The Ottawa Hospital Cancer Centre implemented a TomoTherapy program for image-guided IMRT. Two TomoTherapy units were installed and are used to treat over 18 patients per day. Therapists are involved in all aspects of treatment planning and delivery using a full scope practice model. This allows for streamlined, accurate treatment and reduced toxicities. Over 300 patients have been treated since 2005 over a variety of cancer sites. Planning time has decreased as experience increased. Therapists feel this model allows them to better contribute to patient care.