Has the coronavirus pandemic radicalised ESTRO and are they suffering from ‘Long-Covid’ as a result?


I must admit that I was slightly startled and so were many others by two of ESTRO’s ‘landmark’ debates held during the congress this summer. These are the two motion items of note:

‘This house believes that in the next 5 years the current RTT education curriculum will be obsolete’ and to end with a closing debate called ‘X-ray guided adaptive radiotherapy will make MR-Linac obsolete’.

Two very radical and what could be seen as contentious debates that really warranted a better audience than they seemingly achieved but the word ‘obsolete’ is potentially divisive in our small world of radiotherapy and so I wanted to take a closer look as much of the information is freely available on Twitter and the net!

It was suggested by the motion against that DCR trained therapeutic radiographers like me while having an in-depth knowledge of surface anatomy, worked only with poor images and so therefore somewhere along the way they lacked an ability to interpret contemporary ones or to understand advanced radiotherapy techniques!

It was also suggested that around the time of changing from a vocational diploma to an undergraduate degree (in the early nineties) the ‘pre-technocratic’ diploma while necessitating spending more time in the department created therapeutic radiographers who, although ‘technically proficient, lacked the necessary skills to interpret and apply their knowledge base to their practice’.

It was suggested that the degree course was therefore by default a novel ‘technocratic’ educational advance that aimed to create more professional decision makers as opposed to what I understood to be people trained to simply operate machines. I’m not sure that I agree with this as our training was often very patient centric but we did learn on the job, something that is anathema it seems today.

Aside from real time adaptive radiotherapy on the latest MR Linacs that I covered in my previous blog in September and below, my perception is that recent huge advances in patient motion detection/tracking, surface guidance, artificial-intelligence and robotic control systems among others have in fact created treatment techniques that simply do require staff to simply operate machines for much of the time?

Lastly, the motion ‘against’ offered a summary that the current curriculum combines knowledge and critical thinking which are ‘essential to effective practice’ and provides an ‘appropriate base for future development as advanced and consultant level practitioners’.

However, having worked in radiotherapy for over 40 years clinically and in the corporate sector creating products, services and start-up companies I certainly had the skills to ‘apply my knowledge base to my practice’ as do the great majority of my peers that I trained with and are still working in our sector! Some run big departments or have set up private radiotherapy providers, others work in high-level senior management roles in large NHS Trusts while some lead critical research and development projects or work within our own professional society and at the very top of our profession.

The motion ‘for’ relayed concerns that the current training model is potentially orientated towards a technician-based qualification impacted on by current roles provided by clinical oncologists, medical physicists, nurses and indeed technology that influence a radiographer’s working day and that an ‘a-la-carte’ or pick and mix approach to the core curriculum was likely set to fail. A system of ‘formative assessment’ for students with regular feedback was the favoured way forward it seems. I liked the idea of this and so if you follow this link you can find out more: https://www.gre.ac.uk/learning-teaching/assessment/assessment/design/formative-vs-summative

This is all very well but in my opinion what the motion for and against failed to address or offer an reliable alternative for were recruitment and retention issues and the current high levels of attrition in qualified staff and students in radiotherapy these days, certainly in the UK to the extent that the career is now on the Government’s ‘danger list’ and open to migrant workers. Creating advanced and consultant practitioners will not resolve the problems we face today at ground level.

With the #CatchUpWithCancer campaign calling for an urgent response to the COVID induced cancer backlog, a new national plan and funding to “super-boost” cancer services with ring-fenced funding, we still need to address these issues and find more people wanting to work in radiotherapy but this won’t happen overnight nor is it likely to happen in line with the funding process above. The recent Action Radiotherapy survey suggesting that 65% of respondents said that the pressure of the pandemic or the recovery has caused themselves or colleagues to consider leaving the radiotherapy profession further exacerbates the problems we face.

However, I am sure that in 5 years the training system will certainly be very different. It seems that no definitive debate outcome was reached which is understandable when the word obsolete is mentioned in dispatches although ESTRO did moderate this before the debate by asking whether the therapeutic radiographer’s educational core curriculum might be ‘outdated’ within 5 years while delegates expressed a wish for the debate to discuss ways to ‘future proof’ our profession.

I didn’t attend ESTRO for clarity and so this blog is based on my research, my views and speaking to colleagues who did. I apologise if I have got somethings wrong but at the end of the day like me, I am sure that you want to know what a ‘technocrat’ really is?

The word technocrat can refer to someone exercising governmental authority because of their knowledge, or ‘a member of a powerful technical elite’, or ‘someone who advocates the supremacy of technical experts’.

‘Technocratic’ means relating to or characterized by the government or control of society or industry by an elite of technical experts

Technocracy can also be a political ideology – ‘Technocracy is a proposed system of government in which the decision-maker or makers are selected on the basis of their expertise in a given area of responsibility, particularly with regard to scientific or technical knowledge’

(All three quotes above courtesy of Wikipedia)

Based on my previous blog that explored the issues of dedicated therapeutic radiographer training modules for the MR Linac operation based on the experiences at the Royal Marsden, I concluded that by suggesting that by embracing the rapid progress of AI that also automates the radiotherapy contouring process making it fast, accurate and verifiable, added to dedicated training programs and access to a novel virtual MDT environment, therapeutic radiographer led MRgRT is clearly within reach! You can read last month’s blog here:

Therapeutic radiographers now deliver MR-Linac treatments without clinical oncologist present

https://www.radpro.org.uk/2021/09/07/september-blog/

Currently training for MR Linac operation is an ‘on the job’ process as mentioned above with a desire to move away from this and make it a module for all new staff, however difficult this will be logistically and work is underway in Manchester and London to create specific courses for this complex treatment now. In the words of Helen McNair ‘Adaptive radiotherapy will very much be the future of radiotherapy. It has been identified as a very positive aspect of role development for therapeutic radiographers’ and so this alone will change educational practice beyond what we recognise it to be now.

Is a ‘paid degree apprenticeship’ the way forward?

We can argue about the merits of vocational courses versus academic degrees, a choice of technical versus academic education and the planned but presently ‘in-limbo’, radiotherapy degree apprenticeship but perhaps the holy grail that eventually solves our professional shortages will in fact be a paid degree apprenticeship covering a salary, the award of a degree and vocational training as well-paid apprenticeships really do exist.

I recall being an integral part of the radiotherapy team on my very first day as a DCR student and a vital part of the crew and so why shouldn’t we get paid? I did some more research!

Vocational training has expanded and diversified vastly. You can find courses online varying from designing theatre sets to building spacecraft while many vocational institutions also offer Bachelor’s, Master’s and even Doctorate degrees but myths and misconceptions still abound, casting doubt into students’ and parents’ minds, the main one being that vocational training is for people ‘less academically successful’ and that potential research work is compromised by practical training and teaching work skills. In radiotherapy we know that this is not true and research and development is now an integral part of our working lives both clinically and in the corporate sector.

The pay component might come from the private sector, equipment manufacturers, pharmaceutical companies, cancer charities and the NHS as without therapeutic radiographers treating cancer patients these entities would not exist as they do today.

And so why can’t radiotherapy be taught on a paid apprentice basis just like we do for electricians and all the other trades and careers we know well?

I googled this and these are some of the best-paid apprenticeships in the UK today:

Corporate Banking Apprenticeship – Santander – £23K

Civil Service Fast Stream – ONS – £22k

Accounting Apprenticeship – EY – £22k

Logistics Apprenticeship – Royal Mail – £20k

So my own debate would be called ‘This house believes that the therapeutic radiographer education curriculum should be delivered via a paid degree apprenticeship’…discuss.

‘X-ray guided adaptive radiotherapy will make MR-Linac obselete’.

The closing Debate #ESTRO2021 was ‘X-ray guided adaptive radiotherapy will make MR-linac obsolete’

I have looked at training of therapeutic radiographers in my last blog and revisited it above (the link is up there) with regards to the MR Linac and so I don’t plan to go back there now and I also wrote an MR Linac ‘Guide for Dummies’ like me but the following information is once again freely available on Twitter as are some of the comments discussed during the debate. Once again it is doubtful when the divisive word ‘obsolete’ is used whether any definitive outcome can be agreed and so I am sure the debate will rage on.

However, these are the very different points of view from Ben Heijmen shown first in support of the MR Linac and from Bas Raaymakers for the X-Ray based systems and these were the concluding slides to the debate from each.

I guess at the moment ‘you pays you money and takes your choice’ but it certainly is an exciting time to be working in radiotherapy with so much disruptive technology entering clinical use now.

Long Covid or ‘Long Congress’?

It’s been a long time since we were all allowed to attend conferences in person and we have made the best of the virtual versions offered to us but we must be careful not to kill the goose that lays the golden egg.

Word on the ground was that the footfall in Madrid for the physical exhibition was far, far lower than previous years and meetings, probably for the obvious ‘Covid-related’ reasons but for the commercial companies to put in such huge efforts to attend in person and at enormous cost of travelling long distances, designing and building booths, with ‘face to face’ exhibition space costing 500 euros per square meter and so likely 5,000 for a very small stand to 50,000 euros and much more for a larger booth in Madrid and up to 25,000 euros for a virtual one if not exhibiting in person, these eyewatering fees may not be sustainable in the long run. Value for money will be evaluated extensively by some of those attending.

I also noticed that for some of the key debates audiences were in one case 79 onsite and 49 online and so while I realise that without strategic corporate sponsorship, organisations like ESTRO would not exist but it might be time now and when the pandemic is over to have a root and branch review as to the role these events play and how they might look in the future as it has to work for everyone at these prices and there might just be a better way forward.

So has ESTRO suffered from long Covid, probably not but it would be good to see some clarity as to how many delegates attended on line and in person and how many companies felt that they received a value for money from their radiotherapy exhibition experience.

We don’t as corporate entities want to attend trade shows just so that people don’t wonder where we are and why, or do we!

The October 2021 blog for RadPro by Duncan Hynd DCR(t) A Radiographer’s life, a 40-year career in radiotherapy.