A few questions.

[want2beadoc]

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I understand that radiation oncologists usually work with a team of people such as a radiation physicist (correct me on the job title). Is this always the case? Or does the rad. oncologist have the say on radiation dosing, etc?

I'm interested in this field (just a first year med student). I have read the FAQ, but I'm not getting an idea what the typical day for a radiation oncologist is. I'm sure its varied, but can the residents and attendings give me an idea about what they do? Just walk me through it, give as much or as little detail as you like. Thank you so much.

 

[Gfunk6]

I posted this on another thread but I am reposting it here for your convenience,

I'm certainly not the best qualifed to answer this question, but I'll try.

1. All oncology patients are referred to RadOnc. Therefore, it is best to have cordial relationships with other oncologists and surgeons.

2. At the initial consultation the patient is seen by the attending (sometimes preceded by resident and/or med student). At this time, the attending takes a full history and physical. Prior to the consult, appropriate labs, films, and medical history are reviewed. The attending gives the pt options and we go to the next step if pt wants to proceed with radiotherapy. The choice of treatment depends on what the current literature says, institutional hardware, and the attending's own experiences.

3. Pt is "simmed." Rad techs position the patient in the machine and "simulate" an actual treatment. This way attending can verify the regional anatomy (both bony landmarks and soft tissue critical structures) and make adjustments as necessary.

4. Pt is "planned." Now that the images are on disk, the patient's tumor volumes and critical structures are "contoured" by the resident and/or attending. Once the attending is satisfied with the area covered by radiation (including extra margins for tumor not apparent on imaging) then the plan goes to the dosimetrists.

5. Dosimetrists (w/ or w/o resident) calculates plan including beam angles, doses, and fractionation. Generally, there is some degree of back and forth b/w the attending and dosimetrist with regard to plan optimization. Physics also looks at the plan and approves it.

6. Pt is brought back for first treatment. Everything is set-up and pt is "simmed" one more time to ensure quality treatment. If everything looks good, pt receives first treatment.

7. During the course of treatment pt receives so called "portal films." (usually 1/week) These are images taken with the treatment machine to verify that you are actually irradiating the correct area. Also, patients see the attendings to report any side-effects or if they have any questions 1/week or so -- though obviously immediately for pressing issues.

8. Pt is seen @ follow-up clinics periodically for up to several years post-RT. Generally, the attending reviews scans to evaluate recurrence of disease as well as a physical exam.

That's more or less the sequence.

 

[want2beadoc]

Thanks for taking the time to post. Anyone else want to add anything? After the next test block, I'm going to talk to a few of the people in the rad onc. department to see if I might be able to help in research, etc. I'm pretty ignorant in regards to the field, but from what I gather it has many of the aspects I'm looking for in medicine. Will I be taken seriously without any real knowledge of the field? Would it be better to wait and acquaint myself better? (I'm starting to get the vibe that I'm invading your forum with innane questions now 😉)

 

[nod]

It depends on whether the people you are asking are true educators. I went to the chair of rad onc at my school a month into my first year and asked if I could shadow him in clinic to learn about rad onc, and he was very nice and showed me around. I knew NOTHING at the time and he expected me to know nothing. Then, still knowing nothing, I went to the program director and asked to do research with him, and he was also very nice and set me up with a project.

So it is okay to know nothing, as long as your rad onc department actually cares to teach.

Good luck.

 

[napoleondynamite]

You are a first year, congrats on finding the holy grail of medicine this early on! I would first schedule a shadowing experience with an assistant professor type person in your home dept, that will give you a glance of what radonc is all about with very little risk of looking dumb in front of the residency director (but I agree, they should understand that you are just in your first year and not expect you to know much about radonc). If you still like it after several shadowing experiences, then start asking around about research. If you are truly serious and persistent, I'm sure someone would be glad to have a research assistant on a project. But DON'T over-commit to a project that you won't be able to devote time to. I've seen several friends fall into that trap, and then the research turns into a black mark on your record instead of a positive experience. So I would be sure you're serious about radonc before jumping into a research project that may not turn out to be a good fit for you. Good luck!!

 

[HunterGatherer]

great thread!