Career Opportunities in Radiotherapy
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Career Opportunities in the Radiotherapy Field
A variety of categories of highly skilled professional staff are required to render RT services of acceptable quality, including radiation oncologists, radiographers, medical physicists and mould room technicians.
The Clinical Radiation Oncologist – is a physician who specialises in the evaluation and non-surgical care of patients with cancer. This requires specialised training and knowledge in the relevant aspects of science, biology and psychosocial aspects of patient management. It is a profession that requires a commitment to the finest traditions of medicine in that he or she will be involved daily with patients with serious and life threatening diseases.
The Radiation Oncologist (RO) will be expected to be skilled in the biology of cancer – its causes and patterns of spread. These form the basis of Staging Systems used in Oncology, which guide cancer therapy. These require laboratory or radiological investigations. These investigations must be undertaken in a cost effective way based on the possible therapy that a patient might have. For example, a patient with apparent localised disease who is being considered for curative local treatment might need to have a computerised tomogram to exclude tumour spread. However, a patient who is not a candidate for curative therapy because of their general condition or extent of tumour would have investigation largely directed by their symptoms.
The RO is skilled in the therapeutic use of radiation. This requires training in physics and a licence from regulating authorities. He or she needs to know how to administer and tailor different kinds of radiation for each patient’s specific situation. He will also be skilled in other non-surgical methods of treatment such as chemotherapy and hormone therapy.
The RO determines the goal of treatment (curative or palliative) and the normal tissues, which need to be protected from adverse aspects of radiation. These require knowledge of radiobiology. He or she will need to be aware of the possible gains and costs of different types of therapy. This requires being able to assess study findings. A practical knowledge of statistics is required.
Patients and their families with cancer are naturally anxious – they are vulnerable and face many unknown situations. The RO needs to be the sensitive to their concerns and guide them through their therapy and follow up. Patients respond differently to therapy and these requires individual assessment and knowledge of the anticipated outcome at different stages of treatment.
Cancer therapy requires a multidisciplinary approach with involvement of medical and paramedical staff. Because of their specialised expertise, RO’s in our environment usually coordinate the workup and therapy of patients with cancer.
Therapy radiographers receive a National Diploma after three years of training. This training is quite different of that of a diagnostic radiographer. Thereafter they may either work on the ‘treatment floor’ or receive further training in planning and become a planning radiographer.
Treatment radiographer – is responsible for treating the patients on the high-energy treatment units. S/he sets up the patients and the machine accurately each day for each field, according to the plan devised in the planning section, checking all parameters so that no errors are made. An individual patient’s treatment can vary between simple single fields in a palliative situation to an extremely complicated set up of up to six or eight fields at each treatment session.
Apart from this treatment radiographers need to be sympathetic and understanding of the patient’s situation and know when to get help if the patient’s situation changes. They are the most important person to the patient during any course of therapy.
Planning radiographer – is involved with the RO in the preparation of the patient for treatment. This may be relatively simple e.g. using an image intensifier or simulator to localise the area accurately, or it may be extremely complex with radical treatments that aim to go to a high dose and avoid critical structures. These latter cases involve making casts, CT scanning the patient, and using a planning computer to bring in beams from different angles so that where they converge around the target volume a homogeneous dose is achieved. Close collaboration between RO, radiographer and medical physicist is required. The cast then has to be prepared with the beams and axes drawn accurately on it so that the treatment radiographer has all the information necessary to deliver the treatment as planned.
The Medical Physicist is a professional registered with the HPCSA to take care of the technical aspects of treatment and diagnosis of patients using ionizing radiation. As such the medical physicist renders service in the specialities of radiation oncology, nuclear medicine and diagnostic radiology. Registration with the HPCSA requires a B.Sc. Honours degree in medical physics followed by a 2 years internship in an accredited academic hospital.
In radiation oncology the medical physicist has a very specific responsibility in the successful treatment of the patients. The medical physicist must ensure that the patient receives the radiation dose prescribed by the RO. This entails a wide range of duties including checking the treatment plan for each patient, measuring the dose output of treatment units regularly, performing quality assurance on radiation, optical and mechanical properties of treatment units and planning unit, monitor results of in vivo dosimetry, etc. Furthermore, the medical physicist in radiation oncology is responsible for the radiation protection programme of staff and the public in the department. In an academic hospital the medical physicist lectures to registrars, radiographers, medical physics students and nursing staff.
Other staff categories
Many other Health Care Professionals are involved with patients receiving radiotherapy and/or chemotherapy: oncology nurses, social workers, dieticians, dentists, speech therapists, and stoma therapists. Social workers, in particular are vital in enabling patients to tolerate their course of RT both physically and psychologically.