THE RADIOTHERAPY WORKFORCE - DESCRIPTION OF KEY PROFESSIONAL GROUPS
As identified in the report, the key professional groups essential to the planning and delivery of radiotherapy treatment include Clinical Oncologists, Radiotherapy Physicists (including dosimetrists and engineers) and Therapeutic Radiographers. The complete multi-disciplinary team is very diverse and a wide range of clinical and non-clinical staff groups are crucial to the delivery of a quality and patient centred radiotherapy service. These staff group should not be overlooked and as recommended in the main report, the impact resulting from any core service change must be considered further in relation to the complete multi-professional team.
The following descriptions provide a brief overview of the professional role of Clinical Oncologists, Radiotherapy Physicists and Therapeutic Radiographers to aid understanding of their contribution to the radiotherapy service in Scotland.
Clinical oncologists have a medical degree and have undergone a formal programme of specialist postgraduate medical education. In the United Kingdom, a clinical oncologist is trained in the use of both radiotherapy and chemotherapy to treat patients with cancer.
In relation to radiotherapy:
Clinical oncologists prescribe radiotherapy, generally following a multi-disciplinary meeting to discuss the treatment and management of a patient. The clinical oncologist takes overall responsibility for defining the gross tumour volume, clinical target volume, planning target volume and organs at risk. Before the first fraction of a radical treatment is administered to a patient, the clinical oncologist must authorise the treatment plan.
Clinical oncologists carry considerable patient lists and continue to review patients for some years following cancer treatment/diagnosis. Current recommendations state that a consultant should receive no more than 315 new referrals per annum - this is under review and is likely to be reduced to 250 new referrals per annum. In addition, to the clinical work carried out at the base hospital, consultant oncologists undertake a number of oncology clinics at locations remote to the base hospital.
Radiotherapy Physicists are state registered clinical scientists possessing a degree in a physical science or equivalent, 2 year postgraduate training in medical physics and a further 2 years postgraduate training in radiotherapy physics.
The key roles of a radiotherapy physicists are summarised below:
- Management, development and scientific direction of the radiotherapy physics service
- Ensuring the accuracy of radiotherapy treatment through scientific supervision of dose calculation procedures and ongoing quality control of both equipment and treatment
- Design and implementation of new and innovative treatments
- Leadership of research and development , especially in the technological basis of radiotherapy
- Providing advice on appropriate treatment techniques
- Ensuring radiation safety
- Management of computer systems and software design and development
- Equipment management and procurement of radiotherapy equipment
- Teaching and training of staff (including junior clinical scientists, clinical technologists, doctors, radiographers and nurses).
The dosimetrist is a new and evolving role in radiotherapy. The term is being used to describe staff undertaking all aspects of treatment planning, including patient immobilisation and the preparation of patient related accessories. Dosimetrists may also undertake radiotherapy equipment dosimetry and quality control, and patient in vivo dosimetry. This role may be undertaken by staff trained as clinical technologists, clinical scientists or radiographers but the dosimetrist must be professionally accountable to a medical physicist for the dosimetric aspects of work.
Engineers (sometimes referred to as technologists)
Qualified engineers usually hold an appropriate degree, HND, HNC or equivalent. Four years of further post certification training are required to be eligible for assessment for Incorporated Membership of IPEM and where appropriate Incorporated Engineer status. These professionals normally come from a number of backgrounds, the main ones being electronic engineering, mechanical engineering and clinical physics. Much of the post certification training is undertaken through a designated programme of in-service training. The main roles of engineers in radiotherapy include:
- Management and service development
- Equipment procurement
- Training of staff (including junior engineers, clinical scientists, doctors, radiographers and nurses)
- Preventative and corrective maintenance of radiotherapy equipment
- Manufacture of treatment aids
- Mould room work
- Research ad development
- Quality control and assurance
- Safety testing
- Management of computer systems and software development
- External beam treatment planning including treatment verification
- Brachytherapy treatment planning
Therapeutic radiographers are state-registered practitioners possessing a vocational BSc Hons degree in radiation oncology or equivalent. Therapeutic radiographers possess detailed knowledge of cancers and their associated disease processes. They have an understanding of the variety of modalities employed in the treatment of cancer including surgery, chemotherapy and hormone and gene therapy. During radiotherapy treatment a patient will have daily contact with a therapeutic radiographer since they carry main responsibility for treatment delivery. The main responsibilities of therapeutic radiographers include:
- Mould room work, including manufacture of treatment aids
- Simulation and verification
- Ct planning/ MRI Planning
- Dosimetry planning
- Treatment delivery
- Radiation protection
- Clinical governance and risk management
- Patient care, information and support
- Research and development
- Information management and technology
- Audit and quality management
The role of all staff groups is changing continually to meet the needs of services as they develop. Therefore, the responsibilities listed above may vary between radiotherapy departments and is dependant on the available skill base, local service requirements and opportunity for cross professional development and skill mix within each aspect of the service.