The Canadian Association of Radiation Oncologists recommends that patients in Canada be treated at Radiation Oncology centres where Radiation Oncologists are on-site and readily available to supervise patients’ treatments.  However, it is recognized that the geography of Canada is such that the future development of smaller satellite Radiation Oncology centres may become of value in delivering limited radiotherapy services nearer to patients’ homes in smaller urban centres.  The availability of rapid electronic communication, including the ready transfer of images, raises the possibility of some cancer patients being treated in facilities where a Radiation Oncologist is not necessarily immediately available on-site.  The following guidelines are meant to cover that circumstance:

1. All radiotherapy must be prescribed by a physician licensed to practice as a Radiation Oncologist and following a consultation that includes an appropriate physical examination by that physician.
2. There must be an identified physician on site to deal with acute medical emergencies as well as any anticipated side effects that may arise during the delivery of radiation treatment.
3. During the delivery of the course of radiation treatment and for a minimum period of six weeks thereafter, the prescribing Radiation Oncologist, or qualified designate, must be readily available by phone or in person to advise other members of the health care team about their patient.
4. Patients receiving radiotherapy should have the opportunity to be examined by a qualified Radiation Oncologist on a weekly basis during the course of their treatment and within a maximum of 24 hours notice, if necessary.
5. Facilities must be in place such that portal images or patient set up photographs requiring Radiation Oncologist approval can be reviewed and approved within a maximum time frame of 24 hours.
6. A contingency plan must be in place for dealing with treatment machine break-down to avoid significant interruptions in treatment. In general, this would mean that centres with only one treatment unit would be inadvisable.

Centres without on-site Radiation Oncologists should be formally associated with a radiation oncology department that is staffed according to CARO standards, enabling outreach Radiation Oncology services to be supported.