What Radiation Oncologists Do and Why Precision Matters More Than Ever
For many people, radiation therapy is imagined as a powerful beam aimed at a tumor. In reality, modern radiation oncology is closer to a carefully choreographed performance—one where timing, precision and coordination determine the outcome.
At Sylvester Comprehensive Cancer Center, part the University of Miami Health System, radiation oncologists are physicians who specialize in treating cancer using highly targeted radiation. They design and oversee treatment plans that destroy cancer cells while protecting healthy tissue, working closely with surgeons, medical oncologists and other specialists as part of a patient’s care team.
“As cancer treatment has become more personalized, radiation therapy has had to evolve right alongside it,” says Markus Bredel, M.D., Ph.D., chair of radiation oncology at Sylvester. “What we do today is very different from what patients may remember or expect.”
A treatment plan as unique as the patient
Radiation therapy is not a preset protocol. Before a single treatment is delivered, radiation oncologists study imaging, pathology, and medical history to determine whether radiation is appropriate and how it should be used.
Using advanced planning software and imaging tools, they design an individualized treatment plan that accounts for the tumor’s exact shape and location, nearby organs and how radiation fits into the overall course of care. In many ways, it resembles air‑traffic control: dozens of variables must be calculated and coordinated so treatment arrives exactly where it is needed, at precisely the right moment.
“The planning phase is just as important as the treatment itself,” says Brandon Mahal, M.D., vice chair and residency program director in the Department of Radiation Oncology. “That’s where we can make radiation both safer and more effective for each patient.”
Where artificial intelligence supports human expertise
Increasingly, radiation oncologists are supported by artificial intelligence–driven tools that assist with image analysis, treatment planning and quality checks. These systems can help identify patterns, flag inconsistencies and refine targeting but they do not replace physician judgment.
Instead, AI functions like a second set of eyes, enhancing accuracy and efficiency while leaving final decisions in the hands of experienced clinicians.
“AI helps us manage complexity,” says Dr. Bredel, chair of radiation oncology. “But it’s still the physician who understands the patient’s full story and decides how all of that information comes together.”
Why specialization has become essential
Cancer is not one disease, and radiation oncology reflects that reality. Many Sylvester radiation oncologists focus on specific cancer types, such as breast, prostate, lung, head and neck, brain and spine tumors, or on advanced radiation techniques that deliver high doses with extreme precision.
This specialization allows physicians to develop deep familiarity with how different cancers respond to radiation, much like a musician mastering a particular instrument. That focus helps refine treatment approaches, manage side effects more effectively, and tailor care to each patient’s diagnosis. In fact, Sylvester is one of only a handful of cancer centers that use adaptive radiation therapy, patients’ anatomy is analyzed each day for precise treatment. Bladders shift, a patient may be bloated and organs may move. This technique ensures specificity in treatment, less toxicity and better outcomes.
“When you treat the same type of cancer day in and day out, you see the nuances,” Dr. Bredel says. “That experience matters when you’re making decisions that affect long-term outcomes and quality of life.”
Sylvester’s Department of Radiation Oncology has grown into one of the largest in the U.S., and the most comprehensive program serving Florida — a state with the second-highest cancer burden in the nation — reflecting both the scale of need and the complexity of modern cancer care.
As cancer rates continue to rise across the state, particularly in South Florida, Sylvester has expanded its radiation oncology faculty to care for more patients and to support broader access to clinical trials that bring precision-based treatments closer to home, such as the newest facility in North Miami, UHealth SoLé Mia.
This growth strengthens the program’s ability to:
- match patients with disease-specific expertise
- shorten time to consultation
- integrate advanced radiation therapies and research into everyday care
This ensures that patients benefit from both capacity and innovation as demand continues to increase.
“In the last year, we’ve made top recruits in the radiation oncology division,” says Dr. Mahal, noting the new hires and their specialties.
John Michael Bryant, M.D., gastrointestinal cancer
Alexandra Dreyfuss, M.D., hematologic cancer
Amandeep Mahal, M.D., brain and spinal cord cancer
Raymond Mailhot, M.D., pediatric cancer
Neil Newman, M.D., gastrointestinal and thoracic cancers
Leah Katz, M.D., M.P.H., breast cancer
Sumit Sood, M.D., head and neck cancer and genitourinary cancer
“Today, our radiation oncologists go through extensive training and work across departments through the continuum of care as we learn more about managing certain cancers and apply the latest knowledge gleaned in practice and through clinical trials,” Dr. Mahal says.
A coordinated team behind every treatment
Radiation oncologists work as part of a multidisciplinary team that includes medical physicists, dosimetrists, radiation therapists and oncology nurses. Together, they translate complex treatment plans into daily therapy sessions that are safe, accurate and carefully monitored.
Radiation may be used before surgery to shrink a tumor, after surgery to reduce the risk of recurrence or alongside chemotherapy or immunotherapy to improve outcomes. In some cases, it plays a key role in relieving symptoms and improving comfort.
“Radiation therapy works best when it’s fully integrated into the rest of a patient’s care,” Dr. Bredel says. “It’s not a standalone decision. It’s part of a much bigger picture.”
Like an orchestra, each member of the team has a distinct role — but it is the coordination that ensures the treatment works as intended.
Bringing advanced care closer to home
Radiation therapy often requires multiple visits per week, sometimes over several weeks. For patients and caregivers, long travel times can add stress during an already challenging period.
As Sylvester has expanded cancer services across South Florida, radiation oncology has expanded with it—bringing specialized care closer to where patients live. Having radiation oncologists available at multiple locations helps improve appointment availability, reduce delays in starting treatment and make care more manageable for patients and families.
“Access is a critical part of quality cancer care,” Dr. Bredel says. “If patients can receive highly specialized treatment closer to home, it changes the entire experience.”
Written by Monica Smith.
Tags: adaptive radiation therapy, AI in radiation therapy, Dr. Brandon Mahal, Dr. Markus Bredel, precision cancer treatment
