Radiation Oncology from Dr. Steven E. Lerner & Associates* Introduction: Radiation oncology is the medical specialty devoted to the treatment of cancer (and certain benign diseases) with ionizing radiation. The aim of radiation therapy is to deliver a precisely measured dose of radiation to a defined tumor volume while sparing surrounding normal tissue as much as possible. The goal is to eradicate the tumor while avoiding damage to nearby structures. Radiation therapy plays an important role in the curative treatment of cancer either alone or often in combination with surgery and/or chemotherapy. It may also be used to palliate or prevent symptoms of advanced incurable cancer. Examples would be brain irradiation for brain metastases or bone irradiation to relieve pain and prevent fracture. A few benign diseases may also benefit from radiation therapy including keloids, heterotopic bone following arthroplastic hip surgery and Grave's exophthalmopathy. Recognition of Specialty: Radiation oncology is a specialty recognized by the American Board of Radiology and by the American Board of Medical Specialties. While not legally required the standard of practice in the United States is for radiation therapy to be administered by a physician who is either board eligible or board certified in radiation oncology or therapeutic radiology. Radiation oncologists will normally have completed a three or four year residency or fellowship in an approved training program. Radiation Oncologist: A radiation oncologist is responsible for evaluating a cancer patient with history, physical examination and tests appropriate to ensure adequate staging of a cancer and to allow accurate tumor localization. It is normally appropriate to have pathology slides reviewed to confirm the diagnosis if the original pathologist is not well known to the radiation oncologist. A treatment plan is then prescribed and the patient fully informed of the intent of the treatment prescribed as well as the potential and expected side effects and risks of treatment and the alternatives to this treatment. After obtaining the patient's documented informed consent a patient will undergo simulation and treatment planning to determine how to direct the radiation beams and what tissues to block from the radiation field based on the radiation oncologist's physical examination and review of all diagnostic studies and using beam data provided by the radiation physicist. Actual radiation treatments are supervised by the radiation oncologist who reviews weekly or biweekly port films which verify the accuracy of the radiation beam. The radiation oncologist also directly monitors the patient's progress throughout the treatment and normally sees the patient after the treatment course has been completed to periodically reevaluate the patient for recurrence of a cancer or for complications of the treatment. Under managed care such follow-up may end up being delegated to other physicians. Medical-Legal Issues: Professional liability in the field of radiation oncology may result from inadequate explanation to the patient of the intent, risks, side effects and expected results of radiation treatment. A patient must always be fully informed whenever "experimental" protocols are followed. It is vital that the radiation oncologist coordinate the radiation treatments with surgeons and medical oncologists so as to ensure that any combined modality treatments follow accepted protocols. Inappropriate technique or dosage may subject a patient to increased risk of side effects and complications, though no radiation treatment is completely without any risks. Modern treatment equipment has numerous built-in safeguards to prevent the misadministration of radiation secondary to human error or equipment failure though such problems can and have rarely occurred.