Postgraduate School of Radiation Oncology

Integrated Educational Objectives (i.e., Common Core)
The trainee must have acquired the scientific foundation and theoretical and practical training necessary to practice the profession of specialist and the methodology and culture necessary for continuing education, as well as a level of professional, decision-making, and operational autonomy resulting from the training program followed. The trainee must acquire: essential knowledge derived from the basic sciences, underlying all the various aspects of the training programs and essential for mastering the equipment and the correct application of procedures and methods; fundamental knowledge of molecular biology and genetics; advanced knowledge of the etiopathogenetic mechanisms of cancer; theoretical knowledge and clinical practice appropriate for the prevention, diagnosis, treatment, and follow-up of cancer patients; Finally, the clinical knowledge required for an accurate assessment of pathologies in order to optimally implement the correct diagnostic, interventional, or therapeutic options, also in compliance with current regulations on radiation protection and radiation safety, assessing risks, costs, and benefits; the ability to communicate clearly and compassionately with patients and their families. Finally, the trainee must acquire the ability to interact with attending physicians and other specialists, as well as to collaborate with other radiology professionals, and the ability to interpret scientific English.

Basic training objectives
- knowledge of medical physics, computer science, statistics, tumor epidemiology, anatomy and pathological anatomy, biology, radiation safety, and iatrogenic damage;
- Understand radiation sources and the physical basis of radiotherapy, radiation beam dosimetry procedures, external beam radiation therapy and brachytherapy equipment, simulation equipment, treatment techniques, dose calculation systems, and quality control procedures.
- Acquire essential knowledge of clinical pharmacology for the most commonly used drugs, particularly antineoplastic drugs.
- Acquire the ability to organize the activities of a complex radiotherapy facility.

Educational objectives of the School
- Understand the mechanisms of radiation action on cell populations, tumor response to radiation, the effects of radiation on various organs and systems, indicators of biological response, and radiation protection criteria and procedures.
- Acquire a level of knowledge adequate to acquire, interpret, archive, and manipulate bioimages to formulate independent clinical judgments for therapeutic planning.
- Increase knowledge of the biology of neoplasms, preventive measures, tumor histopathology, classification methods, and prognostic factors.
- acquire adequate knowledge of the symptoms and clinical presentations of neoplastic diseases and acquire theoretical and practical knowledge related to the various therapeutic options in integrated oncology treatments, as well as knowledge of the general role of medical, surgical, and radiotherapy oncology therapy and their integration, as well as supportive and terminally ill therapies;
- be able to recognize and treat terminal symptoms, with knowledge of palliative care and pain management, deepening the knowledge necessary to establish a proper relationship and effective communication between the doctor and patient and with the patient's family.
- define the clinical approach to radiotherapy treatment within a general interdisciplinary framework; they must also be able to perform the various phases of the radiotherapy procedure, both with external beams and brachytherapy, and plan and conduct patient follow-up.

Similar or complementary objectives include:
- the organizational and administrative procedures of a radiotherapy service, managing its human, material, and financial resources;
- medico-legal issues inherent in the profession of radiation oncologist;
basic elements of scientific methodology necessary for understanding scientific literature and developing individual research.


Mandatory Professional Development Activities to achieve the educational objectives of the program include
attending the sections, general and special services of the radiotherapy department (from the outpatient clinics to the inpatient ward, to the external beam radiotherapy and brachytherapy departments), having collaborated in the radiotherapy clinical activities, assuming increasing responsibilities and autonomy, until reaching complete autonomy, as indicated below:
- for 18 months in the inpatient ward under the ordinary regime and day hospital; - for 2 months in the brachytherapy section (ward);
- for 28 months in the external beam radiotherapy, dosimetry, treatment planning, and outpatient departments. In each department, the trainee must participate in the following activities:
a) Inpatient wards.
The resident must participate in clinical activity, from the initial examination to the review of existing documentation, its integration, and the discussion of the diagnostic approach as well as therapeutic decisions, both regarding the prescription of radiotherapy and integrated antineoplastic drug therapy, as well as supportive or palliative therapy. They must also participate in the review of documentation from the external radiotherapy, brachytherapy, dosimetry, and treatment planning departments, and must participate in the evaluation of diagnostic imaging documentation.
The resident must then monitor the progression of the disease. In total, they must personally perform the assigned tasks in at least 60 clinical cases involving patients admitted to the inpatient and day hospital wards.
b) Brachytherapy Units.
The resident must participate in clinical activity related to brachytherapy procedures and the progression of the disease following the therapeutic measures adopted. They must also participate in the discussion of diagnostic imaging documentation.
The trainee must have completed the assigned tasks on at least eight patients undergoing interstitial, intracavitary, and metabolic radiotherapy procedures.
c) External beam radiotherapy departments, dosimetry and treatment planning, outpatient clinic, and follow-up.
The trainee must actively participate in all phases of preparing and administering external beam radiotherapy, both on outpatients and inpatients, using techniques related to: linear accelerators and other external beam radiotherapy equipment; universal simulator and/or CT imaging simulator; CT, MRI, PET, and SPECT scans for the identification and definition of target volumes, critical organs, iatrogenic damage, and recurrences; a mechanical workshop for the production of customized contoured shielding models; use of individual treatment planning systems (TPS); and a dosimetry laboratory for the control and calibration of radiation beams.
The trainee must have acquired experience with conformal and intensity-modulated radiotherapy (IMRT) treatment techniques and their verification systems. The trainee must have treated patients during outpatient radiotherapy, either exclusively or in combination with pharmacological treatment, and during subsequent follow-up.
The trainee must have personally performed the assigned tasks on at least:
- 75 patients treated with external beam radiotherapy;
- 75 previously treated patients examined for follow-up with the use of diagnostic imaging;
- 75 patients studied with a CT simulator and, if deemed necessary, with a simulator;
- 20 patients with radiation volumes defined by CT, MRI, PET, or SPECT;
- 50 individual treatment plan studies with TPS;
- 15 patients treated with specialized techniques (total body irradiation, radiosurgery, intraoperative radiotherapy, etc.)
- 5 models of customized contoured shielding.
Finally, the resident must have personally participated in the conduct of controlled clinical trials.
During the course, the resident must have treated at least 350 patients (inpatient, brachytherapy, external beam therapy, outpatient, and follow-up).
The resident may apply for the diploma after completing the professional development activities.
As part of the training program, the resident must learn the scientific foundations of the School's approach to achieving full maturity and professional competence. This includes adequate ability to interpret scientific innovations and a critical understanding that allows them to consciously manage both care and their own development. This may include participation in meetings, conferences, the production of scientific publications, and periods of attendance at qualified Italian and foreign institutions useful for their training.