Comparison between radiographers with sonography education working in remote Australia and radiologists' interpretation of ultrasound examinations.

INTRODUCTION: Radiographers working in remote Far North Queensland (FNQ), Australia, need to possess unique skills sets in order to provide culturally safe practice to predominantly Indigenous communities. Due to the lack of onsite radiologists in FNQ, radiographers need to provide preliminary findings to referring practitioners including sonographic findings. The accuracy of such findings has not been evaluated to date. The objective of this study was to compare the level of agreement and recommendations for further investigations of FNQ radiographers to teleradiologists' reports. As radiographic findings are not recorded or stored as part of routine practice, only sonographic findings were included in the study. METHODS: Consecutive de-identified ultrasound cases were extracted between January and March 2019 inclusively by an independent investigator. The researcher scored the ultrasound cases between 1 and 4 according to levels of agreement between sonographic findings and teleradiologists' reports, and recommendations between radiographers and teleradiologists were also compared using frequency analysis. RESULTS: Five-hundred and thirty-two ultrasound cases were included for this study. Of those, 517 (97.2%) were in complete agreement and 15 (2.8%) reported minor discrepancies. There were no moderate or major discrepancies suggesting an overall accuracy rate of 100% as the radiographer/sonographer findings were in close agreement with the teleradiologists' reports. There was complete agreement regarding further clinical recommendations in 453 (85%) cases. The discrepancy in the remaining 15% of cases did not lead to any adverse or changed patient management. CONCLUSIONS: This study supports existing evidence about the accuracy and timely communication of sonographic findings to radiologists and other health care professionals, in keeping with the Medical Radiation Practice Board of Australia expectations. It is likely that radiographer comments on plain radiographic images are equally as reliable, but this remains to be explored.

Navigating uncertainty: The implementation of Australian radiation therapy advanced practitioners.

Radiation therapy advanced practice has been implemented in several international jurisdictions; however, it is yet to be systematically integrated into Australian radiation oncology centres. This paper presents the outcomes of a doctoral research study to explore the factors that may be influencing the implementation of radiation therapy advanced practice in Australia. Using a constructivist grounded theory methodological approach to guide procedures, data collection occurred via 6 nationally facilitated online (video mediated) focus groups, and during interviews and observations at 5 purposively selected clinical case study locations. Data analysis led to the development of a grounded theory 'navigating uncertainty' to describe the process influencing the implementation of radiation therapy advanced practice in Australia. Navigating uncertainty is explained by three inter-related contextual processes of conceptualising radiation therapy advanced practice, integrating radiation therapy advanced practice, and becoming the radiation therapy advanced practitioner. The research suggests that the process of actively finding a way to accommodate uncertainty is necessary for advanced practice implementation objectives to be realised.

Duration-dependent margins for prostate radiotherapy-a practical motion mitigation strategy.

BACKGROUND AND OBJECTIVE: The magnitude of intra-fractional prostate displacement (change from initial position over time) is associated with the duration of the patient lying on the radiotherapy treatment couch. This study reports a minute-by-minute association and calculates the impact of this displacement on duration-dependent margins using real-time intra-fractional position data monitored by four-dimensional transperineal ultrasound (4D TPUS). MATERIALS AND METHODS: A total of 55 patients were recruited prospectively. Intra-fractional position of the prostate was monitored in real-time using a 4D TPUS Clarity® system. A total of 1745 monitoring sessions were analysed. Van Herk's margin recipe (2.5∑ + 1.64((σ2 + σp2)1/2 - σp)) was used to estimate the duration-dependant margins for every minute, up to the 15th minute. Linear regression analysis was then performed on the overall margins against time and direction. RESULTS: The mean intra-fractional position was 0.76 mm Inferior (Inf), 0 mm Lateral (Lat) and 0.94 mm Posterior (Post) at the 15th minute. A minimum margin expansion of 2.42 mm (Superior/Inf), 1.02 mm (Left/Right) and 2.65 mm (Anterior/Post) was required for an 8­minute treatment compared to 4.29 mm (Sup/Inf), 1.84 mm (Lt/Rt) and 4.63 mm (Ant/Post) for a 15-minute treatment. The required margin expansion increased linearly (R2 = 0.99) in all directions (p < 0.01). However, while there was no statistically significant difference (p = 0.10) in the required margin expansion in the Sup/Inf and Ant/Post directions respective of the time duration, the margins were much bigger compared to those in the Lt/Rt direction (p < 0.01). CONCLUSION: We report our experience in deriving the minimum duration-dependant margin to generate the required planning target volume for prostate radiotherapy. The required margin increases linearly in all directions within the 15-min duration; thus, the margin will depend on the duration of the technique chosen (IMRT/VMAT/3DCRT/proton).

Quantification of Student Radiographic Patient Positioning Using an Immersive Virtual Reality Simulation.

INTRODUCTION: Immersive virtual reality (VR) simulation environments facilitate novel ways for users to visualize anatomy and quantify performance relative to expert users. The ability of software to provide positional feedback before a practitioner progresses with subsequent stages of examinations has broad implications for primary and allied healthcare professionals, particularly with respect to health and safety (eg, exposing to x-rays). The effect of training student-radiographers (radiology technicians), with a VR simulation environment was quantitatively assessed. METHODS: Year 1 radiography students (N = 76) were randomly split into 2 cohorts, each of which were trained at performing the same tasks relating to optimal hand positioning for projection x-ray imaging; group 1 was trained using the CETSOL VR Clinic software, whereas group 2 was trained using conventional simulated role-play in a real clinical environment. All participants completed an examination 3 weeks after training. The examination required both posterior-anterior and oblique hand x-ray positioning tasks to be performed on a real patient model. The analysis of images from the examination enabled quantification of the students' performance. The results were contextualized through a comparison with 4 expert radiographers. RESULTS: Students in group 1 performed on average 36% (P < 0.001) better in relation to digit separation, 11% (P ≤ 0.001) better in terms of palm flatness and 23% (P < 0.05) better in terms of central ray positioning onto the third metacarpal. CONCLUSION: A significant difference in patient positioning was evident between the groups; the VR clinic cohort demonstrated improved patient positioning outcomes. The observed improvement is attributed to the inherent task deconstruction and variety of visualization mechanisms available in immersive VR environments.

Improvement of radiographer commenting accuracy of the appendicular skeleton following a short course in plain radiography image interpretation: A pilot study.

INTRODUCTION: Radiographers are at times required to provide preliminary information on plain radiography when significant findings are identified. The aim of the study was to evaluate the effectiveness of two short training modules to improve the accuracy of image interpretation of the appendicular skeleton amongst a group of radiographers. METHODS: Eight radiographers volunteered to participate in the study. All undertook a pre-test and, following delivery of course materials, an immediate post-test for two consecutive modules. A retention test was undertaken 6 months later. Sensitivity (Sn), specificity (Sp) and accuracy (Acc) scores were evaluated against the "Gold Standard" radiologists' reports. Paired-samples t-tests were carried out to compare image interpretation scores between the start of module one to the end of module two, and between the end of module 2 and 6 months later. Summary receiver operating characteristics (SROC) scores on each of the participants' module two post-test study results were undertaken. RESULTS: Significant improvements in scores were achieved between the mean (SD) scores of module 1 pre-test (77.5 (±3.9)) and the module 2 post-test (83.6 (±3.2) (P =0.022)). Sn, Sp and Acc scores increased from the start of module 1 pre-test to the end of module 2 post-test (Sn: 82.28-86.25%; Sp: 75.29-84.66%; Acc: 81.68-85.97%). The retention test revealed a non-significant reduction in mean scores (80.0 (±5.1)) when compared to post-test module 2 (83.6 (±3.2) (P =0.184)). SROC revealed an area under the curve of 0.90. CONCLUSION: Participants achieved significant improvements in commenting accuracy on plain radiography of the appendicular skeleton after completion of the two modules. However, continuous application and ongoing professional development is essential in order to maintain and develop the skills acquired.

The implementation of a haptic feedback virtual reality simulation clinic with dynamic patient interaction and communication for medical imaging students.

INTRODUCTION: An immersive virtual reality (VR) simulation clinic with dynamic patient interaction and communication was developed to facilitate the training of medical radiation science students. The software "CETSOL VR Clinic" was integrated into the Medical Imaging programme at Monash University in 2016 in order to benchmark student experiences against existing simulation techniques (Shaderware™). METHODS: An iterative approach to development, based on two cycles of user feedback, was used to develop and refine the simulated clinical environment. This environment uses realistic 3D models, embedded clinical scenarios, dynamic communication, 3D hand gesture interaction, gaze and positional stereoscopic tracking and online user capabilities using the Unity™ game and physics engines. Students' perceptions of educational enhancement of their positioning skills following the use of the simulation tools were analysed via a 5-point Likert scale questionnaire. RESULTS: Student perception scores indicated a significant difference between simulation modalities in favour of the immersive CETSOL VR Clinic, χ2 (4, N = 92) = 9.5, P-value <0.001. CONCLUSION: Student perception scores on improvement of their clinical and technical skills were higher for the hand-positioning tasks performed with the CETSOL VR Clinic™ than with the comparative benchmark simulation that did not provide dynamic patient interaction and communication.

Using Online Meeting Software to Facilitate Geographically Dispersed Focus Groups for Health Workforce Research.

Focus groups as a data collection method in qualitative research have been used for several decades with great effect. Recent developments in online mechanisms for communication have prompted several researchers to explore alternate means of facilitating focus group participation. However, much of the online focus group literature has explored the use of text-based communication; there are few reports on the application of real-time online video-enabled software. In this article, we seek to inform the growing use of online-meeting software-mediated focus groups by reporting and analyzing its application within the context of a health workforce study among geographically dispersed radiation therapy professionals.

Improving the delivery of health care to patients: radiographers and frontline image interpretation.

Australia led the world in raising the level of entry-level education to practice as a radiographer. It now lags behind in formalising radiographer input into the process of image interpretation. The time has come to rectify this situation.

Analysis of intra-fraction prostate motion and derivation of duration-dependent margins for radiotherapy using real-time 4D ultrasound.

BACKGROUND AND PURPOSE: During radiotherapy, prostate motion changes over time. Quantifying and accounting for this motion is essential. This study aimed to assess intra-fraction prostate motion and derive duration-dependent planning margins for two treatment techniques. MATERIAL AND METHODS: A four-dimension (4D) transperineal ultrasound Clarity® system was used to track prostate motion. We analysed 1913 fractions from 60 patients undergoing volumetric-modulated arc therapy (VMAT) to the prostate. The mean VMAT treatment duration was 3.4 min. Extended monitoring was conducted weekly to simulate motion during intensity-modulated radiation therapy (IMRT) treatment (an additional seven minutes). A motion-time trend analysis was conducted and the mean intra-fraction motion between VMAT and IMRT treatments compared. Duration-dependent margins were calculated and anisotropic margins for VMAT and IMRT treatments were derived. RESULTS: There were statistically significant differences in the mean intra-fraction motion between VMAT and the simulated IMRT duration in the inferior (0.1 mm versus 0.3 mm) and posterior (-0.2 versus -0.4 mm) directions respectively (p ≪ 0.01). An intra-fraction motion trend inferiorly and posteriorly was observed. The recommended minimum anisotropic margins are 1.7 mm/2.7 mm (superior/inferior); 0.8 mm (left/right), 1.7 mm/2.9 mm (anterior/posterior) for VMAT treatments and 2.9 mm/4.3 mm (superior/inferior), 1.5 mm (left/right), 2.8 mm/4.8 mm (anterior/posterior) for IMRT treatments. Smaller anisotropic margins were required for VMAT compared to IMRT (differences ranging from 1.2 to 1.6 mm superiorly/inferiorly, 0.7 mm laterally and 1.1-1.9 mm anteriorly/posteriorly). CONCLUSIONS: VMAT treatment is preferred over IMRT as prostate motion increases with time. Larger margins should be employed in the inferior and posterior directions for both treatment durations. Duration-dependent margins should be applied in the presence of prolonged imaging and verification time.

Reduction of intra-fraction prostate motion - Determining optimal bladder volume and filling for prostate radiotherapy using daily 4D TPUS and CBCT.

BACKGROUND AND PURPOSE: Inconsistent bladder and rectal volumes have been associated with motion uncertainties during prostate radiotherapy. This study investigates the impact of these volumes to determine the optimal bladder volume. MATERIALS AND METHODS: 60 patients from two Asian hospitals were recruited prospectively. 1887 daily cone-beam computed tomography (CBCT) images were analysed. Intra-fraction motion of the prostate was monitored real-time using a four-dimension transperineal ultrasound (4D TPUS) Clarity® system. The impact of planned bladder volume, adequacy of daily bladder filling, and rectum volume on mean intra-fraction motion of the prostate was analysed. Patients' ability to comply with the full bladder hydration protocol and level of frustration was assessed using a questionaire. Acute side effects were assessed using the Common Terminology Criteria for Adverse Events (CTCAE) version 3.0 and quality of life (QoL) assessed using the International Prostate Symptom Score (IPSS). RESULTS: The mean (SD) bladder and rectum volumes achieved during daily treatment were 139.7 cm3 (82.4 cm3) and 53.3 cm3 (18 cm3) respectively. Mean (SD) percentage change from planned CT volumes in bladder volume was reduced by 8.2% (48.7%) and rectum volume was increased by 12.4% (42.2%). Linear Mixed effect model analysis revealed a reduction in intra-fraction motion in both the Sup/Inf (p = 0.008) and Ant/Post (p = 0.0001) directions when the daily bladder was filled between 82 and 113% (3rd Quartiles) of the planned CT volumes. A reduction in intra-fraction motion of the prostate in the Ant/Post direction (z-plane) (p = 0.03) was observed when the planned bladder volume was greater than 200 ml. Patients complied well with the hydration protocol with minimal frustration (mean (SD) scores of 2.1 (1.4) and 1.8 (1.2) respectively). There was a moderate positive correlation (0.496) between mean bladder volume and IPSS reported post-treatment urinary straining (p = 0.001). CONCLUSIONS: A planned bladder volume >200 cm3 and daily filling between 82 and 113%, reduced intra-fraction motion of the prostate. The hydration protocol was well tolerated.

A comparison of interfraction setup error, patient comfort, and therapist acceptance for 2 different prostate radiation therapy immobilization devices.

PURPOSE: Our purpose was to investigate interfraction setup error of the immobilization device required to implement transperineal ultrasound compared with the current, standard immobilization device. Patient comfort and radiation therapist (RT) satisfaction were also assessed. METHODS AND MATERIALS: Cone beam computed tomography images were acquired before 4069 fractions from 111 patients (control group, n = 56; intervention group, n = 55) were analyzed. The intervention group was immobilized using the Clarity Immobilization System (CIS), comprising a knee rest with autoscan probe kit and transperineal ultrasound probe (n = 55), and control group using a leg immobilizer (LI) (n = 56). Interfraction setup errors were compared for both groups. Weekly questionnaires using a 10-point visual analog scale were administered to both patient groups to measure and compare patient comfort. RT acceptance for both devices was also compared using a survey. RESULTS: There was no significant difference in the magnitude of interfraction cone beam computed tomography-derived setup shifts in the lateral and anteroposterior direction between the LI and CIS (P = .878 and .690, respectively). However, a significant difference (P = .003) was observed in the superoinferior direction between the 2 groups of patients. Patient-reported level of comfort and stability demonstrated no significant difference between groups (P = .994 and .132). RT user acceptance measures for the LI and CIS were ease of handling (100% vs 53.7%), storage (100% vs 61.1%), and cleaning of the devices (100% vs 64.8%), respectively. CONCLUSIONS: The CIS demonstrated stability and reproducibility in prostate treatment setup comparable to LI. The CIS device had no impact on patient comfort; however, RTs indicated a preference for LI over the CIS mainly because of its weight and bulkiness.

Occupational burnout among radiographers, sonographers and radiologists in Australia and New Zealand: Findings from a national survey.

INTRODUCTION: Evidence demonstrates that health care professionals are more prone to burnout than other professionals due to the emotionally taxing interactions they have with their patients on a daily basis. The aims of this study were to measure occupational burnout levels among sonographers, radiographers and radiologists and to examine predictors of burnout according to demographic characteristics. METHODS: A cross-sectional online survey was administered in 2010 to radiographers, sonographers and radiologists who were members of the following professional bodies: Australian Institute of Radiography, Australian Sonographers Association and The Royal Australian and New Zealand College of Radiologists. The Maslach Burnout Inventory was used to measure burnout levels for each profession. Data were analysed using SPSS Ver 20 (IBM, Chicago, IL, USA) statistical software. RESULTS: A total of 613 radiographers, 121 sonographers and 35 radiologists participated in the survey. Radiographers, sonographers and radiologists had a high mean (±SD) burnout score for emotional exhaustion (39.9 ± 8.5, 42.2 ± 8.5 and 44.9 ± 7.1 respectively) and depersonalization (18.9 ± 5.5, 20.3 ± 5.8 and 20.6 ± 5.6) compared to MBI norms. Radiographers also had low personal achievement (30.8 ± 5.5) compared to MBI norms. Radiographers and sonographers who were male, worked >10 hours overtime and spent <10% of their time training students per week had significantly higher depersonalization scores (p < 0.05). CONCLUSION: Burnout levels among radiographers, sonographers and radiologists are high and likely to vary according to some demographic and work-related factors. Further research is needed to examine ways to alleviate burnout in these professions so that loss of experienced staff due to burnout can be minimized and quality of patient care can be maintained.

Managing clinical education through understanding key principles.

BACKGROUND: Traditionally, a practicum facilitated the integration of on-campus learning and practical workplace training. Over the past 3 decades, an educative practicum has evolved that promotes clinical reasoning, including analytical and evaluative abilities, through reflective practice. Anecdotal evidence indicates that the delivery of clinical education within medical radiation science entry-level programs continues to vacillate between traditional practicums and the new reflective practicums. PURPOSE: To review the literature about clinical education within the medical radiation sciences and identify key principles for practitioners seeking to reflect upon and improve their approach to teaching and supporting students in the clinical environment. METHODS: A search of 3 major journal databases, Internet searches, and hand searches of reference lists were conducted to identify literature about clinical education in the medical radiation sciences from January 1, 2000, to December 31, 2012. Twenty-two studies were included in this review. RESULTS: The 5 key elements associated with clinical education include the clinical support model and quality, overcoming the theory-practice gap, learning outcomes and reliable and valid assessment, preparing and supporting students, and accommodating differing teaching and learning needs. DISCUSSION: Many factors influence the quality of clinical education, including the culture of the clinical environment and clinical leadership roles. Several approaches can help students bridge the theory-practice gap, including simulators, role-playing activities, and reflective journals. In addition, clinical educators should use assessment strategies that objectively measure student progress, and they should be positive role models for their students. CONCLUSION: The successful clinical education of students in the medical radiation sciences depends upon the systems, structures, and people in the clinical environment. Clinical education is accomplished through the collaborative efforts of the clinical practitioner, the academic, and the student. Universities should include introductory material on clinical learning and teaching in their radiologic science curriculum.

An Online Survey Investigating Australian Radiation Therapists' Responses to Hypothetical Dilemmas Concerning Impaired Fitness to Practise.

INTRODUCTION: Impairment in health care professionals has been identified as one of the determinants of fitness to practise (FTP), and practitioners have a legal obligation to notify regulatory authorities if they experience it. However, there remains confusion as to how radiation therapists (RTs) discern what constitutes impaired practice and how they would respond to such dilemmas. The aim of this study was to identify the range of responses to hypothetical professional impairment dilemmas, which may inform an educational strategy for improving reporting occurrences. METHODS: A convenience sample of Australian RTs was invited to participate in an anonymous online survey that presented a range of FTP dilemmas relating to impairment, competence, and values/ethics. Participants were asked to describe how they would deal with such situations. Qualitative responses were coded using NVivo software. This article reports on the themes that emerged from the impairment dilemmas. RESULTS: One hundred eighty-two RTs responded to the survey. The emerging key theme and subthemes included dealing with the situation, removal of the practitioner from the situation, stop working, avoiding responsibility, giving the benefit of the doubt, and carrying on with the workload. CONCLUSIONS: Practitioners' interpretations of the impairment dilemmas varied, which, in turn, influenced their suggestions of how they would deal with them. The continuum of responses supports a key tenant of the interpretive paradigm-multiple interpretations of social phenomena exist. Those seeking to improve practitioner understanding of their obligations under national law should consider a scenario-based approach to raising awareness of FTP issues such as impairment.

Practice education learning environments: the mismatch between perceived and preferred expectations of undergraduate health science students.

BACKGROUND: Practical hands-on learning opportunities are viewed as a vital component of the education of health science students, but there is a critical shortage of fieldwork placement experiences. It is therefore important that these clinical learning environments are well suited to students' perceptions and expectations. PURPOSE: To investigate how undergraduate students enrolled in health-related education programs view their clinical learning environments and specifically to compare students' perception of their 'actual' clinical learning environment to that of their 'preferred/ideal' clinical learning environment. METHOD: The Clinical Learning Environment Inventory (CLEI) was used to collect data from 548 undergraduate students (55% response rate) enrolled in all year levels of paramedics, midwifery, radiography and medical imaging, occupational therapy, pharmacy, nutrition and dietetics, physiotherapy and social work at Monash University via convenience sampling. Students were asked to rate their perception of the clinical learning environment at the completion of their placements using the CLEI. RESULTS: Satisfaction of the students enrolled in the health-related disciplines was closely linked with the five constructs measured by the CLEI: Personalization, Student Involvement, Task Orientation, Innovation, and Individualization. Significant differences were found between the student's perception of their 'actual' clinical learning environment and their 'ideal' clinical learning environment. CONCLUSION: The study highlights the importance of a supportive clinical learning environment that places emphasis on effective two-way communication. A thorough understanding of students' perceptions of their clinical learning environments is essential.

Learning style preferences of Australian health science students.

OBJECTIVES: It has been identified that health science student groups may have distinctive learning needs. By university educators' and professional fieldwork supervisors' being aware of the unique learning style preferences of health science students, they have the capacity to adjust their teaching approaches to best fit with their students' learning preferences. The purpose of this study was to investigate the learning style preferences of a group of Australian health science students enrolled in 10 different disciplines. METHODS: The Kolb Learning Style Inventory was distributed to 2,885 students enrolled in dietetics and nutrition, midwifery, nursing, occupational therapy, paramedics, pharmacy, physiotherapy, radiation therapy, radiography, and social work at one Australian university. A total of 752 usable survey forms were returned (response rate 26%). RESULTS: The results indicated the converger learning style to be most frequently preferred by health science students and that the diverger and accommodator learning styles were the least preferred. CONCLUSION: It is recommended that educators take learning style preferences of health science students into consideration when planning, implementing, and evaluating teaching activities, such as including more problem-solving activities that fit within the converger learning style.

Radiographers' role in radiological reporting: a model to support future demand.

The demand for diagnostic imaging services has grown faster than the supply of radiologists in Australia. Given the predicted ageing of the population and contraction of the health care workforce, the current workforce model is not sustainable. Extending the role of radiographers in a specific range of radiological reporting tasks may help meet demand, relieving some pressure on radiologists. Experience overseas suggests that radiographer reporting can reduce patient waiting times, release radiologists for other duties and improve the retention of radiographers. Evidence shows that, with appropriate education and training, the accuracy of radiographers in interpreting plain x-rays is comparable to that of radiologists. Australian universities are well placed to offer radiographers postgraduate education in image interpretation.

Perceptually lossless medical image coding.

A novel perceptually lossless coder is presented for the compression of medical images. Built on the JPEG 2000 coding framework, the heart of the proposed coder is a visual pruning function, embedded with an advanced human vision model to identify and to remove visually insignificant/irrelevant information. The proposed coder offers the advantages of simplicity and modularity with bit-stream compliance. Current results have shown superior compression ratio gains over that of its information lossless counterparts without any visible distortion. In addition, a case study consisting of 31 medical experts has shown that no perceivable difference of statistical significance exists between the original images and the images compressed by the proposed coder.

Evaluation of selection criteria for graduate students in radiation therapy.

Selection of suitable students into graduate medical and specialist health professional courses can be difficult. Historically, selection of students was primarily based on prior academic performance. Recently, however, more emphasis has been placed on considering broader academic backgrounds and personal characteristics and attitudes of students, but no reliable measurement tool is available to predict student success and satisfaction with their choice of profession. The aim of this study was to survey practising radiation therapists in Australia to seek their opinions regarding suitable selection criteria for graduate entry radiation therapy (RT) students in order to optimize selection procedures for future applicants. Four hundred questionnaires were sent to nine RT centres in three states within Australia. All nine clinics participated in the survey and 189 questionnaires were returned. Results show that the majority of radiation therapists place a high level of importance upon a sound knowledge of physics and mathematics, as well as life experience, and agree that a visit to an RT clinic plus an interview comprise important components of the selection process. Humanities, psychology and a psychometric test were not viewed as essential entry requirements. Experienced radiation therapists placed less value on academic performance in the primary degree and were more likely to include an interview as a selection criterion than junior practitioners. Empathy for patients was identified as the most important personal attribute. It is thus recommended that not only cognitive but also personal skills be evaluated during the selection of prospective radiation therapists.