A Short History of Radiography — Rise Up Against Cancer

To explore the origins of the radiography profession, we must first look further back to the discovery of radiation in the medical world.

X-rays were first discovered in 1895 by Wilhelm Conrad Röntgen and the first x-ray image taken was of his wife’s hand. Just three days after the official announcement of the discovery of X-rays, they were being used to treat cancer. The first treatment involved a 1-hour single treatment for breast cancer. 1903 saw patients with stomach cancer being irradiated 15-30 minutes for a total of 80 fractions with successful disease control and pain improvement. From this date onwards, research has continued to explore how we can use radiation in many different forms in the safest way to treat cancer most effectively.

So we could argue that Wilhelm Röntgen, when taking the image of his wife’s hand, became the first-ever radiographer.

The 1930s saw an increase in radium centres being created in order to utilise and optimise the use of radium in the treatment of cancer. Running these centres were ‘Radium Officers,’ which became the first established full-time radiotherapists.

For the first 50 years of radiology, the roles of technician and radiologist were synonymous however, it was apparent that these roles needed to be differentiated as it was proving difficult to find professionals to fill radiotherapy roles. In the years prior to the birth of the NHS in 1948 the Society of Radiographers wrote to the Faculty of Radiologists requesting that the radiography diploma be split into therapeutic and diagnostic to address the “apparent general disinclination on the part of radiographers to undertake radiotherapy work” whilst recognising “the possible demand in the future for a number of radiotherapy technicians”. Recommendations at this time were stalled somewhat by the war, but in 1945-1951, an additional certificate in therapy was offered whereby radiographers would take their MSR examination and then train for a further six months to acquire their Certificate in therapy. 150 people took this additional examination in that time period. After this, it was decided to separate the two qualifications completely, and this is where the profession officially took its different paths. In 1989, the first radiography degree was offered by the University of Portsmouth. However, this faced some criticism, with it being argued that radiography was a practical subject unsuited to that level of education. Yet, by the mid-1990s, degree entry was the standard for radiography.

Today, diagnostic and therapeutic radiography students share many first-year lessons in anatomy and radiation physics however, after the first year, the two cohorts of students remain separate, both undertaking a full-time 3-year Bachelor of Science degree in diagnostic radiography or Radiotherapy and Oncology. This qualification can be delivered as a post-graduate qualification with a shorter course length, and PhD courses are now available. Today, diagnostic and therapeutic radiography students share many first-year lessons in anatomy and radiation physics however, after the first year, the two cohorts of students remain separate, both undertaking a full-time 3-year Bachelor of Science degree in diagnostic radiography or Radiotherapy and Oncology. This qualification can be delivered as a post-graduate qualification with a shorter course length, and PhD courses are now available.

A published report in 2018 from the Health and Care Professions Council stated that there were 27,041 diagnostic radiographers and 4615 therapeutic radiographers registered in the UK. The profession in the UK now holds three protected titles: Radiographer, Diagnostic Radiographer, and Therapeutic Radiographer, although, around the world, it is known by many different names. Therapeutic radiographers can be known as radiotherapists, Radiation technologists, Radiation technicians, and Therapy Radiographers. Diagnostic radiographers are often referred to as x-ray technicians, radiologic technicians, radiology technologists, and radiologic imaging technologists.

According to NHS health careers, a diagnostic radiographer will use cutting-edge technology to take images of the insides of patients to help understand and diagnose conditions. Based in a hospital, you will work with patients and colleagues to design treatment programmes, and support patients until their treatment ends.

As a therapeutic radiographer, you will be responsible for the planning and delivery of accurate radiotherapy treatments using a wide range of technical equipment.

These definitions are very simplistic and do little to reflect the complexity of these professions and how varied the roles within them can be.

The profession of diagnostic and therapeutic radiographer has developed so much in the last 20 years to include many sub-specialties. The benefit of this has been to elevate workplace pressures on radiography and radiotherapy departments and improve workflow. In the diagnostic setting, it allows professionals to have in-depth knowledge in one area of radiography and one imaging modality; within that modality, they can further sub-specialise. This has allowed radiographers to make important radiographic decisions without having to wait for clinician availability, thereby improving workflow. For therapeutic radiographers, sub-specialising allows for the efficient running of a department, whether a radiographer is an imaging lead, training lead, consultant radiographer, pre-treatment, or review radiographer. A lot of the sub-specialties require further training and qualification to obtain this role and can alleviate the pressures of clinicians by taking over roles and tasks that were initially designated to them. This allows them to focus on other areas of their work and often means patients have better access to care as there aren’t long waits to see Doctors. The acquisition of new qualifications and skills has made radiographers a more present face in the multidisciplinary team; they are better integrated into patient treatment decisions and hospital matters.

In the next ten years, the profession of both diagnostic and therapeutic radiographer will develop even further as we upskill this profession and fight to be recognised as a highly skilled workforce that is integral to the hospital setting.

Kate Yip, Clinical Engagement Manager, Leo Cancer Care

Please note: The Leo Cancer Care technology is not yet clinically available and will not treat patients until the required regulatory approval has been achieved.