This house believes that online adaptive radiotherapy demands a major overhaul of RTT educational programmes

Debate

ESTRO 2026 Congress Report I RTT Track

This debate topic was incredibly topical at this year’s congress, linking in with the theme “Innovating Radiation Oncology, Together”. As the debate opened, the room was largely in favour of the motion, with almost 70% of the audience agreeing that educational programmes are due for a major overhaul; the opposition had their work cut out for them.

Up first was Claudio Votta, arguing strongly for the motion from a clinical perspective. Claudio presented a well-structured argument, focusing mainly on the historic role of the radiation therapist/therapeutic radiographer (RTT). While the core competencies remain the same, Claudio highlighted that our education is based largely on a reproducible chain of simulation, planning, replicating the set-up, treatment verification and treatment itself. With the age of adaptation upon us, it raises the question of whether this is now obsolete. Instead of just evaluating a patient’s position relative to their treatment plan, we are now expected to technically and clinically evaluate a new plan. Are current RTT educational programmes providing enough dosimetric skills to enable new RTTs to fulfil this role? Claudio firmly argued that training needs to be adapted now to ensure RTTs are equipped for the changed workforce in 3-4 years.

Helen McNair took to the stage next, arguing against the motion. Her core argument was that RTTs are skilled, ready, and can adapt. Helen took us on a lovely journey through radiotherapy over the years, including the history of radiotherapy education. Helen argued eloquently that the chain of reproducibility is not obsolete; we just need to put our skills in a different place. The patient’s anatomy is the same, the principles of treatment are the same, but the techniques have become more sophisticated. Importantly, the planning principles are unchanged, and it is currently part of the core training for RTTs. Therefore, Helen believes that an overhaul is not required, rather a re-imagination, and a reminder that continued professional development is integral to the role of RTT.

Rianne de Jong argued for the motion from an education perspective. Rianne agrees with Helen that continued professional development is paramount, but hit back that this is not the core of this debate. Instead, this development should be reserved for professionals currently in practice. For mainstream education, new RTTs should be taught the skills that they will be required to use in practice by 2030. RTTs need to be trained on automation; this needs to be included in undergraduate and postgraduate education. RTTs need to be sufficiently qualified to work in a clinical setting without further training or extended internships. Therefore, there should be an overhaul in training.

Finally, Winnie Li argues with Helen McNair against the motion from an educational perspective. Winnie’s core argument is that RTT education systems are fundamentally strong and that there should be a focus on refinement, not reinvention. Winnie brought us on a historical tour of radiotherapy, from cobalt machines, right up to cone beam online adaptive machines. This highlighted the workflow adaptation RTTs have always performed. Winnie argued that online adaptive radiotherapy introduces new tools, not a new profession. Winnie compared an adaptive workflow to the existing RTT competencies and highlighted how the core skills already taught are transferable to an online adaptive workflow. This was based on the Canadian workforce and the competencies of newly graduated RTTs. Moving to ESTRO's European Qualification Framework, it acknowledges the gap in current education, but highlights that advanced skills are an extension of existing competencies. The gap is in the workflow, not foundational knowledge, so it needs to be upskilled rather than overhauled. A balanced education model was proposed, as a major overhaul is impractical and unsustainable, particularly with rapid advances in technology. Reinventing the wheel cannot happen at each technology turning point.

This was a sharp, hugely enjoyable and quick-witted debate that left the audience pondering the future of radiotherapy education. In the end, Helen and Winnie were triumphant and won the majority vote, disagreeing with the motion.

Emma-Jane White MSc
Senior 1 Treatment & Research Radiographer
The Royal Marsden NHS Foundation Trust Chelsea
London, UK