Radiation oncology unveiled: An insider’s guide to discovering a promising medical specialty

Radiation oncology is a field within the medical profession that is known by some but not fully understood by many. It’s a specialty that involves the use of high-energy radiation to treat cancer patients, but beyond that, there’s a whole world of science, technology and patient care that goes into it.

In this perspective article, we’re going to pull back the curtain on radiation oncology and introduce you to the world of these physicians. We had the privilege of talking to Shauna Campbell, DO, an academic radiation oncologist. Dr. Campbell walked us through a day in the life of a practicing radiation oncologist. She also shared the training required and the role of radiation oncologists in cancer care, from diagnosis to treatment planning to long-term survivorship care.

The road to becoming a radiation oncologist

Dr. Campbell’s initial interest in pursuing a career in radiation oncology was somewhat serendipitous. As an 18-year-old from Canada, she was looking for a degree program that would provide her with a specific skillset. She discovered Wayne State University’s professional program in radiation therapy, which piqued her interest in the field of radiation and oncology. After becoming a radiation therapist, she delivered radiation treatments daily and became increasingly curious about the reasons behind the treatments she was administering.

This curiosity ultimately led her to pursue medical school at Midwestern University Chicago College of Osteopathic Medicine. Unlike most medical students who have little exposure to the field before deciding on a residency program, Dr. Campbell went to medical school with the explicit goal of becoming a radiation oncologist. This made her a unique candidate, as there are few medical students who enter the field with a specific interest in radiation oncology.

“Some students are exposed to the field through personal experiences, while others may learn about it through word of mouth from home residency programs,” Dr. Campbell says.

However, she emphasizes that there is very little true oncology teaching in the medical school curriculum, and as a result, there is often a lack of exposure to radiation oncology. Medical students who are taught by oncologists are typically taught by medical oncologists, as there is limited space in the curriculum for further teaching in radiation oncology.

Residency training for radiation oncology is unique in that it is its own residency program, specific to radiation oncology. The program itself is five years long, with the first year being either a medicine year, transition year or surgery year, followed by four years dedicated to radiation oncology. This extensive training makes radiation oncologists the most trained in oncology of all the oncology specialties.

A day in the life

Dr. Campbell, an academic radiation oncologist at Cleveland Clinic, specializes in treating head and neck cancer and sarcomas. Her typical weekly schedule consists of one day of academic work, three days a week seeing new consults and patients in follow-ups, where imaging and evaluations are done to ensure cancer has not returned, and one day spent doing treatments on all her patients undergoing radiation therapy.

“Contouring is a critical step in radiation therapy planning. It involves identifying the target tumor and surrounding normal tissues on imaging studies, such as CT or MRI scans, and then carefully outlining them to create a 3D model. This process helps us to determine the optimal radiation dose and delivery technique to precisely target the cancer while minimizing exposure to surrounding healthy tissue,” Dr. Campbell explains.

As a radiation oncologist, she works with a team of medical professionals, including nurses, therapists, dosimetrists and physicists. In addition, she collaborates with other physicians and health care providers, such as surgeons and medical oncologists, depending on the patient’s diagnosis.

The role of a radiation oncologist: From consult to treatment planning and quality assurance

“As a radiation oncologist, I often see patients who have already been diagnosed with cancer,” says Dr. Campbell. She spends an average of 60 minutes with each patient during the consult, which is one of the nice things about radiation oncology – the opportunity to spend a lot of time one-on-one with patients. She highlights that, “Compared to some other medical specialties, there’s a little bit less clinical pressure in radiation oncology.”

During a 60-minute consult, she discusses the patient’s diagnosis, presentation, history and other relevant details to create a treatment plan tailored to the patient’s needs. Even though the standard of care treatment is well-defined, it often needs adaptation to suit the individual’s circumstances. Once the patient’s stage is determined, the radiation oncologist talks about the treatment plan, which might involve radiation as the primary treatment or radiation before surgery.

After the consult, the patient comes in for a simulation day where they undergo a CT scan in which the radiation team sets up the treatment position and verifies that everything is in place, since the acquired CT scan will form the foundation of the treatment plan. The simulation day typically takes about one to two hours.

After the patient receives their CT scan, it takes one to two weeks for radiation treatment planning. The radiation oncologist will use the imaging to manually identify the tumor and surrounding areas to determine the target for radiation. This includes identifying areas that may not show signs of cancer but are at risk of developing it.

The radiation oncologist then reviews the plan provided by the dosimetrist, evaluating if the target is being covered by the correct dose while minimizing exposure to normal structures. Once approved, the patient undergoes a quality assurance process before starting treatment, and the radiation oncologist oversees any necessary imaging during treatment.

Radiation oncologists have the opportunity to work hands-on with evolving technology and learn how to read scans from a cancer perspective. There are also procedure-based subsections of radiation oncology, such as brachytherapy, for those who enjoy working with their hands.

The unique balance of patient care and technology in radiation oncology: Dispelling misconceptions

There are some misconceptions about radiation oncology. While radiation does have a significant technological and physics component, the physics involved in radiation is very different from what one learns in high school or undergrad.

“The physics that we do in radiation is very applicable to the therapy we provide. So, I personally found that once I started learning more technical topics, but with a direct radiation oncology application, it was much easier,” Dr. Campbell explains.

“Radiation provides a nice balance between patient care and technology. Radiation oncologists spend a lot of time with their patients and build strong bonds with them. For those who like to work with their hands, there are procedure-based subsections in radiation oncology. While it may not satisfy those who want to be in the OR, radiation oncology is a great option for those who want to work with their hands and not be in clinic all day every day,” she continues.

The emotional toll and rewards of radiation oncology: The impact of radiation treatment

When asked about the potential emotional toll of working with cancer patients, Dr. Campbell noted that “… while it’s impossible to change the reality of cancer diagnoses, it’s possible to make a significant difference in patients’ lives through radiation treatment. As a curative treatment for various types of cancer, radiation offers hope and reassurance to patients during a challenging time. Even for patients with metastatic cancer, radiation can be a valuable tool in relieving symptoms and making them more comfortable.”

Of course, there are difficult moments in this field, such as when cancer returns despite initial curative intent treatment. Nonetheless, the opportunity to develop meaningful relationships with patients and to help them during their toughest moments brings joy to the work. Follow-up visits with patients who are doing well serve as a reminder of the positive impact radiation treatment can have.

“Overall, while there may be emotional challenges in working with cancer patients, the rewards of helping them outweigh the difficulties,” Dr. Campbell says.

The future of radiation oncology: Balancing the role of AI and advancements in treatment options

Regarding the future of radiation oncology and the continuing evolution of artificial intelligence, Dr. Campbell believes that while there is potential for AI to make the daily workload of radiation oncologists easier, the need for human specialists in the field will not be completely replaced by AI.

Instead, AI can be leveraged to reduce physician workload, such as in contouring. The field of radiation oncology is constantly evolving with new technologies being developed to improve cure rates and treatment outcomes and decrease side effects.

Additionally, there are advances being made in systemic therapies, including immunotherapy, and there is a growing interest in combining radiation with these other treatment options to extend time off systemic therapy and improve overall survival.

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