Radiation Therapists

"Every patient that you meet has a diagnosis that puts the fear of death into them," says Lynda Jackson, a radiation therapist at the Cancer Centre of Southeastern Ontario (formerly the Kingston Regional Cancer Centre) in Kingston, Ontario. "Even if you have a cancer that is highly curable, your life will not be the same."

Radiation therapy is a relatively new profession. The story of the first steps in using radiation as a treatment are told by James S. Olson in Bathsheba's Breast: Women, Cancer & History. In 1896, Emile Grubbe, a medical student in Philadelphia, PA, was working part-time in a factory that produced Crookes tubes (vacuum tubes used for physics research). Grubbe developed skin problems and hair loss. His professor, Richard Ludlum, suggested that the invisible rays the tubes produced could be destroying skin cells. Ludlum made the leap that the rays might be useful for destroying tumors and sent a breast cancer patient to Grubbe at the factory. There, Grubbe wrapped her breast in foil and radiated it with a Crookes tube for 18 consecutive nights. The tumors shrank and her pain abated, but the cancer had already metastasized and she died several months later.

Who Can Do It?

Currently, there are over 14,000 registered radiation therapists (THRs) in the US and over 1,190 registered radiation therapists (RTTs) in Canada. In the US, the average hourly wage for radiation therapists is US$25.72, and, in Canada, it is C$22.20. With growing cancer rates, job prospects are very good.

Individuals seeking to study radiation therapy should have a background in biology, mathematics, and physics. Currently, in the US and Canada, radiation therapists obtain their training in certificate, diploma, or degree programs. The American Registry of Radiologic Technologists (ARRT) is now deliberating whether it should make a Bachelor's degree a requirement for certification in radiation therapy.

What, besides a proper education, is needed to do well in radiation therapy?

Above all, radiation therapists must be comfortable with technology. They are expected to manage, simultaneously, data from several computer monitors: the treatment unit, the record and verify screen, the portal imaging monitor, and the beam shaper and output (with a linear accelerator, the beam is not instantaneous; with a cobalt unit it is) – and maybe even a scheduling/workload screen.

Radiation therapists must be able to pay strict attention to detail and do so while performing several tasks at the same time. For example, to avoid mistakes in treatment, they must monitor a patient's position via three lasers shining on positioning "tattoos" – if the patient moves, s/he must be repositioned. Radiation therapists must ensure correct field size (which could be split into four parameters), beam energy, radiation type, accessory placement (e.g., shield, wedge), and immobilizer placement. And they have to document all aspects of the assessment, the treatment, and the side effects.

Emotionally, radiation therapists must be confident and calm. Working to a tight schedule, they must explain what is happening, quickly develop rapport with anxious patients, and put them at ease. Little questions, Jackson says, like asking how a patient slept, show that the therapist is taking an interest and that the rest of the patient's life is important. And they must be aware of the patient's fear, particularly their fear of cancer, radiation, and death.

Though there are daily satisfactions in delivering treatment successfully and in believing she is helping people, according to Jackson, the fact that she doesn't see the long-term survivors is difficult. Other healthcare professionals see their successes in follow-up visits; radiation therapists don't. When radiation therapists say, "Goodbye, I hope I never see you again," at the end of a patient's last visit, they can only hope it's for the right reasons.

In the Treatment Room

In Cancer Care Ontario treatment centers, radiation therapists work in teams of two. Before a patient is brought in, the therapists will have prepared the treatment room, accessories, and treatment bed; gone over the treatment parameters and compared them with the latest doctors' and therapists' notes; and noted any changes to the prescription.

The first visit involves taking a portal image (which shows the radiation treatment field and some anatomical structures), which the radiation oncologist compares with the simulator film. The first visit can be difficult, says Jackson. "You're asking a person you've never met to go into a room, close the door, lay very still and quiet, and trust you – and in an unfamiliar setting and in a situation that is both lifesaving and life-threatening."

In the treatment room, the therapist positions the patient and explains the procedure. Perhaps the most surprising information for patients is that they will not see or feel anything – at least not until there are side effects. Treatment times vary according to disease site and treatment issues, such as whether a mold is needed to immobilize the patient or isolate the treatment location. Usually, radiation therapists see a patient five times per week for three to six weeks. Except for the first visit, most visits take only 10 to 15 minutes, including a mere three minutes of actual exposure to the radiation beam.

Beyond Clinical Work

This demanding field is not Jackson's first career. After working for a number of years in a residential facility for the mentally challenged, she sought a change. In 1987, her husband saw an ad for radiation therapists and suggested the field to her; she completed the program and has been practicing since 1989.

Though the vast majority of radiation therapists work in frontline treatment delivery, Jackson is currently a research radiation therapist, so 90% of her work is research and 10% is clinical. She is involved in several studies, including one on laryngeal cancer and another examining variations in radiation therapy prescriptions and outcomes. She also spent two years (until spring 2003) as a director of the Ontario Association of Medical Radiation Technologists.

This vivacious, determined mother of one daughter and two stepdaughters is a busy woman. She has just completed a Bachelor's degree in therapeutic radiography and she volunteers with the Canadian Cancer Society – even shaving her head to raise money for Breast Cancer Action Kingston.

Jackson is a strong advocate for her profession. At present, she says, radiation therapy is not widely known by the public, and many patients believe she is a nurse. This is one reason why Jackson agreed to be interviewed. "You must be aware that a profession even exists before you'll go there." And she not only wants people to go there, but to stay there and to have new opportunities, like research, to continue to challenge them in their work.

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