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Radiation oncologist

This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on November 29, 2022.

About 5,338 radiation oncologists are practicing in the United States today, according to 2017 data from the U.S. Department of Health and Human Services (HHS). With a population of more than 321 million, that means a ratio of fewer than two radiation oncologists per 100,000 people. Most are found in metropolitan areas. However, radiation oncologists also may practice in smaller communities with academic medical centers. The number of facilities that provide radiation therapy has grown by about 17 percent over the past 15 years, according to data presented at the 2020 American Society for Radiation Oncology Annual Meeting. The distance most patients have to travel for treatment has improved slightly, with nearly 70 percent of the U.S. population within 12.5 miles of a radiation facility (up from 65.4 percent in 2005). Yet still, 4.5 percent of Americans are farther than 50 miles away from radiation care.

Radiation therapy (also called radiotherapy) is used to treat a number of cancers. The treatment uses high doses of radiation to kill cancer cells and shrink tumors. About 60 percent of all cancer patients receive radiation therapy at some time during their illness, according to the National Cancer Institute. Radiation therapy may be used as palliative care.

What does a radiation oncologist do?

Physicians who oversee the care of cancer patients undergoing radiation treatment are known as radiation oncologists. They determine whether patients are candidates for radiation therapy and outline the benefits and side effects of radiation treatment. Radiation oncologists also make sure the amount of radiation given is appropriate and monitor the patient’s progress during treatment. There are different types of radiation therapy, and radiation oncologists recommend certain strategies based on the type and stage of cancer.

Radiation oncologists work closely with other doctors on the cancer treatment team. A medical oncologist may be on the team if chemotherapy is part of the treatment plan. A medical oncologist specializes in administering chemotherapy and other targeted agents used to kill the cancer or slow down its growth. A surgical oncologist also may be part of the team if the treatment plan includes removing tumors or performing biopsies to help diagnose cancer.

What training does a radiation oncologist receive?

Radiation oncologists have completed four years of college and four years of medical school, including one year of general medical training. After choosing radiation oncology as their specialty, they also complete a four-year residency in that area. They are trained in the use of radiation to safely treat disease. Radiation oncologists are certified by the American Board of Radiology after passing its exam. They must stay up-to-date in their field to maintain certification. Before receiving treatment, patients should ask if their radiation oncologist is board certified.

Radiation therapy treatment

All cells grow, divide and multiply, but cancer cells go through this cycle faster than normal, healthy cells. Cancer treatments, including radiation therapy, are designed to damage the cancer cells’ DNA so they stop growing or die.

Radiation therapy is different from other cancer treatments, such as chemotherapy, because it is localized. The radiation is aimed at the part of the body where the cancer is located. Radiation oncologists try to limit harm to healthy tissue as much as possible when they use radiation.

Radiation therapy is used to treat many cancers. It’s also used to treat cancer that has recurred or spread to other parts of the body. Some cancers may be treated with radiation therapy alone, while others require a combination of treatments that may include radiation therapy.

Like other cancer treatments, radiation therapy may cause some side effects. Although it may destroy an existing cancer, radiation therapy may also increase the risk of developing another cancer in the future. There’s also a limit to the amount of radiation any one area of the body may receive in a lifetime, but another area of the body may still be treated with radiation therapy if it’s far enough from the original treatment site.

Types of radiation therapy include:

External-beam radiation: This is the most commonly used type of radiation therapy. A machine called a linear accelerator is used to deliver radiation from outside the body. Specialized computer software is used to adjust the size and shape of the beam needed to target the cancer. Types of external-beam radiation include:

  • Three-dimensional conformal radiation therapy (3D-CRT): Images are created from computed tomography (CT) or magnetic resonance imaging (MRI) to capture images of the cancer and determine how to aim the beam. The intensity of each beam is the same.
  • Intensity-modulated radiation therapy (IMRT): IMRT is more complex. The beam varies in intensity, and IMRT allows the radiation oncologist to target the tumor and avoid healthy tissue.
  • Proton beam therapy: A relatively new treatment, proton beam therapy uses protons (positively charged particles) rather than X-ray beams. This approach limits damage to nearby tissue. However, it requires specialized equipment and is used only to treat specific types of cancer.
  • Image-guided radiation therapy (IGRT): Images are taken before and during treatment. The images are compared to determine how to position the radiation as precisely as possible.
  • Stereotactic body radiation therapy (SBRT): Large doses of radiation are delivered to small areas where tumors are located. SBRT requires the patient not move, so a frame or body mold may be used. SBRT may be delivered in 10 treatments or less, though some patients may require more than one course of SRT.

Internal radiation therapy: Also called brachytherapy, internal radiation therapy places radioactive material inside or nearby the cancer. The placement may be temporary or permanent. There are different types of internal radiation therapy, including:

  • Permanent implants: Seeds the size of a grain of rice are implanted, delivering radiation over time. A patient and those who come in contact with him or her must be protected from radiation that may be emitted by the body. Eventually, the seeds lose radioactivity, but they remain in the body.
  • Temporary implants: Special applicators that use needles and tubes deliver radioactive seeds to the cancer. Most often, the internal radiation therapy delivered this way lasts only a few minutes. This type of internal radiation therapy may need to be given over longer periods. Patients are kept in a private room so they don’t expose others to radiation.

Intraoperative radiation therapy (IORT): During surgery, the surgeon moves healthy tissue out of the way so either external beam or internal beam radiation therapy may be used. IORT may be used when vital organs are close to the tumor.

Systemic radiation therapy: Radioactive material is given orally or by injection. The material is flushed from the body through saliva, urine and sweat. This type of radiation therapy may be used to treat thyroid cancer with radioactive iodine.

Radioimmunotherapy: A systemic therapy, radioimmunotherapy uses monoclonal antibodies—proteins attracted to specific markers on the cancer cells—to deliver radiation to tumors directly. This treatment, which is less harmful to surrounding healthy tissue, may be used to treat some lymphomas.

Molecular radiotherapy or targeted radionuclide therapy: This type of systemic radiation therapy is used to treat some patients with advanced prostate cancer or gastroenteropancreatic neuroendocrine tumor.

What to ask your radiation oncologist?

Familiarity with the treatment and side effects may help make receiving radiation therapy less stressful. Here are some questions to ask providers about radiation therapy:

  • Why is this type of radiation therapy recommended for me?
  • Is this radiation therapy to make me feel better, treat the cancer or both?
  • How many sessions do I need?
  • Where is this therapy given?
  • What are the most common side effects?
  • When are they likely to start?
  • What side effects should I expect?
  • How should they be treated?
  • What, if any, limitations do I have while undergoing radiation therapy?
  • Can I work during radiation therapy?
  • What do I need to do to take care of my skin during treatment?
  • Do creams or lotions help? Which do you recommend?
  • Should I stay out of the sun? Use sunscreen?
  • What can I do to lower my risk of infections? Should I get vaccinations?
  • Is it ok to be with other people? Should I stay away from crowds?
  • What if I cut myself or fall and start bleeding?
  • What over-the-counter medications are safe? Are there any I should avoid while undergoing treatment?
  • What about my diet? Are there foods I should eat more of or avoid?
  • Will I lose my hair? What can I do if I do?
  • What can I do to maintain my strength? Will I feel fatigued?
  • When should I call my doctor’s office about problems I may be experiencing?

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