Medical Radiation Technology Based Experience

Ontario

Current roles in Ontario that could be considered “advanced” vary greatly from centre to centre. A 2003 study asked Ontario therapists how they would define "advanced practice" and what roles they would consider advanced. Roles cited included

• Patient review during treatment: this is done currently with a radiation oncologist in some Ontario centres.
• Patient assessment including taking medical histories: this may be done in partnership with the radiation oncologist (for example, during a palliative planning clinic).  Several therapists also mentioned that they have also assessed patients as part of research studies.
• Therapist-only simulation: this happens to varying degrees currently in Ontario. There may be protocols determining the process and it is usually confined to one or two “simple” sites. The doctor always signs the subsequent simulator films and is still responsible for the initial prescription.
• Contouring of critical structures and more autonomous dosimetry: the therapist may contour spinal cord, kidney, heart etc. The therapist may also have more leeway to creatively plan the treatment using their skill and judgement. The doctor is still responsible for signing off the resultant plan or isodose distribution.
• Catheterisation during simulation: this is a controlled act in Ontario so would be a delegated procedure according to the RHPA (1991).
• Administering contrast during simulation: once again, this is a controlled act.
• Check film sign-off: In most centres the policy is that the doctor signs the machine check films early in the patient’s treatment. The usual aim of these recent studies is to delay or eliminate the need for the doctor’s approval.

Research was the second most popular choice for an area of advanced practice.  Research can vary from daily quality assurance or simple enquiry to multi-centre randomised clinical trials. 

3. Advanced Technologies/Knowledge Translation
There were many different examples of advanced radiotherapy technology and so-called “specialty areas” (such as stereotactic radiosurgery, IMRT or high-dose rate brachytherapy).  It was widely felt that a therapist working in these areas could be considered an advanced practitioner.

4. Palliative Care
This might include a dedicated palliative therapist role (usually working within a specialist palliative clinic) or a more holistic approach to patient care as discussed above.

5. Delegated Acts (under the RHPA)
In keeping with the idea that an advanced role might be one that is outside a therapist’s scope of practice, some respondents felt that any act that was delegated from another regulated health professional (for example, catheterisation as described above) would inherently be an advanced role.

Canada

The CAMRT Advanced Certification is an educational program designed “to stimulate member to further their studies and to broaden their understanding of the art and science of the radiation technologies” (CAMRT, 2003). The program consists of a mixture of self-directed education and course work. There are currently no specific job roles associated with the CAMRT Advanced Certification, although some departments (and union agreements) match promotional opportunities and increased remuneration with the certificate.

In Canada, the CAMRT have described a possible future role for an advanced practice medical radiation technologist as being similar to that of a nurse practitioner. The “MRT practitioner” (also known as an “extended class” MRT) would work on a more independent level and could be utilized in remote areas.

International

US: The United States has recently introduced a radiography advanced practitioner in the form of the radiologic assistant. This role has been created to improve departmental (and radiologist) productivity, patient care and patient access to imaging services (there is currently no equivalent position in radiation therapy). The role includes patient assessment and responsibility for expanded radiology procedures.

UK: The “Skills Mix Project in Radiography” is a government-driven initiative in the United Kingdom that has developed several new roles.

There are two “advanced” roles above the level of state-registered radiographer and an assistant level. All four-tiers are associated with the clinical practice and the model has four aims:

• In a radiotherapy team, roles are assigned according to the individual’s skills and competencies rather than their profession.
• Advanced roles are promoted to encourage life long learning.
• Routes to enter the profession are widened to improve recruitment and retention.
• Practice standards are developed as well as professionals’ inherent potential (Department of Health, 2003).

Nursing Experience

“A nurse who is an advanced practitioner will have advanced academic preparation and advanced clinical skills” (Magennis et al, 1999: 32)

The American Nursing Association/Oncology Nursing Society (ONS) have defined Advanced Oncology Nursing Practice as “expert competency and leadership in the provision of care to individuals with an actual or potential diagnosis of cancer” (Oncology Nursing Society, 2000). The basic requirement for advanced nursing practice is a Master’s degree. The ONS further defines four advanced practice roles, the Clinical Nurse Specialist, Educator, Researcher and Administrator. There are extensive professional practice standards associated with all four roles. The Clinical Nurse Specialist is perhaps the closest model for an advanced position for therapists. This nursing role may involve medication prescription, physical examinations, psychosocial support, patient education and much more.