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Skill mix redesign in Italian radiation oncology: A technical note on advanced practice radiation therapists
1Radiation Oncology Unit, Azienda Ospedaliero-Universitaria di Sassari, University of Sassari, Sassari, Italy; AOU Azienda Ospedaliera Universitaria di Sassari, Radioterapia Oncologica, Italy.
Introduction:
Radiation oncology departments are increasingly required to deliver complex, technology-dependent care while facing medical workforce constraints. In the Italian context, reduced attractiveness of radiation oncology training and increasing workflow complexity highlight the need for transparent skill-mix models. This technical note proposes a practical framework for advanced practice radiation therapists (APRTs) to support selected technical, organisational and protocol-driven components of the radiotherapy pathway while preserving radiation oncologist (RO) accountability for clinical decision-making.
Methods:
A structured narrative and implementation-oriented approach was used. Literature on radiotherapy utilisation, workforce constraints, APRT roles, time-driven activity-based costing and governance was integrated with the Italian professional context. Activities were classified according to medical decision intensity, technical standardisation, patient-specific variability, safety risk and suitability for protocol-based execution.
Results:
Potential APRT roles include simulation preparation, image-guided radiotherapy matching within defined thresholds, organ-at-risk contouring support, auto-contouring review, dosimetric data extraction, toxicity screening, quality assurance, incident reporting and pathway coordination. Non-delegable medical responsibilities include treatment indication, informed consent, prescription, target definition, final plan approval, adaptive decisions affecting prescription or target coverage, toxicity management and oncological follow-up. Safe implementation requires formal education, clinical mentorship, competency assessment, written standard operating procedures, escalation rules, audit and multidisciplinary governance.
Conclusion:
APRTs should not be viewed as substitutes for ROs, but as a structured workforce strategy to preserve medical decision-making capacity and improve workflow resilience in Italian radiotherapy services.
Implications For Practice:
Prospective time-motion, safety and health-economic evaluations are needed to quantify the operational impact and transferability of APRT implementation.
