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10.4. Advanced Practitioner Case Study 2

Breast Specialist Therapeutic Radiographer

I graduated from the University of Orange Free State with a Baccalaureate in Diagnostic Radiography and honours in Radiotherapy and started my career as a Therapeutic Radiographer in 1986 at the National Hospital in Bloemfontein.  At that time there were only a few radiotherapy departments to choose from, which resulted in limited career development and promotional opportunities.  After a year I decided to channel my energy and ambitions into a marketing company where I gained invaluable experience in sales management, recruitment, staff motivation and training and gained promotion to marketing manager and trainer for the UK branch. Despite the challenges the job presented, in 1992 I returned to radiotherapy as I felt I wanted to make a difference to people’s lives. 

During the next ten years I worked in various departments and in 2003, took on the role of the pre-treatment superintendent at Charing Cross hospital. At that time, there was a four month waiting list for patients with breast cancer.  I attended a breast planning and prescribing course with the intention of trying to reduce this.  The course involved developing a competency portfolio under the clinical supervision of a specialist breast consultant.  It was a long and arduous journey to work through the barriers to change presented by colleagues and clinicians; initially some clinicians were reluctant to delegate and my peers were sceptical about the change in my role. 

Whilst developing my portfolios I completed an MSc in Radiotherapy and Oncology and my role and responsibilities progressed from pre-treatment superintendent to breast specialist superintendent. As part of my dissertation, I worked with a radiologist who mentored and supervised me in delineating the brachial plexus and regional breast nodes.  Currently I delineate all planning target volumes and approve treatment fields for the breast, breast boost and supraclavicular and axillary lymph node fields. 

The role entails providing training and support and acting in an advisory role to a multi-professional team comprising clinicians, radiographers, clinical scientists, nursing staff and workshop and mould room technicians.  I provide cover for the breast clinicians and help ensure we maintain the national waiting list targets.  Part of the role is to lead practice and technique development and recently I presented a case for the Active Breathing Coordinator (ABC) and implemented ABC in the department for patients with left-sided breast cancer.

Prior to the development of the breast specialist role radiographers had not been invited to the breast MDT. Attendance has resulted in improvements to patient care; for example, I demonstrated to the surgeons some of the difficulties in breast boost planning and how the insertion of clips during surgery could aid the planning process and result in more accurate treatment delivery.  Since then, insertion of clips in the tumour bed has become routine practice within the Trust. 

Returning to education after 26 years presented me with a host of new challenges, one of which was the sacrifice of many evenings and weekends writing essays or collecting data for the MSc dissertation research project.  The taught modules provided me with a framework to focus on various aspects of practice and guided the development of knowledge required. It enabled me to justify my actions and aided the progression to a point where I am able to continue my own independent professional development. 

I have published on role development and attended numerous conferences to present posters or give presentations on regional breast lymph node radiotherapy, role development and service improvement.  I was a member of the NICE medical technologies evaluation panel, evaluating INTRABEAM Radiotherapy and am a member of the Breast Radiotherapy Interest Group (BRIG).  The next challenge will be to complete my PhD, continuing in the clinical setting, contributing to breast radiotherapy and the career development of therapeutic radiographers.   

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