State of radiation oncology

[Neuronix]

Almost 1 in 3 seniors (29.1%) would not choose the same training program again.

Probably 1 in 3 seniors find out their senior year that their chair and other senior faculty won't make phone calls for them or otherwise help them find a job.

They also might find out that despite all their hard work and discussion of jobs where they trained, they won't be getting a job offer. Or maybe they find out that a job offer is only for a fellowship or instructor level position unless a decent position is secured elsewhere allowing them to negotiate.

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[maxxor]

I said - multi-phase, i.e. a 3 phase liver, or modified pancreatic protocol. Yes, 20mSv would be high for a single phase scan.

I’m quibbling with 20 cGy aka 200 mSv statement above that equates diagnostic CT doses to anything close to what a therapy fraction would be. That’s just not normal with modern scanners and it’s off by an order of magnitude.

We are in agreement on the multiphase at around 20 mSv.

 

[scarbrtj]

I’m quibbling with 20 cGy aka 200 mSv statement above that equates diagnostic CT doses to anything close to what a therapy fraction would be

I went way way worst case and hearkened back to a time when CT scanners might have been giving 20cGy in some cases in smaller individuals e.g.

That said, just back-of-envelope compare a 2 cGy X-ray CT scan of C/A/P with a 200 cGy X-ray treatment.

1) 30E12 cells in human body
2) D-zero of human cells is 200 cGy
3) S.F. = e^(-D/D-zero), S.F. equals survival fraction
4) 200 cGy kills 63% of irradiated cells
5) 2 cGy kills 1% of irradiated cells
6) CT C/A/P gives half body volume (or 15E12 cells) 2 cGy
7) Irradiate 10x10x10cm volume with 200 cGy gives 1% of body volume (or 30E10 cells) 200 cGy

Cell death with 20mSv CT C/A/P = 15E12*0.01 = 15E10 cells die from radiation
Cell death with 200 cGy X-ray tx = 30E10*0.63 = 18E10 cells die from radiation

Obviously I'm making a TON of assumptions. But anyways. A CT C/A/P does about as much cell damage as a 2Gy therapy fraction does to a small field. When the CT doses are higher than 2cGy, it will do more cell damage than a single therapy fraction to a small field. But for non-contrast CT, a doctor does not have to be there. But for 2Gy treatment, a doctor does have to be there. Again, a little crazy if you ask me (nobody did).

 

[karayaa]

Guys, I know you want to impress everyone with your dedication to the science of radiation oncology, but please don't turn this thread into this one FUTURE RESIDENT, DO NOT BECOME A RADIATION ONCOLOGIST!!!

OP, I like this advice. Talk to people in real life. Gain experience.

If you love the field Rad Onc above all other options in medicine...meaning you love the science behind, process of, and relationship developed by giving patients radiation for their cancer, then it wont matter what the state of the field is at some point in time or how much you get paid for doing so. If the specialty itself is what interests you, then by all means go for it. Use your M2, M3 and M4 to explore this field more to be able to make that assessment, or something approaching it to the greatest extent possible.

Most Radiation Oncologists are happy and satisfied with their career choices, as there is a lot that is great about this field. But it's nevertheless true that the statistics and logistics of the employment market in Rad Onc are increasingly strained, and the specialty is still difficult to match into despite the expanding number of residency positions. Again, if Rad Onc truly turns out to be your passion, then you will be happy in regardless of the environment you find yourself in as a residency and eventual job applicant. Please don't have your first point of assessment of any field of medicine be the lifestyle/compensation aspect of it. I'm not quixotic in this regard; those things are important points of consideration to be sure, but what actual aspects of medicine interest you should be your first and major concern at this juncture.