We must creatively combine clinical knowledge into a pragmatic framework for patient management.

The Core

The specialty of radiation oncology comprises a technological and clinical blend of skill and knowledge. This unique practice incorporates the talents of a diverse team of professionals. Therefore, it is incumbent upon us to study, learn, and apply the scientific basis of radiation oncology practice to clinical situations. Patients treated with radiation are subject to rigorous procedures, prolonged treatment courses, and unfamiliar environments, all of which are compounded by the fear of a cancer diagnosis. Numerous questions and anxieties must be addressed.

Radiation oncology continues to refine known treatment techniques and modalities and to investigate new technology. Research studies focus on the enhancement of planning techniques in an effort to provide patients with the most precise regimens. Although advanced treatment planning has become popular, some institutions have not been able to implement them fully due to expense, requirement for additional staffing, and need for sophisticated supportive equipment. Economic constraints continue to plague institutions and hinder the installation of state-of-the-art equipment to deliver cutting-edge technology. By the time smaller, independent, less well-endowed radiation centers install a new technology, it may be dated. Thus it is not the pace of discovery and application of new techniques that is problematic, but rather the struggle of institutions to keep up economically. As such, we must advocate for our specialty so that scientific sophistication and clinical application are promoted and invoked in a timely, effective and appropriate manner.

The Future

Our practice is constantly evolving and is continually faced with the challenges of implementing new technology. This requires cooperation from the entire multidisciplinary team to ensure that seamless transitions and flexibility are in place. Fundamental principles which have been identified to assist with implementation of innovative radiation oncology delivery have been documented and are as follows: identifying clinical efficacy including return on investment and demonstrating the ability to articulate the project and celebrate success.

The evolution of radiation oncology practice in recent decades has included: Accessibility of ISBRT, 3D conformal treatment planning; IMRT; Real-time IGRT; computerized portal imaging systems, simulation guided by CT, MRI and PET scans. Fusion of PET and CT has enhanced treatment planning along with the capability of MR single photo emission computed tomography. Cone Beam CT techniques have emerged which provide verification data for 3D image reconstruction. Treatment advances utilizing localization systems are able to account for the identification of organ motion thus offering enhanced treatment options. These are only a few of the most exciting innovative advances to grace our specialty. It is essential that in order to embrace all of these advances, we work together to pioneer efforts to secure a serious work ethic complemented by clinical brilliance and valued with administrative support.