CT Colonography Service Staff Training and Competency …...CT Colonography Service Staff Training and Competency Record . CTC Competency Record V1.0 Page 2 Created by BCS CTCREDG

CTC Competency Record V1.0 Page 1 Created by BCS CTCREDG – Mar 2018

CT Colonography Service

Staff Training and Competency Record


Foreword

The CT Colonography Radiographer Education Development Group (CTC REDG) was set up in 2015 to review and develop guidelines for CTC education and practice. Membership of this group includes experienced CTC radiographers who are involved in the delivery of short courses and credit-bearing postgraduate awards to support the development of CTC services. Delivering these successful programmes of study has highlighted the wide variation in current CTC practice and education across the UK, and this has provided the momentum to explore what constitutes best practice in all aspects of CTC service delivery.

While the majority of CTC referrals are via the symptomatic service, many Trusts are involved in the provision of CTC examinations for the Bowel Cancer Screening Programme (BCSP). For a national screening programme to be both safe and effective it is important, where possible, to standardise the practice between centres. For this reason our CTC REDG activities have been supported by the Public Health England BCSP Radiology committee, and we are grateful to Public Health England who generously funded the activities of our group.

This Training and Competency Record has been designed by the CTCREDG members as a proforma checklist and tool that may be used to record the acquisition of skills, attitudes and behaviours required for effective CTC practice. The first section covers Level 1-3 of the CTC Service Practitioner Framework, and the second section covers the additional levels. The completion of this proforma can be informed by various competency and skills acquisition assessment methods, including our CTC DOPS (Directly Observed Procedural Skills) toolkit, which provides easy to use checklists for observing clinical skills in those developing their CTC expertise. We recommend that this document is used in conjunction with the CTC REDG Training and Education Framework.

We hope that you will find the information provided in these documents useful in supporting the continuing professional development of CTC service practitioners.

Yours sincerely,

Prof Julie Nightingale, Sheffield Hallam University

Rachel Baldwin-Cleland, London NW University Healthcare NHS Trust

(Co-chairs of the CTC REDG)


Level 1-3 Competency

This section of the document covers Levels 1 to 3 of the ‘CTC Service Practitioner Framework’: Novice Beginner; Novice; Competent


CT Colonography Service - Staff Training / Competency Record

Trainee name : …………………………….. Role / Band : ……………………………….

Competency Assessment

method Date

Signature Comments

Staff / Trainee Supervisor

Underpinning knowledge

Demonstrate knowledge of:

- Anatomy and physiology of the colon

- Medicines management and administration

- Principles of CT scanning

- Radiation protection

- Patient care pre, during and post CTC



method Date

Signature Comments


- Consent and communication recognising the patients’

needs and any barriers to communication

- Common appearances of colorectal polyps and

cancer

- Staging of colorectal cancer

- Local policies, IR(ME)R policies and roles, PGDs

- Referral pathways and how these may differ (e.g.

BCSP)

- Evidence of reflection

- CPD activity



method Date

Signature Comments


Pre-Procedure - Aim: Demonstrate pre-procedure preparation

Patient preparation

Understand and demonstrate knowledge of the following

topics:

- local application of the legal framework for the

prescribing and administration of bowel preparation

- patients diet prior to the procedure

- importance of fluids prior to the procedure

- types of local bowel preparations used

- the potential extreme laxative response from the

bowel preparation

- potential drug interactions with CTC preparation

- alternative investigations

Familiarisation and understanding of the relevant equipment

Demonstrate knowledge and safe use of the automated

insufflator

Demonstrate the correct way to turn CO2 cylinder on/off and

replacement of the cylinder

Identify the controls of the insufflator and describe their

function



method Date

Signature Comments


Identify the features of the rectal tube and describe the

function of these features

Demonstrate the correct use of rectal catheter lubrication gel

/ jelly, and incontinence pads for patient comfort

Demonstrate attachment and removal of the tubing from the

insufflator

Demonstrate the appropriate pressure at the beginning of

insufflation

Understand the significance of the pressure/volume

indicators

Understand the importance of monitoring the level of

discomfort experienced by the patient, how to reassure them

and adapt the technique if this occurs

Familiarisation and understanding of the relevant risks

Identify the potential risk factors (patient and environmental)

of colonic perforation during CTC

Describe the process of events that will occur if a patient

perforates during the CTC

Describe the process of events that will occur if a patient

perforates after the CTC

Explain the importance of a chaperone during the tube

insertion and removal



method Date

Signature Comments


Demonstrate knowledge of safe medicines storage,

availability and handling, including:

- prescribing / administration framework

- equipment required

- aseptic technique

- safe administration including patient checks pre,

during and post administration

- correct disposal

- record keeping

Infection control

Display appropriate infection control techniques, including:

- clean scanner bed, position bed roll and incontinence

pad

- aseptic preparation of medicines / equipment

- hand washing/sanitation pre and post patient contact

- correct use of gloves, aprons and wipes available for

patients and equipment

- correct disposal of rubbish / used equipment



method Date

Signature

Comments

Patient privacy and dignity

Demonstrate good social skills and correct patient preparation in the following areas:

- “Hello my name is………”

- adherence to local policy of Confidentiality, Privacy and Dignity

- check ID; local policy for positive identification

- indication for procedure checked

- compliance with preparation regime

- be able to explain the importance of the patient

visiting the toilet just prior to the CTC test

- ensure patient has been to the toilet prior to the test



method Date

Signature Comments


Informed Consent

Demonstrate correct consent procedure and technique:

- be able to fully explain the sequence of events during procedure to the patient

- understand and be able to complete the pre-procedure check list

- explain the risks and potential complications of

procedure and anti-spasmolytics (e.g. Buscopan)

- check patient understanding and provide opportunities for the patient to ask questions

Evidence of radiographer correctly completing signed

and dated pre procedure checklist’s

Log book



method Date

Signature Comments


During the Procedure: Aim: Demonstrate technical proficiency of the examination

Aim: Demonstrate good interpretation of the insufflator pressure monitoring

Proficiency and knowledge

The radiographer demonstrates:

- correct positioning of the patient on the scanner for

rectal tube insertion, and knowledge of why this is

required

- correct safety instructions, handling and injection of

anti-spasmolytic (e.g. Buscopan)

- safe insertion of the rectal tube

- safe inflation the retaining balloon

- setting the initial pressure for insufflation

- correct positioning of the patient on the scanner for

the first scan

- appropriate support and care for the patient

- good teamwork skills

Understand the significance of pressure/volume indication

Demonstrate awareness of the departmental practice regarding patient position during insufflation and the typical volume required prior to performing the first scan



method Date

Signature Comments


Understand the barriers to achieving good insufflation and how to overcome them

Demonstrate patient awareness during the scan, constant monitoring, and assessing the needs of the anxious or claustrophobic patient

Identify and select the correct scan protocols

Correctly interpret the CT scout / scanogram to appropriately distinguish when to proceed with scanning

Correctly navigate the colon in continuity and quality assure distension in a timely manner

Identify complications of perforation or obstruction necessitating early termination of exam and medical review

Correctly reposition and justify the choice of the second position to ensure optimum distension

Correctly identify whether a third position is required

Correctly understand when to stop insufflation and vent

- natural end of procedure

- termination due to safety reasons

Demonstrate safe removal of the rectal tube and appropriate disposal



method Date

Signature Comments


Post Procedure

Post procedure care and information

Immediate post procedure Radiographer demonstrates:

- reassurance to patient regarding quality and completeness of the examination (or otherwise) and escorts to changing facilities

- explanation of post procedure safety – follows local policy on recovery time

- the importance of providing fluids to the patient, and displays knowledge of where to access these in the department

Recovery post procedure Radiographer ensures:

- abdominal distention has resolved - the patient has received the post procedure

information and reiterates aftercare information o Buscopan – possibility of red/painful eye o abdominal pain o diet and rehydration advice

- cannula has been removed if inserted - the patient has been advised who to contact for their

results



method Date

Signature Comments


Colon Navigation: Aim: Demonstrate technical proficiency at colon navigation

Preliminary clinical evaluation

Select the correct sequences for review

Demonstrate knowledge of the gross anatomy of the colon

Identify the colonic segments and IC valve

Select appropriate window/ level settings

Demonstrate the ability to navigate the entire colon sequentially and identify significant pathology:

- colonic cancer - large irregular polyps - perforation

Describe any significant pathology in the appropriate terms

Achievement of full competency Trainee Signature/ Date: …………………………………………… Supervisor Signature / Date: ...:…………………………………..


Level 4-5 Competency

This section of the document covers Levels 4 - 5 of the ‘CTC Service Practitioner Framework’: Proficient; Expert



method Date

Signature Comments


Authorising and protocolling

Describe the appropriate clinical indications warranting a CTC

Describe the legal and local framework under which authorisation occurs (e.g. IR(ME)R roles and responsibilities, authorisation guidelines etc.)

Describe the inappropriate clinical indications not warranting a CTC

Consistently and appropriately triage indications for CTC or abdominal CT

Logbook

Appropriately advise booking staff and patients on FAQs and alternatives (if warranted) relating to the following topics:

- diet - fluids - preparation - frailty of patient - drug interactions - bowel cancer screening pathways - alternative investigations

Achievement of advanced competency Trainee Signature/ Date: …………………………………………… Supervisor Signature / Date: ...:…………………………………..


Imaging Directorate Training / Competency Record - Reporting CT Colonography

Trainee name : …………………………….. Role / Band : ……………………………….


method Date

Signature Comments


Underpinning knowledge

- Demonstrate knowledge and use of dedicated CTC

image processing system

- Navigate (on an image review platform) through the

bowel from rectum to caecum in axial, sagittal and

coronal views

- Demonstrate extensive knowledge of 2D and 3D

endo-luminal review

- Demonstrate knowledge and skills to cross reference pathology in two differing image sequences



method Date

Signature Comments


- Demonstrate knowledge of:

o anatomy and physiology of the colon (6

sections and location)

o location of the colonic flexures

o location of the Ileocecal valve and appendix

- Demonstrate knowledge of segmental mobility and its

effect on pathology positioning


o appearances of an appendectomy

o appearance of lipoma

o common / uncommon appearances of the

ileocecal valve



method Date

Signature Comments


- Describe appearances of colorectal cancer and the

characterisation of annular carcinoma and semi-

circumferential tumour

- Describe in depth tumour staging and the

enhancement features of colorectal cancer


o common / uncommon appearances of

colorectal polyps

o colonic perforation

o pneumatosis coli



method Date

Signature Comments


- Describe:

o common / uncommon appearances of

diverticular disease and subjective grading

o differentiate the reasons for the appearance of

bowel wall thickening

o characterisation of inflammatory stricture

o common / uncommon appearances of the

rectum and retention balloon in the axial,

coronal and sagittal perspective



method Date

Signature Comments


Reporting structure

Have read and understood the SCoR guidelines of

Preliminary Clinical Evaluation and Clinical Reporting

by Radiographers: Policy and Practice Guidance

Demonstrate knowledge of writing an appropriate report to

include:

o image review equipment specifications

o consent obtained

o bowel preparation used (faecal tagging or non-

faecal tagging technique)

o use of anti-spasmolytic, including route of

administration and quantity given. Where a

spasmolytic is not given the reason for non-

administration should be stated

o orientation of scan positions. e.g. dual / triple

and positions e.g. supine, prone etc.

o whether IV contrast has been used, volume

and rate administered



method Date

Signature Comments


Demonstrate knowledge of standard of examination quality

(Good, Adequate, Poor) – within BCS centres this must

comply with the ‘Minimum dataset for CTC reporting’

o be able to explain why the study qualifies for a

specific category

o display understanding that each report is

individual to the patient, and that these

categories may vary depending on the clinical

question for that referral

o be able to describe any limiting factors which

affect the quality of the study

o be able to record these limiting factors in an

appropriate written style

Understand that there can be anatomical and/or

physiological variations present and demonstrate

appropriate recording terminology to relay these findings if

present



method Date

Signature Comments


Examples of such variations are:

o enlarged IC valves, of fatty attenuation

o incompetent IC valves, allowing large

quantities of CO2 gas to reflux into small bowel

o long / tortuous colon

o redundant loops of sigmoid colon

o inverted caecum

- Describe why the factors below may influence future

medical tests for patients

o long / tortuous colon

o redundant loops of sigmoid colon

o inverted caecum



method Date

Signature Comments


- Accurately find and describe report findings (within

BCS centres this must comply with the ‘Minimum

dataset for CTC reporting’ and comply with C-

Coding) in relation to:

o colonic carcinoma (morphology, size, and

anatomical location)

o colonic stricture (reason for and severity of

lumen occlusion)

o polyps (morphology, size, and anatomical

location)

o other intra-colonic findings (such as diverticular

disease, lipoma)

Achievement of advanced competency

Trainee Signature / Date: …………………………………………… Supervisor Signature / Date: ...:…………………………………..


References and reference material: Preliminary Clinical Evaluation and Clinical Reporting by Radiographers: Policy and Practice Guidance https://www.sor.org/learning/document-library/preliminary-clinical-evaluation-and-clinical-reporting-radiographers-policy-and-practice-guidance Intimate Examinations and Chaperone Policy https://www.sor.org/learning/document-library/intimate-examinations-and-chaperone-policy-0 Course of Study for the Certification of Competence in Administering Intravenous Injections https://www.sor.org/learning/document-library/course-study-certification-competence-administering-intravenous-injections Obtaining consent: a clinical guideline for the diagnostic imaging and radiotherapy workforce https://www.sor.org/learning/document-library/obtaining-consent-clinical-guideline-diagnostic-imaging-and-radiotherapy-workforce Have you paused and checked? IR(ME)R Referrers https://www.sor.org/learning/document-library/have-you-paused-and-checked-irmer-referrers The Diagnostic Radiographer as the entitled IR(ME)R Practitioner https://www.sor.org/learning/document-library/diagnostic-radiographer-entitled-irmer-practitioner Patient Identification: guidance and advice https://www.sor.org/learning/document-library/patient-identification-guidance-and-advice Team working in clinical imaging https://www.sor.org/learning/document-library/team-working-clinical-imaging Caring for People with Dementia: a clinical practice guideline for the radiography workforce (imaging and radiotherapy) https://www.sor.org/learning/document-library/caring-people-dementia-clinical-practice-guideline-radiography-workforce-imaging-and-radiotherapy

https://www.sor.org/learning/document-library/preliminary-clinical-evaluation-and-clinical-reporting-radiographers-policy-and-practice-guidance

https://www.sor.org/learning/document-library/preliminary-clinical-evaluation-and-clinical-reporting-radiographers-policy-and-practice-guidance

https://www.sor.org/learning/document-library/intimate-examinations-and-chaperone-policy-0

https://www.sor.org/learning/document-library/course-study-certification-competence-administering-intravenous-injections

https://www.sor.org/learning/document-library/obtaining-consent-clinical-guideline-diagnostic-imaging-and-radiotherapy-workforce

https://www.sor.org/learning/document-library/have-you-paused-and-checked-irmer-referrers

https://www.sor.org/learning/document-library/diagnostic-radiographer-entitled-irmer-practitioner

https://www.sor.org/learning/document-library/patient-identification-guidance-and-advice

https://www.sor.org/learning/document-library/team-working-clinical-imaging

https://www.sor.org/learning/document-library/caring-people-dementia-clinical-practice-guideline-radiography-workforce-imaging-and-radiotherapy

https://www.sor.org/learning/document-library/caring-people-dementia-clinical-practice-guideline-radiography-workforce-imaging-and-radiotherapy


Acknowledgements With thanks to Public Health England for their generous funding of this work, and to the Society and College of Radiographers for

supporting this activity, for considering the documentation and our related study events for endorsement. In particular our thanks

go to Sue Johnson, SCoR Professional Officer, for her guidance and support throughout the development of these documents. We

wish to acknowledge the CTC REDG members who have contributed to the development of this document:

Janice Muckian St Marks - London NW University Healthcare NHS Trust

Craig Roe Leeds Teaching Hospitals NHS Trust

Sue Johnson Society and College of Radiographers

Anne Williams Bradford Teaching Hospitals NHS Foundation Trust

Dr Ingrid Britton University Hospitals of North Midlands NHS Trust, representative from PHE BCSP Radiology committee

Michael Smith University Hospitals of North Midlands NHS Trust

Mark Richardson University Hospitals of North Midlands NHS Trust

Paul Clarke University Hospitals of North Midlands NHS Trust

Stephen Wilson North West Anglia NHS Foundation Trust (Peterborough)

Liam Gale North West Anglia NHS Foundation Trust (Peterborough)

Maureen Furneaux Portsmouth Hospitals NHS Trust

Christine Bloor Royal Cornwall Hospital, Truro

Julie Nightingale Sheffield Hallam University, representative from PHE BCSP Radiology committee, co-chair CTCREDG

Rachel Baldwin-Cleland St Marks - London NW University Healthcare NHS Trust, representative from PHE BCSP Radiology

committee, co-chair CTC REDG

Documents

CT Colonography Service Staff Training and Competency …...CT Colonography Service Staff Training and Competency Record . CTC Competency Record V1.0 Page 2 Created by BCS CTCREDG