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3. Exploring the Therapeutic Radiography Workforce

3.1 Introduction

This chapter reports data on the therapeutic radiography workforce across the United Kingdom. An online questionnaire was used to seek information on roles and developments in the workforce. Information was sought on the different roles undertaken within clinical practice.

3.2 Methodology

3.2.1 Questionnaire design

The research tool was an online questionnaire via Survey Monkey. A copy of the questionnaire can be found in the appendices.

3.2.2 Participants

Email invitations containing a link to the online questionnaire were sent to the radiotherapy service managers (RTSMs) at the 64 radiotherapy centres in the UK in March 2012. Email addresses were sourced from the SCoR list of radiotherapy service managers. The survey was targeted at the total population as this would ensure that the samples were representative and not biased.

Responses were received from 43 centres which is a 67% response rate. This compares to a 53% response rate in the equivalent 2008 survey. The responses were checked to ensure there was no more than one response per department.

The results are not directly comparable to the 2008 survey as the questions asked in this survey were largely redesigned. However, where an equivalent question was asked in 2008, the results are shown for comparison.

3.3 Results

3.3.1 Demographic data

The region and type of hospital for those responding are shown in table 3.1.
 

Table 3.1 Region and type of hospital

Region NHS Health Board NHS Foundation Trust NHS Trust Private / Independent / Charity Unknown Grand Total
Northern Ireland, Scotland and Wales 5   1     6
London   2 1 2   5
Midlands and East   5 9     14
North of England   5 3     8
South of England   4 4     8
Unknown         2 2
Grand Total 5 16 18 2 2 43

3.3.2 Community roles

Table 3.2 shows the number of centres with radiographers working as community liaison radiographers and taking on health promotion activities in the community.

Table 3.2 Community roles frequencies

Role Number of centres with role Number of respondents to question %        % (2008 survey)
Community liaison radiographers 2 43 5% N/A
Health promotion activities 2 43 5% N/A

 

3.3.3 Service management roles

Table 3.3 shows the frequency of managers (other than RTSMs) outside the radiotherapy department working within cancer services with a therapeutic radiographer background.

Table 3.3 Service management roles frequencies

Role Number of centres with role Number of respondents to question %     % (2008 survey)
Managers (except RTSMs) working within cancer services 7 43 16% N/A

The specific job titles of these managers are: Cancer centre manager (1 centre); Cancer information centre manager (1 centre); Clinical audit facilitator (1 centre); Cancer support service (1 centre); Directorate manager for medical services (1 centre); and R&D manager (2 centres).

 

3.3.4 Cancer network group roles

Table 3.4 shows the frequency that therapeutic radiographers are members of network groups. Note that the questions were not all applicable to all respondents, for example where the role is only present in England.

Table 3.4 Service management roles frequencies

Role Number of centres with role Number of respondents to question %    % (2008 survey)
Members of network radiotherapy group 38 41 88% N/A
Members of the network tumour site groups 16 41 39% N/A
Members of the network technical specialist groups 8 33 24% N/A

3.3.5 Quality management roles

Table 3.4 shows that 91% of centres have therapeutic radiographers responsible for the quality assurance accreditation system in their centres. This has increased from 79% in 2008.

Table 3.5 Quality management roles frequencies

Role Number of centres with role Number of respondents to question %     % (2008 survey)
Quality assurance 39 43 91% 79%

 

3.3.6 Referral roles

Table 3.6 shows the frequency of therapeutic radiographers undertaking referral roles.

Table 3.6 Referral roles frequencies

Role Number of centres with role Number of respondents to question %     % (2008 survey)
Accept newly referred patients for radiotherapy 6 43 14% N/A
Attending cancer multi-disciplinary team meetings 32 43 74% N/A
Attending radiotherapy multi-disciplinary team meetings 39 42 93% N/A
Always or sometimes participating in the decision to treat 22 43 51% N/A

 

3.3.7 Pre-treatment patient preparation roles

Table 3.7 shows that 16 centres have therapeutic radiographers responsible for obtaining informed consent from patients.

Table 3.7 Pre-treatment patient preparation roles frequencies

Role Number of centres with role Number of respondents to question %    % (2008 survey)
Obtaining informed consent from patients 16 43 37% N/A

 

3.3.8 Pre-treatment process roles

Table 3.8 shows frequency of therapeutic radiographer involvement in pre-treatment roles.

Table 3.8 Pre-treatment process roles frequencies

Role
Number of centres with role Number of respondents to question %     % (2008 survey)
Making immobilisation shells for patients 30 43 70% N/A
Making lead masks 15 43 35% N/A
Pre-treatment imaging: CT,CT-PET,CT-MRI 42 43 98% N/A
Radiographer-led treatment planning service 29 43 67% 79%

 

Role Number of centres with role Number of respondents to question %     % (2008 survey)
Radiographer-led IMRT planning 10 43 23% N/A
Volume delineation 17 43 40% N/A
Production of dosimetric plan for individual patients 25 43 58% N/A
Authorisation of the treatment plan 9 43 21% N/A
Prescription of the radiotherapy treatment 5 43 12% 6%
Authorisation of the treatment prescription 4 43 9% N/A
Insertion of fiducial markers 1 43 2% N/A

 

3.3.9 Tumour site specialist roles

28 of the responding centres (65%) have tumour site specialist radiographers. This is an increase from 27% in the 2008 survey. Table 3.9 shows the associated specialities.

Table 3.9 Tumour site specialist roles frequencies

Speciality Number of centres with role Number of respondents to question %     % (2008 survey)
Gynae-oncology 18 43 42% N/A
Head & neck 16 43 37% N/A
Breast 15 43 35% N/A
Paediatric 11 43 26% N/A
Lung 10 43 23% N/A
Neuro-oncology 7 43 16% N/A
Palliative care 3 43 7% N/A

The other specialities given in the free text were: colorectal (3 centres); urology (3 centres); skin (2 centres); upper GI (1 centre); prostate (1 centre); and total body irradiation (TBI) & total skin electron irradiation (TSEI) (1 centre).

 

3.3.10 Technical specialist roles

35 of the responding centres (81%) have technical specialist roles. Table 3.10 shows the associated specialities.

Table 3.10 Technical specialist roles frequencies

Speciality Number of centres with role Number of respondents to question %     % (2008 survey)
IGRT 24 43 56% N/A
Brachytherapy 23 43 54% 61%
IMRT 14 43 33% N/A
4 D adaptive 7 43 16% N/A

The other specialities given in the free text were: imaging (3 centres); pre-treatment (2 centres); systems administration & IT (2 centres); breast mark-up (1 centre); clinical trials and audit (1 centre); and stereotactic (1 centre).

 

3.3.11 Radiographer-led brachytherapy treatment service roles

21 of the responding centres (49%) have therapeutic radiographers responsible for a radiographer-led brachytherapy treatment service. Table 3.11 shows the associated specialities.

Table 3.11 Radiographer-led brachytherapy treatment roles frequencies

Speciality Number of centres with role Number of respondents to question %     % (2008 survey)
Gynaecological cancer 20 43 47% N/A
Prostate cancer 2 43 5% N/A

The other speciality given in the free text was the oesophagus.

3.3.12 Advanced practitioner roles

36 of the responding centres (84%) have therapeutic radiographers who are advanced practitioners. This has increased from 55% of responding departments in 2008.

Table 3.12 shows the associated specialities.

Table 3.12 Advanced practitioner roles frequencies

Speciality Number of centres with role Number of respondents to question %     % (2008 survey)
Technical specialist 21 43 49% N/A
Breast 14 43 33% N/A
Gynae-oncology 12 43 28% N/A
Head & neck 10 43 23% N/A
Lung 8 43 19% N/A
Paediatric 8 43 19% N/A
Neuro-oncology 4 43 9% N/A
Palliative care 3 43 7% N/A

The other specialities given in the free text were: imaging (4 centres); clinic / on-treatment review (4 centres); brachytherapy (3 centres); pre-treatment planning (3 centres); stereotactic (2 centres); breast mark-up (1 centre); clinical trials (1 centre); IGRT (1 centre); dosimetry (1 centre); isotopes (1 centre); patient information and support (1 centre); portal image review (1 centre); prostate (1 centre); tissue viability (1 centre); and urology (1 centre)

 

3.3.13 Consultant practitioner roles

7 of the responding centres (16%) have therapeutic radiographers who are consultant practitioners. This has increased from 9% of responding departments in 2008.

Table 3.13 Consultant practitioner roles frequencies

Speciality
Number of centres with role Number of respondents to question %     % (2008 survey)
Gynae-oncology 3 43 7% N/A
Breast 1 43 2% N/A
Head & neck 1 43 2% N/A
Lung 1 43 2% N/A
Neuro-oncology 1 43 2% N/A
Palliative care 1 43 2% N/A

The other specialities given in the free text was brachytherapy (2 centres).
 

 

3.3.14 On-treatment review clinic roles

Table 3.14 shows the frequency of on-treatment review clinic roles in the responding departments.

Table 3.14 On-treatment review clinic roles frequencies

Role Number of centres with role Number of respondents to question %     % (2008 survey)
Radiographer-led on-treatment review clinics 35 43 81% N/A
Supplementary prescribing of drugs for patients as part of their toxicity management before and during their course of radiotherapy 13 43 30% N/A
Using toxicity assessment scales 33 43 77% N/A

The 2008 survey did not address this area of practice so there is no comparison data. However, the 2012 survey shows that radiographers undertake on-treatment review in most departments.

 

 

3.3.15 Administration and management of chemotherapy (CT) / concomitant RT and CT roles

Table 3.15 shows the frequency of administration and management of chemotherapy (CT) / concomitant RT and CT roles in the responding departments.

Table 3.15 Administration and management of CT / concomitant RT and CT roles frequencies

Role Number of centres with role Number of respondents to question %     % (2008 survey)
Administering cytotoxic chemotherapy 1 43 2% N/A
Co-ordination and management of concomitant RT & CT treatment regimes 26 43 60% N/A

 

3.3.16 Follow up clinic roles

Table 3.16 shows the frequency of follow up clinic roles in the responding departments.

Table 3.16 Follow up clinic roles frequencies

Role Number of centres with role Number of respondents to question %     % (2008 survey)
Radiographer-led follow up services 13 43 30% 30%
Education of patients as part of self management follow up 12 43 28% N/A
Supplementary prescribing of drugs for patients as part of their toxicity management after their course of radiotherapy has finished 3 43 7% N/A
Toxicity assessment, monitoring and management of radiotherapy patients after their course of radiotherapy has finished 10 43 23% N/A

 


3.3.17 Research roles

Table 3.17 shows the number of responding centres with dedicated radiotherapy research roles.

Table 3.17 Research roles frequencies

Role Number of departments with role Total number of respondents to question %     % (2008 survey)
Research radiographers 30 43 70% 61%

Eleven centres have research radiographers at Agenda for Change (AfC) band 6, twenty-one at AfC band 7, seven at AfC band 8a and two at AfC band 8b, c or d.

 

3.3.18 Clinical education roles

Table 3.18 shows the number of responding centres with therapeutic radiographers with a substantive role (0.2 WTE and above) in clinical education.
 

Table 3.18 Clinical education roles frequencies

Role Number of departments with role Total number of respondents to question %     % (2008 survey)
Clinical education radiographers 22 43 51% 67%

Ten centres have therapeutic radiographer roles in clinical education funded by the health board / trust, six are funded by a higher education centre, and six are jointly funded.

 

3.3.19 Other roles

Table 3.19 shows the frequency of other therapeutic radiographer roles in the responding centres.

Table 3.19 Other roles frequencies

Role Number of departments with role Total number of respondents to question %     % (2008 survey)
Professionally trained counsellors who accept patients for counselling therapy 7 43 16% N/A
Information and support services 25 43 58% 45%
IT/Data management and/or RPORT 27 43 63% N/A

Managers were then asked to describe in free text any other roles carried out by radiographic staff in their department that had not been covered in this questionnaire.

There were 14 responses with a total of 30 roles identified across the departments. Table 3.20 identifies the roles presented by managers and the number of sites where they have been adopted. Roles which have been incorporated previously in this report are not included in the table below.

Table 3.20 Other radiographic roles

Role Responses
Lymphoedema specialist 1
Cannulation and administration 5
Blood tests 1
Acupuncture 1
General manager 2
CPD / Practice development manager 2
Cancer bed management 1
Health and safety lead 1
IR(ME)R lead 1
Cancer wait times pathway management for all oncology, haematology and some palliative medicine cases 1
Chemotherapy groups 2

3.4 Discussion

The results from this survey demonstrate that the role of the therapeutic radiographer continues to expand across the entire radiotherapy pathway.

Around one third of centres (37%) have therapeutic radiographers responsible for obtaining informed consent from patients and nearly all centres (93%) have therapeutic radiographers attending radiotherapy multi-disciplinary team meetings.

All but one centre have therapeutic radiographers responsible for pre-treatment imaging. Two thirds of centres (67%) have a radiographer-led treatment planning service which is a decrease of 12% since 2008. Around two thirds (65%) of centres have tumour site specialist radiographers compared to just over a quarter of centres (27%) in 2008. Just over four fifths of centres (81%) have technical specialist roles, although there has been a fall in therapeutic radiographers with brachytherapy roles from 61% in 2008 to 54% in this survey.

The increasing implementation of the career progression framework is shown by a 29% increase in the number of centres with advanced practitioners and a 7% increase of those with consultant practitioners since 2008.

While there are a low number of community liaison roles in only 2 centres (5%), there are 38 centres (88%) with therapeutic radiographers who are members of their network radiotherapy group. 13 centres (30%) have therapeutic radiographers responsible for radiographer-led treatment follow-up and 10 centres (23%) have therapeutic radiographers responsible for toxicity monitoring and management of patients after completion of their treatment.

There has been a growth in the percentage of therapeutic radiographers responsible for the quality assurance accreditation system in their centres of 12% since 2008.

There has been a slight increase in the percentage of centres with research radiographers, from 61% in 2008 to 70% in this survey. However, the proportion of centres with therapeutic radiographers in clinical education roles has reduced from two thirds (67%) in 2008 to just over half (51%) in this survey. The percentage of centres with therapeutic radiographers in information and support services roles has increased from 45% to 58% over the same period.

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