Moving across the pond: Leading the way as a Therapeutic Radiographer

Yat Tsang

First of all, it is much appreciated to have the opportunity to share my career journey in the Imaging and Oncology 2024 issue, especially with my recent relocation from the UK to Canada. I do need to admit that my imposter syndrome kicked in during the preparation of this article: it is daunting to talk about my career when there are so many other colleagues whose career paths are more inspiring than mine. I hope that the readers of Imaging and Oncology will still find my story interesting enough to read!

In the pursuit of professional excellence and a commitment to making a meaningful impact on cancer care, I made the life-changing decision to move from London to Toronto to take on the role of director of radiation therapy in the Radiation Medicine Program at Princess Margaret Cancer Centre (PMCC). Despite PMCC's global recognition for its cutting-edge research and patient-focused approach, the decision to accept the position at PMCC was not an easy one.

Obviously transitioning to another country always brings with it a blend of excitement and the challenge of adapting to a new culture. That is why I moved all the way from Hong Kong to the UK for my very first clinical job as a Therapeutic Radiographer at Mount Vernon Cancer Centre (MVCC) after I obtained my bachelor’s degree in therapeutic radiography at the Hong Kong Polytechnic University. This position consolidated my professional knowledge and clinical experience within radiation therapy, and eventually I was appointed to my dream job as a consultant Therapeutic Radiographer at MVCC in 2014. 

Across radiation therapy services, there has been national acknowledgement that the Therapeutic Radiographer career progression model, including the highest level of practice at consultant level, should be introduced across cancer centres to meet local service need (1). For my consultant practitioner role, I act as both a clinical and technical expert to lead and coordinate the strategic planning of my centre’s specialised radiation therapy service, including stereotactic radiotherapy. As stated by my consultant practitioner accreditation by the Society and College of Radiographers in the UK, I provided clinical leadership within a clinical specialty and bring strategic direction, innovation and influence through the four domains of practice: expert clinical practice; professional leadership and consultancy; education, training and development; and practice and service development research and evaluation (2).

Yat Tsang

Yat Tsang

However, a job offer as the director of radiation therapy at PMCC was just too good for me to turn down! PMCC thrives on collaboration, bringing together experts from various disciplines to drive innovation in cancer research and treatment. As the director of radiation therapy, fostering an environment that encourages cross-disciplinary collaboration is a key focus for the role. Collaborating with oncologists, researchers, and allied health professionals does not only enhance patient care but also contribute to the center's reputation as a global leader in cancer treatment.

Assuming the role of director of radiation therapy at Princess Margaret Cancer Centre does bring with it a set of unique challenges and responsibilities. Managing a team of highly skilled professionals, collaborating within a multi-professional team, and ensuring the seamless integration of cutting-edge technologies are all part of the daily agenda. 

Since my move from London to Toronto in September 2022, I do have my very own insights into the similarities and subtle differences in the profession of Therapeutic Radiographer between the two countries.

Therapeutic Radiographer vs radiation therapist

The first difference that I have noticed is our professional title! The title of Therapeutic Radiographer is protected under the Health and Care Professions Council (HCPC) in the UK (3) (4).  The delivery of medical radiation is a highly specialised field and requires the expertise of a radiographer. Over 30,000 radiographers are registered with the HCPC (4). There are two main branches of radiographers: diagnostic and therapeutic. Diagnostic Radiographers make up the majority of registrants, with 15% of UK radiographers identifying as therapeutic (4). 

Internationally there is no agreed consensus to the title. Radiographers are recognised as medical radiation technologists (MRTs) and Therapeutic Radiographers are titled as radiation therapists (MRT(T)s) as per the Canadian Association of Medical Radiation Technologists (CAMRT) in Canada. In total, there are more than 22,000 MRTs working in medical imaging and radiation therapy across the country. MRTs play a critical role in Canada’s healthcare system delivering medical imaging exams and radiation therapy treatments (5).

Nevertheless, both Therapeutic Radiographers and radiation therapists are defined as professionals responsible for radiation therapy planning and treatment of patients with malignant or benign disease. They use their expert knowledge of radiation protection, anatomy, physiology and pathology in order to evaluate and assess diagnostic images for the purpose of image acquisition and accurate radiation therapy treatment delivery (6).

Career progression and advanced practice

Within the UK and Canada, there has been continuous evolution in the technology employed for planning and delivering radiation therapy. Intensity-modulated radiotherapy, volumetric modulated arc therapy, and adaptive radiotherapy have become standard in routine clinical care. The incorporation of advanced technology has elevated the intricacy of the radiation therapy process, leading to a redefinition of the roles and responsibilities among clinical/radiation oncologists, medical physicists, and Therapeutic Radiographers/radiation therapists. This presents a chance for Therapeutic Radiographers and radiation therapists to expand their roles and broaden their scopes of practice (7).

In the UK, the initiation of advanced practice was initially spearheaded by the National Health Service (NHS) (8).  Recognising the benefits of role development as early as 2000, it was identified that educational strategies were essential for Therapeutic Radiographers to autonomously evolve and operate (1) (2). With the inevitable and not-too-distant reality of real-time online adaption of radiation therapy at the point of treatment delivery, the role of Therapeutic Radiographers will likely further evolve with the requirement for knowledge and skills associated with dosimetry and ultimately increasing ownership of radiation therapy treatment prescription and plans (2) (6).

In alignment with recommendations from the Department of Health (DoH), the UK established a four-tier career structure, providing Therapeutic Radiographers with the opportunity to progress from novice to expert and attain advanced or consultant-level practice (9). This structured career path has been propelled and endorsed by the Society of Radiographers, which has developed clear guidance on advanced/consultant practitioner roles. Within the UK, an SoR robust accreditation process promotes the standardisation of practice, ensuring that advanced/consultant practitioners have successfully met the required domains of practice supported by appropriate education (1).

Since 2003 Ontario, Canada has actively supported radiation therapist advanced practice through the Clinical Specialist Radiation Therapist (CSRT) project by presenting data showcasing improved outcomes, aiming to secure ongoing funding (10). Realising the enhanced patient care outcomes, including equitable treatment access and patient satisfaction, has led to the official acknowledgment of the value of radiation therapist advanced practice (10) (11). This evaluative approach supports the adaptation of roles to meet local requirements (11). These advanced practice roles not only align well with the radiation therapy operational service needs but also stimulate advancements and research within the field (11). CAMRT recognises the benefits AP roles bring to optimising patient care, and initiatives such as advanced practice accreditation programs have been in place (12).

Moving from the UK to Canada to lead the Radiation Therapy department at Princess Margaret Cancer Centre has been a transformative journey, which has been a remarkable chapter in my career. The challenges and triumphs have shaped my perspective and deepened my commitment to advancing cancer care. Working alongside a dedicated multi-professional team in a world-class Radiation Medicine Program, I am proud to contribute to the legacy of PMCC and play a role in shaping the future of radiation therapy. However, this does not mean that I am saying goodbye to my beloved colleagues in the UK and Europe. I do hope that I would be able to utilise my new role to support international collaborations which can foster continued progress and innovation in radiation therapy on a global scale.

Within the UK, the SoR's robust accreditation process promotes the standardisation of practice, ensuring that advanced/consultant practitioners have successfully met the required domains of practice supported by appropriate education. A wider national multi-professional approach is now being taken in England.

References

  1. Tsang Y, Williams S, Nisbet H, Skermer L, Wickers S, McConnell J. Consultant radiographers in the United Kingdom The Society and College of Radiographers (SCoR) Consultant Radiographers Advisory Group (CRAG) Position Paper. Imaging Oncol 2020:6e12. 
  2. Tsang Y, Roberts N, Wickers S, Nisbet H. Embracing skill mix in the clinical oncology workforce – capturing impacts of consultant therapeutic radiographers in the UK. Clinical Oncology. 2021 May;33(5). doi:10.1016/j.clon.2021.02.001 
  3. The Society and College of Radiographers. 2019. An overview of radiotherapy. Retrieved from: https://www.sor.org/about-radiography/patient-information/overview-radiotherapy 
  4. Health and Care Professions Council. 2019. Number of Radiographers registered broken down by gender and modality – January 2018. Retrieved from: https://www.hcpc-uk.org/resources/freedom-of-information-requests/2018/radiographers-by-gender-and-modality-2018/ 
  5. Gillan C, Harnett N, Davis C-A, Dickie C, Liszewski B, Smoke M, et al. Indeed, what’s in a name? Journal of Medical Imaging and Radiation Sciences. 2023 Jun;54(2):235–7. doi:10.1016/j.jmir.2023.02.007 
  6. Tsang YM, Routsis DS. Adapting for adaptive radiotherapy (ART): The need to evolve our roles as therapeutic radiographers. Radiography. 2021 Oct;27. doi:10.1016/j.radi.2021.08.004 
  7. Tsang Y, Harnett N. Advanced practice in radiotherapy: How to move to the next level? Technical Innovations & Patient Support in Radiation Oncology. 2021 Mar;17:57–8. doi:10.1016/j.tipsro.2021.02.004 
  8. Department of Health. NHS Cancer Plan. A plan for investment. A plan for reform; 2000 https://www.thh.nhs.uk/documents/_Departments/Cancer/NHSCancerPlan.pdf 
  9. Department of Health. Radiography Skills Mix. A report on the four-tier service delivery model; 2003. http://www.wales.nhs.uk/sites3/documents/530/ACF6148.pdf
  10. Bolderston A., Smoke M., Lewis D., Harnett N. Ten years of advanced practice in Ontario: reflections and recollections. J Med Imaging Radiat Sci. 2013;44(3):163–165
  11. Harnett N., Bak K., Zychla L., Lockhart E. A roadmap for change: charting the course of the development of a new, advanced role for radiation therapists. J Allied Health. 2014;43(2):110–116
  12. Canadian Association of Medical Radiation Technologists. Advanced practice [Internet]. [cited 2024 Jan 24]. Available from: https://www.camrt.ca/mrt-profession/advanced-practice/  
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