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Radiotherapy is a treatment used to destroy cancer cells, using radiation delivered by a machine called a linear accelerator. The most common types of radiotherapy use high energy x-ray beams, such as photons, but other particles can be used for example protons or electrons.
Therapeutic radiographers play a vital role in the delivery of radiotherapy services and they are the only health professionals qualified to plan and deliver radiotherapy. Therapeutic radiographers are responsible for the planning and delivery of accurate radiotherapy treatments using a wide range of technical equipment. The accuracy of these is critical to treat the tumour and destroy the diseased tissue, while minimising the amount of exposure to surrounding healthy tissue.
Therapeutic radiographers are extensively involved at all stages of the patients' radiotherapy journey. The first stage is pre-diagnosis, which is giving health promotion advice and raising awareness of cancer. Then patient consent is taken by working with patients to enable them to make informed decisions about their treatment options.
Following consent the pre-treatment preparation and planning takes place, which is the use of sophisticated equipment to scan patients and plan treatments. In addition, the preparation of any required devices takes place to ensure the accurate delivery of treatment. The treatment is then performed through the use of a range of radiotherapy equipment to deliver external beam radiotherapy and brachytherapy (internal radiotherapy treatments).
Whilst a patient is undergoing treatment there are regular assessments. Many radiographers qualify to prescribe drugs for patients to counteract the side effects of treatment. They are also responsible for the psychosocial wellbeing of their patients whilst they are attending for treatments. Finally, the patient follow up takes place, including the management and care after treatment has finished.
A growing number of radiographers undertake tumour site specific roles or specialist treatment roles (at both advanced and consultant level practice), where they are responsible for their own patient load from treatment referral, through treatment to post treatment follow up.
They are part of the multi-disciplinary approach to patient management by attending and participating in MDT meetings. These staff provide continuity of care for their patients across their cancer journey, with improved levels of care for their patients as well as efficiency benefits for the service.
Therapeutic radiographers are also involved in clinical research at all levels. This ranges from recruitment to trials through to radiographer led research studies to evaluate the newer technologies and techniques as part of providing evidence based practice.
Radiotherapy Service Managers are professional qualified managers responsible for the strategic delivery and planning of the service along with the day to day operational management of radiotherapy services. Their professional training and expertise is critical to the provision of safe and efficient radiotherapy services.
“A typical day starts at 8.30am, although one of the team will have been in from 7.30am ensuring the linear accelerator is warmed up and has met all of its quality assurance requirements. The machines are very complex but are fitted with numerous interlocks for safety and won’t deliver any radiation if these interlocks are not satisfied. We also have a team of physics staff to support us if anything isn’t quite right".
“Each of our four machines will treat a particular treatment site. Today I’m working on the urology machine, which treats mainly prostate patients as well as some colo-rectal, bladder and gynaecology patients. Therapeutic radiographers always work in pairs and we often have a student alongside us who will be observing or assisting with the patient set-up, depending on how far through the training they are".
“We call our first patient through from the waiting room. He needs a full bladder for his treatment and so I use a bladder scanner (similar to an ultrasound) to check that the volume is what we want. My colleague and I use the lasers in the room to align the patient with some tattoos that he had placed at his pre-treatment CT scan. These tattoos act as reference points to ensure he is lying in the same position each day, once they are in line we are able to move the treatment couch to the correct place for treatment".
“We have to leave the room to deliver the radiotherapy, but we remind the patient that we are watching him on our cameras and to give us a wave if he needs any assistance. Before we deliver the treatment we will take a cone beam CT scan, which we can compare to his original CT and adjust to millimetre precision to ensure the treatment is delivered as accurately as possible".
“The treatment itself takes 2-3 minutes, and there is nothing for the patient to see or feel as the radiotherapy is delivered. We will treat 30-40 patients a day on each of our machines and the patients will only have a ten minute appointment slot so it’s important that I am able to communicate effectively with them in a short space of time to find out how they’re getting on with their course of treatment. If patients are struggling with side effects we can refer them to one of our review radiographers or another health professional such as the dietitian or speech and language therapist".
Therapeutic Radiographers undertake degree qualified training solely in oncology and the care of cancer patients makes them uniquely qualified to undertake this role. There are three routes of entry.
The BSc (Hons) Radiotherapy is a three year full time course generally split 50:50 with academic and clinical placements. Most universities require five GCSEs at grades 4/5 or above (including English, Maths and Science) and around 120 UCAS points from 3 A levels (this must include at least one natural science) or BTEC in a relevant course.
The pre-registration PgDip/ MSc Radiotherapy (pre-reg) is a two year full time course for students who already have a degree. Similar to the BSc, the course is generally 50:50 in terms of academic and clinical placements. Some universities offer the option to top up the PgDip to a full MSc by completing a research module.
This route usually requires a 2:1 or above in a relevant health, or science subject.
The Therapeutic Radiography apprenticeship has been approved for delivery and offers the opportunity to learn on the job as well as studying modules, which will lead to either a BSc Hons or MSc (pre-reg) in Radiotherapy. Entry requirements on to the course are expected to be similar to those detailed above.
Regardless of route of entry, all prospective students are expected to have spent a minimum of half a day in a radiotherapy department to gain an insight into radiotherapy as a career.
“Some of our patients are on treatment for over seven weeks and we will see them each day. You really get to know them over that time so I feel great job satisfaction when we see them ring the end of treatment bell in our department.”