Madrid, Spain

ESTRO 2021

Session Item

August 30
16:45 - 17:45
Proffered papers 35: Adaptive radiotherapy
Remi Nout, The Netherlands
Proffered papers
18:05 - 18:15
Radiographer-led online image guided adaptive radiotherapy: A qualitative investigation
Elizabeth Joyce, United Kingdom


Radiographer-led online image guided adaptive radiotherapy: A qualitative investigation

Elizabeth Joyce1, Helen A McNair1,2, Geraldine O'Gara3, Marcus Jackson4, Bianca Peet5, Robert A Huddart2, Theresa Wiseman3

1Royal Marsden Hospital, Radiotherapy, London, United Kingdom; 2Institute of Cancer Research, Radiotherapy and Imaging, London, United Kingdom; 3Royal Marsden Hospital, Health Research, London, United Kingdom; 4St George's University of London, Radiography, London, United Kingdom; 5Royal Marsden Hospital, Clinical Trials, London, United Kingdom

Show Affiliations
Purpose or Objective

Online MRI guided adaptive radiotherapy (MRIgRT) is resource intensive. To maintain and increase uptake, traditional roles and responsibilities may need refining. This novel study aims to provide an in-depth understanding and subsequent impact of the roles required to deliver MRIgRT.

Material and Methods

A purposive sampling approach was used to invite radiographers, clinicians and physicists from centres with varied experience of MRIgRT. Respondents from six centres participated in Focus Group Interviews (FGIs). FGIs were chosen to allow researchers to obtain several perspectives and reach consensus and were conducted with two facilitators using a semi-structure interview guide. Four researchers independently familiarised themselves and coded the data using framework analysis. A consensus thematic framework of codes and categories was agreed and systematically applied.


Thirty participants took part (Radiographers: n=18, Physicists: n=9 and Clinicians: n=3). Three key themes were identified: ‘Current MRIgRT’, ‘Training’ and ‘Future Practice’. Current MRIgRT identified a variation in radiographers’ roles and responsibilities with pathways ranging from radiographer-led, clinician-light-led and MDT-led as seen in Table 1.

The consensus was to move towards radiographer-led with the need to have a robust on-call service heavily emphasised. The importance of continuity and relevant staff only to be present in designated areas when treatment is undertaken was highlighted. The breadth of knowledge required by radiographers including MRI, contouring, planning and dosimetry, and treatment experience was highlighted. Debate was presented over timing and length of training required. There was dispute over whether training should be delivered pre-MRIgRT exposure or on-the-job, but it was agreed that a blended approach was preferred by all. Future Practice identified the need to have radiographers solely deliver MRIgRT, to reduce staff present which was a main driver by all interviewed. Radiographers reported their enthusiasm for this role and physicists envisioned this happening. Clinicians and Physicists disclosed they had sufficient confidence in radiographers to do this. Time and resources to train radiographers were the main barriers with an emphasis placed on the difficulty of arranging consistent training and lack of MDT availability to deliver it.


Radiographer-led MRIgRT is an exciting development because of the potential radiographer role development. Roles must be created with sufficient support and robust governance to enable evaluation of effectiveness, impact, ongoing sustainability and responsiveness. A national training framework created collaboratively with all stakeholders and professions involved would ensure consistency in skills and knowledge.