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Originally published December 16, 2025
Last updated December 10, 2025
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The world of medicine is fast-changing, and radiation oncology is no exception. While many changes pose new challenges to radiation oncologists and their patients, there are positive impacts, too, says May Lin Tao, MD, a radiation oncologist with USC Norris Comprehensive Cancer Center, part of Keck Medicine of USC. Tao serves as medical director of the cancer program at the Keck Medicine of USC and Henry Mayo Newhall Hospital joint venture in the Santa Clarita Valley. She also directs clinical operations for Keck Medicine’s regional radiation oncology clinics. She is a clinical associate professor in the Department of Radiation Oncology at the Keck School of Medicine of USC.
Here are seven of the biggest influences on the radiation oncology field.
“Ongoing Medicare payment cuts and increased expenses for delivering care are affecting not only who we can treat but also the financial stability of radiation oncology practices and many specialties in medicine,” Tao says. “These factors are affecting both the workforce and patient care, putting the landscape of the field at risk.”
Within the high-tech specialty of radiation oncology, which involves costly equipment, those expenses are likely to only increase as technology advances. While advances in technology will bring about better results, the financial cost of specialized equipment can complicate the business of radiation oncology.
“Medicine is still, to some extent, a business in the sense that to be able to take care of patients, we have to be viable,” Tao says.
There’s also been a recent trend towards fewer and larger radiation oncology practices, rather than many smaller private practices, Tao says. A March 2025 report in the International Journal of Radiation Oncology, Biology, Physics examined data from 2015 and 2023 and reported an overall 16% increase in practicing radiation oncologists — but a drop of 13% in the overall number of practices employing them. Additionally, large practices grew by 51%, while solo ones decreased by 27%.
“This trend goes hand in hand with increased financial challenges and the increased expense of being able to deliver care,” Tao says. “To do what we need to do, we need multimillion-dollar machines, and it’s very hard for a solo practitioner to have that kind of capital readily available.”
Whether consolidation will improve or worsen patient care is hard to predict, Tao adds. One thing it can do, however, is reduce the number care centers, giving patients fewer location options and potentially requiring them to travel outside of their neighborhoods for care. But, in theory, consolidated centers can also result in more types of clinicians and oncologists working together in one place, fostering an environment of multidisciplinary care.
There is an increasing trend of multidisciplinary care and personalized medicine, Tao says: “For example, at Keck Medicine, we have a multidisciplinary tumor board where multiple oncology disciplines, as well as supporting disciplines like pathology and radiology, are represented and review and make recommendations together on individual cases.” Similarly, multidisciplinary clinics exist for certain cancer types, like breast cancer, where a patient is seen by multiple types of specialists for a holistic treatment plan.
“We use a more precise biologic risk classification so that we are dose-intensifying, de-escalating or omitting treatment when appropriate in an effort to reduce the burden and side effects of treatment while maintaining a high cancer control or survival rate,” Tao explains.
“In radiation oncology, you are physically targeting something like an arrow,” Tao says. “When we have better ways of imaging, better ways of controlling any motion of the target and an automated way of using computers and other technology, all of this makes our targeting faster and more precise.”
Keck Medicine also offers a new approach to radiation treatment called biology-guided radiation therapy (BgRT). This technique uses the tumor’s own biological activity — captured in real time through its positron-emission tomography (PET) signal — to continuously track the tumor’s position. By following this “live” signal, clinicians can precisely guide radiation delivery even as the tumor moves with breathing or natural body motion.
“Better precision also allows us to spare normal tissue from any ancillary damage,” Tao says. “BgRT is a transformative leap forward that marries this technology with tumor biology.”
Artificial intelligence is also helping move the field toward higher precision and automation. “More and more, we’re using artificial intelligence to do some of the work for us, or at least the first part of the work,” Tao says. “We determine and specify what target we want, while accounting for tumor motion and daily variances. Then we specify dose avoidance to adjacent normal tissues and use a computer algorithm to generate a plan, which we evaluate. The process is reiterated until an optimal solution is found.”
Additionally, new imaging techniques help with targeting. In the past, X-rays were used to localize the tumor target. But now, radiation oncologists can use more advanced, multimodality imaging to plan and guide treatment, she says.
“We have imaging modalities that are integrated in the treatment delivery machine, allowing us to actually see, in real time, the target, which may be slightly moving since the patient is breathing or might have other slight movements while lying on a table,” Tao says.
As technology has allowed physicians to more precisely target tumors at a sub-centimeter level and avoid adjacent normal tissue, physicians are now able to compress treatment timelines so that they can deliver more dosage over fewer treatment sessions.
“This can lead to a greater ability to both cure and palliate patients,” Tao says. “For example, we can reduce the pain caused by a tumor while lessening the burden on patients in terms of time spent in the doctor’s office receiving treatment and reducing negative side effects.”
Low-dose radiation therapy for benign inflammatory conditions is experiencing a resurgence, especially in the United States, after decades of being used more commonly in Europe, Tao says. Low-dose radiation therapy uses small, carefully targeted doses of radiation — far lower than those used for cancer treatment — to treat non-malignant, inflammatory or degenerative conditions. Typical doses can be 1% or less than what is given for cancer, delivered in one to six sessions, depending on the situation. At lower doses, radiation has an anti-inflammatory and immunomodulatory effect.
“Clinicians are recognizing radiation as a biologically active tool, not just a cancer treatment,” Tao says. It’s useful for conditions like painful osteoarthritis, tendonitis, plantar fasciitis, Dupuytren’s contracture and hidradenitis, heterotopic ossification prophylaxis and keloids, she adds.
“Low-dose radiation therapy is as attractive as it is noninvasive. It has very low toxicity, it’s short in duration, and it has good evidence of durable symptom relief,” Tao says. “It’s especially compelling for older adults or those who have exhausted other therapies. The resurgence reflects a combination of patient need, clinical evidence, technological refinement and broader multidisciplinary awareness.”
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