## 1 Introduction  
### Radiotherapy: A Niche in Healthcare  
Radiation therapy (RT) represents a noninvasive and painless treatment modality for cancer patients. Thanks to modern and sophisticated techniques, the treatment delivery is precise and safe, leading to good clinical results while minimizing side effects [1]. Nowadays, about 45-55% of new cancer patients are treated with RT and about 20-25% are irradiated more than once during their oncological history. It has been estimated that, by 2035, optimal access to RT worldwide would save one million lives annually [2]. Even though evolving technologies and novel therapeutic panorama make RT a dynamic medical specialty, its potential is often underestimated due to cultural and economic issues, commonly configuring it as a Cinderella in the world health policy agenda. RT is still considered a low-priority subject among the oncological specialties in comparison to surgical and medical oncology, even in the medical community at different levels, starting from undergraduates, who could lack a proper exposure and minimal teaching during their medical school course, to other-specialty physicians, who often look to RT as a fast-growing enigmatic world which is harder to understand than the majority of other medical disciplines. This could be explained by insufficient theoretical lessons and time-consuming practical exercitations. A comprehensive overview of a standard RT workflow is reported in Figure 1.  
More complexity arises when the patient, as an RT-treatment candidate, needs to understand what RT is: commonly, people have many irrational concerns about RT and associate radiation with atomic bombs and nuclear incidents. Furthermore, the vocabulary used in RT could have some negative, fearful and war-related connotations (e.g., 'cobalt bomb' for the cobalt treatment unit, bunker for treatment room), and patients are often worried that they would become radioactive themselves and that it would become dangerous for them to be near their relatives, especially children. These misconceptions and fears about RT could potentially influence the treatment choice and lead cancer patients to avoid RT treatment [3] in favor of surgery or chemotherapy, which are frequently more accepted by patients, even in cases of the same curative intent and same oncological outcome in many cancer types (prostate, head and neck, anal canal, etc.) [4; 5; 6]. In addition, most patients have a poor or no understanding of RT and only a minority identify RT as a \"modern\" cancer treatment, suggesting that the perception of RT has not kept up with significant advances in the field [7]. Paradoxically, the perception of the risk/benefit ratio is more unfavorable for RT when compared to surgery or chemotherapy, even if the risk of peri-operative mortality (0.5-3% for surgery) or death due to chemotherapy-related toxicity (0.5-2%) is higher than that for RT (the risk of RT-related death is extremely low) [8; 9]. The popular understanding of a double-edged sword effect of any treatment (toxicity vs. efficacy) seems much more indulgent in the case of surgery or chemotherapy than of RT. For example, in a study on breast cancer patients, women interviewed on their initial feelings regarding RT commonly reported fear and anxiety [10], due to the misbelief that radiation is painful and not easily controllable since it is invisible. Overall, the physical, psychological and social distress caused by a cancer diagnosis can be further exacerbated by the perception of having little control over treatment indications and their related side effects [11]. If, on the one hand, general awareness of RT is scarce, on the other, it is often difficult for healthcare professionals to convey clear and concise explanations through  
Figure 1: A schematic representation of radiotherapy workflow. Abbreviations: CT (Computed Tomography); LINAC (LINear ACcelerator). conventional and static approaches (e.g., pictures, computer screens), especially in the rather limited timeframe dedicated to medical consultations.