How to Talk to Your Doctor About LDRT

Many primary care doctors and orthopedic surgeons have never referred a patient for low-dose radiation therapy for arthritis. That is normal. This is a new use of an old treatment, and most doctors outside radiation oncology have not followed the recent research. The American Radium Society's own guideline says it plainly: "Shared decisionmaking should occur between the patient and their provider(s) prior to referral for evaluation for LDRT"^[1]. The conversation starts with you.

Bring the Guideline

The strongest thing you can bring is the American Radium Society's Appropriate Use Criteria for radiotherapy for osteoarthritis, published in 2026. It is the first US consensus guideline on LDRT for arthritis, written by a multispecialty panel of radiation oncologists, rheumatologists, orthopedic surgeons, and a patient advocate. The panel reviewed 44 studies plus 8 more from citation searching, and reported overall response rates of 60 to 90 percent, concluding LDRT "may provide pain relief, improved joint mobility, and quality-of-life benefit in selected patients with OA"^[1][2].

Print the summary or save the link on your phone. A doctor who has never heard of LDRT for arthritis will take it more seriously coming from a published expert guideline than from a website alone. The full document is free to read^[1].

Show What You Have Already Tried

Doctors think in steps. The 2019 American College of Rheumatology and Arthritis Foundation guideline for hand, hip, and knee osteoarthritis strongly recommends starting with exercise, weight loss for knee and hip arthritis, self-management programs, tai chi, and cane use, with medicines and injections as later steps^[3]. Bring a short list of what you have tried and for how long: physical therapy, medicines (including topical anti-inflammatories), injections, braces, weight loss. LDRT has generally been reserved for patients who did not get enough relief from these measures^[1], so showing that history makes the referral conversation much easier.

Questions Worth Asking

The Agency for Healthcare Research and Quality offers a free QuestionBuilder tool that helps patients prepare questions before a visit and organize them by topic^[4]. The National Institute on Aging advises bringing a prioritized list of concerns, a complete list of your medicines with doses, and someone to take notes if that helps you^[5]. For an LDRT conversation specifically, consider asking:

• Am I a candidate for LDRT for my joint, given my age and the treatments I have tried?
• Are there alternatives I have not tried yet, and how do they compare?
• What are the possible risks and side effects of LDRT for my joint?
• Can you refer me to a radiation oncologist for an evaluation?

These track the Agency for Healthcare Research and Quality's suggested questions for any treatment decision: why it is needed, what the alternatives are, and what the complications may be^[6].

How the Referral Works

LDRT is delivered by radiation oncologists, in radiation oncology departments. In published studies, patients were typically referred by their treating orthopedic specialist^[7]. The usual path is: your doctor refers you for an evaluation, the radiation oncologist reviews your history and imaging, plans the treatment, and delivers six short outpatient sessions over two to three weeks^[8]. Be aware that insurance coverage for radiotherapy for benign conditions varies by payer and is not guaranteed, so check your coverage before assuming it is paid for^[9].

If Your Doctor Has Not Heard of It

Do not take it as a verdict. Ask what would make them comfortable: reading the guideline, speaking with a radiation oncologist, or seeing your imaging again. You can also contact a program in our directory directly and ask whether they accept self-referred patients for an evaluation. Either way, the decision should be shared, as the guideline itself recommends^[1].

References:
1. American Radium Society Appropriate Use Criteria for Use of Radiotherapy for Treatment of Osteoarthritis. Expert Panel for Use of Radiotherapy in the Treatment of Arthritis. 2026. Full guideline document. Full document (PDF)
2. Dove A, et al. American Radium Society (ARS) Appropriate Use Criteria (AUC) for Low-Dose Radiotherapy for Treatment of Osteoarthritis. American Journal of Clinical Oncology. Published online 2026, ahead of print. PubMed
3. Kolasinski SL, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis and Rheumatology. 2020. PubMed
4. Agency for Healthcare Research and Quality. QuestionBuilder App. AHRQ
5. National Institute on Aging. How To Prepare for a Doctor's Appointment. NIA
6. Ten Questions to Ask Your Doctor. Agency for Healthcare Research and Quality list, via KFF Health News. KFF Health News
7. Weissmann T, et al. Low-Dose Radiotherapy Leads to a Systemic Anti-Inflammatory Shift in the Pre-Clinical K/BxN Serum Transfer Model and Reduces Osteoarthritic Pain in Patients. Frontiers in Immunology. 2022. Full text (PMC)
8. Low-Dose Radiation Therapy Making a Comeback for OA. Medscape. 2025. Article
9. The Emerging Use of Radiation Therapy for Benign Conditions. Summary (PDF)