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The evolution of radiation therapy as a key pillar in the management of cancer patients has revolutionised the roles within the multidisciplinary teams providing care. As a consequence, the traditional boundaries in which radiation oncologists, radiation therapy technologists (RTT) and medical physicists work have become increasingly blurred. Technology has evolved considerably, necessitating change within our workforces to meet the needs and complexities of current and future clinical radiation oncology practice.

One such initiative to support this change has been the development, evolution and acceptance of RTT advanced practitioners (AP). With varying levels of structure, recognition and ultimately, success, RTT AP programs have been established in Australia, New Zealand, Canada and the United Kingdom. Scope of practice for the RTT AP ranges from direct patient care as a surrogate for medically trained professionals, through to image guidance and adaptive radiotherapy treatments.

With a significant paradigm shift towards adaptive, individualised, image guided treatments, the scope of practice for RTT’s has broadened considerably, requiring a highly specialised skillset to deliver precision radiotherapy. In many cases, this skillset resides outside the traditional scope of RTT practice, demanding the expansion of traditional knowledge and acquisition of completely new skills and responsibilities. Subsequently, the role of the RTT and RTT AP in image guidance has never been more critical as we move into this new era of radiotherapy.

Recent literature supports the competency of the RTT AP in image guided radiotherapy, to deliver adaptive, complex treatments in conjunction with their medical colleagues. Furthermore, we are witnessing the expansion of the RTT AP into routine clinical practice as peer-to-peer knowledge transfer occurs.

Like it or not, the role of the RTT in image guidance is here to stay and will only become more prominent. It raises an interesting debate as to whether in fact the RTT AP can be classified as ancient history, ultimately because it will become the role of every RTT- AP or not.

This presentation will discuss the evolution of image guidance into the RTT scope of practice, both now and into the future, and aim to instigate discussion as we arrive at this imminent crossroad in the RTT profession.