Professional Perspectives of Radiation Oncologists: Nilesh S. Patel, Kate Castle, and Christina Huang

I was initially interested in radiology but quickly realized I wanted patient interaction. During my radiology rotation, a radiation oncologist did a presentation on their field, and it sparked my initial interest. During my OB/GYN rotation, I interacted with my first radiation-treated patient who had brachytherapy for cervical cancer, which solidified my interest. After that interaction, I decided to do an elective in radiation oncology to get exposure and knew it was the right field for me while on it.

Oncology is an involved and emotional field but being able to take our time with each patient and help our patients with difficult diagnoses is really rewarding. The addition of technology for treatment planning and advancements in radiation therapy keeps me engaged in my work and is appealing. While we are not diagnostically reading imaging reports, our constant review for tumor location, procedure guidance, and response to treatment keeps me closely connected to my original interest in radiology.

For me, I really enjoyed the clinical aspect of patient care and treatment of a variety of cancer types. I work in a community practice where there is a large breadth of diseases that I can treat, address, and be a part of. Some folks may go the academic route and be more focused on a disease site, for example, prostate cancer or head and neck cancer, but for me personally, I enjoyed the variety and breadth of oncology as a whole, and being a general radiation oncologist allows me to see different disease states and treatments.

Radiation oncology technology has advanced as rapidly as the iPhone with newer planning systems, imaging, and treatment precision. The standard of care today, like IMRT, was in its infancy while I was in residency, and to see better outcomes with fewer side effects is really encouraging. Imaging has also improved both in quality and modalities with advancements like PSMA PET scans, multiparametric MRIs, theragnostic imaging, and even radioligand therapy. Our field is continuously innovating to stay at the forefront of medical and cancer care to maximize outcomes of good therapy.

With more precise treatment and less side effects, negative mindsets towards radiation, where many people felt that there would be a lot of tissue damage and long-term complications, have alleviated. We are also now seeing more data from Europe toward low-dose radiation therapy use in benign conditions such as Dupuytren’s contracture, plantar fasciitis, and osteoarthritis. It will be interesting to see how the next decade goes in terms of benign conditions and indications of radiation for treatment in those types of pathologies.

If someone had stage 4 cancer or metastasis, radiation therapy was used for palliative purposes. Now with advancements in terms of systemic therapy and immunotherapy, patients are living longer with longer rates of remission or progression-free survival. Research on patients with oligometastatic disease, where spread is beyond the primary site but still limited, shows that incorporating radiation therapy with systemic therapy can improve outcomes with higher remission rates and longer disease control. Utilizing radiation therapy more in these settings is only expanding our indications of treatment.

Compiling the thousands of prior radiation plans into a database, I can see AI optimizing parameters and translating patterns to quickly and efficiently create a treatment plan for specific cancers. This would not only allow for faster throughput and faster treatment onboarding but may also help us follow and monitor our patients in terms of their cancer state. Follow-up imaging or blood testing can be analyzed and a prediction of better or worse outcomes for a patient could help us make good medical decisions.

I am excited to see how AI really impacts our field and hope it will not only make our lives as physicians easier but also translate to better outcomes for our patients. I am also excited about the role of radioligands. Most of our treatments now with radioligands are more focused on prostate cancer but I am interested to see the development for other cancer types and ages.

Declining reimbursement, insurance pre-authorization, and being dictated by insurance on how we treat patients are some challenges we face that may limit access or indications of radiation therapy, a proven beneficial treatment for patients with cancer. On top of that, the expense to utilize the newest tech may be prohibitive for certain areas. As physicians, we need to ensure we think about how we can be available for our oncology patients and not let economic factors prevent that. Another challenge is to continue to educate people that with current protocols and therapies, the horror stories people may have heard are far less common than they used to be.

Do an in-depth rotation where you see the day-to-day workings of our field; follow the radiation oncologist, nursing staff, radiation therapists, physicists, and dosimetrists to really understand the team approach. You must have a passion for oncology and the ability to communicate with your patients. You need empathy, understanding, and patience and must ask yourself if you can engage in and handle the difficult conversations. This is a rewarding field, but you must have the right mindset when dealing with patients with cancer.

I am a part-time radiation oncologist specializing in breast and gynecologic malignancies, currently practicing with TN Oncology in Nashville, TN. My path to this role has been shaped as much by my passion for patient care as by a commitment to my family and personal values.

I began my academic journey at Vanderbilt University, majoring in neuroscience. After graduation, I spent 2 years conducting research in radiation oncology at Vanderbilt—an experience that first exposed me to the field. Still, it wasn’t until my third year of medical school that I fully recognized the unique impact radiation oncologists could have in both curative and palliative settings. This realization ultimately led me to pursue residency training at MD Anderson Cancer Center.

At MD Anderson, I developed a strong clinical and research interest in gynecologic malignancies, particularly cervical cancer. I was drawn to the complexity of care required—technically, emotionally, and logistically—and became passionate about making these treatments as supportive and patient-centered as possible.

During residency, my husband and I welcomed our first child. That experience brought clarity to my priorities: I was committed to practicing high-quality medicine, but also to being present for my growing family. At the time, part-time roles in radiation oncology were rare, but in 2014 I joined Mary Bird Perkins Cancer Center in Baton Rouge, LA, in a 2.5-day-per-week position as a general radiation oncologist. Over time, I helped develop and transition into a dedicated Women’s Cancer Center, focusing exclusively on breast and gynecologic malignancies and leading the creation of an interstitial brachytherapy program.

In 2023, I stepped into the role of Medical Director of Radiation Oncology, expanding to full-time work with 3 clinical days and 2 administrative days. The leadership experience was deeply fulfilling, allowing me to grow in new ways professionally. However, I also recognized how much I missed having the space and energy to support my family in a meaningful way.

When an opportunity arose with TN Oncology in early 2025, it offered a rare alignment of professional specialization and part-time work, in a city my family had long hoped to return to. Making the decision to leave my leadership role and practice in Baton Rouge was difficult, but the move has allowed me to once again integrate the 2 parts of my life that matter most—my work as a physician and my role as a mother.

After college, my goal was to determine whether I wanted to attend medical school or pursue a career in research. Somewhat serendipitously, I landed a position as a research assistant in the Department of Radiation Oncology at Vanderbilt University through a personal connection. This opportunity provided early exposure to the field and, fortunately, led to several publications in radiation oncology before I even began medical school.

My time in the lab was invaluable—it helped me realize that while I appreciated the scientific process, my true passion lay in clinical work. However, it wasn’t until I completed a full clinical rotation in radiation oncology during medical school that I knew for certain this was the specialty I wanted to pursue.

I was drawn to the unique role radiation oncologists play. I loved the depth of the patient relationships, the blend of high-level treatment planning, procedural work, and the opportunity to spend meaningful time in the clinic.

There are so many things that I love about my job but the one that gets me out of bed every morning is the strong relationships that I get to build with patients over the course of time.

The most challenging aspect of our job, like most other medical specialties, is the amount of time spent on documentation. This part of the job can be very overwhelming while simultaneously being unfulfilling.

A good radiation oncologist is much more than a technician. What sets a radiation oncologist apart from a technician is the broader understanding of cancer management. Interdisciplinary cancer has become quite complex given so many chemotherapy and immunotherapy treatments and decisions about sequencing of care, etc. The key to navigating this complexity is having great professional relationships with colleagues, excellent communication, and reliability.

My top recommendation for medical students seeking a reliable oncology resource is the NCCN Guidelines. These guidelines are freely accessible—students just need to create an account using their email.

It’s important for students to recognize that radiation therapy is often just one component of a broader cancer treatment plan. Understanding where and how radiation fits into this framework is essential. The NCCN Guidelines help by breaking down each disease site according to staging and relevant clinical factors, clearly outlining appropriate treatment options and highlighting where radiation plays a role.

Additionally, the guidelines include dedicated sections with more in-depth information on radiation therapy. For those who want to delve even deeper, there’s a comprehensive discussion section at the end of each guideline. This section explains the rationale behind the recommendations and presents the supporting evidence, offering students a deeper understanding of current best practices in oncology.

Don’t be intimidated—that’s my main advice. I remember several times during my training when I felt so overwhelmed that I nearly gave up on pursuing Radiation Oncology—and that includes early residency. This is such a unique field that even if you’re a top-performing medical student, you’ll likely walk into your first rotation with very little applicable knowledge. That’s completely normal.

What matters most is staying focused on what drew you to the field in the first place. If you’re willing to work hard and stay dedicated to mastering the material, success is absolutely within reach.

On a more personal note, I found the physics aspect particularly intimidating. Physics was never my strength, and I initially worried it would hold me back. But here’s what I tell students: you absolutely need to learn enough physics to communicate effectively with your physicists—but remember, we have an entire team of them for a reason. Your role is to understand the clinical side and collaborate with your physics team, not to become a physicist yourself.

So hang in there. Keep working hard, trust yourself, and trust the process.

Although I am now somewhat removed from the residency application process, I believe a strong applicant demonstrates the ability to work hard and a clear dedication to applying that work ethic toward learning the field of radiation oncology. The knowledge and technical skills can be taught, but the internal drive and genuine desire to learn and advance the field must come from the applicant. I also believe it’s essential for applicants to show that they can communicate effectively with both patients and staff and approach patient care with compassion.

I would love to see medical students receive earlier exposure to radiation oncology during their training. Many of us in the field discovered it almost by chance. There are likely countless physicians in other specialties who would have made outstanding radiation oncologists and found the career deeply fulfilling, but either never learned about the field or encountered it too late in their training

During medical school, I found I was interested in an outpatient specialty and wanted to offer local therapies while forming long-term relationships with patients and their families. I considered different surgical subspecialties, but was not sure about committing to a certain disease site while initially applying to residency. I also considered radiology, but wanted a specialty with more clinical patient interaction. I met with a transitional year resident who matched into radiation oncology, and their enthusiasm about the field was palpable. They introduced me to the radiation oncology department at IU, where I met residents and the program director, who were very approachable and encouraging to join projects and take a clinical elective.

In addition to early exposure at IU, I did 2 away rotations, both remote due to the pandemic. Both were great experiences. I was able to meet many patients and faculty virtually, review charts, and dive into imaging. Between M3 and M4, I did a research year, which was a really nice opportunity to build skills in biostatistics and grant writing, and more importantly, to explore radiation oncology and feel certain about the specialty selection. A research year is not needed to match into radiation oncology, but I went directly to medical school after college, and the extra year gave me the opportunity to speak to many people at different stages of their careers to understand what drew them to the field and different pathways within the specialty.

Radiation oncology is a great specialty for students interested in anatomy and thinking head-to-toe to plan local interventions like surgical oncologists, while also considering systemic disease like a medical oncologist. This is a field in which you will develop deep relationships with patients and their families and frequently engage in goals of care conversations.

Brachytherapy can be an excellent treatment for some patients due to how targeted the therapy is while minimizing dose to adjacent organs at risk. I have an interest in procedures and wanted to build a diverse skillset during residency. Duke was a great fit for residency since it is a high-volume brachytherapy center. I also did an away rotation at MSK to further my brachytherapy training and am excited to offer it in my practice upon graduation.

Radiation oncology is a small field, and many residents and faculty are very open to sharing their experiences and helping students learn. Cold emailing and coffee chats can be very informative. Be sure to email with a purpose, not just to get your name out. Many people have ongoing projects and are happy to have students who can help. If working on a project with mentors, it is understandable that students are busy at times, but make sure to communicate frequently and openly about your availability with the aim of finishing projects. People you meet in radonc during medical school are people you will know for the rest of your career. Additionally, away rotations can be wonderful opportunities, both for being able to see different clinics and workflows, as well as to get a feel of whether certain cities and departments will be a good fit.