The Specialist Radiographer—does the role justify the title?

Perceptions on site-specific advanced practice roles for radiation therapists in Singapore - A single centre study

Perception of the radiation oncologists (ROs) and radiation therapists (RTTs) on site-specific advanced practice (SSAP) roles for RTTs, the establishment of SSAP in radiotherapy and the possible implication on current services in Singapore were assessed. Opinions of ROs and RTTs on management support, driving forces, restraints and implication upon successful establishment of SSAP were obtained. Main findings include strong RO's support for SSAP development and RTTs' requisition for fair opportunities on role development. Other potential benefits include RTTs' career advancement, job satisfaction and retention. Enhancement of inter-professional relationship, service quality and patient satisfaction is anticipated with greater communication and collaboration.

Are reporting radiographers fulfilling the role of advanced practitioner?

BACKGROUND

Advanced practice roles are emerging in all disciplines at a rapid pace and reporting radiographers are ideally placed to work at such level. Advanced practitioners should demonstrate expert practice and show progression into three other areas of higher level practice. Most existing literature has focussed on the image interpretation aspect of the role, however there is little evidence that plain film reporting radiographers are undertaking activities beyond image interpretation and fulfilling the role of advanced practitioner.

METHOD

Letters were posted to every acute NHS trust in the UK, inviting reporting radiographers to complete an online survey. Both quantitative and qualitative information was sought regarding demographics and roles supplementary to reporting.

RESULTS

A total of 205 responses were analysed; 83.3% of reporting radiographers describe themselves as advanced practitioner, however significantly less are showing progression into the four core functions of higher level practice. A total of 97.0% undertake expert practice, 54.7% have a leadership role, 19.8% provide expert lectures and 71.1% have roles encompassing service development or research, though most of these fall into the service development category. 34.5% felt that they were aware of the differences between extended and advanced practice though much less (9.3%) could correctly articulate the difference.

CONCLUSION

Few individuals are aware of the difference between extended and advanced practice. Though the majority of plain film reporting radiographers identify themselves as advanced practitioners, significantly less evidence all four core functions of higher level practice. The number of individuals undertaking research and providing expert-level education is low.

Role Development for Radiation Therapists: An Examination of the Computed Tomographic Simulation Procedure for Patients Receiving Radiation Therapy for Breast Cancer

PURPOSE

This study investigated the role of radiation therapists (RTs) in the computed tomographic (CT) simulation procedure for patients receiving radiation therapy for breast cancer at a large comprehensive cancer clinic. RTs had developed a "hybrid role" whereby they practiced autonomously during a "therapist-led CT simulation." As well as CT scanning, RTs assessed the images, performed isocentre and field placement, and contoured the organs at risk in preparation for dosimetrists to optimize the dose distribution. A comparison between the confidence of the radiation oncologists (ROs) in delegating tasks to RTs for this procedure was compared with the RTs' confidence (self-assessed) in performing the task. Changes to the patient's plan after the CT procedure were recorded to examine the level of autonomy that was achieved as well as to identify areas for the development of RT skill, knowledge, and judgment.

METHODS

A prospective mixed method two phase study was performed. In phase 1, seven key areas of critical tasks performed by RTs in the CT simulation procedure were identified and documented by the study population. Changes made to these critical tasks after CT simulation was complete were categorized. Responsibility for the changes (RT or RO), the presence of the RO at the CT simulation, and other issues were documented. In phase 2, surveys were distributed to ROs and RTs to rank their confidence levels of RTs performing the identified critical tasks during the CT simulation.

RESULTS

For phase 1, 330 CT simulation cases for breast cancer over a 4-month period were documented. Eighty-four percent of cases remained unchanged and were approved by the RO; the majority of changes were initiated by a second more experienced RT. The majority of changes were related to cardiac coverage for left-sided patients (4.8%) and scar coverage (3.3%). ROs were present for 42% of the cases. For phase 2, 9 RO surveys (75% response) and 21 RT surveys (81% response) were returned. The majority of ROs and RTs agreed that they had confidence in RTs' abilities to perform the identified critical tasks. Factors that influenced RTs' confidence were complexity of the patient; self-confidence; and experience of the RT, RO practice preferences, and RT training availability and consistency.

CONCLUSIONS

RTs have achieved a level of autonomy in their practice illustrated in the CT simulation process for breast cancer patients. This may be expanded with continued training and education. Formal mentoring relationships in CT simulation may aid in knowledge development. Enhanced communication between ROs and RTs will improve the process. This will enable RTs to provide a more efficient process and better patient care through improvements to continuity, flow, and quality.