Tutorial 1
When to consider radiation medicine
From years of misunderstanding, therapeutic radiation went from being unsafely over-used to being vastly under-used and feared to excess. Diagnostic X-ray is already in many primary-care offices. Therapeutic radiation has a role too.
A useful differential, not a sales list
Radiation medicine is not only “send the cancer to the bunker.” Superficial and low-dose techniques reach a set of problems primary care already owns: selected skin cancers, keloids, osteoarthritis of extremities, Dupuytren contracture, Ledderhose, plantar fasciitis, gynecomastia, hidradenitis, Peyronie disease. Some of those have mature evidence. Some are historical or case-series only. The Society’s job is to keep those states distinct.
Ask these questions first
- Is the problem malignant, pre-malignant or inflammatory/fibrotic?
- What is best available non-radiation care, and has it actually been tried?
- What is the patient’s age and remaining life expectancy — the radiogenic-risk clock?
- Is there a radiation oncologist who will share the plan, or is this an isolated office experiment?
- Is the indication investigational? If yes, it belongs in a protocol, not a Friday afternoon add-on.
Hub and spoke, as education
In a hub-and-spoke model, radiation oncologists at equipped hubs supervise and collaborate with primary-care clinicians in community spokes: case review, planning support, and a shared standard for when not to treat. That model only works if the spoke is taught. SIRiiM writes the syllabus. Partner clinics run the preceptorship. Continue to LDRT basics or partner training.
Informational Society education, not medical advice and not an offer of partnership.