The Specialist in Radiotherapy must have acquired methodological skills in relation to the clinic, patient management and diagnostic/therapeutic decisions that guarantee a general and unitary approach to the solution of clinical problems. In particular in radiotherapy with external beams (with linear accelerator, telecobalt therapy and simulator), brachytherapy, dosimetry and treatment plans.

For the Postgraduate School of RADIOTHERAPY (divided into four years of the course), the training profiles are as follows:

Basic learning objectives:

• know medical physics, computer science, statistics, epidemiology of tumors, anatomy and pathological anatomy, biology, protectionism and iatrogenic damage;
• know the radiation sources and physical bases of radiotherapy, radiation beam dosimetry procedures, external radiotherapy and brachytherapy equipment, simulation equipment, treatment techniques, dose calculation systems, quality control procedures;
• acquire the essential knowledge of clinical pharmacology for the most commonly used drugs and in particular for antineoplastic drugs;
• acquire the ability to organize the activities of a complex radiotherapy structure.

Educational objectives of the type of School:

• know the mechanisms of action of radiation on cell populations, on the tumor response to radiation, on the effects of radiation on the various organs and systems, on the indicators of the biological response, on the criteria and procedures of radiation protection;
• to achieve a degree of knowledge adequate to acquire, interpret, archive and manipulate bioimages to formulate autonomous clinical judgement for the purposes of therapeutic planning;
• deepen knowledge on the biology of neoplasms; on prevention measures on the histopathology of tumors, on classification methods and prognostic factors;
• acquire adequate knowledge on the symptoms and clinical pictures of neoplastic diseases and acquire theoretical and practical knowledge related to the different therapeutic possibilities in integrated treatments in oncology and knowledge on the general role of medical, surgical, radiotherapy oncological therapy and their integration, as well as on support and assistance therapies for the terminally ill;
• to be able to recognize and treat the symptoms of the terminal phase with knowledge related to palliative care and pain therapy, deepening the knowledge necessary to allow a correct relationship and effective communication between doctor/patient and with his/her family;
• define the clinical approach of radiotherapy treatment in a general interdisciplinary framework;
• he must also be able to perform the various phases of the radiotherapy procedure both with external beams and with brachytherapy and to plan and carry out the patient's follow-up.

Integrated training objectives (i.e. common core): the student must have acquired the scientific bases and theoretical-practical preparation necessary for the exercise of the profession of specialist and the methodology and culture necessary for the practice of lifelong learning, as well as a level of professional, decision-making and operational autonomy deriving from the training course followed. The student must acquire: the essential knowledge deriving from the basic sciences, underlying all the different articulations of the training courses and indispensable for the knowledge of the equipment and for the correct application of procedures and methods; the fundamental knowledge of molecular biology and genetics, the advanced knowledge on the etiopathogenic mechanisms of neoplastic disease, the theoretical knowledge and clinical practice adequate for the prevention, diagnosis, therapy and follow-up of the neoplastic patient; finally, the clinical knowledge necessary for an accurate classification of pathologies in order to be able to optimally exercise the correct diagnostic, interventional or therapeutic options, also in compliance with current regulations in the field of radiation protection and protection, evaluating risks, costs and benefits; the ability to communicate clearly and humanely with the patient and family members. Finally, the resident must acquire the ability to interact with attending physicians and other specialists, as well as to collaborate with other professionals in the radiology area and the ability to interpret scientific English.

The following are compulsory professionalizing activities for the achievement of the educational purposes of the type:

• attend the sections, general and special services of the radiotherapy department (from the outpatient clinics to the inpatient ward to the radiotherapy department with external beams and brachytherapy) having collaborated in the clinical activity of radiotherapy, assuming increasing responsibilities and autonomy, up to complete autonomy, as indicated below:
  • for 18 months in the ordinary inpatient ward and day hospital;
  • for 2 months of the brachytherapy section (department);
  • for 28 months of the radiotherapy departments with external beams, dosimetry and treatment and outpatient plans.

In the individual departments, the student must participate in the following activities:

a) Inpatient wards.

The resident must participate in the clinical activity, from the initial visit to the review of the existing documentation, its integration and discussion of the diagnostic approach as well as therapeutic decisions, both with regard to the prescription of radiotherapy treatment and that of integrated antineoplastic pharmacological treatment and that of supportive or palliative therapy. He must also participate in the review of documentation from the departments of external radiotherapy, brachytherapy, dosimetry and treatment plans, and must participate in the evaluation of diagnostic imaging documentation.

The resident must then follow the evolution of the disease. In total, he/she will have to personally perform the tasks entrusted to him/her in at least 60 clinical cases relating to patients admitted to the ordinary inpatient and day-hospital wards.

b) Brachytherapy Units (Departments).

The resident must participate in the clinical activity relating to brachytherapy procedures and the evolution of the disease following the therapeutic measures adopted. He/she must also participate in the discussion of diagnostic imaging documentation.

The resident must have performed the tasks entrusted to him, on at least 8 patients undergoing interstitial brachytherapy, endocavitary and metabolic radiotherapy procedures.

c) Radiotherapy departments with external beams, dosimetry and treatment plans, outpatient and follow-up.

The resident must actively participate in all phases of preparation and execution of a radiotherapy treatment with external beams, both on outpatients and hospitalized patients, with techniques related to: linear accelerators and other equipment for radiotherapy with external beams; universal simulator and/or CT simulator for images; CT, MRI, PET and SPECT sections for the identification and definition of target volumes, critical organs, iatrogenic damage, recurrences; mechanical workshop for the production of customized shaped shielding models; use of individual treatment planning systems (TPS); dosimetry laboratory for the control and calibration of radiation beams.

The student must have acquired experience in conformal treatment techniques and intensity-modulated radiotherapy (IMRT) and systems for their verification. The resident must have followed the patients during the outpatient radiotherapy treatment, exclusive or integrated with pharmacological treatment, and in the subsequent follow-up.

The student must have personally carried out the tasks entrusted to him/her on at least:

• 75 patients treated with external beam radiotherapy;
• 75 patients already treated examined for control with the use of diagnostic images;
• 75 patients studied with CT simulator and, if deemed necessary, with simulator;
• 20 patients with irradiation volumes defined by CT, MRI, PET or SPECT;
• 50 studies of individual treatment plans with TPS;
• 15 patients treated with special techniques (total body irradiation, radiosurgery, intraoperative radiotherapy, etc.);
• 5 custom contoured shield patterns.

Finally, the resident must also have personally participated in the conduct of controlled clinical trials.

During the course, the resident must have followed at least 350 patients (hospitalization, brachytherapy, external beam therapy, outpatient clinic and follow-up).

The following are similar or supplementary objectives:

• the organizational and administrative methods of a Radiotherapy service, managing its human, instrumental and economic resources;
• medical-legal problems inherent in the profession of radiation therapist;
• basic elements of the scientific methodology necessary for the understanding of the scientific literature and for the development of individual research.

The student will be able to compete for the diploma after completing the professionalizing activities.

As part of the training course, the student will have to learn the scientific bases of the type of School in order to achieve full maturity and professional competence that includes an adequate ability to interpret scientific innovations and critical knowledge that allows him to consciously manage both assistance and his own updating; In this context, participation in meetings, congresses and the production of scientific publications and periods of attendance in qualified Italian and foreign institutions useful for his/her training may be envisaged.