Rad Onc Meme Thread

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jondunn said:
are truebeams cheaper overseas?
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I believe they are... Pricing is market specific or so I've been told. It wouldn't make sense though if the cost of goods are X regardless of where the machine is going to. Varian was based in palo alto last i remember? Machines are from there as well?
 
jondunn said:
Next thing you’ll see is places opening up an MR Linac fellowship. Some grifter place like Willis Knighton that’s trying to open up a residency or maybe Inova may just swing right and open a MRI Linac fellowship!
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You joke but that gets jobs here in Canada. My coworker did one and got hired here. We are just about to get a twin pair of MRLs
 
medgator said:
I believe they are... Pricing is market specific or so I've been told. It wouldn't make sense though if the cost of goods are X regardless of where the machine is going to. Varian was based in palo alto last i remember? Machines are from there as well?
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The pricing varies widely even here in the United States, so I have no doubt it varies substantially between countries as well.
 
E8E050D2-7880-4112-AB45-475738CEF23E.jpeg


What a move from deleted1002574
 
jondunn said:
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Strike two. This person keeps posting things that make me think he doesn't get it. I guess they don't teach motion evaluation at Wake. This occurs in order to determine the need for motion management. It's called a 4D scan. Presumably, they don't perform 4Ds at Wake for SBRT ever, as there's no need if motion will always be managed. In any case, the dog needs training in motion eval. Dr. Razavian may as well in a couple years.
 
Ray D. Ayshun said:
Strike two. This person keeps posting things that make me think he doesn't get it. I guess they don't teach motion evaluation at Wake. This occurs in order to determine the need for motion management. It's called a 4D scan. Presumably, they don't perform 4Ds at Wake for SBRT ever, as there's no need if motion will always be managed. In any case, the dog needs training in motion eval. Dr. Razavian may as well in a couple years.
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4D is considered (in my documentation) motion management during simulation. Abd Compression or ABC or breath hold or respiratory gating is considered motion management during treatment.

Think he means doing SBRT without at least a 4DCT...

Which still only applies to SBRT lung, liver, other things that actually move. Can SBRT a bone met without motion management. But this guy types more than he thinks at times so is what it is.
 
evilbooyaa said:
4D is considered (in my documentation) motion management during simulation. Abd Compression or ABC or breath hold or respiratory gating is considered motion management during treatment.

Think he means doing SBRT without at least a 4DCT...

Which still only applies to SBRT lung, liver, other things that actually move. Can SBRT a bone met without motion management. But this guy types more than he thinks at times so is what it is.
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I would hope so; otherwise he is a *****.
 
I just received a consult asking for radiation therapy in a really old patient.

The referring colleague asked for "age adjusted radiotherapy"

I thought I'd make a meme out of it.
1648198806741.png


I think we are going to offer a fellowship for this revolutionary development.
 
Palex80 said:
I just received a consult asking for radiation therapy in a really old patient.

The referring colleague asked for "age adjusted radiotherapy"

I thought I'd make a meme out of it.
View attachment 352304

I think we are going to offer a fellowship for this revolutionary development.
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I do age adjusted 5 fx breast RT. Despite toxicity concerns, I think more aggression is warranted to prevent lr in younger patients. Hence, in patients 65 and under I give 27 gy in 5, whereas the older ones get 26 in order to substantially reduce the toxicity profile.
 
Ray D. Ayshun said:
I do age adjusted 5 fx breast RT. Despite toxicity concerns, I think more aggression is warranted to prevent lr in younger patients. Hence, in patients 65 and under I give 27 gy in 5, whereas the older ones get 26 in order to substantially reduce the toxicity profile.
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I do age-adjusted RT as well.

I look at the schedule to see the age of the docs who will see my plans in chart rounds, and lean towards conventional fractionation so I don't have to hear about Gilbert Fletcher and the dangers of large fraction sizes.

(kidding, of course - I tee up slamming boomer memes and mock them into silence)
 
elementaryschooleconomics said:
I do age-adjusted RT as well.

I look at the schedule to see the age of the docs who will see my plans in chart rounds, and lean towards conventional fractionation so I don't have to hear about Gilbert Fletcher and the dangers of large fraction sizes.

(kidding, of course - I tee up slamming boomer memes and mock them into silence)
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Oddly, at least with head and neck, it's the younger ones who have a harder time.
 
Ray D. Ayshun said:
Oddly, at least with head and neck, it's the younger ones who have a harder time.
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Millennials just whine more about pain. I would too...
The folks who survived Vietnam (less of them nowadays) and Korea while chain smoking cigs can push through mucositis and maintain their weight. Having to convince some of the old timers to take narcotics is one of the most time consuming parts of h&n OTVs. Lot of fear of getting addicted that takes time to break.
 
evilbooyaa said:
Millennials just whine more about pain. I would too...
The folks who survived Vietnam (less of them nowadays) and Korea while chain smoking cigs can push through mucositis and maintain their weight. Having to convince some of the old timers to take narcotics is one of the most time consuming parts of h&n OTVs. Lot of fear of getting addicted that takes time to break.
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This is absolutely a phenomenon (see: my rants in the prostate hypofrac thread). We can be more broad:

People who have been generally healthy up until their diagnosis of cancer will subjectively experience significantly more toxicity from radiotherapy.

A 44 year-old guy with T1N1 p16+ SCC of the tonsil is going to have a MUCH harder time than a 76 year-old Vietnam vet missing a leg.

We have physician-reported toxicity, patient-reported toxicity, but I want a third category: physician stress experienced on OTV day.

I would take 30 OTVs with women in their 60s undergoing PMRT over 15 OTVs with 50 year old men getting prostate hypofrac.
 
Contrast an 85 year old nun getting extended pelvic XRT for endometrial to the 20 year old football player getting PA for testicular. (perhaps neither happen any more)

In my experience, the young men do the worst and the old ladies just rock right through it.
 
I think the PM has mixed up his football. The children appear to be playing the beautiful game and the PM is playing NFL or Aussie rules.
 
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