Radio Therapy Course, Treament and side Effects,,

Radiotherapy means the use of radiation, usually x-rays, to treat cancer cells. You might have radiotherapy from inside the body, this is called internal radiotherapy. Or external radiotherapy is from outside of the body.

Radiotherapy can be used to try to cure cancer, reduce the chance of cancer coming back or to help relieve symptoms. You might have it by itself or with other treatments such as chemotherapy or surgery.

Nearly 50 out of 100 (50%) people have radiotherapy at some point during their cancer treatment.

Most types of radiotherapy use photons. But you might have electrons or more rarely protons. Your doctor will decide which type you need.

Radiotherapy Technicians work in cancer hospitals and aid in chemotherapy treatment. The subject of Radiotherapy is also an integral part of B.Sc. in Medical Technology pursed by Medical Technologists.


Top Institutes offering this course are: 

Adayr Cancer Institute, Chennai.
AIIMS, New Delhi
Christian Medical College, Vellore
Kasturba Medical College, Mangalore
Madras Medical College, Chennai
Government Medical College, Nagpur


The curriculum covers areas of study such as Radiation Physics, Radiobiology, Radiation Oncology, Chemotherapy and related topics. Eligible candidates are needed to be well- versed in the constantly evolving techniques and drugs applied in chemotherapy, besides the use of computers, radiological concepts etc.


The average tuition fee charged in India for the course ranges between INR 80000 and 10 Lacs. Admission to the course is based on the candidate’s rank in the National Eligibility cum Entrance Test (NEET).

MD Radiotherapy: Eligibility


Applicants aspiring to pursue the course need to have completed any of M.B.B.S., B.D.S., D.M.S., D.H.M.S., B.H.M.S., B.A.M.S., B.A.S.M., B.E.M.S., B.I.A.M.S., B.N.Y.T., B.A.T.S., B.U.M.S., B.P.T., B.Pharma., N.O., and M.D (A.M).


Practitioners and research workers who have been practicing for the last 10 years, are exempted from fulfilling such requirements of basic minimum qualification, and may directly apply for the program.

MD Radiotherapy: Admission Process


Admission to the course is based on the candidate’s performance in any of the following entrance examinations: 

Centrally-conducted NEET PG (conducted by NBE)
A State- level PG exam
Autonomously- conducted entrance exam such as those conducted by any of AIIMS, PGI and JIPMER
Institute- specific entrance examination conducted by a concerned college.



Successful postgraduates of the course are hired in capacities such as Radiation Oncologist/ Radiation Therapist, Radiology Technicians, Ultrasound Technician/ Diagnostic Medical Sonographer, MRI Technician, CT Tech/ CAT Scan Technologist/ CT Scan Technologist etc.


They are hired in industries related to healthcare, including Hospitals, Physician Practices, Integrative Healthcare Clinics, Public Health Clinics, College Health Centers, Natural Apothecaries etc. The average annual salary offered in India for such positions varies between INR 2 and 10 Lacs.


Radiologist Technologists aid the Radiologist in processes of diagnosis and imaging. They take the imaging and take care of the safety and comfort of the patient. The RT is not involved in the actual diagnosis as it is performed by the Radiologist.


Radiologist Assistants perform advanced techniques to investigate disorders. They help Radiologists in complex radiology procedures and perform fluoroscopy under his supervision. They are a channel between the radiology department and the physician. Venous diagnostic exams and feeding tube installation are the other duties.


Radiation oncologist. This type of doctor specializes in giving radiation therapy to treat cancer. A radiation oncologist oversees radiation therapy treatments. He or she works closely with other team members to develop the treatment plan.

Radiation oncology nurse. This nurse specializes in caring for people receiving radiation therapy. A radiation oncology nurse plays many roles, including:

• Answering questions about treatments
• Monitoring your health during treatment
• Helping you manage potential side effects

Medical radiation physicist: This professional has expertise in radiation equipment. He or she helps design treatment plans.

Dosimetrist :This professional helps the radiation oncologist calculate the right dose of radiation.

Radiation therapist or radiation therapy technologist. This professional operates the treatment machines and gives people their scheduled treatments.

Other health care professionals. Additional team members may help care for physical, emotional, and social needs during treatment. These professionals include:


Social workers,Nutritionists or dietitians,Physical therapists,Dentists


Your course of treatment


When deciding on your course of treatment your doctor takes into account:

• your type of cancer
• the position of the cancer in the body
• any other treatment you've had, are having, or is planned for you
• your general health and fitness

Aim of radiotherapy treatment

The principal platform for external beam radiotherapy delivery, the Linear Accelerator (LinAc), had also reached something of a plateau of development, albeit with improved reliability, but few fundamental changes. Caesium tubes were transported from the “radium safe”, locked in an underground vault, to the operating theatre in a lead-lined trolley, where they were only loaded into “central tubes” and “ovoids” after the examination under anaesthetic (which was performed with the patient in the knee-chest position); they were then manually placed into the patient, who went to be nursed on an open ward, albeit behind strategically placed lead barriers.

For no sites outside the cranium was Computer Tomography (CT) scanning available. Magnetic Resonance Imaging (MRI) was still a vision seen only by a small number of enthusiasts.

All these limitations were met by a developing team of scientific and clinical enthusiasts believing in the future of radiotherapy if only technology could deliver solutions to address an improving understanding of the differing cancers and their radiobiology.

In the latter half of the eighties these solutions began to crystallise. Computers were being introduced across the NHS and their impact was not lost in radiotherapy. Pads of tracing paper were replaced with the first generation of planning computers. The simple “Bentley-Milan” algorithms could account for patient outlines accurately and speedily and optimising different beam configurations became practical. Consideration of Organs at Risk, as defined by the various International Commission on Radiation Units (ICRU) publications, became increasingly relevant. Recognition of the importance of delineating the target volumes and protecting normal tissue required improved imaging and this was provided by the new generation of CT scanners. In the nineties these were shared facilities with diagnostic radiology departments. However, the improvements provided by this imaging, enabling accurate 3-dimensional mapping of the disease with adjacent normal tissues and organs at risk, dictated their inclusion into every radiotherapy department soon after the millennium. The added bonus of using the grey scale pixel information, or Hounsfield numbers, to calculate accurate radiation transport distributions soon followed when the mathematical and computer technology caught up with the task. The value of MR and Positron Emission Tomography (PET) imaging was also recognised in the diagnosis, staging and planning of radiotherapy and the new century saw all of these new technologies embedded within the department.

Mould room technology was also improving with “instant” thermoplastic immobilisation shells replacing the uncomfortable plaster and vacuum forming methods. Custom shielding with low melting high density alloys was becoming routine and it was not long before these techniques were married with the emerging CT planning to provide “conformal” treatments.

LinAc technology also received added impetus. Computers were firstly coupled as a front end to conventional LinAcs as a safety interface to reduce the potential for “pilot error”. Their values were soon recognised by the manufacturers and were increasingly integrated into the machine, monitoring performance digitally and driving the new developments of Multi Leaf Collimators (MLC) and On Board Imaging (OBI).

The dominos for the radiotherapy renaissance were stacked up, but it needed the radiographers, clinicians and scientists to decide on the direction of travel. Computer power coupled with advanced electro-mechanical design had transformed MLC efficiency and resolution. Conventional conformal planning was now progressively superseded by sophisticated planning algorithms using merged CT and MR images. Intensity Modulated RadioTherapy (IMRT) had arrived in its evolving guises of multiple fixed field, dynamic arc therapy (RapidArc) or Tomotherapy. Whichever technique, they all offered the radiotherapy “Holy Grail” of providing three dimensional homogeneous dose distributions conformed to the Planning Target Volume (PTV) whilst achieving the required dose constraints for organs at risk and normal tissue preservation.
Radiotherapy with the aim of curing cancer usually lasts between 1 to 7 weeks.

For radiotherapy to relieve symptoms, you might have anything between a single treatment to 2 weeks of treatment. It might be longer than this. Your doctor will tell you how many treatments you’ll have.

Most people have daily treatment from Monday to Friday, with a rest at weekends. But this can vary. For example, you might have treatment once a week for a set number of weeks. It is also sometimes possible to have more than one treatment per day.

Let your radiographer (sometimes called a radiotherapist) know at your planning radiotherapy appointment if you have any commitments such as work or childcare that mean you need a specific time for your appointments. They will try to be as flexible as possible, but it can difficult depending on how busy the department is.




Understanding Radiation Therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time.
Goals of radiation therapy

Radiation oncologists use this type of treatment to destroy cancer cells and slow tumor growth without harming nearby healthy tissue.

Sometimes, doctors recommend radiation therapy as the first cancer treatment. Other times, people receive radiation therapy after surgery or chemotherapy. This is called adjuvant therapy. It targets cancer cells remaining after the initial treatment.

When it is not possible to destroy all of the cancer, doctors may use radiation therapy to shrink tumors and relieve symptoms. This is called palliative radiation therapy. Palliative radiation therapy may reduce pressure, pain, and other symptoms. The goal is to improve a person’s quality of life.

More than half of people with cancer receive some type of radiation therapy. For some cancers, radiation therapy alone is an effective treatment. Other types of cancer respond best to combination treatments. This may include radiation therapy plus surgery, chemotherapy, or immunotherapy.

1,External-beam radiation therapy

This is the most common type of radiation therapy. It delivers radiation from a machine outside the body. It can treat large areas of the body, if needed.

A machine called a linear accelerator, or linac, creates the radiation beam for x-ray or photon radiation therapy. Special computer software adjusts the beam’s size and shape. This helps target the tumor while avoiding healthy tissue near the cancer cells.

Most treatments are given every weekday for several weeks. Form-fitting supports or plastic mesh masks are used for radiation therapy to the head, neck, or brain to help people stay still during treatment.

The types of external-beam radiation therapy are:

Three-dimensional conformal radiation therapy (3D-CRT):  Detailed 3-dimensional pictures of the cancer are created, typically from computed tomography (CT) or magnetic resonance imaging (MRI) scans. This allows the treatment team to aim the radiation therapy more precisely. It often means that they can safely use higher doses of radiation therapy while reducing damage to healthy tissue. This lowers the risk of side effects. For instance, dry mouth is common after radiation therapy for head and neck cancer. But 3D-CRT can limit the damage to the salivary glands that causes dry mouth.

Intensity modulated radiation therapy (IMRT): This a more complex form of 3D-CRT. The radiation therapy intensity is varied within each beam in IMRT unlike conventional 3D-CRT, which uses the same intensity in each beam. IMRT targets the tumor and avoids healthy tissue better than conventional 3D-CRT.


Proton beam therapy: This treatment uses protons rather than x-rays. A proton is a positively charged particle. At high energy, protons can destroy cancer cells. The protons go to the targeted tumor and deposit the specific dose of radiation therapy. Unlike with x-ray beams, the radiation therapy does not go beyond the tumor. This limits damage to nearby healthy tissue. Currently, doctors use proton therapy to treat certain types of cancer. This therapy is relatively new and requires special equipment. Therefore, it is not available at every medical center.

Image-guided radiation therapy (IGRT): This type of therapy allows the doctor to take images of a patient throughout treatment. These images can then be compared to the images used to plan treatment. It allows better targeting of the tumor and helps reduce damage to healthy tissue.

Stereotactic radiation therapy: This treatment delivers a large, precise radiation therapy dose to a small tumor area. The patient must remain very still. Head frames or individual body molds help limit movement. This therapy is often given as a single or a few treatments. But some patients may need several treatments.

2,Internal radiation therapy

This type of radiation therapy is also called brachytherapy. Radioactive material is placed into the cancer or surrounding tissue. Implants may be permanent or temporary and may require a hospital stay.

Types of internal radiation therapy include:

Permanent implants. These are tiny steel seeds that contain radioactive material. The capsules are about the size of a grain of rice. They deliver most of the radiation therapy around the implant area. But some radiation may exit the patient’s body. This requires safety measures to protect others from radiation exposure. Over time, the implants lose radioactivity. And the inactive seeds remain in the body.

Temporary internal radiation therapy. This is when radiation therapy is given in one of these ways:

• Needles
• Tubes, called catheters, that carry fluid in or out of the body
• Special applicators

The radiation stays in the body for anywhere from a few minutes to a few days. Most people receive radiation therapy for just a few minutes. Sometimes, people receive internal radiation therapy for more time. If so, they stay in a private room to limit other people's exposure to the radiation.

3,Other radiation therapy options

Intraoperative radiation therapy (IORT). This treatment delivers radiation therapy to the tumor during surgery using either external-beam or internal radiation therapy. IORT allows surgeons to move away healthy tissue in advance. This treatment is useful when vital organs are close to the tumor.

Systemic radiation therapy. Patients swallow or receive an injection of radioactive material that targets cancer cells. The radioactive material leaves the body through saliva, sweat, and urine. These fluids are radioactive. Therefore, people in close contact with the patient should take the safety measures recommended by the health care team.

Radioimmunotherapy. This is a type of systemic therapy. It uses monoclonal antibodies to deliver radiation directly to cancer cells. This therapy delivers low doses of radiation directly to the tumor. It does not affect noncancerous cells. Examples include ibritumomab (Zevalin) and tositumomab (Bexxar).

Radiosensitizers and radioprotectors. Researchers are studying radiosensitizers. They are substances that help radiation therapy better destroy tumors. Radioprotectors are substances that protect healthy tissues near the treatment area. Examples of radiosensitizers include fluorouracil (5-FU, Adrucil) and cisplatin (Platinol). Amifostine (Ethyol) is a radioprotector.

Peptide receptor radionuclide therapy (PRRT). This type of radioactive therapy works by attaching to specific proteins that can be found on the surface of certain tumor cells. These proteins are called receptors. After attaching to the receptor, the drug enters the cell, allowing radiation to damage the tumor cell. Recently, the FDA approved a treatment called 177Lu-dotatate (Lutathera) for advanced neuroendocrine tumors of the gastrointestinal tract.

Safety for the patient and family

Doctors have safely and effectively used radiation therapy to treat cancer for more than 100 years.

Having radiation therapy slightly increases the risk of developing a second cancer. But for many people, radiation therapy eliminates the existing cancer. This benefit is greater than the small risk that the treatment could cause a new cancer.

During external-beam radiation therapy, the patient does not become radioactive. And the radiation remains in the treatment room.

However, internal radiation therapy causes the patient to give off radiation. As a result, visitors should follow these safety measures:

Do not visit the patient if you are pregnant or younger than 18.
Stay at least 6 feet from the patient’s bed.
Limit your stay to 30 minutes or less each day.

Permanent implants remain radioactive after the patient leaves the hospital. Because of this, the patient should not have close or more than 5 minutes of contact with children or pregnant women for 2 months.

Similarly, people who have had systemic radiation therapy should use safety precautions. For the first few days after treatment, take these precautions:

Wash your hands thoroughly after using the toilet.


Where radiotherapy is given

You usually have radiotherapy in a hospital that has a major cancer treatment centre. This means you may have some treatment at your local hospital, such as surgery or chemotherapy. But you may have radiotherapy at a different hospital.

You usually have external beam radiotherapy as an outpatient. If you are unwell, or are having chemotherapy at the same time, you may need to stay in hospital. In this case, you will go to the radiotherapy department each day from the ward.

If you are having some types of internal radiotherapy, you may have to stay in hospital for a few days.

A Radiotherapist / Radiation Oncologist is a specialist who deals with treatment of cancer patients mainly with the use of different modalities of radiation. The treatment of cancer is a multimodality comprehensive treatment with surgical oncology, radiation oncology and medical oncology being integral parts of it.


CT Tech is responsible for producing computerized tomographic scans of certain sections of the patient’s body. CAT Scan Technologists perform abdominal scans, gynecological and obstetric scans, ultrasound examinations, as well as retroperitoneal scans to create three-dimensional cross-sections or slices of the body.

MRI Techs operate a magnetic resonance scanner to obtain two- or three-dimensional maps of various tissue types within the patient’s body that are used by physicians in the diagnosis and treatment of pathologies. After entering and monitoring the patient’s data, the MRI Technician transfers images from disk to magnetic media in order to create and develop the film for the doctor or radiologist to analyze.

Diagnostic Medical Sonographers are skilled technicians who use ultrasound technology on a wide range of soft-tissue procedures, including obstetric and gynecologic sonography, abdominal, cardiac, and neuro-sonography.

X-ray Technicians (also known as X-ray Technologists or Radiologic Technologists) use cutting-edge imaging methods to visualize the inside of the human body. The pictures they create help physicians diagnose and treat illnesses or injuries with great accuracy.

Radiotherapy can cause side effects.

 Your side effects may depend on

• the area of your body being treated
• the type of radiotherapy you have
• other treatments you are also having.

Most people have a few side effects during or after radiotherapy. Your radiotherapy team will tell you about the possible side effects. They will explain if you have a risk of side effects that may be long-term or only start months or years after radiotherapy. General side effects may include:

• tiredness
• problems with eating and drinking
• feeling sick
• skin reactions
• hair loss.

Side effects do not usually happen straight away. They may develop during treatment or in the days or weeks after treatment finishes. Sometimes side effects get worse for a time before they get better.

There are ways to manage side effects. If you feel unwell, or need any help and advice, tell your radiotherapy team. Always tell them if you have signs of infection or unexplained bleeding or bruising. Levels of cells in your blood may be low and may need treatment.

Prepared by M.Ajmal Khan.

Thanks to:Dr J.Fathima Jaffar MBBS,MD (Radio Therapy)

                   Adyar Cancer Institute, Chennai.