Which New Service Lines Should a Radiation Oncology Department Launch?

A radiation oncology network can only stand up so many new services at once, which makes the selection itself a clinical decision. Asked how leadership decides which service lines are worth building, Heath Skinner, MD, PhD, professor and Claude Worthington Benedum Chair of Radiation Oncology at the University of Pittsburgh and chief medical officer of the Radiation Oncology Network at University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center, called it a complicated question and then laid out 3 considerations that govern the answer.

The first is the straightforward arithmetic of benefit. Skinner framed it as a question rather than a formula: how might we benefit the most patients in any given period of time? Resources and personnel are finite, and within that constraint the question becomes how to do the most good for the most patients in a given environment.

The second is the local practice environment, which is where a network complicates the picture. Skinner noted that his practices range from very small rural communities to relatively large urban areas, and the practice environment in each is different. How a given technology, technique, or service can best be implemented varies accordingly.

The third consideration is the individual clinician. Skinner said leadership has to account for the talents, skills, and interests of the clinician at the individual site. A program depends on the person delivering it, and a technique that fits one site’s clinical interests may not fit another’s regardless of what the equipment allows.

All of these things, he said, have to play a role in deciding how best to utilize the resources available to help the most people. The question was posed at the 2026 UPMC Hillman Cancer Center Radiation Oncology Symposium, whose program was organized around 4 service lines: stereotactic radiosurgery, advanced brachytherapy, low-dose radiation therapy for benign disease, and theranostics.

Transcript:

CancerNetwork: In leadership, how do you decide which new service lines are worth building?

It’s a complicated question. First and foremost, how might we benefit the most patients in any given period of time? If you have a finite set of resources and a finite set of people, how can you do the most good for the most patients in a given environment?

You also need to look at the local practice environment. We have practices that range from very small rural communities to relatively large urban areas, and the practice environment in each is different. How you can best implement a given technology, technique, or service varies, and it could vary quite differently between a very rural area and a very urban area. You have to take those things into account. You have to take the talents, skills, and interests of the clinician at the individual site as well. All of these things have to play a role in deciding how we can best utilize the resources that we have to help the most people.