Nuclear Medicine CESR Portfolio Guide

• Aware of, and adheres to, the GMC professional requirements
• Aware of public health issues including population health, social determinants of health and global health perspectives
• Demonstrates effective clinical leadership
• Demonstrates promotion of an open and transparent culture
• Keeps up to date through learning and teaching
• Demonstrates engagement in career planning
• Demonstrates capabilities in dealing with complexity and uncertainty
• Aware of the role and processes for commissioning
• Aware of the need to use resources wisely

• Aware of national legislation and legal responsibilities, including safeguarding vulnerable groups
• Behaves in accordance with ethical and legal requirements
• Demonstrates ability to offer apology or explanation when appropriate
• Demonstrate ability to lead the clinical team in ensuring that ethical and legal factors are considered openly and consistently

• Communicates clearly with patients and carers in a variety of settings
• Communicates effectively with clinical and other professional colleagues
• Identifies and manages barriers to communication (e.g. cognitive impairment, speech and hearing problems, capacity issues)
• Demonstrates effective consultation skills including effective verbal and non-verbal interpersonal skills
• Shares decision making by informing the patient, prioritising the patient’s goals and wishes, and respecting the patient’s beliefs, concerns and expectations
• Shares decision making with children and young people
• Applies management and team working skills appropriately, including influencing, negotiating, re-assessing priorities and effectively managing complex, dynamic situations

• Makes patient safety a priority in clinical practice
• Raises and escalates concerns where there is an issue with patient safety or quality of care
• Demonstrates commitment to learning from patient safety investigations and complaints
• Shares good practice appropriately
• Contributes to and delivers quality improvement
• Understands basic Human Factors principles and practice at individual, team, organisational and system levels
• Understands the importance of non-technical skills and crisis resource management
• Recognises and works within limit of personal competence
• Avoids organising unnecessary investigations or prescribing poorly evidenced treatments

• Manages clinical information / data appropriately
• Understands principles of research and academic writing
• Demonstrates ability to carry out critical appraisal of the literature
• Understands the role of evidence in clinical practice and demonstrates shared decision making with patients
• Understands public health epidemiology and global health patterns
• Demonstrates appropriate knowledge of research methods, including qualitative and quantitative approaches in scientific enquiry
• Demonstrates appropriate knowledge of research principles and concepts and the translation of research into practice
• Follows guidelines on ethical conduct in research and consent for research
• Recognises potential of applied informatics, genomics, stratified risk and personalised medicine and seeks advice for patient benefit when appropriate

• Delivers effective teaching and training to medical students, junior doctors and other healthcare professionals
• Delivers effective feedback with action plan
• Able to supervise less experienced trainees in their clinical assessment and management of patients
• Able to supervise less experienced trainees in carrying out appropriate practical procedures
• Able to act as a clinical supervisor to doctors in earlier stages of training

• Have a comprehensive understanding of Nuclear Medicine investigations and interventions pertinent to pathologies
• Collaborate effectively with referrers to determine the most appropriate imaging pathway or therapeutic intervention for each patient
• Exercise evidence-based practice by utilising current peer-reviewed literature to inform selection for all patient groups
• Weigh up the relative clinical and radiation risk/benefit when advising on imaging or therapeutic intervention
• Tailor Nuclear Medicine scan protocols appropriately as per Ionising Radiation (Medical Exposure) Regulations, IR(ME)R
• Prescribe diagnostic and therapeutic radiopharmaceutical doses accurately and appropriately according to accepted local Diagnostic Reference Levels (DRLs) based on Administration of Radioactive Substances Advisory Committee (ARSAC) limits
• Safeguard patients, including vulnerable groups such as paediatric patients and patients with dementia, acting in accordance with current safety guidelines and legislation with respect to ionising radiation protection
• Be able to advise referrers and patients regarding radiation exposure tailored to individual clinical contexts to facilitate informed decision making

• Have understanding of Nuclear Medicine investigations and how these may be optimised
• Have understanding of importance of patient preparation and pharmaceutical interventions
• Recognise image artefacts from various sources and the importance of regular gamma camera quality control (QC) and quality assurance (QA)
• Work closely with physicists and Nuclear Medicine technologists to optimise image quality
• Able to process and enhance image quality with various software and analysing data, including quantification
• Recognise the importance of national and international guidelines and their appropriate implementation at a local level

• Demonstrate sound knowledge of the normal physiological distribution of commonly used radiopharmaceuticals, normal variants and artefacts and relevant anatomy as demonstrated on diagnostic Nuclear Medicine imaging studies
• Formulate a clinically relevant written report targeted to the referrer, providing where appropriate relevant differential diagnoses and using clinical judgement to provide recommendations for further imaging investigations, follow-up and/or management
• Communicate imaging findings to the referrers (and to patients if appropriate) in a timely manner including significant, unsuspected or critically urgent findings
• Demonstrate insight into personal level of expertise and appropriately refer or seek a second opinion if required
• Recognise and appropriately respond to imaging findings that may raise safeguarding concerns
• Demonstrate insight into diagnostic certainty and communicate this in written and/or verbal reports
• Combine knowledge of physiology/function and anatomy with pathology, adopting a safe and systematic approach to interpretation of diagnostic imaging

• Demonstrate sound knowledge of tracer distribution, in normal and pathological conditions, of commonly used therapeutic radio-pharmaceuticals
• Good understanding and use of diagnostic and therapeutic agents for tailoring a personalised management and therapy pathway for the individual patient (theragnostics) using evidence based practice
• Demonstrate the ability to appropriately select patients for therapy working closely with local or regional multidisciplinary teams (MDTs)
• Have strong physicianly skills in history taking and clinical examination in patients undergoing consideration for therapy for holistic care
• Able to explain the radiopharmaceutical therapy and obtain informed consent for treatment
• Sound knowledge of radiation effects and hazards, and effective communication with physics and radiation safety experts to provide a safe environment for the patient and staff
• A sound knowledge of appropriate patient preparation, prescription, dispensing, handling and administration of therapeutic radiopharmaceuticals appropriately tailored to the patient condition and requirements
• Have a sound knowledge of the efficacy and side-effects of therapy and their management
• Working knowledge of the radiation protection measures and procedures for safe administration and treatment, to minimise radiation to the public & staff, including contamination management
• Arrange for appropriately timed follow-up and further management to monitor therapy effects

• Understand and apply the roles of Administration of Radioactive Substances Advisory Committee (ARSAC), the Environment Agency (EA), the Health and Safety Executive (HSE) and Medicine and Healthcare products Regulatory Agency (MRHA), and their legislative framework governing clinical study, research, production, transport, storage and disposal of radioactive substances
• Understand and apply the legislative regulations of Ionising Radiation (Medical Exposure) regulations - IR(ME)R. Understand the responsibilities of the practitioner, operator and referrer which deals with justification and optimisation of each exposure
• Work closely with Radiation Protection Advisor (RPA), Radiation Protection Supervisors (RPS) and Employers (University, NHS and Private)
• Ensuring compliance with Good Clinical Practice (GCP) for all research studies
• Understanding legal framework for dealing with the young, the old, the vulnerable and their/ guardians/ parents/carers
• Recognise the importance of monitoring performance through audits, quality improvement projects; learning from mistakes through discrepancy, morbidity and mortality meetings and adopting a no blame culture in order to ensure high standards of care and optimise patient safety

• Collaborate effectively with referrers to determine the most appropriate imaging pathway for a given presentation
• Exercise evidence-based practice by utilising current peer-reviewed literature to inform imaging selection for all patient groups
• Protocol CT and MRI scans appropriately
• Safeguard patients, including vulnerable groups, and act in accordance with current safety guidelines and legislation in respect of ionising radiation and other imaging techniques/equipment
• Be able to advise referrers and patients regarding radiation exposure tailored to individual clinical contexts to facilitate informed decision making

• Possess a sound understanding of radiological anatomy, normal variants and artefacts as demonstrated on all of the common imaging modalities.
• Combining a sound knowledge of radiological anatomy, physiology and pathology, adopt a safe, systematic approach to interpretation of imaging
• Formulate a clinically useful written report targeted appropriately to the referrer, providing where appropriate a refined differential diagnosis, and demonstrate clinical judgement by providing recommendations for further investigation and/or management
• Communicate pertinent imaging findings to referrers, and where appropriate to patients, in a time-appropriate manner, including significant, unexpected or incidental findings

• Explain imaging examinations, risks and findings facilitating informed patient choice
• Obtain informed consent for relevant imaging examinations and/or procedures from all patients including vulnerable groups, showing sensitivity to issues of equality and diversity
• Understand and safely prescribe medication relevant to imaging and procedures
• Manage adverse reactions (including anaphylaxis) to administered contrast and drugs
• Maintain an up to date knowledge of cardiopulmonary resuscitation (CPR) techniques
• Implement current health and safety and infection control techniques in the context of imaging examinations/procedures
• Demonstrate insight into level of personal expertise and appropriately refer/seek second opinion

• Evaluate image quality and feed back to the imaging team appropriately to facilitate maintenance of equipment and/or improve practice
• Appropriately refer to image quality within written reports when there is impact on diagnostic certainty

• Produce reports in a timely manner according to clinical need in the context of emergency care
• Maintain knowledge and skills required to perform, interpret and report imaging in an emergency setting
• Maintain an up to date knowledge of appropriate equipment for image guided biopsies and drains
• Perform or arrange (as appropriate) any clinically urgent image-guided interventional procedures

• Able to review imaging studies to provide an answer to a clinical question posed by the MDT
• Integrate clinical, pathological and radiological information to refine a differential diagnosis
• Contribute to/lead the decision making of the MDT by clearly articulating a clinical opinion
• Maintain knowledge of local and national guidelines alongside current peer-reviewed literature to ensure recommendations are evidence-based, clinically relevant and safe

Currency Window

Evidence of your recent practice will be given more weight to reflect current capabilities and we suggest that approximately 50% of your evidence for a curriculum outcome is drawn from within the last five years of clinical practice (WTE).

Evidence Volume

around 100 electronically uploaded documents