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.

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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

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RCT Radiography and Clinical Technology board

SAQA South African Qualifications Authority

QA Quality Assurance

QC 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.

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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

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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:

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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 1st 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 1st 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.

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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

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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.

-1 1 2

Comment

Part 2: Room and equipment preparation

Cleanliness and infection control should be assessed.

-1 1 2

Comment

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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

-1 1 2

Comment

Projection 2

-1 1 2

Comment

Projection 3

-1 1 2

Comment

Projection 4

-1 1 2

Comment

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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.

-1 1 2

Comment

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

-1 1 2

Comment

Projection 2

-1 1 2

Comment

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Projection 3

-1 1 2

Comment

Projection 4

-1 1 2

Comment

Total Marks/22 Percentage

Assessor’s name: ....……………………………….......... Assessor’s

signature........................................

Radiographer’s name: ...................................... Radiographer’s

signature.................................

Date:……………………………………………………………

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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)

-1 1 2

Comment

b) Name at least five tests performed by the technicians on mammography equipment. (5)

-1 1 2

Comment

c) Describe at least five tests performed in the mammography department. (5 marks per

test = 25)

-1 1 2

Comment

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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)

-1 1 2

Comment

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)

-1 1 2

Comment

Total Marks/65 Percentage

Assessor’s name: ....……………………………….......... Assessor’s

signature........................................

Radiographer’s name: ......................................... Radiographer’s

signature..............................

Date:……………………………………………………………