Rad Onc Meme Thread
Started by evilbooyaa
I basically had no esophageal patients for the past year. But all the sudden I got several that went through the chemo and just said no way to the surgery after achieving a cCR on PET/EGD.
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We still get goose. Some pts just aren't surgical
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So they get 4cyc FLOT (surgeon says no way) then basically Cross after that?
The patient declines to go through with esophagectomy after FLOT (despite that being the initial up front plan) so then standard chemo/RT to 50.4 Gy is offered.
With great dose conformity comes great responsibility!
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the future is nigh
Don't we all do the last part already?
ASTRO back door meeting:
How do we make radiation oncology less fulfilling and redundant?
D
deleted1217978
The guy in the middle frame looks perfectly identical to a certain rad onc on the east coast. Which makes this even more hilarious.
As in "definitely palliative"?
Physics and me discussing my last SRS
- Definitely 20. - Definitely 20?
Rain Man (1988) clip with quote - Definitely 20. - Definitely 20? Yarn is the best search for video clips by quote. Find the exact moment in a TV show, movie, or music video you want to share. Easily move forward or backward to get to the perfect clip.
www.getyarn.io
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Having trouble embedding, but oh my lord is this just hilarious. I can’t stop laughing. Thank you medical physicists
I choke/cough/laughed
That's art! That should be nominated for some Hollywood award show!
I have never felt so many emotions in such a brief amount of time.
10/10 will 100% watch again.
Haven't seen a tomo plan since residency but from what I recall back then it was a garbage machine with planning taking all night and lots of limitations on SBRT and it was down a lot.
I guess that's what the video was trying to get at?
I think there were a lot of satirical elements in the video haha. Someone should just write a paper describing all the elements of rad onc culture that show up in internet memes and submit it to the red journal. But with lots of examples lol
Tomo does a few things decently well. Homogeneous VMAT plans, sure. Long fields that would normally take two isos, sure.
That's about it. Everything else it does much worse than a TB. Lord help you if you're doing SBRT on a Tomo. The like entire planning system literally can't fathom not having a maximum heterogeneity of 107-110%
Tomo was never designed to deliver SBRT but some chose to use it that way. IIRC - they had started to develop real time imaging with an imager that would move with the patient. But after Accuray purchased them they had no plans to develop a machine that would compete with Cyberknife.
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Oh wow. For billing and coding purposes is Tomo always 77412, like an iso per tomo slice you could argue.
Today I joined this ASTRO benign webinar thing. It was free, props to them... emerging indications/treatments should have plentiful free education. Nice to see some restraint on their greed.
On this webinar one of the "experts" made a comment about treating both hands with a single iso versus an iso per hand. The comment was basically if you do 2 isos, its level 3. I could not tell if they were advising to do that or not to do that and kind of laughed a little bit.
The tomo comment here is a joke, maybe so, maybe not.
But there are many examples of billing advocacy masked as technical or scientific guidance in our history. The SkinCure saga is a great contemporary example. I think the mask is a lot more transparent to outsiders than some ROs think and it makes us look bad. I wish people speaking/publishing on behalf of "radiation therapy" would stop it.
We need to talk about the single vs double iso issue for arthritis, but we should do it in the Business of Radonc Forum
Absolutely makes us look bad. If you add in the proton centers defaulting on bonds look (Emory Proton Therapy Center’s current owner, Georgia ProtonCare Center, Inc., has filed for protection under Chapter 11 of the Bankruptcy Code) coupled with protons' lack of evidence support, the ViewRay debacle, the current BgRT "raping of the system" sure to end in ignominy as well (BgRT is, by far, the most remunerative rad onc code known to man)... we are looking about as good as a kiln of farts to the powers/payors that be.
I mean JFC, I gotta go out here and convert my doing-god's-work NCI cancer center to a part-time arthritis clinic these days! WTF?!
On another note can you image the sh* t storm billing fiasco if we layered ROCR on top of the 2026 billing coding changes at United/Aetna/Humana etc right now? I would probably shoot myself.
ed note: tomo comment was NOT a joke
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I do not, but would love to see others talk about it. My practice has optimized hands for plan quality/robustness, patient comfort, and efficiency (minimal therapist/physician burden). Thats whats important to us.
Totally understand the billing issue is a huge problem for many practices and it could limit access to LDRT for some patients. But this about optics and I agree with all of @TheWallnerus post.
It is absolutely insane to me that ROCR has signed on industry partners, literally writes that industry gets to weigh in on the quality program that can penalize you for old equipment, and residents are out there advocating for it. This is like the crappy obvious example of regulatory capture that even lay people should see. ASTRO presidents are yes men/women by definition, I get that.
But, like, rad onc residents dont care? Crazy times.
Back in the day it would cost ~$800K to upgrade your 21ix (the best “IMRT machine” then) with the OBI so it could do CBCT. Given that CBCT now nets about $30 per scan, the “average rad onc” would need something like 6 years’ worth of patients just to break even on an OBI upgrade. Want any kind of profit? You’ll need to figure on using the OBI for those 6 years plus 6 more, most likely. (I can buy a $20k Xray unit and do thirty dollar chest X-rays in a family doc’s office!)
So while I could layer in a few more calculations, etc., I think our field doesn’t realize that we just priced IGRT out as being a viable thing you can financially justify anymore. (Thanks ASTRO.) But hey goshdarnit, shucks, IGRT is now “bundled” into every linac. You can’t buy even an old used non IGRT linac anymore.
We need (lower priced) non IGRT linacs now if many clinics are going to be able to make it long term. And the clinics MUST have “old equipment” (keep their new stuff a long time) to maintain viability. Ergo ROCR is stupid.
Siemens, make that non IGRT linac for us. And if Siemens does, how long will it take them to become unenamored with the whole rad onc thing? If Siemens got out of the rad onc business tomorrow, what kind of specialty would rad onc be?
The billing and coding changes of 2026, and my specialty’s culpability for and response to them, remind me more and more of a thirsty man stranded on a boat in the ocean who starts drinking sea water.
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Blame Matt
Paul, I am not Matt. Its in the title.
I have no idea what happened with the threads crossing. Apologies to the mods, please fix or delete my posts or whatever. Sorry about that.
will someone generate a meme, stat, to re-rail this thread
Hospitals capturing 10x cms prices still make huge profits from radiation. Obviously, this forces consolidation as the free standing centers are forced to sell or close. Astro is really not that upset about the new reality.
Sidenote: I joined sdn 10 years ago mostly to rant about extortionistic pricing while astro was lying to us with “choosing wisely.”
Sidenote: I joined sdn 10 years ago mostly to rant about extortionistic pricing while astro was lying to us with “choosing wisely.”
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