Completely lost the onc narrative years ago.ASTRO was a cesspool 5-7 years ago. Not even sure how to describe it now
Some select group of doctors who do things with radiation that occasionally get together and conspire and self congratulate.
Completely lost the onc narrative years ago.ASTRO was a cesspool 5-7 years ago. Not even sure how to describe it now
ASTRO gutting technical and coming for YOUR hard earned technical money?
They are trying to create an even greater competitive advantage for themsleves.Good discussion on Twitter…
What is it exactly about this proposal that would limit further cuts exactly? If they switch to per patient (not per fraction) billing, why does that limit future cuts? Or does it not limit cuts but more so just protects protons/PPS exemption?
I don't buy the excuses about the PPS exempt centers/proton exemptions either.
One of the books that has shaped my thinking on these "big picture" issues is Skin in the Game. Taleb has his own issues, but the notion that a group of people that have major COI/exemptions from rules they wish to impose being intimately involved with drafting policy is asinine.
I bet if I ran the numbers I make more money with this proposal.
I'm pro fee only and hypofrac a TON. I bet if I ran the numbers I make more money with this proposal.
Maybe I should support this but at face value I didn't like lack of comment period and lack of transparency and the carve outs. I feel like if they got that part wrong, then there may be other things going on that they got wrong.
The silence from Neha is deafening. Vote Sameer!This, and also the implication that if you personally benefit from this program compared to right now, then it's good. Or the idea that we shouldn't get too caught up in the details, thats how RO-APM died. Yes, "run your personal numbers, dont worry about all the other stuff". So thoughtful these folks.
Believe it or not, I have a really good handle on the stakes for my personal job, but I also care about this field and the future. Is that so hard to believe? I guess probably it is for some ASTRO board members.
One "ASTRO insider" (although not on this policy) seems to be standing out to me as exceptionally reasonable the last couple days. If you are still an ASTRO member, vote Sameer!
Can't vote if you can't vote ....cause you ain't a memberThe silence from Neha is deafening. Vote Sameer!
Can't vote if you can't vote ....cause you ain't a member
Doing the hard work..
It's super fun when those involved in ASTRO leadership disparage its members
It's super fun when those involved in ASTRO leadership disparage its members
It's super fun when those involved in ASTRO leadership disparage its members
edit: this is probably better for the twitter discussion, but it's directly related to the above post so I put it here
Must be sad to have to find ways to make themselves feel more valuable and then have to use Twitter to verify their importance to each other.
Pretty much. Probably true for my SBRT volume tooAs a general radonc, I have more stage iii lungs under treatment than the thoracic radonc that trained me.
The student has become the master?Pretty much. Probably true for my SBRT volume too
Yes. The student has become the master.... Baiter.The student has become the master?
He's drew. Why do you think he's at the VA rather than main campus through multiple jobs nowAs somebody who is disconnected from academic circles, I don’t understand. Drew Moghanaki is a VA doc. I would never ask him for his opinion on lung cancer. Why is he getting all elitist
Wonder what he does when a prostate case comes in.He's drew. Why do you think he's at the VA rather than main campus through multiple jobs now
routine 4D CT for a large bulky stage III?
I don't think its routinely necessary. If they are able to breath gently, the whole thing is usually tethered to the hilum. I guess, as my old flight instructor used to say.. "it depends."
Level 7 can move > 1 cm... will have to dig up the image, but I have posted an example here before. You don't know if you needed a 4D... unless you get a 4D
Multiple fused free breathing “slow” CT scans are another kind of 4DCT too (it does create a larger ITV)
100%Ok I’m not a thoracic “expert” but you guys are kidding yourself. Only advancement in 20 year has been immunotherapy and not better or tighter RT margins. Granted it makes sense to the employee the best RT technique possible but to pretend this is meaningfully moving the needle in IIIA/B is ridiculous.
Fair, past 15 years.I think IMRT (circa 2005) and SBRT (circa 2010) were really the last steps forward. Protons ain't nothing but a financial grind. FLASH if it pans out, maybe. Other than that, we are just spewing minutiae. I have my cynicism level set to 99.8% that we will make any further meaningful advances.
Well, except for "Radiation + (latest) IO removes need for (insert surgical procedure/s)!" if we aren't totally eradicated by "25 fractions, 5 fractions, NO FRACTIONS.. .GGGGG G GGGG GONE!"
Preach.100%
People who think contouring is the most important factor in outcomes are kidding themselves (obviously to a certain extent). The compounding uncertainty added in subsequent steps of planning and delivery processes far outweigh that of finely detailed contouring IMO. I roll my eyes at certain faculty who nitpick fine contouring details then ignore how steep dose gradients fall apart when hitting play on the 4DCT
Narcissism of small differenxesPreach.
Really...just...this.
The further I get away from residency, as a very busy generalist in various far-flung settings...the more and more my memories of residency seem absolutely absurd. They feel dissociative, like the concerns the faculty had and tried to impart into me were some sort of fiction.
It's incredibly unfortunate that basically all Radiation Oncology residency programs take place at urban academic medical centers, which are all different degrees of "large". Sure, a residency in the New York City metro area is bigger than a residency in the Durham/Chapel Hill "triangle" area of North Carolina....but the triangle is still significantly better than a thousand other practices.
Because that's really the gap. The 2022 "Geographic Access" paper has 2,313 radiation facilities in the USA.
View attachment 373722
If you think about it, that crazy cluster of green dots from Boston to DC is where the vast majority of us get our training, along with California and the zig-zag line that runs from Houston to Chicago.
Obsessing over stupid, millimeter changes to a crappy circle drawing on a static slice of a DICOM file is NOT what affects outcomes for millions of cancer patients in this country.
In my clinic yesterday, much of my time was spent figuring out alternative nutrition strategies for a patient who couldn't afford a weekly 6-pack of Ensure, or an 80-year-old woman on TID Xanax from her PCP who tells me she doesn't want to be alive anymore, or the 5-week delay in getting basic diagnostic scans performed...none of those folks care about millimeter expansions.
Let alone proton carve outs in proposals submitted to Congress.
Strong work, ASTRO.
routine 4D CT for a large bulky stage III?
I don't think its routinely necessary. If they are able to breath gently, the whole thing is usually tethered to the hilum. I guess, as my old flight instructor used to say.. "it depends."
Oh cool we're doing this again..
@medgator found someone else who agrees with them? 🤣Oh cool we're doing this again...
how much do you think?How much stage III lung do u even treat, bro