Radiation Therapist, Estonia

In Estonia, there are two radiotherapy departments with seven linear accelerators serving the population of 1,6 million people. Cancer incidence is on the rise – and with it, the workforce crisis in radiotherapy. Its impact on RTTs (radiation therapy technologists) reached a peak several years ago and the situation continues to be challenging.

In Estonia, RTTs are trained as radiographers at the undergraduate level with the radiotherapy specific content comprising roughly 3% of the curricula. Considering the rapid technological development, it is clearly not enough for RTTs to be able to start working independently as they graduate. Consequently, training starts at the clinic and might last from months to even years depending on who is available there to mentor and teach.

In addition, radiotherapy requires a totally different skillset: RTTs are part of an oncology treatment team, caring for psychologically challenged patients, being able to recognize the side effects and perform extremely precise treatments with high doses. To address the educational issue at some level, there is master`s program in radiotherapy. However, due to low number of target students, the program is international and in English. So far, the program has attracted RTTs interested in working as researchers, lecturers or dosimetrists which is of high importance as well, but the lack of knowledge of graduate RTTs is a continuing issue and requires extra resource from the departments in order to bring them to a standard where they can work accurately and safely.

Besides the educational aspect of the crisis, the number of RTTs who have changed their career path to diagnostics has increased. The prime reason: higher salaries. While the work in radiotherapy is rewarding and patients are profoundly grateful, it is also very intense. The number of patients can be overwhelming, resulting in hectic schedules, not enough time for quality treatment, and new colleagues to supervise. In one of the two departments, largely due to the aforementioned reasons, 1/4 of full-time RTTs quit during one year, ultimately resulting in shortening the linear accelerator working times. In this situation, it is impossible to treat patients within the timeframe for quality criteria. There have been cases where the disease has progressed while the patient has waited for the beginning of radiotherapy.

RTTs can have a significant impact on a cancer patient's treatment pathway, and they do. But their input is also needed on quality assurance teams, leadership, and patient counseling and education, besides the daily positioning and IGRT. At present, they simply do not have enough time – and motivation – to take on these extra responsibilities.

The RTTs current situation and rapid need for unified educational benchmarks across the EU, must be highlighted. With radiotherapy, many cancer patients can be treated but only if performed with high quality.