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Before radiotherapy starts you are asked to agree to it in writing, after someone trained in your kind of treatment has explained what it aims to do, its likely and rare side effects, the other options including no treatment, and anything that matters to you in particular. You should have time to think, you are asked to confirm before treatment begins, and you can change your mind at any point.
In the UK, consent for radiotherapy follows the GMC's Decision making and consent (2020) and the Montgomery judgment (2015): the patient must be told of any material risk, judged by what a reasonable person in their position, or this particular patient, would think significant, and of reasonable alternatives including no treatment. The Royal College of Radiologists (RCR) publishes national site-specific consent forms (most sites, plus SRS, brachytherapy and a blank form; current versions from 2025, with Welsh-language versions), written with lawyers, patients and risk communication specialists, which list expected (50% to 100%), common (10% to 50%), less common (under 10%) and rare (under 1%) early and late side effects. The RCR recommends but does not mandate them.
The RCR implementation guidance (2021): consent is taken by a consultant clinical oncologist, a trained clinical oncology doctor, or an expert radiographer or specialist nurse trained in consent for that site; it is documented before the first fraction, ideally days before; it is confirmed before treatment starts (for example at planning); a patient in doubt is offered a second consultation; consent is renewed after a material change such as a new site or diagnosis; and withdrawal is documented. The forms are for adults with capacity only, not for children or adults who lack capacity. Patient-specific risks (job, health, activities, previous radiotherapy, radiosensitising drugs) are written in, and alternatives including no treatment are recorded in the notes. Separately, IR(ME)R 2017 requires employers' procedures to give the person, wherever practicable and before exposure, adequate information on the benefits and risks of the radiation dose. The RCR endorses no commercial e-consent platform and warns that some do not transfer the full signed form to the electronic record.
Why: The person explaining has to know the treatment well enough to answer your questions about it.
“Consent should be taken by a healthcare professional with sufficient training and experience who is also experienced in the management of the radiotherapy treatment site and protocol.”
Why: Agreeing to a treatment only means something if you know what else you could choose.
“In light of the Montgomery judgment it is essential that alternative treatments are discussed with the patient prior to the process of taking consent.”
Why: The law in the UK since 2015 is that you are told what matters to you, not only what doctors usually mention.
“The test of materiality is whether, in the circumstances of the particular case, a reasonable person in the patient’s position would be likely to attach significance to the risk, or the doctor is or should reasonably be aware that the particular patient would be likely to attach significance to it.”
Why: A side effect that is minor for most people can matter a great deal to one person, such as a voice change for a singer.
“Discussions should be personalised and must include any specific risks that are likely to be significant to that patient.”
Why: UK radiation law requires that people know why they are being exposed and what the dose may do.
“providing that wherever practicable, and prior to an exposure taking place, the individual to be exposed or their representative is provided with adequate information relating to the benefits and risks associated with the radiation dose from the exposure;”
Why: Time to think, talk to family and come back with questions makes the decision your own.
“Ideally there should be time (measured in days rather than hours) for the patient to reconsider their decision to undergo treatment before the first fraction is administered.”
Why: Weeks may pass between the clinic and the first treatment; a person may have new questions or a change of mind.
“When consent is taken in advance of treatment the patient should be asked to confirm consent before the start of treatment, for example, at their planning appointment.”
Why: Doubts deserve a proper conversation, not a signature under pressure.
“Where a patient expresses doubt about proceeding with the treatment, the opportunity to have a second consultation with a suitably trained and experienced healthcare professional prior to commencing treatment should be offered.”
Why: Agreement to one treatment is not agreement to a different one.
“Renewed consent should be sought where there is material change in the radiotherapy which will be delivered, which was not discussed at the initial consent.”
Why: You can stop treatment whenever you choose; the team should talk through what stopping means and write it down.
“A patient can withdraw consent at any time. Where consent is withdrawn this should be discussed and documented in full in the patient notes.”
Why: Decisions for children and for adults who cannot decide for themselves follow different legal rules.
“The RCR SSR consent forms should not be used in situations where a patient lacks capacity. In this situation the hospital should provide an appropriate alternative form. The RCR SSR consent forms should not be used for children/minors who are undergoing radiotherapy.”
Why: You keep a record of what you agreed to, and you have a say in how your information is used beyond your care.
“It is important that departments also have a local policy for patients to opt out of the use of information collected during radiotherapy being used in research, audit and teaching.”
Why: Some e-consent systems have been found to drop important details when the form is saved to the patient record.
“There is some evidence showing that with certain commercial e-consent forms, critical details of the e-consent are not transcribed when the signed e-consent is transferred to the patient’s electronic patient record.”
How care is usually carried out, read from the guidelines and standards cited. Your own team's protocol and their judgement come first; this page is for understanding it, not for doing it yourself.
In the UK: consent by a professional trained in that site, after a discussion of alternatives including no treatment and of every risk material to this patient (Montgomery 2015; GMC 2020), recorded on the RCR national site-specific form with patient-specific risks written in, taken days before the first fraction where possible, confirmed before treatment begins, renewed after any material change, and withdrawable at any time (RCR implementation guidance 2021; forms reissued 2025). IR(ME)R 2017 separately requires information on the benefits and risks of the radiation dose before exposure wherever practicable. These are consensus and legal standards; no trial compares consent processes for radiotherapy on outcomes. Practice outside the UK (the ACR-ASTRO practice parameter in the United States) could not be read here.
The Royal College of Radiologists 2021 · The Royal College of Radiologists 2021 · The Royal College of Radiologists 2025 · UK legislation (legislation.gov.uk) 2017
Where it differs: Many UK centres had their own site-specific forms before the national set; the RCR found no consensus on which side effects they listed. The RCR forms are recommended, not mandatory, and adoption goes through each hospital's consent or governance committee.
Evidence: RCR Development (2021): 54% of centres had a site-specific consent form for prostate cancer, with no consensus between them on the side effects included.
The Royal College of Radiologists 2021 · The Royal College of Radiologists 2021
Where it differs: Commercial e-consent systems present the consent form on a screen and save it to the electronic record. The RCR endorses none of them, says it knows of none that faithfully reproduces its forms, and asks organisations using them to risk-assess content accuracy, transfer to the record, updates and version control.
Evidence: RCR position statement (2026), citing some evidence that critical details are lost on transfer to the electronic record.
Where it differs: The RCR FAQs discuss sending forms in advance; the forms carry the patient's own initials on each page of side effects and a statement that alternatives were discussed.
Evidence: No trial; RCR practice advice.
The Royal College of Radiologists 2025 · The Royal College of Radiologists 2025
| Recommendation | Grade, as printed | Source |
|---|---|---|
| The RCR recommends but does not mandate its site-specific forms “The RCR supports and advises that hospitals use the SSR consent forms for radiotherapy. However, the RCR does not mandate the use of these forms.” | ungraded (college guidance) | The Royal College of Radiologists 2021 |
| A form does not replace the conversation “The consent form does not replace the need for a conversation and dialogue around the consent process.” | ungraded (college guidance) | The Royal College of Radiologists 2021 |
| Information on benefits and risks of the dose before exposure | statutory requirement (IR(ME)R 2017, Schedule 2) | UK legislation (legislation.gov.uk) 2017 |
| The RCR endorses no commercial e-consent platform “The RCR does not currently endorse ANY commercial e-consent platform for the delivery of radiotherapy consent forms.” | ungraded (position statement) | The Royal College of Radiologists 2026 |