WORK ETHICS & LEARNING CURVES OF A RADIATION THERAPIST FURTHERMORE CHALLENGES IN COVID  

1. Subrata Roy
Senior Radiation Therapist
WORK ETHICS & LEARNING CURVES OFA
RADIATION THERAPIST FURTHERMORE
CHALLENGES IN COVID

2.  Radiation Therapist Overview
 Work ethics of Radiation Therapist
 Learning Curves of Radiation Therapists with advance Techniques
 Challenges faced During the COVID Pandemic
 Modification of workflow in Radiation Delivery during Covid
 Conclusions
Table of Presentation

3. What is a Radiation Therapist… (RTT)
Radiation therapists are part of the multidisciplinary
team who all work together to plan and administer
treatments and monitor the condition of patients.
They are the professionals with direct responsibility
for the daily administration of delivery of radiation .
The role of the Radiation Therapist always
encompasses the safe and accurate delivery of the
prescribed radiation dose, by working with Radiation
Oncologists and Medical physicists.

4. Work ethics of Radiation Therapist
The term ethic derives from the Greek word ethos,
meaning “moral custom.”
An ethic, therefore, is “a principle of right or good
conduct”
Health care ethics is a term that has come very much to
the fore in the National Health Service during the past
few years due to greater awareness of the subject and
issues involved and challenging attitudes on the part of
both health care professionals and patients
Ethics of Patient Care…….

5. Values in medical ethics
Six of the values that commonly apply to medical ethics discussions are:
 AUTONOMY- the patient has the right to refuse or choose their treatment
 BENEFICENCE - a practitioner should act in the best interest of the patient.
 NON MALEFICENCE- "first, do no harm“
 JUSTICE- concerns the distribution of scarce health resources, and the decision of
who gets what treatment (fairness and equality).
 DIGNITY- the patient (and the person treating the patient) have the right to be
treated with dignity.
 TRUTHFULNESS and HONESTY- the concept of informed consent has increased in
importance since the historical events of the Doctors' Trial of the Nuremberg trials
and Tuskegee Syphilis Study

6.  For a profession, ethical environment is embodied in
its professional code of ethics.
 A code of ethics, therefore, provides “a set of
principles or values that govern the conduct of
members of a profession while they are engaged in
the enactment of that profession.
 provides guidelines for making judgments about
what is acceptable and desirable behavior in a given
context or in a particular relationship.
 It creates consistency and lessens arbitrariness in
our choices when confronted with difficult dilemmas
(Gonzales, et al., 1991).
Code of ethics

7. This Code of Ethics is to act as a guide to Radiation Therapists:-
 Radiation Therapist working in all modalities of medical radiation technology in
maintaining a high level of ethical conduct.
 The radiation therapist advances the principal objective of the profession to provide
services to humanity with full respect for the dignity of mankind.
 They delivers patient care and service unrestricted by concerns of personal
attributes or the nature of the disease or illness, and without discrimination on the
basis of sex, race, creed, religion or socioeconomic status.
 Radiation Therapist will act in such a manner that will justify public trust and
confidence. This will be achieved through high standards of professional
competency as well as through professional conduct and appearance.

8.  Radiation Therapists are committed to the provision of the best possible service to
patients.
 Therapists are committed to keeping the radiation dose as low as reasonably
achievable to produce diagnostic results or for treatment needs.
 They will protect the patient's right to privacy and keep all patient information in the
strictest confidence and continually strive to improve their knowledge and skills of
their profession
 Therapist will be respectful of fellow workers and work in a professional and co-
operative manner with other health care workers.
 Radiation Therapists will be responsible for reporting any unethical conduct, unsafe
practice or illegal professional activities to the appropriate bodies.

9. Skills & Knowledge Requirement to Become an Outstanding Radiation Therapist
Radiation therapists should be well-oriented. Depending on local policy this may
include treatment preparation and planning, treatment delivery, clinical and
psychosocial care of the patient on a daily basis during treatment and immediate
post treatment review.
As the professional in daily contact with the patient it also includes monitoring
of side effects and appropriate referral. Furthermore the RTTs liaise with all the
other associated professionals in ensuring that the needs of the patient are met.
Learning Curves of Radiation Therapists with advance
Techniques
The technology advancement for the cancer patients radiation therapy services and the
changes the roles of radiation therapist.
Through the decades the primary challenges on radiotherapy treatment aimed at how to
ensure the beam reaching the tumour as planned and how to minimize the dose to the
normal structures.

10. The RTT needs to be able to understand and interpret
the treatment prescription in order to accurately
prepare and deliver a course of treatment to an
individual patient. This requires knowledge of human
anatomy, physiology, cancer as a disease, the
technology used in radiotherapy and the interaction
between them, knowledge of radiation physics,
familiarity with radiotherapy doses and schedules
and applied mathematics.
As the main daily contact point for the patient on treatment,
they must ensure that they inform the patient of the
procedures at every stage and they must continuously monitor
the physical and psychosocial status of the patient prior to any
procedures taking place.

11. As a Part of the the multidisciplinary team, The RTT
must understand how to interpret, apply and
disseminate the appropriate information for each
stage of the process to the relevant personnel. The
RTT should assimilate the conceptual changes and
technological developments in the global context of
radiotherapy.
Radiation Therapist should exercise, in addition to
technical activities relevant to the profession, the
role of educator transmitting knowledge to new
professionals, patients and families. He/she should
conduct all professional activities with the highest
scientific, ethical and moral standards.

12. An Idle Radiation Therapist should be competent in the following eight areas:
 Understanding and interpreting the treatment prescription
 Treatment preparation
 Treatment delivery and patient management
 Treatment verification
 Information management
 Professional responsibility
 Radiation protection, health and safety
 Ability to critically evaluate practice

13. Professional Responsibility
Professional responsibility as the RTT is the person who
interacts with the patient on a daily basis, he/she must
respect the dignity and privacy of the patient at all
times. Inter and intra professional communication
between all members of the multidisciplinary team is
crucial to safe practice.
RTT who must be conscious of projecting a professional
image at all times. This includes professional
appearance and manner, self-awareness and
competency limitations, a high standard of ethical and
moral behaviour, reliability and responsibility, autonomy
and respect for patients.

14. Challenges faced by Therapist During Covid -19 Outbreak
Under the influences of COVID-19, challenges have been
imposed to general medical care practices, including radiation
oncology.
Here I'm Highlighting Few challenges and Obstacles Came
During Covid
• The pre-existing burden on RTTs can be enhanced causing
severe psychological distress. The profession is being put
under pressure to provide optimum care to patients and
often are required to wear PPE for extended periods.
• Stretching of Duty hours due to lack of transport availability
for Patients.
• Fear of Getting effected by Covid -19 and loosing Job
• Need to give close attention on couch Hygienic and
Cleaning
• As RTTs guided to work in Teams so extra load of work made
mind distressful.
• Lack of Transportation availability For Medical Stuffs

15. COVID-19 has been suggested to be a highly contagious virus transmitted from human
to human, spreading via respiratory droplets or touching a virus contaminated surface
For the purpose of minimising the spread of the virus, the general public who present
with COVID-19 symptoms are often given recommendations such as social distancing
and self-quarantine
Therapist Should maintain effective communication channels with the patient,
reassuring them that extra safety precautions are in place.
RTT,s play a non-replaceable role in a cancer patients’ RT path- way. As well as planning
and delivering treatment, they provide a ‘‘face to face” contact and advise patients on
all aspects of RT at a time when patients are frightened and vulnerable. In this context,
RTTs are among frontline healthcare workers who are at risks of being exposed to
COVID-19.
.

16. Following key points on Patient care should be considered:
 Patients should be provided with educational information related to COVID-19
stressing the importance of good personal hygiene and comprehensive hand washing.
 Patients will be screened and triaged when entering the RT department
by checking their temperature and asking if they have any COVID-19 symptoms RTTs
should discuss the patients’ fitness for continuation of RT with the responsible radiation
oncologists. RT treatments may need to be deferred until symptoms resolve or may
continue with the appropriate precautions in place.
 Patients wear their own personal face masks even when they do not have symptoms.
Universal patient masking can be considered with the aim of minimising exposure risk
to both patients and staff. Patients should be advised that it may be necessary to take
off the face masks for some types of RT delivery e.g. head and neck external beam
radiotherapy.
 Patients should be asked not to bring accompanying persons into the RT department
unless absolutely essential. This will help reduce the number of people in the waiting
area of the RT department

17. .
The following recommendations are to be adopted in the RTT workflow:
 RTTs should wear face masks and must strictly follow appropriate ate hand hygiene
for setting up all RT patients. The wearing of a face mask should be considered not
only for protection of RTTs, but primarily for patient safety.
 RTTs should be provided with personal protection equipment (PPE) as per national
or WHO recommendations for treating patients with suspected or confirmed COVID-
19 status. For treatments and procedures where there is a higher chance of droplet
transmission, eye goggles and face shields should be considered.
 Patients with suspected or confirmed COVID-19 status should be treated on a
separate treatment machine with its own entrance if possible. Alternatively, these
patients can be treated at the end of the day to minimise any unnecessary contact
between these patients and other COVID-19 negative patients.
 RTTs should be split into teams with no crossover of staff from one team to another.
Additionally, a separate team can be assigned to duties without patient contact.
Modification of workflow in Radiation Delivery during Covid

18.  Where additional personnel for online image guided RT (IGRT) decisions are
required e.g. complex cases, gross anatomy changes, tumour displacement, these
should be viewed and approved at a remote station.
 Recognised offline IGRT correction protocols should be used if daily online imaging
is not possible, whilst ensuring that coverage for uncertainty is maintained.

19. .
Conclusions
In the current COVID-19 pandemic, normal life has been
affected immensely and will probably to some extend be
part of the near future.
RTTs should be empowered with appropriate guidance
and PPE in order to provide a safe RT service by limiting
potential viral exposure to patients, healthcare workers
and general public. In terms of the resource limitations
and short- age imposed by the COVID-19 outbreak.
The pre-existing burden on RTTs can be enhanced causing
severe psychological distress. The profession is being put
under pressure to provide optimum care to patients and
often are required to wear PPE for extended periods. RTTs
can be in constant distress worrying if they will get
infected or infect others at work and at home.