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Leech M, Abdalqader A, Alexander S, Anderson N, Barbosa B, Callens D, Chapman V, Coffey M, Cox M, Curic I, Dean J, Denney E, Kearney M, Leung VW, Mortsiefer M, Nirgianaki E, Povilaitis J, Strikou D, Thompson K, van den Bosch M, Velec M, Woodford K, Buijs M. The Radiation Therapist profession through the lens of new technology: A practice development paper based on the ESTRO Radiation Therapist Workshops. Tech Innov Patient Support Radiat Oncol 2024; 30:100243. [PMID: 38831996 PMCID: PMC11145757 DOI: 10.1016/j.tipsro.2024.100243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 06/05/2024] Open
Abstract
Technological advances in radiation therapy impact on the role and scope of practice of the radiation therapist. The European Society of Radiotherapy and Oncology (ESTRO) recently held two workshops on this topic and this position paper reflects the outcome of this workshop, which included radiation therapists from all global regions. Workflows, quality assurance, research, IGRT and ART as well as clinical decision making are the areas of radiation therapist practice that will be highly influenced by advancing technology in the near future. This position paper captures the opportunities that this will bring to the radiation therapist profession, to the practice of radiation therapy and ultimately to patient care.
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Affiliation(s)
- Michelle Leech
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College Dublin, Ireland
- Trinity St. James’s Cancer Institute, Dublin, Ireland
| | | | - Sophie Alexander
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, United Kingdom
| | - Nigel Anderson
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness & Research Centre - Austin Health, Heidelberg, Australia
| | - Barbara Barbosa
- Escola Internacional de Doutoramento, Universidad de Vigo, Spain
- Medical Physics, Radiobiology and Radiation Protection Group, IPO Porto Research Center (CI-IPOP), Porto Comprehensive Cancer Center (Porto.CCC) & Rise@CI-IPOP (Health Research Network), Porto, Portugal
| | - Dylan Callens
- University Hospital Leuven, Department of Radiation Oncology, Leuven, Belgium
- KU Leuven, Laboratory of Experimental Radiotherapy, Leuven, Belgium
| | | | - Mary Coffey
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College Dublin, Ireland
| | - Maya Cox
- Auckland City Hospital, Auckland, New Zealand
| | - Ilija Curic
- Radiosurgery and Stereotactic Radiotherapy Department, University Clinical Center of Serbia, Belgrade, Serbia
| | - Jenna Dean
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness & Research Centre - Austin Health, Heidelberg, Australia
| | | | - Maeve Kearney
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College Dublin, Ireland
- Trinity St. James’s Cancer Institute, Dublin, Ireland
| | - Vincent W.S. Leung
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong
| | | | | | - Justas Povilaitis
- The Hospital of Lithuanian University of Health Sciences Kauno klinikos, Kaunas, Lithuania
| | - Dimitra Strikou
- Radiation Oncology Unit, University and General Attikon Hospital, Athens, Greece
| | - Kenton Thompson
- Department of Radiation Therapy Services, Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Michael Velec
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Katrina Woodford
- Department of Radiation Therapy Services, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Medical Imaging and Radiation Sciences, Monash University, Clayton, Australia
| | - Monica Buijs
- InHolland Haarlem, University of Applied Science, Haarlem, the Netherlands
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Duffton A, Harnett N, McNair HA, Bennett E, Clarkson M, Guilherme Couto J, Lawler G, Matthews K, Oliveira C, Rozanec N, Simões R, Tsang Y. RTT advanced practice and how it can change the future of radiotherapy. Tech Innov Patient Support Radiat Oncol 2024; 30:100245. [PMID: 38595787 PMCID: PMC11002743 DOI: 10.1016/j.tipsro.2024.100245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 03/15/2024] [Accepted: 03/16/2024] [Indexed: 04/11/2024] Open
Abstract
The radiation therapy (RT) landscape is continuously evolving, necessitating adaptation in roles and responsibilities of radiation therapists (RTTs). Advanced Practice Radiation Therapists (APRTs) have taken on a proactive role in expanding services and assuming responsibilities within multi-professional teams. A European Society for Radiotherapy and Oncology (ESTRO) brought geographically diverse and experienced RTTs together, to discuss how advanced practice (AP) in the RTT profession should be future-proofed and create a global platform for collaboration. Challenges in achieving consensus and standardisation of APRT was identified across jurisdictions, emphasising the importance of international collaboration. Whilst highlighting the pivotal role of APRTs in driving innovation, improving patient care, and navigating the complexities of modern RT practice, this position paper presents outcomes and recommendations from the workshop. Discussions highlighted the need for standardised role definitions, education frameworks, regulatory support, and career development pathways to enable the advancement of APRT effectively. Increasing networks and collaboration is recommended to ensure APRTs can shape the future of RT.
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Affiliation(s)
- Aileen Duffton
- Radiotherapy Department, Beatson West of Scotland Cancer Centre, Glasgow, UK
- Institute of Cancer Science, University of Glasgow, UK
| | - Nicole Harnett
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, CA
- Department of Radiation Oncology, University of Toronto, CA
| | - Helen A McNair
- Institute of Cancer Research, London, UK
- Royal Marsden NHS Foundation Trust, London, UK
| | - Erica Bennett
- Bon Secours Radiotherapy Cork in partnership with UPMC Hillman Cancer Centre, Cork, IE
| | - Melanie Clarkson
- College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, UK
| | | | - Gavin Lawler
- Research & Innovation Infrastructures Unit, Research Strategy & Funding Directorate, Health Research Board, Dublin, IE
| | - Kristie Matthews
- Faculty of Medicine, Nursing and Health Sciences, Monash University, AU
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, AU
| | - Celeste Oliveira
- Radiotherapy Department, Instituto Português de Oncologia do Porto (IPO Porto), PT
| | - Natalie Rozanec
- Department of Radiation Oncology, University of Toronto, CA
- Stronach Regional Cancer Centre, Southlake Regional Health Centre, CA
| | - Rita Simões
- Institute of Cancer Research, London, UK
- Royal Marsden NHS Foundation Trust, London, UK
- University College London Hospitals, London, UK
- Radiotherapy Trials quality assurance (RTTQA) group, UK
| | - Yatman Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, CA
- Department of Radiation Oncology, University of Toronto, CA
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Oliveira C, Barbosa B, Couto JG, Bravo I, Hughes C, McFadden S, Khine R, McNair HA. Advanced practice in radiotherapy across Europe: stakeholders' perceptions of implementation and evolution. Radiography (Lond) 2024; 30:896-907. [PMID: 38608565 DOI: 10.1016/j.radi.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/09/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024]
Abstract
INTRODUCTION Adapting radiotherapy services with workforce innovation using skills-mix or task-shifting optimises resources, supporting current and future demands. Advanced practitioners (APs) work at a different level of practice (beyond initial registration) across four pillars: clinical practice, leadership and management, education, and research. There is limited cross-country research on the advanced therapeutic radiographers/radiation therapists (TR/RTTs), particularly in Europe. This study aimed to investigate European radiotherapy stakeholders' perceptions regarding current and future advanced practice (AP). METHODS From June to September 2022, one-to-one online semi-structured interviews were conducted in English, and audio and video were recorded. Full verbatim audio files were independently transcribed and checked by interviewer and interviewees. Braun and Clarke's seven steps guided the thematic analysis (using NVivo). RESULTS Thirty-three interviewees working or studying in 16 European countries represented practitioners (n=14), managers (n=6), educators (n=4), professional bodies (n=4), students (n=3), and regulators (n=2). Four overarching themes emerged: "AP drivers and outcomes", "AP challenges vs enablers", "Current vs future AP", "Becoming and being advanced practitioner". Participants identified research as the neglected AP pillar due to a lack of protected time, limited staff skills, no research culture, no funding, workload, and clinical priorities. Interviewees highlighted the importance of consistency in job titles, harmonisation of education models and curricula, definition of AP requirements, and support for all AP pillars through job plans and workforce planning. CONCLUSION Neither the profession nor education of TR/RTTs are harmonised across Europe, which is highly reflected in advanced-level practice. Advanced TR/RTTs should work across all pillars, including research, and these should be embedded in master's programmes, including leadership. IMPLICATIONS FOR PRACTICE This study highlights a policy gap in the education and practice of APs in radiotherapy.
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Affiliation(s)
- C Oliveira
- Radiotherapy Department, Instituto Português de Oncologia do Porto (IPO Porto), Portugal; Escola Internacional de Doutoramento, Universidad de Vigo, Spain.
| | - B Barbosa
- Radiotherapy Department, Instituto Português de Oncologia do Porto (IPO Porto), Portugal; Escola Internacional de Doutoramento, Universidad de Vigo, Spain; Medical Physics, Radiobiology Group and Radiation Protection Group, IPO Porto Research Centre (CI-IPOP), Instituto Português de Oncologia do Porto (IPO Porto), Portugal.
| | - J G Couto
- Radiography Department, Faculty of Health Sciences, University of Malta, Malta.
| | - I Bravo
- Medical Physics, Radiobiology Group and Radiation Protection Group, IPO Porto Research Centre (CI-IPOP), Instituto Português de Oncologia do Porto (IPO Porto), Portugal.
| | - C Hughes
- School of Health Sciences, Ulster University, United Kingdom.
| | - S McFadden
- School of Health Sciences, Ulster University, United Kingdom.
| | - R Khine
- European Federation of Radiographer Societies, Utrecht, Netherlands; Institute of Health Sciences Education, Faculty of Medicine & Dentistry, Queen Mary, University of London, United Kingdom.
| | - H A McNair
- European Federation of Radiographer Societies, Utrecht, Netherlands; The Royal Marsden NHS Foundation Trust, Radiotherapy and the Institute of Cancer Research, Surrey, United Kingdom.
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Joyce E, Jackson M, Skok J, Rock B, McNair HA. What do we want? Training! When do we want it? Now? A training needs analysis for adaptive radiotherapy for therapeutic radiographers. Radiography (Lond) 2023; 29:818-826. [PMID: 37331130 DOI: 10.1016/j.radi.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/14/2023] [Accepted: 05/24/2023] [Indexed: 06/20/2023]
Abstract
INTRODUCTION Therapeutic radiographers (TRs) have adapted to the changing requirements and demands of the oncology service and in response to advanced techniques such as on-line adaptive MRI-guided radiotherapy (MRIgRT). The skills required for MRIgRT would benefit many TRs not just those involved in this technique. This study presents the results of a training needs analysis (TNA) for the required MRIgRT skills in readiness for training TRs for current and future practice. METHODS A UK-based TNA was used to ask TRs about their knowledge and experience with essential skills required for MRIgRT based on previous investigations into the topic. A five-point Likert scale was used for each of the skills and the difference in values were used to calculate the training need for current and future practice. RESULTS 261 responses were received (n = 261). The skill rated the most important to current practice was CBCT/CT matching and/or fusion. The current highest priority needs were radiotherapy planning and radiotherapy dosimetry. The skill rated the most important to future practice was CBCT/CT matching and/or fusion. The future highest priority needs were MRI acquisition and MRI Contouring. Over 50% of participants wanted training or additional training in all skills. There was an increase in all values for skills investigated from current to future roles. CONCLUSION Although the examined skills were viewed as important to current roles, the future training needs, both overall and high priority, were different compared to current roles. As the 'future' of radiotherapy can arrive rapidly, it is essential that training is delivered appropriately and timely. Before this can occur, there must be investigations into the method and delivery of this training. IMPLICATIONS FOR PRACTICE Role development. Education changes for therapeutic radiographers.
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Affiliation(s)
- E Joyce
- Royal Marsden NHS Foundation Trust, London, UK.
| | - M Jackson
- St George's University of London, UK
| | - J Skok
- St George's University of London, UK
| | - B Rock
- Royal Marsden NHS Foundation Trust, London, UK
| | - H A McNair
- Royal Marsden NHS Foundation Trust, London, UK; Institute of Cancer Research, UK.
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Oliveira C, Barbosa B, Couto JG, Bravo I, Hughes C, McFadden S, Khine R, McNair HA. Advanced practice roles amongst therapeutic radiographers/radiation therapists: A European survey. Radiography (Lond) 2023; 29:261-273. [PMID: 36608396 DOI: 10.1016/j.radi.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/24/2022] [Accepted: 12/04/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Advanced Practice (AP) roles in Radiotherapy (RT) over time are variable, often locally developed and not underpinned by professional standards which leads to conceptual and practical gaps. This study aimed to assess AP roles amongst Therapeutic Radiographers/Radiation Therapists (TR/RTTs) and identify educational gaps for this level across Europe. METHODS An anonymous online survey was designed, validated, and distributed across Europe. Convenience sampling was used to recruit advanced TR/RTTs practitioners or TR/RTTs working in AP roles. Descriptive analysis from closed questions and thematic analyses from open questions are reported. RESULTS A total of 272 responses were obtained, of which 189 eligible participations were from 21 European countries. 42% of respondents acknowledged additional education required to perform AP, and 25% reported a minimum of five years of RT practice to perform AP roles/tasks. There is a trend to work more on the clinical practice domain with a low percentage of working time allocated to research. Inconsistency was found in job titles, scopes of practice, and educational backgrounds across and even within countries. Education needs regarding knowledge about image-guided and adaptive RT, multimodal imaging and technologies, and advanced treatment planning were found. Training needs on leadership and management skills and clinical site-specific expertise were identified. CONCLUSION This study clearly shows a gap in education support, a need for standardisation in job titles and scopes of practice across Europe. IMPLICATIONS FOR PRACTICE As the first large-scale assessment of current AP roles and educational support amongst TR/RTTs across Europe, this study recommends the establishment of governance structure and role regulation. It also informs the curricula for master programmes to align the education with current and future practice.
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Affiliation(s)
- C Oliveira
- Radiotherapy Department, Instituto Português de Oncologia do Porto (IPO Porto), R. Dr. António Bernardino de Almeida 865, 4200-072 Porto, Portugal; Escola Internacional de Doutoramento, Universidad de Vigo, Circunvalación ao Campus Universitario, 36310 Vigo, Pontevedra, Spain.
| | - B Barbosa
- Radiotherapy Department, Instituto Português de Oncologia do Porto (IPO Porto), R. Dr. António Bernardino de Almeida 865, 4200-072 Porto, Portugal; Escola Internacional de Doutoramento, Universidad de Vigo, Circunvalación ao Campus Universitario, 36310 Vigo, Pontevedra, Spain; Medical Physics, Radiobiology Group and Radiation Protection Group, IPO Porto Research Centre (CI-IPOP), Instituto Português de Oncologia do Porto (IPO Porto), R. Dr. António Bernardino de Almeida 865, 4200-072 Porto, Portugal.
| | - J G Couto
- Radiography Department, Faculty of Health Sciences, University of Malta, Msida, MSD2080, Malta.
| | - I Bravo
- Medical Physics, Radiobiology Group and Radiation Protection Group, IPO Porto Research Centre (CI-IPOP), Instituto Português de Oncologia do Porto (IPO Porto), R. Dr. António Bernardino de Almeida 865, 4200-072 Porto, Portugal.
| | - C Hughes
- School of Health Sciences, Ulster University, Shore Road Newtownabbey Co, Antrim, BT37 0QB, United Kingdom.
| | - S McFadden
- School of Health Sciences, Ulster University, Shore Road Newtownabbey Co, Antrim, BT37 0QB, United Kingdom.
| | - R Khine
- European Federation of Radiographer Societies, Utrecht, Netherlands; School of Health Care and Social Work, Buckinghamshire New University, Buckinghamshire, United Kingdom.
| | - H A McNair
- European Federation of Radiographer Societies, Utrecht, Netherlands; The Royal Marsden NHS Foundation Trust, Radiotherapy and the Institute of Cancer Research, Surrey, SM2 5PT, United Kingdom.
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Joyce E, Jackson M, Skok J, Peet B, McNair HA. Images and images: Current roles of therapeutic radiographers. Radiography (Lond) 2022; 28:1093-1100. [PMID: 36054937 DOI: 10.1016/j.radi.2022.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/26/2022] [Accepted: 07/31/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Therapeutic radiography is a small profession and has adapted in response to advanced techniques. An increase in on-line adaptive MRI-guided radiotherapy (MRIgRT) will require role extension for therapeutic radiographers (TRs). This study will investigate the current role description for TRs and the activities they currently undertake with regards to MRIgRT. METHOD A training needs analysis was used to ask TRs about their current roles and responsibilities and essential skills required for MRIgRT. For the purposes of this paper, the authors present the results from the demographics of the individual, their current job title with roles and responsibilities, and experience with decision making and image assessment. Descriptive statistics was used to analyse the data. RESULTS 261 responses were received (n = 261). Only 28% of job titles listed contained the protected title of 'therapeutic radiographer'. Advanced clinical practice roles were expressed by participants indicating that if a service need is presented, emerging roles will be created. Variation existed across the standardised roles of TRs and this discrepancy could present challenges when training for MRIgRT. TRs are pivotal in image verification and recognition on a standard linac, and skills developed there can be transferred to MRIgRT. Decision making is crucial for adaptive techniques and there are many skills within their current scope of practice that are indispensable for the MRIgRT. CONCLUSION It has been demonstrated that TRs have a range of roles that cover vast areas of the oncology pathway and so it is important that TRs are recognised so the pivotal role they play is understood by all. TRs have extensive soft-tissue IGRT knowledge and experience, aiding the evolution of decision-making skills and application of off-protocol judgments, the basis of MRIgRT. IMPLICATIONS FOR PRACTICE Role development and changes in education for therapeutic radiographers.
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Affiliation(s)
- E Joyce
- Royal Marsden NHS Foundation Trust, UK
| | - M Jackson
- St George's University of London, UK
| | - J Skok
- St George's University of London, UK
| | - B Peet
- Royal Marsden NHS Foundation Trust, UK
| | - H A McNair
- Royal Marsden NHS Foundation Trust, UK; Institute of Cancer Research, UK.
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