Guidelines for Mammography Additional Qualification

FORM 298 HEALTH PROFESSIONS COUNCIL OF SOUTH AFRICA PROFESSIONAL BOARD OF RADIOGRAPHY AND CLINICAL TECHNOLOGY Guidelines for Mammography Additional Qualification Guidelines to be used by educational institutions offering training for radiographers in mammography as well as for recognition of prior learning for radiographers with recognized and acceptable experience in mammography.

Health Professions Council of South Africa Professional Board for Radiography and Clinical Technology Mammography Additional Qualification Guidelines for Higher Education Institutions Offering Postgraduate Qualification in Mammography The effectiveness and success of breast imaging depends on consistent production of high resolution, high contrast mammography images. Poor quality mammography can lead to missed breast cancers or give rise to unnecessary additional tests that increase patient anxiety and decrease the public s confidence in the efficacy of mammograms. Public Health Agency of Canada. From the Radiation Control Directorate, Department of Health, South Africa (SA); concern has been raised that the quality of the mammography images produced were poor and quality control tests were performed incorrectly or not performed at all. There is a need to align the SA practice with international standards. The Professional Board for Radiography and Clinical technology has developed these guidelines in line with the needs of the SA society; provide consistency in training as well as to meet the international standards. The course should be offered to all diagnostic radiographers with a minimum of two year postgraduate clinical experience and registered with the HPCSA. NB: The institutions already accredited to offer the course, should ensure that their courses are in line with these guidelines. The professional board reserves the right to conduct random evaluations on the accredited institutions if and when necessary to check compliance with these guidelines. ADD LIST OF ABBREVIATIONS USED THROUGHOUT DOCUMENT HPCSA Health Professions Council of South Africa 2

RCT SAQA QA QC Radiography and Clinical Technology board South African Qualifications Authority Quality Assurance Quality Control 1. Post Course Certificate Education Institutions currently accredited to offer radiography education and training are invited to apply for accreditation to offer the abovementioned course. The course should carry a minimum of 120 credits. The application to the professional board should provide information on the following: a) The course should be in SAQA format and include the specific outcomes and their associated assessment criteria. b) The course content should include; breast anatomy, physiology and pathology, imaging and processing equipment as well as the accessories for specialized procedures and projections, positioning for basic and specialised projections as well as pattern recognition. c) Entrance requirements: Include minimum requirements as stipulated by the RCT board, need for training facilities and qualified supervisor (radiologist or radiographer with mammography experience and recognized as such by the RCT board) d) Mode of delivery and contact sessions: Lectures, demonstrations and any other mode of delivery should be specified. Where the training is done in digital departments, candidates should be exposed to conventional mammography equipment and vice versa. 3

e) Recording and monitoring clinical experience through the use of log books should provide for the minimum examinations to be performed (basic and specialized projections and procedures). f) Quality assurance and quality control tests for imaging, processing and viewing equipment. Emphasis should be placed on teamwork among all members of the breast imaging team as well as radiation protection. g) Ethics, Human Rights and Medical Law: This is the requirement of the HPCSA and should cover topics like ethical responsibilities of the mammography radiographer (radiation protection and safety in the department), professional conduct as well as psychological considerations in patient care. h) Management of the mammography department: The importance of accurate keeping of patient s records and other information necessary for the department to run efficiently should be emphasized. i) Assessments: An outline of both the theoretical and practical assessments to be conducted during the course of study as well as the examination format where applicable. Further indicate the minimum mark or percentage that should be acquired during the course of study before the candidate can be considered for the final examination. j) Calculation of the final mark: Provide weighting of the theoretical and practical component that the candidates should achieve in order to be deemed as competent and meeting the minimum requirements of the course. The professional board further recommends that candidates should compile a portfolio of evidence, where they reflect on their learning experience, both during theoretical contact sessions and the practical environment. This is where the log book should be used as evidence of the experience gained in the practical environment. The candidate should provide evidence that he/she has performed the following examinations alone or with the radiologist. This list is the minimum number and types of examinations to be performed: 100 basic projections 60 specialized or additional projections 4

3 stereotaxis needle localizations 3 examinations of the augmented or male breasts 3 magnification projections 3 fine needle aspirations I ductogram The log book should further include evidence of the candidate s visit to the Nuclear Medicine, Radiation Therapy, Magnetic Resonance Imaging, Ultrasound department as well as the Breast Clinic. The board further recommends that the submission of the portfolio be a prerequisite for the candidate to sit for the final examinations. Should the candidate fail to provide evidence of clinical experience as stipulated above within the stipulated period of study, the course may be extended for a minimum of six to maximum 12 months. Failure to comply after the additional 12months would mean that the candidate did not meet the minimum requirements and thus studies should be suspended. NB: It is the responsibility of the education institution to ensure that the candidates are exposed to all examinations as stipulated above. 2. Exemption for the experienced mammography radiographers. Education institutions which have applied for accreditation to offer the mammography postgraduate qualification are invited to conduct the examinations on radiographers with mammography experience. These examinations are necessary for these radiographers to register the qualification with the HPCSA without having to do the whole course. This is a form of exemption or recognition of prior learning which in this case is the experience gained in the field of mammography. To ensure national standards and consistency in exempting these practitioners, the education institutions should follow the following guidelines: 5

a) Recognition of prior learning should be offered to qualified diagnostic radiographers, who have been performing mammography examinations in a specialized department for the minimum of four years, as on the 1 st January 2008. b) To be accepted for RPL, the radiographer should; i. Provide proof of identity ii. Provide proof of current registration with the HPCSA iii. A letter from the radiologist to confirm employment history as well as the examinations performed. iv. A description of the available mammography equipment in the department in which you are currently employed. v. Submit a portfolio of evidence which should include a reflection on the experience gained in the clinical environment as well as the number types of examinations performed alone or with the radiologist. These will be examinations performed prior to January 1 st 2008 and should include the following as minimum: 100 basic projections 60 specialized or additional projections 3 stereotaxis needle localizations 3 examinations of the augmented or male breasts 3 magnification projections 3 fine needle aspirations I ductogram A quality assurance (QA) manual that includes all aspects of mammography QA as indicated by the Radiation Control Directorate. Records of the tests and time schedule thereof to be included. Candidates will be expected to answer questions relating to this QA manual and could be requested to demonstrate a QC test. 6

The log book should further include evidence of the candidate s visit to the Nuclear Medicine, Radiation Therapy, Magnetic Resonance Imaging, Ultrasound department and the Breast Clinic. c) The education institutions should assess the knowledge and skills of the radiographer. The assessment should include clinical competency and QA requirements of mammography. A candidate requires 75% to pass. d) Emphasis in both assessments should focus on: Positioning techniques, to include the basic and specialized projections as well as pattern recognition. Quality assurance and quality control tests. Ethics, human rights and medical law. NB: Radiologists and medical physicists working with mammography equipment are also in the process of developing accreditation guidelines as well as the criteria to exempt experienced practitioners from the need of additional training. It is thus expected that they will be in a position to offer assistance where necessary. The following guidelines should be used to determine the clinical competency, knowledge and application of ethics, human rights and medical law as well as the ability to perform and interpret quality control tests. Two assessments should be performed. The assessor should further provide comments in the space provided. The candidate s performance should be rated according to the following criteria. -1: Poor = unacceptable performance. 1: Acceptable = complies with most of the criteria but needs improvements in others. 2: Optimal = complies with all criteria. The Radiation Control Directorate recommends that quality control tests be performed as stipulated in the American College of Radiology, Committee on Quality Assurance in 7

Mammography, 1999, Mammography Quality Control Manual. The following have been listed as compulsory tests to be performed by the radiographers in mammography departments: Phantom test Compression test Screen/film contact test Darkroom fog Daily sensitometric monitoring Repeat analysis Analysis of fixer retention Assessment 1: Clinical Competence NB: For every projection where the assessor interjects to avoid repeats, or where a projection is repeated due to radiographer s error, 10% should be deducted from the final mark because the patient is exposed to more radiation. Part 1: Patient identification, care before the procedure and verification of clinical history Assessment should include professional conduct of the radiographer in relation to the rights of the patients as well as how the communication skills demonstrated in completing the mammography questionnaire. Part 2: Room and equipment preparation Cleanliness and infection control should be assessed. 8

Part 3: Radiographic Technique (maximum of four projections) For each projection, assess setting and recording of exposures factors, lead letter placement and technical skills in positioning as well as patient care. Projection 1 Projection 2 Projection 3 Projection 4 9

Part 4: Patient care after the procedure Does the radiographer explain to the patient what to do after the examination? For example, wait for the report or there are further procedures to be performed. Part 5: Image evaluation and pattern recognition (maximum four images) Assess the ability of the radiographer to evaluate the images for correct positioning, technical quality as well as the identification of suspicious areas which may be indicative of pathology. Projection 1 Projection 2 10

Projection 3 Projection 4 Total Marks/22 Percentage Assessor s name:...... signature... Assessor s Radiographer s name:... signature... Radiographer s Date: 11

Assessment 2: Quality Assurance This assessment should take the form of an oral and demonstration. a) Name at least five acceptance tests performed on newly installed mammography equipment. (5) b) Name at least five tests performed by the technicians on mammography equipment. (5) c) Describe at least five tests performed in the mammography department. (5 marks per test = 25) 12

d) Demonstrate at least two tests (simulated) and explain the acceptable limits for each. Assessor to stipulate tests to be demonstrated. (10 marks per test = 20) e) Explain why it is a legal requirement to have tests performed on mammography equipment. The explanation should be related to human rights and ethical responsibilities. (5) Total Marks/65 Percentage Assessor s name:...... signature... Assessor s Radiographer s name:... signature... Radiographer s Date: 13