I'm certainly not the best qualifed to answer this question, but I'll try.
1. All oncology patients are referred to RadOnc. Therefore, it is best to have cordial relationships with other oncologists and surgeons.
2. At the initial consultation the patient is seen by the attending (sometimes preceded by resident and/or med student). At this time, the attending takes a full history and physical. Prior to the consult, appropriate labs, films, and medical history are reviewed. The attending gives the pt options and we go to the next step if pt wants to proceed with radiotherapy. The choice of treatment depends on what the current literature says, institutional hardware, and the attending's own experiences.
3. Pt is "simmed." Rad techs position the patient in the machine and "simulate" an actual treatment. This way attending can verify the regional anatomy (both bony landmarks and soft tissue critical structures) and make adjustments as necessary.
4. Pt is "planned." Now that the images are on disk, the patient's tumor volumes and critical structures are "contoured" by the resident and/or attending. Once the attending is satisfied with the area covered by radiation (including extra margins for tumor not apparent on imaging) then the plan goes to the dosimetrists.
5. Dosimetrists (w/ or w/o resident) calculates plan including beam angles, doses, and fractionation. Generally, there is some degree of back and forth b/w the attending and dosimetrist with regard to plan optimization. Physics also looks at the plan and approves it.
6. Pt is brought back for first treatment. Everything is set-up and pt is "simmed" one more time to ensure quality treatment. If everything looks good, pt receives first treatment.
7. During the course of treatment pt receives so called "portal films." (usually 1/week) These are images taken with the treatment machine to verify that you are actually irradiating the correct area. Also, patients see the attendings to report any side-effects or if they have any questions 1/week or so -- though obviously immediately for pressing issues.
8. Pt is seen @ follow-up clinics periodically for up to several years post-RT. Generally, the attending reviews scans to evaluate recurrence of disease as well as a physical exam.
That's more or less the sequence.
