This interview is with Maryna Von Aulock, Editor in Chief at Oncology..

Maryna Von Aulock, Editor in Chief, Oncology.

Welcome, Maryna! Could you please introduce yourself to our readers and share a bit about your background and expertise in the field of radiotherapy and healthcare?

I'm an instructor in the Radiotherapy Program at the British Columbia Institute of Technology (BCIT). My journey in healthcare began over four decades ago, starting in diagnostic imaging before finding my true calling in radiation therapy, where I've been privileged to work directly with cancer patients during some of their most challenging life moments.

Throughout my career, I've witnessed the remarkable evolution of radiation treatment technology—from the early days of 2D planning on physical simulators to today's sophisticated image-guided therapies that can target tumors with millimeter precision while sparing healthy tissue. What continues to inspire me after all these years is the unique blend of technical precision and compassionate care that radiotherapy demands.

In my classroom at BCIT, I emphasize to my students that while understanding physics, anatomy, and treatment planning is essential, equally important is developing the emotional intelligence to support patients through their cancer journey. These dual aspects of our profession—being both scientifically rigorous and deeply human—are what make radiotherapy such a rewarding field, and why I remain passionate about preparing the next generation of radiation therapists.

Can you walk us through your professional journey that led you to your current role? What inspired you to specialize in radiotherapy?

My professional journey began in Cape Town, South Africa, in the mid-1970s when, as a 17-year-old fresh out of high school, I followed my father's practical advice to pursue healthcare—one of the few professional fields readily accessible to women in South Africa at that time. Initially, I trained in diagnostic radiography, fascinated by the technology that could reveal the invisible within the human body.

But everything changed when I rotated through the radiation oncology department during my training and witnessed the profound impact radiation therapists had on cancer patients' lives—not just technically administering treatment, but providing emotional support through what was often the most challenging chapter of their lives.

After several years of clinical practice, I discovered that I had a passion for teaching and mentoring newer colleagues, which eventually led me to accept a teaching position at Cape Peninsula University of Technology (CPUT) in Cape Town. What drew me to education was the opportunity to shape not just individual patient experiences but the entire field through the next generation of practitioners. The most rewarding aspect was watching students transform from nervous beginners into confident professionals who understood that technical excellence and compassionate care are equally essential in radiation therapy.

In the early 2000s, I made the life-changing decision to immigrate to Canada, drawn by both personal circumstances and professional opportunities at BCIT's renowned Radiotherapy Program. The transition presented challenges—adapting to a new healthcare system and educational framework, but the fundamental principles of radiation oncology remained my anchor.

Looking back over five decades in this field, what continues to inspire me is how radiotherapy perfectly balances scientific precision with deeply human care, and how dramatically treatment technologies have evolved while the core mission of supporting patients through their cancer journey remains beautifully unchanged.

You mentioned the importance of adaptive radiation therapy (ART) in improving patient outcomes. Can you share a specific instance where utilizing ART led to a significant positive outcome for one of your patients? What were the key takeaways from that experience?

Happy to share my experience with this technology, which has indeed transformed treatment outcomes for many patients. One particularly memorable case involved a 62-year-old patient with locally advanced head-and-neck cancer who experienced significant weight loss and tumor shrinkage after the first two weeks of his six-week treatment course.

Using our daily cone-beam CT imaging, we observed these anatomical changes and recognized that continuing with the original treatment plan would have resulted in unnecessary radiation to healthy tissues while potentially underdosing parts of the tumor. By implementing an adaptive approach—reimaging, recontouring, and creating a new treatment plan midway through therapy—we were able to refocus the radiation beams precisely on the remaining tumor volume while sparing his parotid glands, which significantly reduced his risk of long-term dry mouth and improved his quality of life after treatment.

This case reinforced several crucial lessons for our clinical team: first, that cancer treatment isn't static. Patients' bodies and tumors change throughout the course of therapy. Second, that technological advances like daily image guidance provide valuable opportunities to personalize treatment in real-time. And third, that the additional time invested in plan adaptation pays tremendous dividends in both tumor control and reduction of side effects.

What makes adaptive radiotherapy so valuable is that it acknowledges the dynamic nature of cancer treatment, allowing us to respond to each patient's unique biological response rather than delivering a one-size-fits-all approach.

You emphasize continuous learning for yourself and your team. What are some creative strategies you've used to encourage ongoing learning and development, especially when it comes to staying updated on the latest advancements in radiotherapy?

In my classroom at BCIT, I've found that one of the most effective strategies for continuous learning is what I call "reverse mentorship" – pairing experienced radiation therapists with new graduates in mutual learning relationships. The veterans bring clinical wisdom and problem-solving skills, while recent graduates contribute fresh theoretical knowledge and comfort with emerging technologies.

This approach dismantles the hierarchy that can sometimes inhibit knowledge sharing and creates a culture where learning flows in multiple directions rather than just top-down.

Another approach that has proven remarkably successful is our monthly "journal club with a twist," where team members take turns not only presenting recent research but also creating hands-on simulations or case studies that demonstrate practical applications of the published findings. For example, when discussing a paper on cardiac-sparing techniques for left-sided breast cancer, the presenter created an anonymized treatment planning challenge using the new approach versus conventional methods, which transformed abstract concepts into tangible clinical skills.

I've also instituted "technology immersion days" where we partner with vendors or nearby research institutions for hands-on workshops with emerging technologies before they reach our clinic, allowing staff to provide input on implementation and workflow integration without the pressure of immediate clinical adoption.

The most powerful continuous learning strategy, however, has been creating opportunities for direct patient feedback on their treatment experience through recorded interviews or optional post-treatment discussions with our team. These raw, honest accounts of the patient journey provide context and motivation that purely technical learning cannot match – when a radiation therapist hears firsthand how their precision and compassion made a difference, it reinforces why staying at the cutting edge of our field matters beyond academic interest.

In radiotherapy education, we must remember that technology and techniques are ultimately in service of the human experience of cancer treatment.

Beyond technical skills, what soft skills do you believe are crucial for success in the field of radiotherapy, and how can aspiring radiation therapists develop these skills?

In my four decades of practice and teaching, I've observed that the most successful radiation therapists possess exceptional emotional intelligence alongside their technical expertise. Empathetic communication is perhaps the most crucial soft skill—the ability to explain complex technical procedures to frightened patients in accessible language, to recognize unspoken anxiety in body language, and to provide reassurance without false promises.

Equally important is emotional resilience; working daily with cancer patients means witnessing tremendous suffering, celebrating recoveries, and sometimes processing losses, all while maintaining the focus needed for precise treatment delivery. Adaptability is another essential quality, as radiation therapists must seamlessly adjust their approach for each patient—from the highly anxious person who needs extra explanation and reassurance, to the stoic individual who processes through quiet concentration, to the patient with cognitive challenges requiring modified communication strategies.

Cultural sensitivity has become increasingly important in our diverse healthcare environments; understanding how different cultural backgrounds affect patients' understanding of illness, their comfort with certain procedures, or their communication preferences can significantly impact treatment compliance and overall experience. For aspiring radiation therapists looking to develop these soft skills, I recommend seeking opportunities for patient interaction early in training through volunteering at cancer support centers or shadowing experienced therapists during patient consultations.

Role-playing exercises with peers can be surprisingly effective. Practicing difficult conversations, such as explaining side effects or addressing a patient's fear while receiving constructive feedback, helps build communication muscles in a safe environment. Keeping a reflective journal about patient interactions, particularly challenging ones, helps develop self-awareness and emotional processing skills that prevent burnout. What continues to surprise many of my students is that these soft skills can be systematically developed just like technical competencies—they're not innate traits that some people simply have or lack.

The healthcare landscape is constantly evolving. What do you see as the biggest challenges and opportunities facing the field of radiotherapy in the next 5-10 years? How can professionals prepare for these changes?

The most significant challenge facing radiotherapy in the coming decade is undoubtedly the integration of artificial intelligence and automation into our workflow—not because the technology itself is problematic, but because we must carefully navigate how to preserve human judgment and compassionate care while leveraging computational power for treatment planning and delivery.

We're entering an era where AI can contour organs and tumors, generate treatment plans, and predict outcomes with remarkable accuracy, yet the critical question becomes, how do we ensure these tools remain servants to human expertise rather than replacements for clinical reasoning and the therapeutic relationship? Simultaneously, we face tremendous opportunities through the convergence of radiotherapy with immunotherapy, targeted agents, and radiogenomics, allowing us to personalize radiation treatment based on each tumor's unique biological characteristics rather than just its anatomical location.

This biological adaptation—beyond the physical adaptation we currently achieve with techniques like ART—will enable us to modulate radiation dose based on tumor response, potentially sparing patients unnecessary treatment while improving outcomes. However, this evolution brings the challenge of increasingly complex decision-making and the need for radiation therapists and oncologists to develop a deeper understanding of cancer biology alongside technical expertise.

Another dual challenge-opportunity lies in the global distribution of radiotherapy expertise and technology; while high-resource settings push boundaries with MR-linacs and proton therapy, many regions worldwide still lack access to basic radiotherapy services despite 50-60% of cancer patients requiring radiation during their treatment journey. The field must address this disparity through innovations in more affordable, robust treatment systems and creative approaches to training and supporting professionals in underserved regions.

For professionals preparing for these changes, I recommend a three-pronged approach: First, develop strong foundational knowledge that transcends specific technologies, as the underlying principles of radiation biology and physics remain constant even as delivery methods evolve. Second, cultivate adaptability through continuous learning and cross-training in complementary disciplines like medical imaging and cancer biology. Third, invest in strengthening the human elements of care.

Patient care is at the heart of healthcare. How do you approach patient communication and education, especially when discussing complex treatments like radiotherapy? What strategies do you use to ensure patients feel heard, understood, and empowered in their care?

Effective patient communication in radiotherapy begins with recognizing that each person arrives with their own unique context—their medical understanding, emotional state, cultural background, and support system—all of which profoundly influence how they process information about their treatment.

I've learned that the first appointment should focus more on emotional connection than technical details; I start by asking patients what they already understand about their diagnosis and treatment, which not only prevents redundant explanations but also reveals misconceptions and gives me insight into their baseline knowledge. This patient-centered approach allows me to tailor my communication to their specific needs rather than delivering a standardized explanation that might overwhelm some while underwhelm others.

For explaining complex technical concepts, I rely heavily on visual aids that progressively build understanding—starting with simplified anatomical models to show where radiation will be directed, then introducing more detailed visuals only as needed. I've created a library of before-and-after planning scans that demonstrate how precisely we can target tumors while sparing healthy tissue, which often provides more reassurance than verbal explanations alone.

Analogies have proven invaluable over my career; comparing radiation beams to spotlights that can be shaped and directed helps patients understand why they need to maintain specific positions during treatment, while likening treatment planning to a custom-tailored suit rather than off-the-rack clothing helps them understand why preparation takes time.

The most transformative communication approach I've developed is what I call the "teach-back loop"—after explaining a concept, I ask patients to explain it back to me in their own words, which reveals gaps in understanding immediately rather than discovering misconceptions later. This technique shifts the dynamic from passive information reception to active engagement and allows me to clarify misunderstandings in real-time.

I also provide information in multiple formats—verbal discussions supplemented with written materials, diagrams, and increasingly, curated video resources they can review at home with family—recognizing that stress and anxiety during appointments often inhibit information retention. Perhaps most importantly, I approach patient education as a process rather than an event—beginning before their first appointment even begins.

What advice would you give to someone considering a career in radiotherapy? What are the most rewarding and challenging aspects of this profession?

For those considering a career in radiotherapy, I always emphasize the importance of self-assessment: this profession requires a unique blend of technical precision and emotional intelligence that isn’t suited to everyone. The ideal candidate is someone who finds fulfillment in both the scientific aspects—understanding radiation physics, anatomy, and treatment planning—and the human elements of guiding patients through what is often the most vulnerable period of their lives.

Before committing to the educational path, I recommend shadowing a radiation therapist for several days to witness firsthand the pace, emotional landscape, and technical demands of the role; many students are drawn to the technology but haven’t fully considered the emotional weight of working with cancer patients day after day.

The most rewarding aspect of radiotherapy, without question, is the profound impact you have on patients during a critical life journey—being the steady, knowledgeable presence who helps transform their fear of radiation into understanding, who delivers treatments that can cure or significantly extend life, and who often develops meaningful connections over weeks of daily treatments. There’s immense satisfaction in mastering complex technology and applying it with millimeter precision to target disease while sparing healthy tissue, especially as you gain experience and develop an intuitive understanding of treatment planning and delivery.

Additionally, the field continues to evolve rapidly with technological advancements, offering constant intellectual stimulation and growth opportunities throughout your entire career. The challenges, however, are equally significant and shouldn’t be underestimated. Emotionally, you’ll form connections with patients who don’t always have positive outcomes; learning to process grief while maintaining professional composure and continuing to provide excellent care to other patients requires emotional resilience that builds over time.

The technical aspects demand meticulous attention to detail, as errors in radiation delivery can have serious consequences. This responsibility creates a positive pressure that drives excellence but can also be stressful, particularly for new practitioners. Yet despite these challenges, I’ve found that those who are well-suited to this profession discover that the rewards—seeing patients complete their final treatment, receiving a heartfelt thank you from family members—provide profound meaning to work.

Thanks for sharing your knowledge and expertise. Is there anything else you'd like to add?

After four decades in this field, what I find most remarkable is how radiotherapy embodies the perfect intersection of cutting-edge technology and deeply human care—something that continues to inspire me every day in the classroom. What I would emphasize for both aspiring radiation therapists and my colleagues is that while we work with sophisticated equipment and complex treatment plans, our most powerful tool remains our humanity—our ability to see the person beyond the diagnosis, to be present during difficult moments, and to use our technical expertise in service of preserving not just life, but quality of life.

The future of radiotherapy is incredibly bright, with advances in targeted therapies, artificial intelligence, and biological response modification continuously expanding our capabilities. However, I firmly believe that regardless of how sophisticated our technology becomes, the essence of our profession will always remain the therapeutic relationship we build with patients facing cancer.

To those considering this field or already practicing within it, remember that technical excellence is your foundation, but compassion is your superpower—together, they make radiation therapy not just a treatment but a healing journey for patients during one of life’s most challenging chapters. I remain profoundly grateful for the privilege of contributing to this field, both at the treatment console and in the classroom, and for the countless patients and students who have taught me far more than I could ever teach them.