Defining Advanced Practice Radiation Therapy at the University of Texas MD Anderson Cancer Center: A Delphi Study



Journal Title

Journal ISSN

Volume Title



Background: U.S. research hospitals are using new technologies and techniques to develop treatment procedures that redefine the practice of radiation oncology and require an advanced practice radiation therapist (APRT). For example, at the University of Texas, MD Anderson Cancer Center (MD Anderson), physicians, physicists, and radiation therapists are developing treatment protocols for malignancies using the Elekta Unity, a hybrid magnetic resonance linear accelerator (MRL). MD Anderson initiated a program for radiation therapists to obtain diagnostic magnetic resonance imaging (MRI) credentials upon adopting MRL technology. The further education and clinical training required for MRI credentialing necessitate defining the competencies needed for the APRT. Purpose: This research aimed to identify a Comprehensive Competencies Profile (CCP) for advanced practice radiation therapy at MD Anderson. The CCP will be used to determine the role, responsibilities, and educational criteria for creating a master of science degree in advanced practice radiation therapy at MD Anderson. Methods: This study measured experts’ perceptions regarding the inclusion or exclusion of competencies for a CCP of practice standards for the APRT. Two panels of MD Anderson employees comprised the participants: Panel A had five expert radiation therapists who advised and made decisions regarding survey content; Panel B had 14 expert-level radiation therapists, 10 radiation oncologists, and 10 medical physicists. Competencies listed on the survey originated from the experiences of the Panel A members, the existing competencies for U.S. physician assistants (PAs) and radiologist assistants (RAs), and APRTs practicing in England, Canada, and Australia. Consensus was defined at 75%. Results: Panel B assessed a total of 107 competencies in a three-round Delphi consensus survey. The response rate for each round was 100%, 94.1%, and 91.12%, respectively. The first round produced a consensus for 39 of the 97 competencies. Participants contributed an additional 10 clinical practice competencies for rounds two and three consideration. The second round resulted in a consensus for 22 of the 67 items. The third round resulted in a consensus for four of the 45 competencies. The finding suggests that the APRT CCP should consist of 65 competencies, including three research, 12 leadership and management, and 50 clinical practice. The 65 competencies originated from five sources: 12 (18.5%) from MD Anderson, 22 (33.9%) from U.S PA and RA competencies, 19 (29.2%) APRT competencies in England, eight (12.3%) APRT competencies in Canada, and four (6.2%) APRT competencies in Australia. The level of agreement and comments for the remaining 42 competencies that did not reach consensus were categorized by potential reasons for disagreement. Conclusion: The Delphi method effectively determined which competencies should be included in the CCP that defines APRT practice at MD Anderson. This method allowed experts from three diverse disciplines to provide input and comments on which competencies would be the most valuable for APRTs. The CCP is cross-referenced to the radiation therapy practice standards and content specifications and may serve as the structure for a master of science degree in advanced practice radiation therapy.



Delphi, Advanced practice, Radiation therapy, Radiation oncology