The impact of emerging technologies on education, roles and career progression of radiation therapists: a delphi consensus based on the ESTRO RTT workshop

<h2>Abstract</h2> Rapid technological advances in radiation oncology, including artificial intelligence (AI), online adaptive radiotherapy, and advanced imaging, are transforming radiotherapy practice and professional roles. Radiation Therapists (RTTs) must adapt their education, scope of practice, and career pathways to safely implement these technologies, yet international consensus on how this should be supported remains limited. A modified Delphi study was conducted following two online international workshops organised by the ESTRO Radiation Therapist (RTT) Committee. Expert RTTs participated in facilitated discussions exploring the impact of emerging technologies on RTT education, role extension, and career progression. Workshop data were thematically analysed to generate consensus statements, which were refined and validated through two survey rounds. Consensus was defined as ≥ 80% agreement. High levels of agreement were achieved across all themes. Participants agreed that emerging technologies expand rather than replace RTT roles, shifting responsibilities towards validation, quality assurance, and clinical decision-making. Structured education, critical thinking, and clear competency frameworks were identified as essential, alongside defined career pathways and access to continuing professional development. This position paper presents international expert consensus to inform education, workforce planning, and professional development in technologically evolving radiotherapy practice.