Radiation Oncology

What is a radiation oncologist?

Radiation oncology is that branch of clinical medicine concerned with the causes, prevention, and treatment of cancer and certain non-neoplastic conditions utilizing ionizing radiation. Radiation oncologists are an integral part of the multidisciplinary management of the cancer patient, and must collaborate closely with physicians and other health care professionals in related disciplines in managing the patient (1).

A radiation oncologist uses ionizing radiation and other modalities to treat malignant and benign diseases. Radiation oncologists also may use computed tomography (CT) scans, magnetic resonance imaging (MRI), ultrasound, and positron emission tomography (PET) as additional interventions to aid in treatment planning and delivery.

Radiation Oncology is distinct from other radiology specialties such as Diagnostic Radiology and Interventional Radiology as Radiation Oncology is a clinical oncology specialty. 

How to become a radiation oncologist?

Training required is five years: one year of general clinical work, followed by four years of dedicated Radiation Oncology training.

What does a radiation oncologist do?

Radiation oncology is a branch of clinical medicine devoted to the treatment of both malignant and benign disease with ionizing radiation. The radiation oncologist heads a team of nurses, radiation therapists, dosimetrists and medical physicists who are involved in the evaluation, planning, delivery and follow-up of patients treated with radiation.

In its early years of development, radiation oncology was considered a subspecialty within radiology traditionally referred to as therapeutic radiology. During that time, radiologists received training in both diagnostic and therapeutic radiology. Over the years, as each of these disciplines became more complex, the training and certification processes for radiation oncology became separate from diagnostic radiology.

Although some radiation oncologists choose  to focus their practice on a specific disease site, radiation oncologists are trained and certified to treat a broad spectrum of diseases utilizing various radiation modalities, with the central guiding principle of achieving maximal therapeutic gain while minimizing radiation exposure to normal tissues. Ionizing radiation includes X-ray, gamma ray and charged particles such as proton that have high enough energy to remove tightly bound electrons from atoms to create ions. Ionizing radiation can be delivered through external beam therapy or implantation of radionuclides in a procedure called brachytherapy. Conventional external beam radiation typically involves fractionated daily treatments over 2 to 8 weeks. The newer technologies of stereotactic body radiation therapy (SBRT) and stereotactic radiosurgery (SRS) are commonly delivered in 1 to 5 fractions, and administer highly precise and highly potent radiation treatments. Intra-operative radiation, IMRT, IGRT and protons are additional examples of technological advances.

The radiation oncologist works in a multidisciplinary team alongside surgeons and medical oncologists to ensure comprehensive care for cancer patients. There is also close collaboration with primary care physicians, pathologists, diagnostic radiologists and other health care professionals.

Radiation oncology is an extremely rewarding, challenging field. Although complex cancer biology and rapidly evolving sophisticated technology are an attraction for many medical students, the passion for working with cancer patients is generally a significant factor influencing the decision to enter the field. The field is particularly appealing to those who enjoy the quantitative nature of radiation oncology and at the same time the humanistic aspect of direct care of cancer patients.

For those who are interested in research, radiation oncology is an outstanding specialty. In addition to clinical trials, which remain an active part of most academic practices and many private community practices, unlimited opportunities in translational and basic research are available.

The ACGME Residency Review Committee in Radiation Oncology oversees the education and training in radiation oncology. Graduating medical students are required to do a one-year clinical internship prior to entering the four-year training program in radiation oncology.

The certification process is overseen by the American Board of Radiology, which issues certificates in radiation oncology to successful candidates. Certification involves passing written examinations in radiation biology, medical physics and clinical radiation oncology. After successfully passing the three components of the written examination, the trainee must pass an oral examination, which covers the full spectrum of diseases encountered in clinical radiation oncology. As with all other medical specialties, certification is currently time-limited, and diplomates are expected to enter a lifelong process of learning and practice improvement through a Maintenance of Certification program.

1. Accreditation Council for Graduate Medical Education (ACGME)