1. Development of an advanced practice radiographer role during the clinical implementation of image guided radiotherapy (IGRT) at The James Cook University Hospital, Middlesbrough H.Bayles, C. Huntley, K. Pilling Patricia Benners model of Novice to Expert (1982) provides a template with which to exemplify the therapy radiographers journey to advanced practitioner. When achieved the Society of Radiographers guidelines for advanced practice can be utilised as a guide to evidence and maintain this level of practice. Expert Proficient Novice ‘The novice is extremely limited and inflexible’ An expert has an intuitive grasp of situations based on deep understanding When proficient decision-making is less laboured

2. As novices in the field of IGRT the enthusiastic team began to establish a skill set by: Attending a 3D anatomy study day at Sheffield Hallam University (SHU) Undertaking manufacturer applications training Beginning to cone beam CT (CBCT) scan palliative patients Undertaking offline CBCT scans with consultant mentorship Novice ‘ The novice is extremely limited and inflexible’ Development of an advanced practice radiographer role during the clinical implementation of image guided radiotherapy (IGRT) at The James Cook University Hospital, Middlesbrough H.Bayles, C. Huntley, K. Pilling To develop as proficient practitioners the team completed in house consultant lead competencies which enabled autonomous online CBCT image assessment of patients receiving radiotherapy for prostate, bladder, lung and oesophageal cancer. After visiting other radiotherapy centres both in the UK and Europe and in conjunction with the observations seen at The James Cook Hospital protocols and site specific advice were written and introduced. Consideration was made with regard to IRMER and the legal and ethical responsibilities of establishing a radiographer led IGRT service Proficient When proficient decision-making is less laboured Expert An expert has an intuitive grasp of situations based on deep understanding After working as proficient practitioners for some time the decision was made that to develop our role further we needed to formalise our level of practice. The IGRT team enrolled on the Expert Practice Module at SHU. Completion of this module led to an increase in responsibility and further imaging sites for online assessment were added to our autonomous working, including IGRT of patients undergoing IMRT for head and neck and SBRT for ca lung. We also became involved in imaging trails and instigated protocol changes to aid set up accuracy on the non IGRT capable linear accelerators. This was done using evidence from the IGRT imaging data obtained during the first two years of practice. To further formalise our role we are now working towards the SoR advanced practice accreditation.

3. Development of an advanced practice radiographer role during the clinical implementation of image guided radiotherapy (IGRT) at The James Cook University Hospital, Middlesbrough H.Bayles, C. Huntley, K. Pilling ‘The advanced practitioner will demonstrate expert clinical practice to secure service delivery of the highest quality’ SCoR 2010 Advanced Practitioner Expert practice is the core function of the advance practitioner role alongside professional leadership, practice and service development, education and training and research and development. The ability to fulfil these requirements has been achieved through many aspects of our practice. Involved in decisions to extend working day Sharing knowledge via user group meetings, presentations, site visits and online resources. Professional Leadership In house evidence based introduction of new immobilisation The development of new protocols and patient information Practice and Service Development Attending and undertaking study days and MSc modules relevant to practice Training others in the use of imaging software and image interpretation Education and Training Dietary protocols for patients undergoing prostate radiotherapy Imaging assessment of new immobilisation equipment before introduction into the radiotherapy department Research and Development The introduction of IGRT into the radiotherapy department at The James Cook University Hospital and the development of the three advanced practice roles has enabled;  Increased accuracy in treatment delivery  Increased efficiency  Reduced workload for consultants  Increased radiographer job satisfaction  Expansion of the initial service References: Benner, P., 1982. From novice to expert. The American Journal of Nursing, 82(3), 402 Society and College of Radiographers, 2010. Education and Professional Development Strategy: New Directions. SCoR