Long live independent rad onc....

[emt409]

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This is where how you practice will have such a big impact on your legacy.

If you put forward the resources (or better yet, convinced a third party to do so), run this practice from a business plan and market directly to desperate patients, you will (contingent on demographics/payors) make a sh!% ton of money...and no one will know if you did good by your patients in aggregate (sort of like chiropractic). These are conditions where subjective outcomes are important and are hard to measure. I have no doubt that you will have patients thanking you for your care.

But...this is much more dangerous tool than a set of hands (not entirely benign either). It also is high cost. 4% significant toxicity in the brain is serious. This is not 3 Gy over 6 fractions to a joint with a complex plan.

It would be nice if you found a way to contribute scientifically from an independent practice if you are taking on cases like this.

Curious as to why you couldn't carve out a practice directed at indications like this at a place like the James?

Agree with your sentiments. We will tracking all our outcomes on a prospective registry study (same one at OSU).

No procedure is risk free, and being able to manage your own complications is critical in niche foci. But If you examine the SRS outcomes compared to MRgFUS for ET, our toxicities is much lower. Efficacy is same or better at 1 year, but takes SRS a little longer to get there

I do this enough that I see the 4% complication rate, and we are leveraging radiomic patterns to predict and intervene on hyperresponders earlier.

I did carve this out at OSU and had the support of and great collaborators in the Neurosurgery department, but can’t do any more gray winters.

 

[emt409]

Are you planning any PD research? Id love to donate.

Yes, we are working on a trial for lesioning along the pallidothalamic tract (near H1) that we hope could treat both tremor & dystonic symptoms at same time.

 

[medgator]

Haha that has definitely not been my experience, but the milage really does vary. So institution dependent.

I also think there are fewer and fewer differences between a large non-academic network and an academic network these days.

Look at places like Baptist in Miami, innova, etc. Baptist got protons well before UM did in Miami

 

[thesauce]

We need more pioneers like this in the field imo

 

[emt409]

If you need a good independent IRB to help with clinical trials, WCG (Wirb Copernicus Group near Seattle) is excellent; very efficient and although they charge for protocol approvals, etc, that your university won't bill you for, they can turn things around in days/weeks instead of months/years.

I have no ties except having used them before.

Will check them out. Western is hella $$$

 

[IonsAreOurFuture]

Will check them out. Western is hella $$$

WCG used to be Western IRB. They are not cheap but they are the best in that space, and literally have turned things around in 2 days that take 2 months in my circuitous university IRB.

It costs a lot to open and run a study anywhere, at least with WCG you'll know the cost and time-lines upfront instead of sitting in activation limbo that costs you chances to enroll and actually do the study.