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Strong programs in clinical Rad Onc

Discussion in 'Radiation Oncology' started by LightHouse123, Mar 19, 2012.

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  1. LightHouse123

    LightHouse123

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    Just a little aside, without having to start a whole new thread.

    Can anyone give me a list of good/great rad onc residencies that are known for clinical rad onc rather than an academic emphasis?
  2. Gfunk6

    Gfunk6 Troublemaker Moderator Lifetime Donor

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    I moved your post to a new thread so that users can easily see what your are asking.
  3. LightHouse123

    LightHouse123

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    Can anyone please respond??? Por favor?? s'il vous plaƮt ??
  4. ramsesthenice

    ramsesthenice

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    Lighthouse,

    Remember that all rad onc residencies are at academic centers so every one of them will have an academic flavor to them while you are a resident. That being said, some places are more supportive of people leaving academics than others. Of the places I interviewed there were a few which had a diverse array of equipment and procedures along with high patient volume which had a track record of producing more private practice than academics after graduation. They included:

    U Cincinnatti
    Case Western
    Ohio State (though they really want to become more academic under new leadership)
    U Rochester (supportive either way)
    UNC (they are very supportive either way)

    The only places I would stay away from that I know of are

    Michigan (they straight up say in the interview they don't usually train people for PP)
    Vandy (they claim to be open to it, but don't have much of a record as of yet)
  5. neo87

    neo87

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    Out of the places I interviewed this year, in addition to those listed: Arizona, Minnesota, and Allegheny. I think these were all heavily tilted to clinic, with good volume and job placement.
  6. LightHouse123

    LightHouse123

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    Thank you guys so much for responding! It is very much appreciated.

    If anyone wants to add more to the list please do so without reservation.

    Gratefully yours,
    LightHouse.
  7. r90t

    r90t Senior Member

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    Kaiser, Los Angeles
  8. Neuronix

    Neuronix Super Corgi Away! Administrator SDN Senior Moderator SDN Advisor

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    I think this thread is silly. Any program is going to train you to be a competant clinical radiation oncologist. You have to apply to at least 30 programs, probably more like at least 40 programs, to be competitive. If you aren't interested in academics, apply to the private hospital places and places that give the least amount of research (typically not the big name programs). From that, rank the places that seem strongest to match your interests and location preferences.

    People in this thread are just going to list the few places they have firsthand experience with. Every program has stengths and weaknesses as far as volume, variety, procedures, equipment, etc...
  9. medgator

    medgator Senior Member

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    I nominate this the MVP of this thread.
  10. FIREitUP

    FIREitUP

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    your taste in movies is impeccable :thumbup:
  11. SimulD

    SimulD Senior Member

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    I think you are mostly right about most programs, but I have to say, from meeting people around, certain highly ranked places teach their residents the literature - they are definitely brainiacs and some of the smartest people I've met. But, they weren't necessarily instructed about the practicalities of modern image-based 3D/IMRT treatment planning - i.e. - contouring axial anatomy, simulation/set-up, etc. I was surprised when studying for board exams that many people were not well trained regarding "how-to" in terms of contouring pelvic LNs, contouring for gastric CA, etc. etc. or not know concepts of GTV-CTV-PTV planning vs bony anatomy/block margins. I've heard multiple times for head and neck "I'd contour level II, III, and IV lymph nodes and the supraclav" not realizing that level IV=supraclav. People talk about a 5cm longitudinal PTV margin for esophageal tumors to block margin when what they mean is a 2-3 cm for CTV, a cm for PTV, and then a block margin. Heck, even the older books don't explain it properly and some of the modern RTOG protocols don't get it clearly either - i.e. for GBM the volumes are huge compared to older texts!

    I think what helps is if the program has a "generalist" or an instructor that knows the practicalities of "how to treat" that is able to show you those things, so when you get out there, you aren't doing things wrong.

    It's easy enough to say - "I'd contour out the gross tumor, paraesophageal lymph nodes, celiac LNs b/c it's distal" but hard to actually do it, unless you actually get taught. In the community, you see people who just don't know how to do some very basic things in terms of 3D/IMRT treatment planning.
  12. Gfunk6

    Gfunk6 Troublemaker Moderator Lifetime Donor

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    Not to nitpick but level IV LNs are actually superior to what is considered the supraclavicular LNs. See here. Where the caudal extent of level IV ends, the cranial extent of the supraclavicular fossa begins.

    I think this is a distinction to be made for H&N cancers, but not so important for breast as a "supraclavicular field" is actually treating the supraclav fossa & level IV LNs.

    However, I agree with the general message of your post. I think training in an "old school" way (e.g. fluoroscopic simulations, treating directly on the couch, hand calcs for emergent treatments, showing up to every simulation) is much more helpful in the long-run then "high tech" training. If you have mastered the basics it is very easy to transition to more complex systems but the reverse is more difficult.
  13. SimulD

    SimulD Senior Member

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  14. medgator

    medgator Senior Member

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    There's a good descriptive/pictorial diagram that explains the difference Gfunk is referring to in the Hansen/Roach handbook. I was also surprised the first time I saw it because I had been using the RTOG H&N atlas up to that point.
  15. napoleondynamite

    napoleondynamite Chief Resident

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    My understanding is that the SCV fossa contains nodes from levels IV and V. It's called a FOSSA but when people refer to the SCV "nodes" they are talking about the nodes in that fossa (which happen to be levels IV & V).

    Could be wrong, but that's my take
  16. napoleondynamite

    napoleondynamite Chief Resident

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    Ok scratch that - just looked at the blue book and medgator is spot on

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