4 July 2015

By Dr Martin Borg MD FRANZCR

Dr Martin Borg is a Senior Consultant Radiation Oncologist in the Royal Adelaide Hospital. He is also the Secretary of the Faculty of Radiation Oncology, Royal Australian and New Zealand College of Radiologists.

Readers are reminded that this account applies for the Royal Adelaide Hospital in Australia and there may be variations from centre to centre. There are differences between Malaysia and Australia and you are encouraged to find out more: An Interview with Dr Gerard Lim, Head of Department, Department of Radiotherapy and Oncology, Hospital Kuala Lumpur.

What is Radiation Oncology or Who are Radiation Oncologists?

Figure 1 – Linear Accelerator

Radiation Oncology is a specialty, which deals with the treatment of benign and malignant tumours, and some non-malignant conditions such as ischaemic heart disease.

Radiation Oncologists are medical doctors specialising in this field who are able to prescribe radiation therapy (externally using a Linear Accelerator, or internally – brachytherapy or radioactive isotopes; figures 1 and 2) where this is indicated.

A Typical Day as a Radiation Oncologist

Figure 2 – Brachytherapy

In the morning…
As cancer is unfortunately a common condition and affects around 1 in 3 people in their lifetime, our work occupies our time for the better part of the week. On a typical day, work usually commences around 8.00 am with a multi-disciplinary meeting where specialists from other fields, including Surgeons, Physicians, Radiologists, Pathologists, Nurses, Social Workers, Geneticists, Data Managers and Medical Oncologists together to discuss the management of a number of patients. The new patient and follow-up clinic usually commences at 9.00 am, where patients referred to the Radiation Oncology Department for the first time are examined and provided with verbal, written and sometimes visual information on the proposed radiotherapy. Patients who have completed treatment are also reviewed in this clinic to assess their response to treatment, to detect early recurrence of cancer and to manage side effects that may occur as the result of treatment.

During lunchtimes…
Lunchtimes are usually occupied by a departmental meeting, commonly a quality assurance meeting, where patients’ treatment planning is reviewed by all consultants, trainees and Radiation Therapists. Radiation Therapists are persons skilled in the planning and delivery of radiation therapy. They are specifically trained to run a Linear Accelerator. The Linear Accelerator is a computer-controlled machine, which delivers radiation therapy with pinpoint accuracy to the tumour or area of concern (figure 1).

In the afternoon…and evenings…

The afternoons are usually occupied by a visit to various hospitals where patients are seen both in outpatient clinics and in the wards. Later on in the evening further meetings occur, often during a sponsored dinner. Physicians take turns to discuss a topic of interest, such as management of breast cancer, followed by discussion and often accompanied by a visit from a specialist from interstate or overseas. These meetings are organised by the various specialty groups of South Australia (e.g. the Head and Neck Study Group).

Planning Radiation Therapy…

On other days the Radiation Oncologist may spend 2-3 hours in the planning suite, to plan the delivery of radiation (together with the Radiation Therapists and Physicists) to a particular site using 3-dimensional computer planning system and to ensure accurate reproducibility of the setup on a day-to-day basis. Planning involves the fusion of MRI, CT and PET scans, and the incorporation of operative, clinical and pathological findings, based on a sound knowledge of the natural history of progression of tumours. All this information is molded into a treatment plan for the benefit of the patient. Radiation Oncology, particularly with the advent of computer planning and the very modernised Linear Accelerator, involves an exciting opportunity to interact with engineers, physicists, radiobiologists, anatomists, other oncologists, palliative care physicians, and other staff members.

How to get training in Radiation Oncology In Australia ?

Training courses are organised by the Royal Australian and New Zealand College of Radiologists, Faculty of Radiation Oncology. The course is subdivided into 2 parts. Part 1 includes a 1-2 year course in Radiobiology, Radiation Physics and Anatomy. The second part involves a further 3 years and a second and final examination in Radiation Oncology, Medical Oncology, Palliative Care, Haematology and Pathology.

Between the Part I and Part II examinations, modules are organised in statistics, paediatric radiation oncology, breast cancer, and other related topics. Training is essentially ‘free’ as each department runs a structured teaching course. All registrars or trainees must be employed in an accredited training position, or if sponsored (usually overseas graduates) work as Trainee Registrars. It is a requirement that all specialists reserve some time for teaching. Although the various specialties mentioned above involve plenty of theoretical study (ie books, CD interaction, etc) all candidates are assessed on their ability to apply their theoretical knowledge to the individual patient care.

Why did I become a Radiation Oncologist?

I was attracted to Radiation Oncology because of the opportunity to deal with cancer and the ability to either cure patients or assist them in living through their remaining months and years with dignity and a good quality of life. Apart from the personal satisfaction one derives from teaching and research, the courage and fortitude shown by our patients and the generosity and kindness shown by our staff are some of the better rewards derived from this profession. The remuneration is also very rewarding!

What is the Malaysian counterpart of the Radiation Oncologist in Australia?

Radiology Malaysia talks to Dr Gerard Lim, Head of Department, Department of Radiotherapy and Oncology, Hospital Kuala Lumpur.

Editor: Dr Martin Borg has given us an account of a rather “hectic” day for a radiation oncologist where he works. Is the same setting applicable for Malaysia?

Dr Lim: In Malaysia, the training and system followed is such that the specialist, called the Clinical Oncologist is able to administer radiation therapy as well as chemotherapy and hormonal therapy. In Australia, the Radiation Oncologists mainly work in radiation therapy, although their training also includes other modules such as medical oncology. Therefore, our daily work routine in Malaysia will include both aspects of radiation therapy (planning and decision making) as well as medical oncology. In other words, the patient just needs to see one Clinical Oncologist if the treatment for his/her cancer requires both radiation therapy as well as chemotherapy, although the administration of the therapy will be on separate occasions.

Editor: What other countries follow the “system” of Clinical Oncology – the combined specialty?

Dr Lim: Britain, Ireland, Sri Lanka, Hong Kong, South Africa.

We have been told there is an acute shortage of clinical oncologists in Malaysia. What is Malaysia doing to overcome this?

Dr Lim: This year, we have managed to get going a local training programme. The University of Malaya runs this Masters in Clinical Oncology. Their first intake was in June 2002. The “pioneer batch” consists of three candidates, one each from the Ministry of Health, University Kebangsaan Malaysia and University Malaya Medical Centre.

Training can also be arranged for the overseas programme. This was traditionally in the United Kingdom but the Hong Kong College of Radiologists (HKCR) now offers training positions for Malaysian candidates. The HKCR also conducts the same examination as in the United Kingdom, the Fellowship of the Royal College of Radiology (FRCR).

Starting from this year (2002), the Jabatan Perkhidmatan Awam (JPA) began offering a 4-year scholarship for candidates taking up training in FRCR in Hong Kong. Otherwise, the cost of the course and an unpaid training position can be quite hefty.

Editor: Would you have any message to give our readers of Radiology Malaysia?

Dr Lim: The burden of cancer is high in Malaysia- being the 4th largest killer but we only have so few hands involved in this field of medicine. In addition to clinical oncologists, we also need more nurses, technologists (radiation therapists) and medical physicists as the management of cancers requires a team of well trained and highly motivated personnel.

I would like to urge more people to consider careers in these related fields.