Rad Onc Twitter

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I have never posted on MedNET but do reference it. I admit that sometimes I'm just looking to see what Beriwal says because always reasonable. I remember a very valuable Crane post about extent of nodal dissection in TME and the fact that iliac nodes are not dissected and should be boosted. These are cases where the name brand of the poster makes me feel better.

But in general, anonymous always better for coming up with consensus. (at least among a group of people with reasonable knowledge of the material). I can't think of a scenario where being deferential ever helps with figuring out the truth. Would be nice if these folks posted anonymously here.
 
communitydoc13 said:
I have never posted on MedNET but do reference it. I admit that sometimes I'm just looking to see what Beriwal says because always reasonable. I remember a very valuable Crane post about extent of nodal dissection in TME and the fact that iliac nodes are not dissected and should be boosted. These are cases where the name brand of the poster makes me feel better.

But in general, anonymous always better for coming up with consensus. (at least among a group of people with reasonable knowledge of the material). I can't think of a scenario where being deferential ever helps with figuring out the truth. Would be nice if these folks posted anonymously here.
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Mednet is generally awesome. "glancing at mednet," will be a board answer of mine.
 
medgator said:
Cranes post is edited as well. Very interesting. Sounds like the mednet editors are more heavy handed than the north Korean news service over at ROHub
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Late to the party. Can someone summarize what the thread looked like before the changes, and what was changed?
 
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Here is Crane’s original post and then my response. I didn’t grab Schuler’s who posted a PPS exempt article showing higher costs.

The discussion of financial toxicity discussion used to be the tower telling us to use less fractions/simpler technique. Now, it’s the rest of us discussing price and costs. This has made many, many people uncomfortable. I wonder if pressure came from the institution to remove the answers.
 

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RealSimulD said:
The discussion of financial toxicity discussion used to be the tower telling us to use less fractions/simpler technique. Now, it’s the rest of us discussing price and costs. This has made many, many people uncomfortable. I
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Yip. Not just financial toxicity, but residency expansion as well. Greedily Wrecking this field.
 
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RealSimulD said:
View attachment 340741View attachment 340742

Here is Crane’s original post and then my response. I didn’t grab Schuler’s who posted a PPS exempt article showing higher costs.

The discussion of financial toxicity discussion used to be the tower telling us to use less fractions/simpler technique. Now, it’s the rest of us discussing price and costs. This has made many, many people uncomfortable. I wonder if pressure came from the institution to remove the answers.
Click to expand...
RealSimulD said:
View attachment 340741View attachment 340742

Here is Crane’s original post and then my response. I didn’t grab Schuler’s who posted a PPS exempt article showing higher costs.

The discussion of financial toxicity discussion used to be the tower telling us to use less fractions/simpler technique. Now, it’s the rest of us discussing price and costs. This has made many, many people uncomfortable. I wonder if pressure came from the institution to remove the answers.
Click to expand...
Ah I see. So in summary they edited out any discussion of cost effectiveness from all posts? Wouldn’t surprise me if Crane complained to the editors. I know from a good source he’s been peeved before by other posters directly disagreeing with him in an assertive way.
 
Krukenberg said:
Ah I see. So in summary they edited out any discussion of cost effectiveness from all posts? Wouldn’t surprise me if Crane complained to the editors. I know from a good source he’s been peeved before by other posters directly disagreeing with him in an assertive way.
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Boomer gets triggered. News at 11
 
Krukenberg said:
Ah I see. So in summary they edited out any discussion of cost effectiveness from all posts? Wouldn’t surprise me if Crane complained to the editors. I know from a good source he’s been peeved before by other posters directly disagreeing with him in an assertive way.
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Crane's range of emotions while reading mednet

1) Oh a notification…let’s see how brilliant they think I am

nicolas cage smile GIF


2) SIMUL how DAAAREEE YOOOOU

Nicholas Cage Film GIF


3) "hello mednet, they are being mean to meeeee"

Nicolas Cage Crying GIF
 
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frijoles said:
Thought I was on #radoncrocks for a min

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I wonder who, over on the Pathology side, accuses "anonymous internet trolls" as "magical thinkers".

I also wonder if they have an 80-year-old Chair who regularly Tweets insulting and inappropriate things while his faculty applaud his behavior as "radical candor".
 
TheWallnerus said:
fr26FRQ.png

???

Should be nuked from space. Not coddled.
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FOUR RESIDENCIES DON'T HAVE HEME/ONC PROGRAMS??

That is egregious and inexcusable, I honestly didn't think there were any residencies that didn't meet at least that requirement. Just when I think I've discovered how deep the hole goes, another curtain is pulled back and I manage to feel disappointed YET AGAIN.
 
frijoles said:
Thought I was on #radoncrocks for a min

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I mean, how does the poster not understand that the entire group (including the previous chair) either left because the administration was abusive or was fired en masse because the administration had no doubt that they'd be able to hire like 20 pathologists instantly due to the over supply?
 
TheWallnerus said:
fr26FRQ.png

???

Should be nuked from space. Not coddled.
Click to expand...

That is garbage on top of garbage. Completely inexcusable. How were these places even approved initially? Whatever committee/board members of ACGME that allowed this to exist should be fired and blacklisted.
 
List of programs participating in ERAS 2022:

Currently listed as "not participating" (9 programs):
  • UAMS (Little Rock)
  • U Arizona (Tucson)
  • Cedars-Sinai (Los Angeles)
  • U Colorado (Aurora)
  • U Miami/Jackson Health (Miami)
  • Rush (Chicago)
  • U Mississippi (Jackson)
  • NYU Presbyterian (Brooklyn)
  • Texas A&M (Temple)
 
elementaryschooleconomics said:
Well, we made it like, what, 4 months between Urology and RadOnc Twitter battles?
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I complain online, but I actually work with a good group of urologists.

It is just surprising to see two top dog urologists quoting insane high #s for xrt induced cancers…completely in conflict with the actual data from protect.

if they’re going to fight online I want Spratt in the mix. If we can get his secretary at Case to start spiking his coffee /post workout protein shake with amphetamines and steroids we can get him really going 🙂
 
BobbyHeenan said:
It’s so defeating to see literally the worlds leading urologists have zero understanding of the literature. Thank God for Spratt.



Click to expand...

I don’t think anyone is born racist. It has to be taught. Inculcated through cultural immersion.

Likewise, no urologist was born with a bias against rad onc.
 
Protect and EORTC data as above is the highest quality we have.

It’s just not a good look when Spratt, Mudit, and Kishan break out the goods and Stephenson throws out a giant straw man.
 
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Is Simul being a Karen?

(No offense to anyone named Karen)

This fella Dattoli - his website - there are many of us that have seen it before (he has posted on TheMedNet before). Yes, it's ... interesting. Here is the issue - how many radonc departments, proton centers, medoncs, surgeons that we know and interact with say outlandish things? How many make outlandish claims about their cure rates (I love the single institution studies that have no randomization, but make claims that "we cure so many more of our patients than everyone else")?

How many of our colleagues and faculty and partners engage in this? How many practice very bad medicine? How many give 25 fx for bone mets and treat 87 year old men on dialysis with GS6 prostate cancer? How many of our attendings are mistreating patients and contouring poorly? How many of our attendings are mistreating residents? How many are grossly incompetent and we'd never send our worst enemy to? I've seen contours from "experts" trying to treat sites that they don't usually that would make you want to strip their license. There are docs that I know that are quite prominent and treated the wrong side and had to settle.

What is the benefit to the pile-on this guy? Is this so important for the UCLA men's club to be tagged to comment on it? This doctor is in Florida - no where near Westwood - so letting your colleagues locally know - is this truly in the interest of patient safety? Did they call this doc or email him and say - hey - you may want to update this? Or, if this is a sincere public health issue - did you send a note to the FL dept of health? Do you really care about the outlandish claims or are you using this as a cover to be a dick?

There was a resident that matched at Case, an FMG from the Caribbean, and there was a short burst of teasing here, and then SDN cut that **** out. Because even in "the 4 chan of radonc", people here seem to have decency and respect. Oh wait, wasn't that one of Dr. Spratt's future residents? Yeah, I think it was. And, SDN did the right thing. Part of my reason for wanting to come back and be a part of the community.

I will continue to support this field, and residents, and the great work we do. I will continue to call out programs for expanding. Do you ever hear me call out program directors by name? Do you ever hear me gossip publicly about dirtbag attendings and chairmen/women? No. I don't.

I think this crew has every right to free speech. But, just because you have that right, doesn't mean you have to use it. If you truly want to be an agent of change, focus on the institutions. But, maybe you can change my mind? The character limit on Twitter makes it difficult to have much nuance. Curious to hear your thoughts. I may be way off base and could consider joining the pile-on. Seems like the boys had a good ol' time with it.

(Oh, and remember one of the ringleaders - when involved in a debate/disagreement with me insulted me and then blocked me? Yes, this is the crew we are working with here.)
 
RealSimulD said:
Is Simul being a Karen?

(No offense to anyone named Karen)

This fella Dattoli - his website - there are many of us that have seen it before (he has posted on TheMedNet before). Yes, it's ... interesting. Here is the issue - how many radonc departments, proton centers, medoncs, surgeons that we know and interact with say outlandish things? How many make outlandish claims about their cure rates (I love the single institution studies that have no randomization, but make claims that "we cure so many more of our patients than everyone else")?

How many of our colleagues and faculty and partners engage in this? How many practice very bad medicine? How many give 25 fx for bone mets and treat 87 year old men on dialysis with GS6 prostate cancer? How many of our attendings are mistreating patients and contouring poorly? How many of our attendings are mistreating residents? How many are grossly incompetent and we'd never send our worst enemy to? I've seen contours from "experts" trying to treat sites that they don't usually that would make you want to strip their license. There are docs that I know that are quite prominent and treated the wrong side and had to settle.

What is the benefit to the pile-on this guy? Is this so important for the UCLA men's club to be tagged to comment on it? This doctor is in Florida - no where near Westwood - so letting your colleagues locally know - is this truly in the interest of patient safety? Did they call this doc or email him and say - hey - you may want to update this? Or, if this is a sincere public health issue - did you send a note to the FL dept of health? Do you really care about the outlandish claims or are you using this as a cover to be a dick?

There was a resident that matched at Case, an FMG from the Caribbean, and there was a short burst of teasing here, and then SDN cut that **** out. Because even in "the 4 chan of radonc", people here seem to have decency and respect. Oh wait, wasn't that one of Dr. Spratt's future residents? Yeah, I think it was. And, SDN did the right thing. Part of my reason for wanting to come back and be a part of the community.

I will continue to support this field, and residents, and the great work we do. I will continue to call out programs for expanding. Do you ever hear me call out program directors by name? Do you ever hear me gossip publicly about dirtbag attendings and chairmen/women? No. I don't.

I think this crew has every right to free speech. But, just because you have that right, doesn't mean you have to use it. If you truly want to be an agent of change, focus on the institutions. But, maybe you can change my mind? The character limit on Twitter makes it difficult to have much nuance. Curious to hear your thoughts. I may be way off base and could consider joining the pile-on. Seems like the boys had a good ol' time with it.

(Oh, and remember one of the ringleaders - when involved in a debate/disagreement with me insulted me and then blocked me? Yes, this is the crew we are working with here.)
Click to expand...

I agree with your critique vis a vis bullying… but I am not gonna lie, part of me thinks the guy had it coming. Doctors over promising to patients is a major pet peeve. To the rad onc community… this guy seems pathetic and you almost feel bad for him, but for a patient (or even a referring MD), it sounds impressive. He’s like a bad used car salesman, and he still probably manages to dupe some people.
 
Lamount said:
I agree with your critique vis a vis bullying… but I am not gonna lie, part of me thinks the guy had it coming. Doctors over promising to patients is a major pet peeve. To the rad onc community… this guy seems pathetic and you almost feel bad for him, but for a patient (or even a referring MD), it sounds impressive. He’s like a bad used car salesman, and he still probably manages to dupe some people.
Click to expand...
Pretty much any proton site would probably say the same thing (or any cyberknife site from a decade or two ago).
 
medgator said:
Pretty much any proton site would probably say the same thing (or any cyberknife site from a decade or two ago).
Click to expand...
I don’t disagree. Im an advocate for protons but think they are dangerous if uncertainties and RBE aren’t properly accounted for, and I think many make promises without acknowledging (or understanding) the limitations. They are no better than this guy. They both deserve a little humility imposed upon them.
 
Lamount said:
I don’t disagree. Im an advocate for protons but think they are dangerous if uncertainties and RBE aren’t properly accounted for,
Click to expand...
How do you account for these known unknowns? Rbe of let is dependent on fraction size, o2 status, tissue, just to name a few. Even Thinking about it as single number doesn’t even do it justice.
 
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RickyScott said:
How do you account for these known unknowns? Rbe of let is dependent on fraction size, o2 status, tissue, just to name a few. Thinking about it as single number doesn’t even do it justice.
Click to expand...
Robust/LET optimization. Simultaneously optimizing for a multitude of scenarios under a multitude of assumptions. Limiting range uncertainties with dual energy CT. Avoiding dumping distal Bragg peaks with dose limiting serial constraints. Proper beam angle selection.

Generally, protons are best used to minimize low/intermediate dose to parallel structures in circumstances where this can offer a clinically significant improvement in toxicity.

As for O2 and fraction size, I don’t think protons RBE is ever high enough that these will have a significant impact. Those things are more relevant for high LET particles. And for what it’s worth, fraction size impacts can be modeled.
 
radiaterMike said:
The guy has made outlandish claims for years (claims to have invented IGRT). But calling him out on Twitter makes Drew look like the tool.
Click to expand...
I think the rest of Drew Moghanaki's Twitter makes him look like a tool. He's either fellating someone, trying to ride other people's coattails, or doing stuff like this, dogging on other docs.
 
RealSimulD said:
Is Simul being a Karen?

(No offense to anyone named Karen)

This fella Dattoli - his website - there are many of us that have seen it before (he has posted on TheMedNet before). Yes, it's ... interesting. Here is the issue - how many radonc departments, proton centers, medoncs, surgeons that we know and interact with say outlandish things? How many make outlandish claims about their cure rates (I love the single institution studies that have no randomization, but make claims that "we cure so many more of our patients than everyone else")?

How many of our colleagues and faculty and partners engage in this? How many practice very bad medicine? How many give 25 fx for bone mets and treat 87 year old men on dialysis with GS6 prostate cancer? How many of our attendings are mistreating patients and contouring poorly? How many of our attendings are mistreating residents? How many are grossly incompetent and we'd never send our worst enemy to? I've seen contours from "experts" trying to treat sites that they don't usually that would make you want to strip their license. There are docs that I know that are quite prominent and treated the wrong side and had to settle.

What is the benefit to the pile-on this guy? Is this so important for the UCLA men's club to be tagged to comment on it? This doctor is in Florida - no where near Westwood - so letting your colleagues locally know - is this truly in the interest of patient safety? Did they call this doc or email him and say - hey - you may want to update this? Or, if this is a sincere public health issue - did you send a note to the FL dept of health? Do you really care about the outlandish claims or are you using this as a cover to be a dick?

There was a resident that matched at Case, an FMG from the Caribbean, and there was a short burst of teasing here, and then SDN cut that **** out. Because even in "the 4 chan of radonc", people here seem to have decency and respect. Oh wait, wasn't that one of Dr. Spratt's future residents? Yeah, I think it was. And, SDN did the right thing. Part of my reason for wanting to come back and be a part of the community.

I will continue to support this field, and residents, and the great work we do. I will continue to call out programs for expanding. Do you ever hear me call out program directors by name? Do you ever hear me gossip publicly about dirtbag attendings and chairmen/women? No. I don't.

I think this crew has every right to free speech. But, just because you have that right, doesn't mean you have to use it. If you truly want to be an agent of change, focus on the institutions. But, maybe you can change my mind? The character limit on Twitter makes it difficult to have much nuance. Curious to hear your thoughts. I may be way off base and could consider joining the pile-on. Seems like the boys had a good ol' time with it.

(Oh, and remember one of the ringleaders - when involved in a debate/disagreement with me insulted me and then blocked me? Yes, this is the crew we are working with here.)
Click to expand...
Good for you to do what you did. We have a lot of problems already in radiation oncology, many of which you discuss quite frequently. Calling out other rad oncs makes them a dick, all of the while CMS and other specialties are eating our lunches.
 
Lamount said:
Robust/LET optimization. Simultaneously optimizing for a multitude of scenarios under a multitude of assumptions. Limiting range uncertainties with dual energy CT. Avoiding dumping distal Bragg peaks with dose limiting serial constraints. Proper beam angle selection.

Generally, protons are best used to minimize low/intermediate dose to parallel structures in circumstances where this can offer a clinically significant improvement in toxicity.

As for O2 and fraction size, I don’t think protons RBE is ever high enough that these will have a significant impact. Those things are more relevant for high LET particles. And for what it’s worth, fraction size impacts can be Robust/LET optimization. Simultaneously optimizing for a multitude of scenarios under a multitude of assumptions. Limiting range uncertainties with dual energy CT. Avoiding dumping distal Bragg peaks with dose limiting serial constraints. Proper beam angle selection.
Click to expand...
Lamount said:
Generally, protons are best used to minimize low/intermediate dose to parallel structures in circumstances where this can offer a clinically significant improvement in toxicity.

As for O2 and fraction size, I don’t think protons RBE is ever high enough that these will have a significant impact. Those things are more relevant for high LET particles. And for what it’s worth, fraction size impacts can be modeled.
Click to expand...
Almost none of this was implemented 10 years ago when large centers were making fantastical claims about protons for prostate and weren’t (and still don’t) reporting side effects. modeling is truly “robust” when centers can stop using space oar and balloons for prostate.
 
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This is what I have problem with

"At the conclusion of the daily DART treatments, a plan for brachytherapy (seed implant) is made. The seed implant procedure is done on an outpatient basis, but requires an over-night stay for observation. A waiting period of 2 to 8 weeks is required between the daily radiation treatment and the seeding appointment.

Approximately 90 days following the seeding we will begin the 3rd part – follow-up DART radiation to the lymph nodes in the pelvis and abdomen. There are may be 3-10 of these daily treatments prescribed to complete the treatment plan."

huh?

Is this for billing purposes? If so, I don't think this is the hill to die on. Blast the big boys when they are financially toxic, and lil rad onc who milks the system at patient expense isn't free from the hammer of truth either.
 
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