RadOnc and Academic/Intellectual Pursuits

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oopsy

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Hey Everyone,

I've been reading these boards for a while now and have appreciated all of the insight, and I'd like to ask a particular question. I've done my best to read through most of the posts on this board in particular, so hopefully it's not a duplicate.

I'm an MD/PhD student on the back end of the program now, trying to figure out what to be when I grow up. I did my PhD in neuroscience, and really loved the work in the field. I'm in the middle of my third year clerkships, and I've found my clinical interests to be somewhat variable and difficult to sort out. My goal is to work in an academic environment and have a lab, and I'd like my clinical work to focused on translational research & medicine. I really love the neurosciences, but that said, I also enjoyed basic cancer biology going into grad school, and just ended up in neuroscience because of the particular fit of the lab, project, etc.

I've been actively reading up on and getting exposure to a variety of clinical fields including neurology, med-onc, and rad onc. My neurology experience was mixed, I didn't love it as much as I thought I would, but I found the basic premise of identifying and managing the lesions/diseases fascinating. Nonetheless, there's not a whole hell of a lot of neurological management/intervention/etc we can do for acute stroke patients, and that kind of experience tempered my interest. I still find it interesting and exciting, but I'm just trying to sort out other possibilities. That said, my limited experience on onc-services was very cool because so much of it is incredibly translational, evidence-based, and rooted in basic science. So all in all, I've been trying to find fields where I can be somewhat interventional, evidence-based, and have a well defined role that leaves room for a research career in a translational field.

Rad Onc seems to fit the bill very nicely, lots of translational work, interventional, and very sick patients who would be greatly served by future efforts.

I'm interested to hear from current rad oncs, training/private/academic, what it is within rad onc that's particularly intellectually stimulating to you in clinical practice, and what kinds of things you find of interest translationally? I've seen clinic visits which seem relatively straightforward thus far, but most of the patients had been tolerating the treatments well. I haven't seen much of treatment planning, but what within that is particular stimulating or exciting? I can imagine it is---I just haven't seen it. I'm considering doing an elective to get a better idea, but I thought I'd touch base here for an initial insight. But basically, what within rad onc is most fascinating to you?

Thanks in advance for any of your comments.

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I'm interested to hear from current rad oncs, training/private/academic, what it is within rad onc that's particularly intellectually stimulating to you in clinical practice, and what kinds of things you find of interest translationally?

Things I find intellectually stimulating:

1. Strong-evidence based treatment paradigms which are frequently evolving necessitating staying up to date on literature
2. Very diverse range of oncologic practice with many different types of cancers
3. Lots of procedures (e.g. brachytherapy, fiberoptic exams, fiducial placement for IGRT)
4. Physics is complex enough to be "fun" but not so complex that it requires high-level math
5. We get to dabble in reading diagnostic studies (CT, MRI), much more so than Med Oncs
6. Debating/discussing treatment paradigms in tumor boards/chart rounds
7. Teaching medical students/Rad Onc residents

Don't do translational research (anymore) so I can't really comment on that.

I've seen clinic visits which seem relatively straightforward thus far, but most of the patients had been tolerating the treatments well. I haven't seen much of treatment planning, but what within that is particular stimulating or exciting?

I LOVE treatment planning. I use MIM for contouring so I go ape-**** when it comes to fusing multiple image sets (CTs w/ contrast, MRI, PET) using deformable registration. I also like using tools such as PET edge, auto-pilot, and smoothing. Complex IMRT plans like for H&N and CNS are things I particularly enjoy. When you draw ~20 avoidance structures, it's also stimulating to prioritize dose avoidance with target coverage which is a bit different for each case. I also like to go over the QUANTEC data for tough cases to see how much dose/volume I can get away with for treating normal structures.
 
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