Jul 29, 2016
5
0
Hi Guys,

I've been reading up on Radiation Oncology and I'm really leaning towards it now. I've got an opportunity to undertake a research project in the field and have started thinking about how to set up my electives accordingly.

Now, I love physics, mathematics and statistics. I enjoy dealing with oncology patients (though I understand it's a bit different when you're doing it day-in day-out compared to as a student). Before I commit fully, however, I do want to make sure I inform myself fully about the field so I'm not entering with rose-tinted glasses. So I have a few questions:

i) I understand that clinic forms the bulk of the work (rad onc being a predominantly outpatient specialty). However, what % of your time is spent in clinic and what % is spent contouring, planning, simulating, talking with radiation therapists? Is it like a 75-25 split or more like a 90-10 split; or how many half-days out of clinic?

ii) This is the most important question for me. How formulaic is treatment? Is it a matter of "This patient has X cancer and Stage Y --> hence, prescribe this method + dose"? Or is it more individualized/tailored to the individual patient? Do you use much physics/mathematics when coming up with treatment plan or contouring?

iii) I understand there are some procedures (e.g. brachytherapy) - what exactly does the radiation oncologist do during these? Do they decide upon the dosage and then the urologist does the implantation? Or does it vary by institution?
 

Ray D. Ayshun

5+ Year Member
Sep 7, 2014
541
275
As a resident living in academia, my answer to i isn't meaningful. The answer to ii is, about as formulaic as medicine in general, i.e., evidence-based. Theres a framework in general for treating a certain cancer a certain way, but every case is at least a little different. The answer to iii at my institution is everything but the anesthesia. It's pretty fun.
 
OP
Y
Jul 29, 2016
5
0
Thanks for the reply - appreciate it. The more I look into Rad Onc, the keener I am. Think I'll go ahead with the research project and set up my electives for the coming year accordingly.
 
Jun 23, 2015
2
0
Hi Guys,

I've been reading up on Radiation Oncology and I'm really leaning towards it now. I've got an opportunity to undertake a research project in the field and have started thinking about how to set up my electives accordingly.

Now, I love physics, mathematics and statistics. I enjoy dealing with oncology patients (though I understand it's a bit different when you're doing it day-in day-out compared to as a student). Before I commit fully, however, I do want to make sure I inform myself fully about the field so I'm not entering with rose-tinted glasses. So I have a few questions:

i) I understand that clinic forms the bulk of the work (rad onc being a predominantly outpatient specialty). However, what % of your time is spent in clinic and what % is spent contouring, planning, simulating, talking with radiation therapists? Is it like a 75-25 split or more like a 90-10 split; or how many half-days out of clinic?

ii) This is the most important question for me. How formulaic is treatment? Is it a matter of "This patient has X cancer and Stage Y --> hence, prescribe this method + dose"? Or is it more individualized/tailored to the individual patient? Do you use much physics/mathematics when coming up with treatment plan or contouring?

iii) I understand there are some procedures (e.g. brachytherapy) - what exactly does the radiation oncologist do during these? Do they decide upon the dosage and then the urologist does the implantation? Or does it vary by institution?
Take what I say with a grain of salt as I am just a PGY-1. I did 3 months of rad onc rotations in addition to many other electives in other fields while trying to figure out a field. I can't speak to (i) in general but at the academic institutions I was at, a pretty clinically-focused attending would see patients about 5-6 half days (2-3 for new consults, rest as follow-up and on-treatment visits) in clinic (including simulation) and spend about 1 day on contouring/planning/admin and maybe 1 day of research. Keep in mind the responsibilities often blend ("Let's just pop down to sim this patient/talk to the dosimetrist about that other patient while waiting for the next consult to arrive") so this accounting is not 100% accurate.

For (ii) this was almost the only thing I considered when choosing a specialty among many different ones as I entered medicine rather than other service-oriented professions mainly for the intellectual component. I think rad onc has probably the most cerebral decision-making at the attending level out of any field. I think as a med student/resident many fields are intellectually stimulating as you are still learning, but watching attendings in rad onc and other fields, I felt that rad onc had the most tailoring/thought/arguing about which data applies to the patient/taking into account the patient's clinical situation, and this is the main reason I chose this field. It is not as simple as patient has cancer X at stage Y so you give this RT to this volume. If it were that easy you would not need residency or even radiation oncologists.

For (iii) at the big academic places I rotated at, the radiation oncologist does the procedures. I thought they were fun but honestly a little simple. It is more of a "procedure" rather than "surgery" (not to say that anyone would call brachytherapy a surgical procedure). There is no cutting or sowing or bleeding control like you might have seen on surgical rotations.