AHPs behind the scenes: Precision, technology, and patient care

A unique blend of skills

Being a therapeutic radiographer requires a diverse skill set that bridges science and compassionate care.

• Radiation physics—We use high-energy radiation to treat cancer, so a deep understanding of radiation physics is essential to using it safely and effectively.
• Anatomy and radiobiology—We work with CT scans and X-rays daily. This demands expert knowledge of human anatomy and how radiation interacts with the body on a cellular level.
• Patient care—Most importantly, we support patients throughout their cancer journey. This requires empathy, compassion, and the ability to provide care during a difficult time.

Watch this video to learn more about me and my advanced practitioner therapeutic radiographer role.

Scene one video: Imobilisation mask

An immobilisation mask is a custom-fit device used during radiotherapy, particularly for treating cancers in the head and neck. It is sometimes called a shell.

The mask is made from a thermoplastic mesh, a special material that becomes soft and pliable when placed in warm water. This allows the radiography team to mould it perfectly to the patient’s face, head, and shoulders.

Once hardened, its purpose is to hold the patient comfortably and completely still. This absolute precision is vital because it:

• Makes sure radiation is delivered to the exact target with sub-millimetre accuracy during every session.
• Protects healthy tissue by preventing movement while the treatment is underway.
• Makes each session safer, quicker, and more effective.

It's a perfect example of how this simple device is fundamental to delivering advanced, precise radiotherapy.

Creating the immobilisation mask

In this video, my colleague and I are preparing to create a custom-fit immobilisation mask. This is a critical step before my patient's radiotherapy treatment begins.

My patient is lying down, as I calmly and reassuringly explain the procedure. I describe how a sheet of thermoplastic mesh is being heated in a water bath to make it soft and pliable.

I lift the warm, wet mesh sheet from the bath. At the same time, I describe to the patient that when I place it on them, it will feel warm. I compare it to a facial to help ease any anxiety. With my colleague's help, we carefully drape the soft mesh over the patient's face and shoulders.

When the mesh is in position, we begin gently but firmly pressing and moulding the material. We need to mould it to the exact contours of the patient's head, face, and shoulders, so it is a perfect fit. I specifically pinch the material around the patient's nose to shape it accurately. Throughout the process, I offer constant verbal encouragement.

Because the patient cannot speak once the mask is on, I establish a non-verbal cue, asking for a "thumbs up" to confirm they are comfortable. After getting this confirmation, I instruct the patient to remain as still as possible while we wait for the mask to cool, harden, and set into a rigid, personalised shell.

Scene two video: Pre-treatment checks

I start by guiding a patient through the treatment setup process. Initially, I direct the patient onto the treatment couch and help them lie back comfortably. I then make small adjustments for the patient's comfort and correct positioning. This includes moving their hair out of the way and placing a support cushion under their knees. I continue checking in with the patient to make sure they are comfortable.

Next, I raise the couch into position and carefully place the pre-made immobilisation mask over the patient's face and shoulders. I continue to make sure the patient is comfortable and perfectly positioned before clipping the immobilisation mask into place. After a final small adjustment, the mask is secured.

With the patient set up, the room lights are dimmed, and the patient is advised that we are leaving the room to begin the treatment from the control area. I reassure the patient by telling them what to expect next. They will hear an alarm sound and the machinery moving to take verification X-rays.

In the control room, I discuss treatment parameters with my colleague as we begin acquiring the pre-treatment images. Before proceeding with the radiation delivery, I then confirm that all the parameters are correct.

Scene three video: Reviewing a radiation treatment plan

An essential part of my role is creating highly detailed patient radiation treatment plans. Sometimes, I have a particularly complex case that requires discussion with a senior colleague to get the best possible outcome.

In this scene, I'm reviewing my patient's radiation treatment plan with Tony, a consultant clinical oncologist. I needed his expert advice on a challenging case involving my patient's titanium prosthetic hip. Our planning software has limitations in calculating the dose accurately. This is because metal's high density can interfere with the radiation beams.

I showed Tony the plan I had created, using the software's "beam's eye view" to demonstrate my solution. I had programmed the radiation beams to turn off just before they reached the hip and then switch back on after they had passed. The result would be wrapping the treatment around the metal prosthesis instead of going through it.

Tony reviewed my work, looking closely at the dose distribution maps on the screen. He confirmed that my pragmatic approach of avoiding the hip was the safest and most appropriate strategy. He checked the radiation levels and was happy that my plan successfully avoided the prosthesis while still delivering the necessary dose to the target area.

This kind of collaboration is crucial in my job. It helps to make sure even the most complex treatment plans are safe, accurate, and designed for the patient's needs.