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Ability of radiation therapists to assess radiation-induced skin toxicity


  • U Acharya BAppSc (MRS) – Radiation Therapy; J Cox PhD; M Rinks PhD; P Gaur MPH; M Back MBBS, RANZCR.
  • Conflict of interest: The authors do not have any conflicts of interest related to the contents of this article.


Dr Jennifer Cox, Northern Sydney Cancer Centre, Radiation Oncology, Royal North Shore Hospital, St Leonards, NSW 2065, Australia.




Radiation therapy has seen enhancement of the radiation therapist (RT) role, with RTs and nurses performing duties that were traditionally in the radiation oncologist's (RO) domain. This study aimed to assess whether RTs can consistently grade radiation-induced skin toxicity and their concordance with the gradings given by ROs.


Digital photographs of skin reactions were taken at weeks 1, 3 and 6 of radiotherapy on nine patients with breast cancer. The randomly ordered photographs were reviewed once by eight ROs and four RO registrars and on two occasions separated by 6 weeks by 17 RTs. All graded the skin toxicities using the revised Radiation Therapy Oncology Group system.


No significant difference was seen between the median scores of the RTs at the first scoring session and the RO/Registrar group. The RTs at both measurement times showed greater inter-rater reliability than the RO/Registrars (W = 0.6866, time 1 and 0.6981 time 2, vs. 0.6517), with the experienced RTs the most consistent (W = 0.7078). The RTs also showed high intra-rater reliability (rho = 0.8461, P < 0.0010).


These results from RTs with no specific preparation indicate that experienced RTs could assess breast cancer skin toxicity as part of their role.