and internal

radiation dosimetry purposes. Broad advanced knowledge of other areas in Medical Physics, including therapy procedures

and practices. High level of understanding of patient and staff risks arising from equipment failure and staff

error. Broad advanced knowledge of Clinical Radiology working practices. Broad advanced knowledge of Clinical Nuclear Medicine working practices. Specialist knowledge of Digital Imaging technologies.


IT Able to use Excel, Word, PowerPoint etc to set up documents and spreadsheets and extract

information, SPSS for statistics and various workstations in radiology for operation of x-ray equipment, analysis of images and extraction of dose information.

Able to specify computing equipment for imaging needs. Able to use software test tools in order to carry out QA of Digital imaging equipment. Understanding of Picture Archiving Communication Systems (PACS) environment.

General Good report writing and presentational skills, including the production of clear and concise

reports, verbal presentations and periodic scientific papers. Good knowledge of statistical methods.

Teaching and Training skills, experience of teaching/ lecturing to medical students, health professionals post-graduates on radiation physics and radiation protection.

Good communication skills Demonstrable organisational skills and the ability to manage/supervise personnel.

EnvironmentalUnderstanding of hazards posed by, and precautions needed with: Ionising radiation – sealed and unsealed sources of. Non-ionising radiation Infected material (clinical and putrescent radioactive waste) Electrical hazards

ESSENTIAL ADDITIONAL INFORMATION

8. SYSTEMS AND EQUIPMENT

The post holder must be familiar with the operation of a wide range of diagnostic radiology equipment for the purpose of assessing performance: specifically – i) all plain film x-ray sets in Tayside including mammography, ii) all image intensifier equipment in Tayside, iii) all interventional imaging equipment in Tayside, iv) Digital imaging modalities such as Computed Radiography and flat panel detector technologies.

The post holder must be familiar with the operation of a wide range of radiation monitoring and testing equipment including survey monitors, radionuclides calibrators, ionisation chambers, proportional counters, kV meters.

The post holder must also have the ability and skill to manipulate unsealed sources of radioactivity using syringes from time to time and to handle other forms of radionuclides safely and be able to train other members of the section in these practical skills.

The post holder should also be able to use the following: Picture Archiving and Communication Systems (PACS) for storage and retrieval of medical


images. Personal computers with associated operating systems and basic software packages for

accessing e-mail, the internet, word processing, spreadsheets and presentations and SPSS for statistical analysis.

The post holder will be able to evaluate test tools and testing equipment and have responsibility for purchasing such equipment in order to ensure provision of radiation protection service.

The post holder must be familiar with a wide range of personal protective equipment.

The postholder is responsible for the development of systems to maintain records of patient doses radioactive waste disposal, radionuclide holdings, medical imaging equipment, audits of radiation environments etc.

RESPONSIBILITY FOR RECORDS MANAGEMENT All records created in the course of the business of NHS Tayside are corporate records and are public records under the terms of the Public Records (Scotland) Act 1937. This includes email messages and other electronic records. It is your responsibility to ensure that you keep appropriate records of your work in NHS Tayside and manage those records in keeping with the NHS Tayside Records Management Policy and with any guidance produced by NHS Tayside specific to your employment.

9. PHYSICAL DEMANDS OF THE JOB

The post holder must be able to concentrate frequently when subject to unpredictable working patterns (e.g. when interrupted to provide urgent advice)

The post holder must be able to concentrate for prolonged periods (e.g. carrying out radiation measurements; undertaking statutory inspections, designing radiation facilities)

Dexterity, co-ordination and sensory skills are required to use and calibrate precision measuring tools to test patient diagnostic equipment.

Requires dexterity and co-ordination to occasionally manipulate sources of unsealed radioactivity using syringes and pipettes for QA purposes in radiation protection and train junior members of staff in these techniques.

Speed and accuracy when checking expensive equipment to minimise downtime. Lone working in specialist areas.

Handle hazardous radioactive waste, including patient contaminated waste. Occasionally exposed to levels of ionising radiation which exceed regulatory limits.

Frequently enter and perform routine radiation protection tasks within designated radiation areas including laboratories and radiation waste store where noxious and hazardous materials are present.

Works at all hospitals and clinics throughout Tayside that use radiological equipment or radionuclides often as sole worker.


Occasionally works in environment with exposure to highly unpleasant and hazardous working conditions, e.g. decontamination of serious levels of clinical or other radionuclide spillage.

Postholder will provide advice and carry out radiation monitoring for staff and patients on wards and in theatres such as in neurosurgery during Inter operative radiotherapy treatment (IORT).

Frequently lifts heavy weights such as lead shielding and heavy testing equipment, transports such equipment throughout NHS Tayside.

Occasionally required to transport unsealed sources of radiation within NHS Tayside, in compliance with Road Transport legislation in order to carry out radiation protection testing.

Frequently required to wear heavy lead protection whilst carrying out routine surveys for 3-4 hours and longer.

Occasionally required to move mobile Image Intensifier equipment and accessories within anX-ray department.

Frequently required to undertake precise calibration of patient dose monitoring equipment

Needs to deal with frequent interruptions and competing demands for attention.

Requires basic keyboard skills

10. DECISIONS AND JUDGEMENTS

The post holder is managerially and professionally accountable to the head of Radiation Physics and to the Director of Medical Physics for all scientific matters, but works in an unsupervised manner and takes responsibility for own workload. The post holder is responsible for managing and planning his/her own work time and that of the one other scientific staff member and offers advice and supervision to a second physicist and technician, Part I and student trainees as required.

The post holder has autonomy for own work and professional advice but acts under the responsibility of the Radiation Protection Advisor who is also the head of Radiation Physics. The post holder must exercise his/her knowledge and expertise to arrive at judgements regarding the way in which the advice is delivered and the degree to which escalation should take place.

The post holder will develop procedures and guidance on diagnostic radiology and radiation measurement equipment in terms of radiation safety, dose optimisation and image quality and development of quality assurance programmes for other staff members to follow, both internally and externally.

The post holder will use their professional judgment to recommend the removal from clinical use diagnostic radiology equipment and other radiation monitoring equipment in terms of radiation safety and/or image quality as a result of the quality assurance checks performed by the postholder and/or junior members of Radiation Physics staff. In so doing the postholder will rely on own professional judgment and that of his/her peers together with any national guidance.

11. MOST CHALLENGING/DIFFICULT PARTS OF THE JOB


Providing a high standard of Diagnostic Radiology Physics support to NHS Tayside. Providing high standard of radiation protection throughout NHS Tayside. Communicating advice in a meaningful, relevant and appropriate way to wide range of staff in

NHS Tayside Providing advice on procurement and performance evaluation, acceptance and

commissioning testing of new technology in the fields of Diagnostic Radiology and Radiation Protection.

Conducting appropriate research and development work.


Essential Additional Information: Radiation Physics An Overview

The Radiation Physics service provides 1) a Radiation Protection Service 2) A Diagnostic X-ray Service and 3) and MRI Physics Service to NHS Tayside. It also provides a radiation protection service to the University of Dundee Medical School. The Radiation Physics Section aims to

i) Ensure the safety of all patients, visitors and staff who come into contact with sealed or unsealed sources of ionising radiation,

ii) Ensure that a high level of scientific support is provided so that the highest quality MRI service is provided to NHS Tayside patients and

ii) Provide in depth technological and scientific support to the Clinical Radiology department, especially in the case of high technology equipment.

1) Radiation Protection

Medical radiation contributes some 95% of the total radiation dose to the UK population from all man made sources. In patient terms, it is essential that all of this radiation is beneficial, i.e. the risk to the patient is outweighed by the benefit obtained from the diagnosis or therapy. In terms of staff and members of the public, it is essential that radiation doses are kept as low as reasonably practicable since these groups receive no direct benefit whatsoever. There is no threshold dose of radiation below which the risk of cancer induction or genetic defect disappears. The role of a radiation protection service in a hospital is therefore two fold. Firstly, to ensure that there is an optimal balance between the delivered patient dose and the desired diagnostic or therapeutic outcome and secondly, to ensure that radiation doses to staff and members of the public are kept as low as possible. Consequently, the service plays a role in every environment where radiation is used, e.g. Nuclear Medicine, Radiotherapy, Diagnostic Radiology, Neurosurgery, University Laboratories and so on.

The role extends across Tayside. The following bullet points are intended to give an indication of the breadth of the role played by staff members who will.

Advise NHS Tayside and the University on, and determine compliance with, legislative and other requirements relating to radiation. The primary concern is with the Ionising Radiation Regulations 1999 (patients, staff and members of the public) the Ionising Radiations Medical Exposure Regulations 2000 (patients) and the Radioactive Substances Act 1993 ( patients, staff and the environment)

Assess risks associated with planned new facilities or services involving radiation, specify design features for these facilities or services and specify radiation protection and control features required for new facilities.

Develop and implement organisational policies for radiation protection. Develop and implement procedures for management and control of radioactive substances. Develop and implement procedures for control of equipment generating radiation and of the

radiation emitted, i.e. Clinical Radiology and Radiotherapy Develop and implement procedures for audit, measurement and calculation of radiation dose

to individual patients and then interpret and act on the results. Develop and implement frameworks for the determination of radiation doses to staff and then

interpret and act on the results. Develop and implement QA programmes for radiation equipment and procedures and ensure

any recommendations are carried out. Develop and implement procedures and policies for management and control of incidents

involving radiation.


Develop and implement operational plans for minimising exposure resulting from radiation emergencies and investigate, remediate and report on radiation incidents.

Promote safe and effective working practices in areas which may be affected by radiation. Optimise practices which involve radiation. Assess environmental radiation levels within NHS Tayside and in the surrounding areas and

interpret and act on results. Co-ordinate storage, disposal and transfer of radioactive substances arising from the work of

NHS Tayside and the University of Dundee. Collect, monitor and record radioactive waste. Calibrate and test all equipment that measures radiation. Provide teaching and training to diverse groups on all matters relating to radiation safety. Carry out research in the field of radiation protection.

2) Diagnostic Radiology Physics

Physicists have been closely involved with radiology since the discovery of X-rays byRoentgen in 1895. Since then a wide range of diagnostic and therapeutic applications of x-rays have been developed by and are supported by physicists. In 2002 43 million X-ray examinations were carried out in the UK; the resulting radiation dose to the population was 30 times greater than that from all other man-made sources of radiation, including nuclear power. There are obvious significant implications for the management of patients, the radiation dose to the population and health and safety of staff. The medical physicist’s role is concerned with the selection of highly technical x-ray equipment, quality assurance of equipment performance and imaging techniques, the monitoring and control of radiation doses (see also radiation protection above), the optimisation of imaging equipment and the development and improvement of techniques and methodologies.

Selection and acceptance of Equipment

In NHS Tayside, members of staff from Radiation Physics sit on the procurement team for all high technology X-ray equipment and advise on technical and patient dose related issues. Recent areas of involvement include the purchase of Multi Slice CT scanners for Ninewells and Stracathro Hospitals, the purchase of flat panel detector interventional radiology equipment for Ninewells Hospital and the purchase of a new cardiac catheterisation laboratory. After purchase, members of staff carry out acceptance checks and assessments of all x-ray equipment on behalf of NHS Tayside to ensure that the equipment is fit for purpose and can be paid for and put into clinical use. The level of complexity is such that the tests can take up to a week.

Quality Assurance and performance evaluation of x-ray equipment

Objective technical assessment of equipment performance is vital in ensuring satisfactory and safe operation. The results of the assessment of new equipment determine whether or not the equipment is acceptable for clinical use and monitor its subsequent performance. Performance evaluation includes determining the relationship between dose and image quality for any particular imaging system and clinical application. Consequently, members of staff carry out regular assessments (in accordance with regulatory guidelines) of all x-ray equipment in Tayside to identify how performance is changing with time a) so that diagnoses can be as accurate as possible and b) to ensure that this is not at the expense of patient radiation dose.

Monitoring of patient radiation doses (see also radiation protection above).

A considerable effort is spent monitoring patient radiation doses from a large contingent of examinations to ensure that practice throughout NHS Tayside is harmonised and in line with UK practice. A variety of techniques are employed, the majority of which involve direct measurement.


Complex calculations are used to determine individual patient doses when assessments are made in retrospect – for example following an examination when it is discovered that the patient is pregnant or when an incident has occurred and judgements need to be made about its impact on the patient and whether it should be reported to SEHD.

Optimisation of Equipment and Image Acquisition.

This area is becoming increasingly important with the advent of more and more complex digital x-ray equipment. Two examples are a) The profound technological and dosimetric challenges introduced by the adoption of 4, 8 and 16 slice Computed Tomography which demand extra expertise in computing and data handling and b) the introduction of Computed Radiology across Tayside which has resulted in the need to conduct lengthy trials using patients and phantoms in order enable the acquisition of diagnostic images.

Clinical Research & Development

Most clinical research and development is carried out in the areas of patient dosimetry and optimisation. Typical fields of endeavour would dosimetry with novel imaging technologies, determination of metrics to characterise imaging systems, optimisation studies such as that mentioned in the previous paragraph and evaluation of observer performance when evaluating images.

3) Physics Support of MRI

MRI is an established imaging modality by which it is possible to non-invasively visualise the soft tissue structures of the human body by exposure to a strong static magnetic field and radiofrequency (RF) radiation. Initially the soft tissues under investigation are exposed to the strong static magnetic field, and then subjected to a pulse of radio waves from an RF coil that delivers energy to the water protons in the tissue. The MRI image is then formed by signals detected from the water protons as they release energy, and the position of these signals can be localised in very thin ‘slices’ across the patient by the use of further small magnetic fields called magnetic field gradients. The time taken for these small signals to develop is very specific to each individual tissue in the human body, and this forms the basis of the unique soft tissue contrast that underpins MRI as a vital tool for state-of-the-art radiological diagnosis.

The main roles of Medical Physics MRI support include (1) MR equipment and site specification, (2) acceptance testing of equipment and Quality Assurance (QA), (3) MRI safety, (4) clinical scientific optimisation of techniques, post-processing and data analysis, (5) education and staff development, and (6) clinical development and research. Further details of each of these key task areas are listed in this summary document, below.

1. MR Equipment and Site Specification

Provision of technical input for appropriate purchasing of new equipment (or upgrades) for each MRI site across NHS Tayside, and supply of technical support and advice for site requirements concerning safety, positioning and specification.

2. Acceptance Testing of Equipment and Quality Assurance (QA)


Acceptance testing – assessment of baseline technical data and performance of new magnets, gradients, and RF coils in conjunction with installation engineers.

Implementation of QA programmes to test imaging hardware (e.g. RF coils) at each site, and analysis of QA data collected at all sites to evaluate quality of service and gradient, coil and magnet performance.

3. MRI Safety

Appropriate screening of implantable devices (e.g. hearing aids, coronary stents) at each centre to ensure safe scanning of individual patients, and the development of an ‘implantable devices’ database for NHS Tayside.

Active participation as part of the Trust MRI safety committee covering each centre, and participation in regular committee meetings to ensure safe operating practice in line with the MRI local rules at all sites.

Completion of full safety training and responsibility as a grade I (category a) authorised person in MRI. Provision of safety and educational MRI lectures to maintain staff awareness of MRI safety and understanding.

4. Clinical Scientific Optimisation of Techniques, Post Processing and Data Analysis

Optimisation and customisation of complex image acquisition parameters where appropriate (in conjunction with MR applications specialists and consultant radiologists) in order to enhance the clinical service.

Advanced clinical MRI post processing of individual patient images at each centre is an essential requirement to enable correct diagnosis, and this is undertaken in conjunction with clinical radiology sessional timetables. The major areas of workload support the cardiovascular and oncology MRI imaging service.

5. Education and Staff Development

Education of radiologists, radiographers and other staff in the basic principles of MRI scanning and safety.

Education and support of clinical placement trainees in radiology, medical physics or other disciplines.

Assistance with education programmes for medical/dental students and external groups (e.g. physics teachers).

6. Clinical Development and Research

Clinical development of all relevant clinical research interests and general research support in MRI as scanner technology improves. The main areas of clinical development include cardiovascular MR at Ninewells Hospital, and MR spectroscopy of brain function at Perth Royal Infirmary. The provision of a Stracathro MRI unit will also allow these clinical developments to be based at alternative sites within Tayside.

Refinement of novel MR applications, ensuring reliability and reproducibility of such techniques, and communicating results via peer reviewed publications or presentations at national/international meetings.

Applications for funding of research/clinical development projects via grant submissions through the NHS, research councils or charities.

Summary of Main Areas of Clinical Support, Research and Development

Cardiovascular MRI


Cardiovascular MRI consists of ECG-gated imaging of the heart and MR angiographic imaging of the arteries to ensure appropriate assessment of cardiovascular morphology and function. These techniques require Physics input at the data acquisition and post-processing stage in order to generate suitable quantitative data (e.g. ejection fraction, left ventricular mass) for the purposes of accurate radiological reporting. Other useful clinical indices such as organ size, length and perfusion are also derived to aid clinical assessment of patients who may require cardiovascular intervention.

Musculoskeletal MRI

The focus of musculoskeletal MRI research involves the detection of specific features of articular cartilage structure and function. With suitable high-resolution imaging and post-processing analysis, the structure, thickness and volume of the human articular cartilage can be measured. This helps to improve clinical and scientific understanding about the processes that are involved in the development of rheumatoid and osteoarthritis.

Oncology

The use of MRI in oncology imaging is evolving rapidly, with the availability of MR spectroscopy (MRS), functional MRI (fMRI), MRI diffusion and perfusion, and dynamic contrast-enhanced MRI for the diagnosis and staging of cancer. Each of these techniques requires significant MRI Physics support if they are to be used to their potential.

MR Spectroscopy – Neuro, Body

MRI Spectroscopy involves the analysis of chemical spectra arising from areas of healthy tissue and pathological lesions (e.g. tumours). Quantitative analysis of the relative ratios of the tissue chemical components (e.g. choline/creatinine) can assist with accurate lesion identification and appropriate oncological staging.

Functional MRI - Neuro

Functional MRI involves the mapping of areas of active brain whilst a patient performs a simple task such as finger tapping or listening to music. The technique is based upon blood oxygen level dependency, since the MRI signal characteristics change when the relative levels of blood oxygen become altered as a result of brain activity. Correct identification of these MRI signals by appropriate MRI Physics analysis can provide Radiologists and Neurosurgeons with the ability to identify areas of normal or abnormal brain function as part of diagnosis or disease management.

Diffusion/Diffusion Tensor MRI – Neuro, Body

Diffusion MRI techniques are now available, where it is possible to identify regions of ischemic tissue (e.g following stroke). It is also possible to highlight the white matter tracts of the brain using diffusion tensor imaging by mapping diffusion along different orientations across the white matter.

Perfusion/Dynamic Contrast Enhanced MRI – Neuro, Body


Dynamic contrast enhanced MRI requires the careful analysis of contrast agent uptake in healthy and diseased tissue. With appropriate post-processing, the contrast uptake kinetics can provide valuable information as to the perfusion characteristics of the tissues, along with the type and severity of lesions present. Contrast uptake techniques are clinically used to identify breast MRI lesions, and also aid the investigation and staging of colorectal cancers.

Future Areas of Growth in MRI Physics

A major area of growth in MRI is the field of molecular imaging, where specific contrast agents are able to target individual tissues or lesion types. This technique will undoubtedly involve substantial post-processing assessment of contrast uptake distribution and kinetics. Although in the developmental stage, this field is expected to become very important over the next few years as MRI becomes further recognised as an established functional imaging technique.

It is vital that the Trust is able to keep up-to-date with the continuously improving technical methods that underpin MRI examinations in all areas of neurological, cardiovascular, musculoskeletal and body MRI. With appropriate Physics support, the recently upgraded MRI scanning facilities can be utilised most effectively in these areas.

Date post:	11-Nov-2014
Category:	Technology
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Senior Physicist 8a Radiation Physics

Technology