can other docs administer RT?

[CancerCare]

Turf battles are common in medicine. I was told that the saving grace of radonc is that, by NRC guidelines, no other MD can administer RT (other than maybe a nuclear medicine physician). is that true? can radiologists administer RT?

thx

---

Members don't see this ad.

 

[Gfunk6]

Not exactly true. There are many surgeons who routinely use radiosrugery (e.g. CyberKnife) on their patients. Whether or not this is a good thing is fairly clear when you look at their complication rates. RadOnc residency is four years for a reason.

 

[CancerCare]

thanks for the reply gfunk.

is our specialty then in danger? if surgeons can do radiosurgery, why can't ENT surgeons do IMRT for H&N tumors, urologists do IMRT/brachy for prostate ca, breast surgeons do post-lumpectomy rt, etc. ...? as treatment planning systems become more computerized and more efficient, what role will rad onc's play?

 

[stephew]

g funk is right. and radonc is finally beginning to address this. ironically what has kept radonc in when neurosurgeons and urologists do this is rad *physics*. These people are NOT qualified to do this without radonc on board. it is bad medcine, just as doing brachy is bad medicine without the urologists on board.

but no our speciality isnt in danger. we do far more than those couple of things. and with frameless srs (ie no billing for surgeons) there is a practical reason radonc should regain turf there. but trun wars aside, no radonc is TERRIBLE medicine. And again, no not in danger. as Gfunk said, its a 5 years for a reason (4 radonc years and fellowships will be increasing).

 

[temujim]

do you know which states surgeons are allowed to prescribe/deliver radiation? Rad Onc has successfully staved off most neurosurgeons from going it alone, so i'm somewhat surprised to hear that...

 

[stephew]

you guys aren't really getting the dynamic. radoncs need to be involved. its just the level of involment varies and that is the fault of radonc. its getting mroe complex and over time should happen less (also if radoncs are smarter than they have been and stop acting like a phlebotomy service that comes when you call them and more like the primary oncologists they are)

 

[Gfunk6]

This is kind of an ancient thread, but I wanted to bump it to bring your attention to an important report in the latest Red Journal.

American Society for Therapeutic Radiology and Oncology (ASTRO) Emerging Technology Committee report on electronic brachytherapy.
Park CC, Yom SS, Podgorsak MB, Harris E, Price RA Jr, Bevan A, Pouliot J, Konski AA, Wallner PE; Electronic Brachytherapy Working Group.
Int J Radiat Oncol Biol Phys. 2010 Mar 15;76(4):963-72.
PMID: 20206016

I tried to upload the whole article but unfortunately it exceeds the attachment size limit.

Anyway, I wanted to draw your attention to a key point,

In some juristictions, no user regulations are in place, so there is no requirement for a radiation oncologist to be involved in the procedure, although a physicist is typically required to perform pretreatment calibrations and intraoperative monitoring. Therefore intraoperative EBT [electronic brachytherapy] could potentially be performed by a surgeon or other personnel who have no expertise in radiation treatment of caner, brachytherapy principles, radiation safety and biology, or normal tissue tolerances.

A few more interesting points brought up by the report:

1. These are medical devices not drugs so their FDA approval does not require proof of their efficacy.
2. Since these devices electronically generate brachytherapy rather than with isotopes, they are not regulated by the NRC. Therefore they are not explicitly subject to regulations regarding calibration and quality assurance.
3. These devices are not without side effects and these may not be appropriately managed by non-radiaiton oncologists.

As future radiation oncologists we should be aware of these issues and (as much as possible) try to participate in randomized clinical trials (such as TARGIT for breast).

 

[deleted4401]

In addition, Stark Law loophole is an absolute disaster. Everyone knows or has heard of what has happened to even major medical centers - the precipitous drops in prostate brachy cases at MDACC secondary to Urorads, the initiation of "breast centers" with the breast surgeons doing the same the thing the urologists did.

As a group, radoncs have been meek but also complicit. Advocacy Day is one way to get involved, but we have to become more protectionist. Also have to somehow convince people that taking a monkey job in a basement of a urorad facility in North Houston is terribly wrong.

ASTRO in conjunction with a researcher (Jean Mitchell) is working on a study to show the change in practice patterns due to surgeon owned radiation facilities, and I think this is some evidence that will be needed to convince legislators to close the loophole.

Other physician groups have been strong. The AMA doesn't work for us, nor do the radiology groups. They will sell us down the river to protect their own constituencies. We need to make sure that we are stronger organizationally to promote the concept that radiation oncologists should be delivering radiation. For whatever reason, we are having a very hard time selling this idea.

S
(Though, I have to admit, activism and advocacy to protect our salaries and turf isn't as inspiring as, say, women's suffrage or ending slavery ...)

 

[medgator]

nor do the radiology groups.

They probably aren't too happy with the recent medicare cuts they took and which we were luckily spared from thanks to the advocacy from our specialty and cancer survivors.

 

[ghgi8]

I think cancer survivors are a huge resource for the sustainability of Rad Onc in regard to some of its challenges, such as the one discussed here. Whether it is ethical to solicit patients for their support is another issue entirely.

I think specialization in medicine is a very important thing to have, but it needs to be played out in a responsible manner. With lives on the line, we need a way to objectively compare all aspects of treatment, including practice-type and characteristics. The required reporting of treatment outcome in the private sector could help to accomplish this goal. Perhaps this will show that these "UroRad" practices are truly inferior.