I guess from the description you gave it sounds like the medical physicist is responsible for most everything except talking with the patients. I know that is an oversimplification but is that sentiment correct? Thanks!
Definitely not, you are oversimplifying greatly.
Generally this is how it goes,
1. Radiation Oncologist receives new patient referral and sees patient. The decision whether or not to give radiation is solely in the hands of the Rad Onc. In addition to discussion with the patient, the Rad Onc is also responsible for reviewing relevant pathology, imaging, medical co-morbidities, etc. In addition, he is responsible for coordinating radiation with chemotherapy and/or surgery as appropriate. In addition, the Rad Onc must decide which treatment technique to use: IMRT, 3DCRT, clinical set-up, radiosurgery, etc. Also the total dose and fractionation scheme must be decided based on both literature and the clinician's own experience and judgement.
2. The patient comes in for a simulation to map their anatomy for treatment. The Rad Onc must decide how the patient needs to be set-up. This can range from routine to very complex w/ much trial and error. The use of devices like alpha cradles, aquaplast masks, use of contrast agents, etc. are all considered based on the treatment site.
3. Once the patient's images are up-loaded to the treatment planning system the Rad Onc must define what needs to be treated. This is not so simple as drawing the tumor. The gross tumor volume must be specified in ADDITION to the margin around that must be treated. Nearby critical strucutres may make this decision more complex and involved. Also, involved and potentially involved nodal groups must be defined (this is not easy for sites such as head & neck). Finally, dose limits to organs at risk (such as spinal cord) must be defined for the treatment planners. If patients are being re-irradiated (often the case especially with metastatic patients) then this requires thought.
4. Once the dosimetrist and/or physicist come up with a plan there may be many rounds of optimization before the physician is satisfied. There are many CLINICAL parameters that are important to this process that the treatment planner may be unaware of. This is precisely why physicians need to be intimately involved in treatment planning.
5. When the patient starts treatment for the first time (and periodically thereafter) the Rad Onc must check the port films to verify that the patient is anatomically in the correct treatment position. All the fancy IMRT planning is for naught if the patient is not lined up correctly.
6. Every week during treatment the Rad Onc sees the patient and manages clinical problems. In many sites, radiation WILL cause significant acute/chronic issues which must be managed appropriately with medication, advice, or referral as appropriate.
7. After treatment the Rad Onc typically follows up with the patient (sometimes for years) and reviews relevant imaging, labs, and pathology for treatment effect and possible recurrence.
Therefore I submit to you while dosimetrists and physicists are indispensable to the radiation team the physician's job entails a little more than talking to patients.
