What aspect is most intellectually stimulating?

The most rewarding part was when he gave me my money.

Seriously, though . . .

For me the most intellectually stimulating part is the evidence-based medicine approach. I read a ton of literature, even as an attending. For common malignancies (prostate, breast, lung) there are always new studies being published or accruing patients that advance the field in different ways. For rarer cancers that are a lot of quality retrospective studies that are always being published. I feel like I'm always on the bleeding edge.

Also, the physics and radiobiology are fascinating and very clinically relevant.

Finally, I really enjoy tumor boards, especially when the other participants are well-versed in relevant literature. You can really have some stimulating and interesting discussions.

As for the division of work, it goes something like this:

1. MD sees patient, does full history & physical, decides if XRT is appropriate and, if so the parameters (dose, fractionation, fields)
2. Pt returns for treatment planning which should ideally be supervised by the MD; the therapists position the patient based on your orders (supine/prone) with various immobolization devices (thermoplastic masks, knee sponges, vac-lok devices)
3. Pt plan is then designed by the dosimetrist based on the MD parameters (you not only prescribe the dose, but also dose/volume limitations to organs at risk); for complex plans (head & neck for instance) this may take several cycles of optimization
4. Physics does a QA of the plan to make sure everything is kosher
5. Therapists position the patient on the machine and deliver the treatment; daily/weekly imaging is verified by the MD to ensure accurate setup
6. During treatment the MD sees the pt at least weekly, answering questions and managing side effects
7. Following treatment, the patient follows up with the MD as appropriate

jejun said:

I did a 4 week rotation in RadOnc and really loved the patient interaction. I got to do some basic contouring which was somewhat dry for me. I did not get to see what the attending physicians do outside of seeing patients and while I know they were working on plans and research, I wanted to know what exactly this entails. In short: what about RadOnc is the most intellectually satisfying?

I also did not fully understand the division of work between physicists, dosimetrists, and RadOncs. I am planning on going to back to address some of these questions with the attendings however I would love to hear feedback on the forum.

Click to expand...

It seems you didn't really dig in to the field during your rotation. A lot goes on behind the scenes with treatment planning and the approach to deciding to treat with radiation or not. There are so many different types of treatment modalities that can be used and the physics and rad bio involved, there is no other field like it.

As a med student I wondered the same thing and really didn't appreciate my rotations as much but as a resident you find out "there's more that meets the eye" in this field and you're tested on your knowledge every time you see a patient since there is so much you need to know.

I suggest next time you do a rotation follow the physicists, dosimitrists as they work on a plan and work with the radiation therapist during a simulation and to not just focus on clinics because that part can become mundane, less technical and not as challenging.

-R

jejun said:

I did a 4 week rotation in RadOnc and really loved the patient interaction. I got to do some basic contouring which was somewhat dry for me. I did not get to see what the attending physicians do outside of seeing patients and while I know they were working on plans and research, I wanted to know what exactly this entails. In short: what about RadOnc is the most intellectually satisfying?

Click to expand...

I personally love the technology aspect of it, as well as physics/biophysics - interaction of radiation with matter, wave-particle duality and such... Of course, as a rad onc clinician you are an advanced user of technology (rather than an engineer/physicist who develops it) - but I think it's amazing that we do have to know a lot of these concepts. And who knows, sometimes advanced users become tinkerers...