Session Item

Modern medicine is driven by scientific endeavour and radiotherapy is no exception. The practice of radiation oncology demands study in radiobiology, radiation physics and statistics, all hard data driven sciences leading to their own principles and laws which guide our use of radiation to cure and palliate cancer. Clinical practice demands high level clinical trial evidence to define our protocols and guidelines. Yet closer examination reveals that let loose in the clinical setting, faced with real patients the radiotherapist/radiation oncologist/clinical oncologist gives only passing heed to the latest science. Examples abound. There is a vast warehouse of data showing the efficacy of single doses of radiation in many palliative settings in particular metastatic bone pain yet when we survey practice on average only 30-40% of patients are treated with single doses. Training, reimbursement and prejudice (ie lack of understanding and belief) are the usual reasons put forward to explain this but perhaps a more generous view is that we all practice the art of medicine not the blind application of science. We recognise that real patients do not usually fit the guidelines, evidenced by the difficulty in accruing patients into clinical trials where the entry criteria are too rigid. We also know them as individuals with their own beliefs, sociological background and expectations to whom we apply our scientific knowledge. Plato says that art imitates the objects and events of ordinary life. Radiotherapy is moving into a new era; artificial intelligence and machine learning is rapidly evolving to replace many of the traditional tasks undertaken by the radiotherapist; computers will take over the drudge of volume definition, treatment planning, verification and delivery; protocol deviations according to individual whim will be highlighted and outlawed. Against this background what remains for the radiotherapist of the future?