Making it happen: Consultant Radiographers - the vision and the reality. Kate Burton AHP Consultant Radiographer in Neuro-Oncology

The Vision (1) Consultant practitioners are those… who have achieved mastery of their field of practice have an inspirational approach to the development of new skills able to foresee opportunities for service and professional development able to act as ‘agents for change’. working across boundaries to enhance patient care. strategic, independent, creative thinkers advancing research and education to enrich practice. using their skills to develop and advise others. A strategy for the education and professional development of therapeutic radiographers COR 2000

The Vision (2) The therapist consultant posts will help to: provide better outcomes for patients by improving quality and services; provide a new career opportunity to help retain experienced members of the allied health professions recognise their clinical contribution strengthen professional leadership. Meeting the challenge: A strategy for Allied Health Professions DOH 2000

The reality…..

History and background 1998 – ‘specialist radiographer’ post 1998 – ‘specialist radiographer’ post Co-ordination, ‘smoothing’ of pathways Co-ordination, ‘smoothing’ of pathways 2004 – Advanced practitioner post 2004 – Advanced practitioner post Identified radiographer-led practice Identified radiographer-led practice On-treatment reviews On-treatment reviews Informed consent Informed consent Palliative brain pathway Palliative brain pathway Nov 2007 – Consultant post Nov 2007 – Consultant post ‘autonomous’ practice ‘autonomous’ practice Professional leadership Professional leadership Education, training, development

Scope of Practice A.H.P. CONSULTANT RADIOGRAPHER in NEURO-ONCOLOGY ‘Expert’ Clinical 50% Professional leadership Education, Training & Development Service development, Audit & research

Expert clinical practice Patient & carer support (NP, during RT, telephone FU) Patient & carer support (NP, during RT, telephone FU) Information provider Information provider On-treatment review clinics (2/wk) On-treatment review clinics (2/wk) Informed consent for palliative GBM patients Informed consent for palliative GBM patients Manage SRT/SRS programme Manage SRT/SRS programme Act as ‘brain expert’ for treatment Radiographers Act as ‘brain expert’ for treatment Radiographers Radiographer-led Vestibular Schwannoma pathway Radiographer-led Vestibular Schwannoma pathway

Vestibular Schwannoma pathway SURVEILLANCE MRI Patient diagnosed using MRI Review by specialist skull based surgeon Tumour small, discreteTumour larger, abutting brain stem SURGERYRADIOTHERAPY: 1# SRS / fractionated SRT No growth SURVEILLANCE MRI Tumour growth seen RADIOGRAPHER-LED CLINIC Patient choice

Radiographer-led clinic Prior to consultation: Review case & imaging with Oncologist Review case & imaging with OncologistConsultation: Take full history Take full history Explain radiotherapy treatment options Explain radiotherapy treatment options Discuss outcome: Discuss outcome: Control rate Control rate Acute, transient & late toxicity Acute, transient & late toxicity Discuss patient preference Discuss patient preference Provide written information, contact details Provide written information, contact details Post consultation Clinic letter to: referring clinician, GP and patient Clinic letter to: referring clinician, GP and patient Complete form if patient has opted for fractionated RT Complete form if patient has opted for fractionated RT Refer onwards if patient wishes to seek 1#SRS opinion Refer onwards if patient wishes to seek 1#SRS opinion

Education & training In house competency package 3 procedures = observed 3 procedures = observed 3 procedures = supervised 3 procedures = supervised 4 procedures = unsupervised 4 procedures = unsupervised Plus personal based learning – anatomy, audiometry, radiology, skull based MDT Plus personal based learning – anatomy, audiometry, radiology, skull based MDT M level informed consent module. M level informed consent module. Practice review – observed procedure at least 1 / year. Practice review – observed procedure at least 1 / year.

Future plans… Target volume delineation Target volume delineation Skull based clinic Skull based clinic Radiotherapy prescribing Radiotherapy prescribing Follow up – telephone clinic Follow up – telephone clinic

Scope of Practice A.H.P. CONSULTANT RADIOGRAPHER in NEURO-ONCOLOGY ‘Expert’ Clinical 50% Professional leadership Education, Training & Development Service development, Audit & research

Research & development International & national clinical trials International & national clinical trials EORTC Adjuvant Post-Operative High-dose Radiotherapy for Atypical and Malignant Meningioma: A Phase II and Observational Study EORTC Adjuvant Post-Operative High-dose Radiotherapy for Atypical and Malignant Meningioma: A Phase II and Observational Study BIBW Phase I/II Trial to explore MTD, Safety and Efficacy of combining BIBW 2992 and Radiotherapy with or without Temozolomide in Newly Diagnosed GBM BIBW Phase I/II Trial to explore MTD, Safety and Efficacy of combining BIBW 2992 and Radiotherapy with or without Temozolomide in Newly Diagnosed GBM Local research Local research TORPEDO - Inter and Intra Observer Variation in the Gross Tumour Volume (GTV) Delineation for Grade IV Glioma (Glioblastoma) during Radiotherapy Planning TORPEDO - Inter and Intra Observer Variation in the Gross Tumour Volume (GTV) Delineation for Grade IV Glioma (Glioblastoma) during Radiotherapy Planning Comparison of high melting point V’s low melting point thermoplastic material for immobilisation using daily MVCT imaging. Comparison of high melting point V’s low melting point thermoplastic material for immobilisation using daily MVCT imaging.

Scope of Practice A.H.P. CONSULTANT RADIOGRAPHER in NEURO-ONCOLOGY ‘Expert’ Clinical 50% Professional leadership Education, Training & Development Service development, Audit & research

Education, training & development Teaching & mentorship Teaching & mentorship under-graduates, Assistant Practitioners, Radiographers under-graduates, Assistant Practitioners, Radiographers SpRs, medical students SpRs, medical students Nurses and health care professionals Nurses and health care professionals Patients and public awareness Patients and public awareness National & local information National & local information Monthly brain tumour support group Monthly brain tumour support group Advisory member of AMNET Advisory member of AMNET Local patient information Local patient information

Scope of Practice A.H.P. CONSULTANT RADIOGRAPHER in NEURO-ONCOLOGY ‘Expert’ Clinical 50% Professional leadership Education, Training & Development Service development, Audit & research

Professional leadership Raise awareness of the profession Presenting and publications Trustee for Meningioma UK Member of the NRIG SBRT group BIR Oncology Committee member Advanced practice forum Monthly meetings Review & develop practice

The reality is…………..