Building a Radiation Oncology Practice: Volume, Case Mix & Benchmarks
Documenting the first three years of building a community radiation oncology practice with treatment-level data
I joined Main Line Health in March 2023 at Lankenau and Riddle Hospitals on the Main Line outside Philadelphia. Empty schedule, but a great referral network already in place. The job was to show up, do good work, and let the volume come.
I’ve been tracking my numbers, and here’s what it looks like so far.
2024 was my first full calendar year—335 patients, 391 courses. 2025 jumped to 484 patients and 562 courses, a 44% increase. At the current pace, 2026 is on track for about 595 courses.
The case mix ended up being really broad. Lung is the biggest chunk at 24%, but GI, GYN, CNS, palliative, and head & neck all have real volume. SRS and SBRT make up about a quarter of everything. I also started building a benign radiotherapy program—low-dose RT for osteoarthritis and keloids went from 24 courses in 2024 to 67 in 2025, and it’s on pace for over 90 this year.
For context—the ASTRO 2017 Workforce Study puts the national median at 250 new consults per year. The ASCO 2019 Survey found an average of 204. Different practice settings and definitions make direct comparison tricky, but the trajectory speaks for itself.
Annual Summary
| Year | Courses | Unique PatientsPts | vs ASTRO Medianvs ASTRO |
|---|---|---|---|
| 2024 | 391 | 335 | +34% |
| 2025 | 562 | 484 | +94% |
| 2026 (proj.) | ~595 | ~575 | +130% |
2026 projected from Q1 pace (122 courses through 3/16). ASTRO median = 250 new consults/year (2017 Workforce Study).
Hospital Volume
| Hospital | 2024 | 2025 | 2026 (proj.) | Total |
|---|---|---|---|---|
| Lankenau | 256 | 309 | ~312 | ~877 |
| Riddle | 135 | 253 | ~283 | ~671 |
Treatment Courses by Year
Treatment courses from ARIA reports. 2026 projected from Q1 pace. Dashed line represents the ASTRO 2017 Workforce Study median of 250 new consults per year.
Monthly Breakdown: 2024 vs 2025
New treatment courses starting each month. 2025 exceeded 2024 in 11 of 12 months.
Courses by Hospital
Volume distribution across Lankenau and Riddle Hospitals. Riddle nearly doubled from 135 to 253 courses between 2024 and 2025. 2026 projected from Q1 pace.
Case Mix (All Years, 1,075 courses)
Disease site classification based on ICD-10 codes and treatment site inference. Sorted by volume.
Fractionation (All Years, 1,075 courses)
Fractionation derived from prescribed dose and daily dose limits. Conventional and hypofractionated courses are roughly equal, with SBRT as the third largest category.
Disease Site Breakdown by Year
Year-over-year growth across all disease sites. 2026 projected from Q1 pace. Lung is the largest category, with meaningful volumes across GYN, GI, palliative, CNS, and head & neck.
Fractionation Scheme by Year
Distribution of treatment techniques. 2026 projected from Q1. SBRT and SRS together represent 24.5% of all courses. Hypofractionation (29%) reflects modern practice patterns.
Where Does This Practice Fall?
Unique patients treated per year, compared to every published national benchmark. Sources span ASTRO workforce surveys, ASCO practice operations data, and self-reported community ranges. Orange bars = this practice by year.
Cancer vs Benign Courses by Year
Benign radiotherapy (primarily osteoarthritis) has grown substantially, reflecting an expanding referral base for low-dose radiation therapy. 2026 projected from Q1.
Honestly, I don’t think any one thing drove the growth. It’s tumor boards compounding over time, referring docs seeing their patients come back doing well, word of mouth. That’s how community practices grow—slowly, then all at once. Curious to see what the next year looks like.
Methodology
Treatment course data comes from Varian ARIA reports at Lankenau and Riddle Hospitals covering 2024, 2025, and Q1 2026. Disease categories were assigned from ICD-10 codes when available, with inference from treatment site names for courses lacking diagnosis codes. Fractionation was classified from prescribed dose and daily dose limit ratios. 2026 projections annualize Q1 pace (122 courses through March 16).
Caveats: A small number of courses remain unclassified due to missing diagnosis codes and treatment site identifiers. Some patients appear in multiple years. “Unique patients” is per-year; the cross-year total is deduplicated by patient ID.
Data Sources & References
- Varian ARIA treatment reports (2024–2026), Lankenau and Riddle Hospitals, Main Line Health.
- Fung CY, et al. ASTRO 2017 Radiation Oncologist Workforce Study. IJROBP. 2019;103(3):547-556. (median 250 consults/year, 20 on-treatment/day).
- ASCO 2019 Survey of Oncology Practice Operations (SOPO). JCO Oncology Practice. 2021. (204 new patients/year, 11,955 wRVUs, 4,197 EBRT fractions/FTE).
- Hoverman JR, et al. The National Practice Benchmark for Oncology: 2015 Report. JCO Oncology Practice. 2016. (“standard physician” = 26 daily treatments, 6,604 sessions/year).
- Nabavizadeh N, et al. Trends in American Radiation Oncology Workforce, Patient Volume and Technology Utilization. IJROBP. 2023. (SBRT/SRS fractions +182%, 2012–2019).
- ASTRO 2019 Scope of Practice Study. IJROBP. 2020. (on-treatment census: academic 16.8, non-academic 20.7, private practice 26.6).
- Changes in Employment and Practice Locations 2015–2023. IJROBP. 2025. (~5,087 ROs nationally, solo -27%, large practice +51%).
- Trends in RT Fractionation 2010–2020. PMC. 2022. (mean fractions/course: 17.5 → 13.6).
- MGMA DataDive — Radiation Oncology (median wRVUs ~9,079). SCAROP Financial Survey (academic 25th: 6,803; 50th: 8,668; 75th: 10,208).
- NY State Medicare Analysis — OTV billing (median 196 CPT 77427/year, mean 240.5). Cureus. 2017.