These boots were made for walking…

A look at how we can attract more men to become therapeutic radiographers and how will the NHS’s need for an extra 2000 therapeutic radiographers by 2027 be met?

When I started working at Mount Vernon in 1986 I had to wear a pair of steel toe cap boots when handling lead blocks as the lead radiographer for mould room services. These had the natty name of “toe-tectors”, were made by “Grafters” and were available only in a tan colour and so by no means a natty fashion accessory but more like an oversized “Chelsea boot”.

I’m not sure why other radiographers (both male and female) working on the Linacs and Cobalt units didn’t have to wear them as well as they handled the same blocks but I’m sure that these boots would not be a good look with what was essentially an old-fashioned, marron and white “nurses uniform” for female radiographers!

Pic: Planning images for big and heavy mantle blocks


It would also have made complete sense for the patients to wear a hard hat as regularly we would handle a few kilos of lead just above the patient’s head! I am sure today’s health and safety regulations would dictate that they did. The bespoke lung-shielding blocks for mantle treatments when Hodgkin’s disease was treated were very heavy (circa 1 or 2kg each) as were the shadow trays they sat on, a danger to staff and the patients made worse by the potential of tripping or falling into the pit provided in those days to allow complete rotation of megavoltage units without impacting on the isocentre’s height and by default the couch and patient.

Pic: Why did patients not need hard hats in the 80’s?

However, in the days prior to mandatory PPE (Personal Protective Equipment) I was given daily a free pint of milk as a way to avoid issues of Cadmium poisoning as the bespoke poured blocks contained this toxic element. I’m sure the MLC systems now are also a lot safer for the operator.

I also had to wear a white coat as most male radiographers did in those days and was often confused with a doctor when walking around the hospital complex and so the boots were less of an encumbrance when hidden by my trousers.

A truly varied career including treating patients from the Kings Cross fire

18 November 1987, at approximately 19:30, a fire broke out at King’s Cross St Pancras tube station, a major interchange on the London Underground. As well as the mainline railway stations above ground and subsurface platforms for the Metropolitan, Circle and Hammersmith & City lines, there were platforms deeper underground for the Northern, Piccadilly, and Victoria lines. The fire started under a wooden escalator serving the Piccadilly line and, at 19:45, erupted in a flashover into the underground ticket hall, killing 31 people and injuring 100.

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Pic: Kings Cross St Pancras tube sign

Mount Vernon was regional burns unit for North London and many of the injured were attended to here. Patients with burns especially those on the face required plastic masks to be made that suppressed the formation of scars especially keloids and allowed lotions to be applied that would stay in place. The requisite masks were almost identical to those made for our radiotherapy head and neck cases and so I spent much time taking impressions of burns patients and making clear plastic masks for them too.

I kept my boots after leaving the clinical radiotherapy world to join the commercial one in 1990 and have used them for gardening since. However, this month they gave up the ghost and fell apart (see picture) and so have lasted me around 34 years! I’m still involved in radiotherapy to this day and so I really can vouch for the fact that a career in radiotherapy for a male radiographer is a very varied and fulfilling profession that can last a life-time, an important consideration when making a career choice for a bloke. My DCR vocational course gave me a very thorough and fundamental understanding of the processes of radiotherapy and patient care in a very hands-on, non-virtual environment, right from the start and crucially on my first day.

Pic: My 34 year-old boots from Mount Vernon, now very worn.

So how can we attract more male radiographers now and also a further 2000 more in general by 2027 or in just 7 years-time?

A Cancer Research UK paper published this month suggest that an 80% growth of therapeutic radiographer is required in 2017 or an additional 2000 people.

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A Sheffield Hallam University (SHU) research project has also now been launched to look at how to attract more men to become therapeutic radiographers.

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The SHU project to attract more men is well meaning and I hope it works but I do have some reservations.

The article mentions seven bullet points on new recruitment ideas, off which the first one suggests that a focus on technology and science might be better than cancer care and interpersonal skills.

I am not sure that as we now live in the early age of artificial intelligence, machine learning and big data that this is the way to go. My May blog entitled “The role of a therapy radiographer in the age of Artificial Intelligence (AI)” suggests that this might be the wrong focus. Here is a brief snippet from this blog and a link to it.

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“How will AI affect us as workers” asks Max Tegmark in his new book…Life 3.0 being Human in the age of artificial intelligence.

Max looks at what career advice we should give to our children now focusing especially on ones where machines are presently bad at performing the roles and may not get automated any time soon.

He suggests that if you answer yes to these questions below more than once you are on the right track:

Q: Do you have to interact with people using social intelligence?

Q: Are you creative and come up with clever solutions?

Q: Do you work in an unpredictable environment?

That means that the following careers are suitable for you: Teacher, Scientist, Entrepreneur, Lawyer, Social Worker, Engineer, Programmer and Hairdresser to name a few.

He suggests that if you work in a field of highly repetitive or structured actions then your time is likely up such as train drivers, tele-marketing persons, warehouse and bank workers to even car, bus and taxi operatives with accountants somewhere down the line and so what about therapeutic radiographers?

I asked:
My question is that are the powers that be simply focusing on recruitment and retention issues and dealing with those when they perhaps should be concentrating on the role of a therapy radiographer and its definition over the coming years and how that might look in the years leading up to 2050.

My conclusion was:
Will we as therapy radiographers create an employment niche for ourselves in the bright new AI world by 2050 or will we by stealth be replaced by robots who simply put patients into an automated radiotherapy treatment production line and a big-data algorithm, AI-based sausage factory?

So how DO we attract more men and 2000 more radiographers by 2027?

The more you read on AI and its potential to change how we work the more it seems that a career of a therapeutic radiographers is starting in horse racing terms to look like an odds-on favourite to be one that is directly affected and in a very short period of time. Unless the actual role is critically looked at as opposed to a continual review of recruitment and retention we will shortly stare into a “big data” radiotherapy radiographer abyss. Vocational training has always been my hobby horse in radiotherapy and I have been very vocal about this during my whole career in that this needs to be returned to as soon as possible and so I fully support the proposed apprenticeship scheme when any ongoing issues are ironed out.

However, a bigger focus on cancer care and interpersonal skills might be an angle that saves the profession as opposed one that needs less emphasis as SHU suggest.

I’m not sure that our remit is “killing cancer with big laser guns” as SHU state or that this is age appropriate unless we launch a version on Nintendo and I am not at all supportive of displaying “Lego-Linacs” at recruitment events as that sells our profession short in my opinion. I do however agree that a sustainable career, pay, pension and career progression are very important and need toi be looked at as part of a strategic review.

Pic: This picture was retweeted by the Society and College of Radiographers @SCoRMembers twitter feed this week (October 2019) and was to be used at an upcoming recruitment event ☹

However, I very much concur that more male role models are required at recruitment events and am happy to help but have not been asked as yet and that might be better step than the Lego imagery!

What attracted me to the profession?

I must admit I got into it by accident but that applied to many of my student colleagues in 1980, I had a place guaranteed at the Turner Dental School in Manchester but my A level grades did not match the 3 C’s I required. In those days this was an offer that meant that they really wanted you so I was a bit distressed but got over it eventually!

I know that attending medical school to study medicine now is almost impossible aside from the very select few applicants with the highest grades and so perhaps we need to catch people failing to obtain places in these primary healthcare roles by offering a formal safety net of a career in radiotherapy. If it worked for me, why not others. Why not directly contact and meet with all the Medical Schools and Universities that offer Medicine and Dentistry degrees and ask them to hand out our career information to all their failed applicants. Many would be interested I am sure.

I also have to say that when you qualify as a doctor and dentist it is unlikely you will use your degree a few years later to work in the oil and gas industry and so I return to my hobby horse and offer vocational training as a major focus for future development too. We really can’t afford to lose any people who see their degree as a passport to alternative careers or life-style changes.

For me my vocational qualification allowed me to work as a clinical radiographer right through to becoming a successful business owner and entrepreneur in the radiotherapy field, designing products and new ground breaking and disruptive services and eventually employing many radiographers to assist me and for them take their own step to the commercial world. So the potential exists for both men or women to have a fulfilling and varied career and this would be my main thrust in recruiting more men perhaps.

How might the next 5 years or so look.

My May blog focused on how radiotherapy is becoming increasingly automated and why the career may fall foul of AI and it seems that increasingly focusing on technology and science as SHU suggest might be a mistake.

Even today, once the patient is on the treatment couch, radiotherapy set up and delivery is almost entirely computerised and increasingly robotic. Patients are empowered by new technology to assist in their positioning and staying where they should be for the duration of the treatment with dynamic monitoring. Systems that use 3D rendering can create a virtual immobilisation shell that the patient needs to fit inside having been positively ID’d by the same product. Breath-hold systems empower patients with 3D virtual reality glasses to assist their breathing control themselves.

Highly adaptive treatment delivery systems automate treatment within pre-defined tolerances using dynamic imaging with human input only required if variations exceed these and treatment plans are delivered that have been largely created using machine learning over and above inverse planning technology while patients are scheduled and treatments recorded using on-board computer software. You could argue in a world about to be radically changed by AI that the above can be completed successfully without a radiographer’s input at all and by playing devil’s advocate.

The Radiographers role is now potentially limited to the time the patient is not on the couch, a step-change away from my first days in a radiotherapy centre. It could also be argued that diagnostic radiographers could perform the pre-treatment data-collection role when patients are imaged now in a largely CT/MRI environment with these images sent to the treatment planning computers to create the ideal plan. The clinical oncologist only having to sign off a plan that has been created automatically based completely on his or her “red-lines”, their role now incorporating much of what a therapeutic radiographer would have been expected to manage in the past.

While the above is a potentially a dark place for a therapeutic radiographer it does open up the role to increased levels of expertise and management skills in providing advanced cancer care and using enhanced interpersonal skills. There would be a primary role in patient support, psychology and assisting patients dealing with cancer treatment while both communicating and managing their AI based treatment journey. Perhaps we do this now but we will need to do more.

There are however some parts of radiotherapy delivery not likely to affected by AI that are largely combined directly with surgical interventions such as IORT that will have a wider role to play once trial data matures and is the ultimate form of adaptive radiotherapy, HDR brachytherapy, prostate seed implants, while you can add superficial skin cancer treatment to name a few.

Pic: Finding 2000 new radiographer is a huge task

In 2027 the 2,000 extra therapeutic radiographers required according to CRUK will likely not look at all like the ones working in the field today and so who is now empowered with this critical decision-making process and the vital remit to refocus on the role of a therapeutic radiographer in the age of AI? The Society of the New Age therapeutic radiographer perhaps?

My summary

A quick return to vocational training.

A formal safety net to catch failed applicants for medical and dental schools.

More male role models at recruitment events.

Stress that a varied and fulfilling career awaits from clinical cancer care to business management and entrepreneurial opportunities

A major re-focus on cancer care and interpersonal skills

A complete strategic review of the role of the therapeutic radiographer in the age of AI

I am proud to be a radiographer and always start my corporate presentations by letting people know this fact and so I hope the powers that be are able to fulfil the UK’s future recruitments needs but in a truly innovative way.