Review of the manpower issue in radiation oncology.
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Biomedical subjects
Publications and source records attributed to D F Flynn.
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To assess a variety of issues concerning physician-trainees in radiation oncology, a survey was conducted by the Association of Residents in Radiation Oncology (ARRO). Ultimately, 70% of residents responded to the survey. The survey identified perceived strengths as well as shortcomings in training programs. We conclude that residents are generally satisfied with their training. Future surveys are planned to expand this important database.
Spinal cord or cauda equina compression from prostatic cancer is an oncologic emergency necessitating prompt evaluation and treatment. The strong correlation between pretreatment motor status and treatment outcome underscores the importance of immediate treatment before further neurologic deterioration and before the damage to the spinal cord becomes permanent. Patients with known osseous metastases should be alerted by their clinicians to seek medical help within hours should they develop weakness in an extremity. Prompt MRI of the entire spine should be done prior to treatment. Myelography should be reserved for those patients who cannot undergo a technically adequate or expeditious MRI study. The convenience of MRI relative to myelography allows clinicians to diagnose actual or impending spinal cord compression earlier. High-dose steroids (dexamethasone) should be instituted immediately, and endocrine therapy should be started if not already in use. Ambulatory and moderately paraparetic patients seem best treated initially with radiation alone. Immediate surgical decompression should be used in patients with an expected lifespan of at least 6 months who deteriorate during radiation, who have had previous radiation to the involved site, or who have a potentially correctable unstable spine. In addition, paraplegic patients or severely paraparetic patients with recent neurologic deterioration should be treated with immediate surgical decompression if they are judged reasonably able to tolerate the surgery. These patients should then receive postoperative radiation treatment.
The fourteenth survey of postgraduate medical education in radiation oncology in the United States was conducted in the first three months of 1988. It revealed stability in the number of approved programs, positions offered, and physicians in training compared with 1986. The proportion of trainees who were U.S. citizens by birth rose to an all-time high of 88%, and the proportion of foreign medical graduates decreased to 9%. The proportion of women in residency has remained unchanged (24%) over the past 6 years. At present, approximately 150 physicians complete residency and enter practice each year, one-third of whom commence in an academic setting. A high proportion of recent graduates of approved programs successfully completes the examinations and becomes certified by the American Board of Radiology.
The thirteenth survey of training in Radiation Oncology in the United States, conducted in the first half of 1986, revealed a reduction in the number of approved programs, but little change in the number of positions offered. For the first time, every program had trainees, and every available training position was filled. The proportion of foreign exchange students in training fell from 52% 20 years ago, to 12% a decade later, to less than 1% at present. The proportion of foreign medical graduates fell from 29% in 1984 to 18% at present. The proportion of women in residency remained unchanged from 1982 and 1984. Approximately 150 physicians can be expected to complete training and enter the practice of radiation oncology each year for at least the next 4 years.
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The modulated, 160-MeV proton beam produced by the Harvard Cyclotron has been examined in detail for its ability to kill mammalian cells as assayed by colony forming ability. Using two different cell exposure techniques, the characteristics of position and total dose in producing cell death in two aneuploid cell lines selected for their radiobiological relevance have been determined...
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