Rad Onc Twitter

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medgator said:


Should come in handy for those programs lucky enough to have to choose amongst numerous fluent top US MD students
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5x8yto.jpg
 
medgator said:


Should come in handy for those programs lucky enough to have to choose amongst numerous fluent top US MD students
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This study isn't great... it's a lazy univariate association coupled with a bold and unsupported conclusion. Truth is, this makes it more-or-less average (which doesn't speak highly of the quality of published data).

The controversary surrounds the conclusion. If the same methods found that those who overcame a poor upbringing are more likely to be successful, it would be championed as "proof" that economic diversity yields positive results. From my perspective, DEI is an important area of study, but it has a flaw in that one is only "allowed" to publish studies with the "correct" conclusion.
 
medgator said:
The match is probably immune to all that...i believe they withstood an antitrust lawsuit earlier this century iirc
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It didn't actually withstand lawsuits. When it became apparent that the match was illegal mass collusion/antitrust they got a government carve out as a special rider in some giant bill under Bush II. The amount of wage theft that the match essentially makes legal over the past two decades is staggering.
 
fiji128 said:

Jung v. Association of American Medical Colleges - Wikipedia

en.wikipedia.org en.wikipedia.org

This is one of the reason why I would never voluntarily be a member of the AMA.
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This was a pretty big deal at the time. It looked like the plaintiffs might prevail. And then they got literally Bushwhacked.

Does anyone recall the guy suing the ABR over MOC? The judge tossed that one. He was suing over anti-trust, but the judge said "this is not anti-trust."

In medicine it seems it's a big hill to climb to successfully allege anti-trust. Anyone who thinks it would be a criminal or civil offense for rad onc programs nationwide to decrease residency slots has 1) no sense of history and 2) a screw loose.
 
TheWallnerus said:
This was a pretty big deal at the time. It looked like the plaintiffs might prevail. And then they got literally Bushwhacked.

Does anyone recall the guy suing the ABR over MOC? The judge tossed that one. He was suing over anti-trust, but the judge said "this is not anti-trust."

In medicine it seems it's a big hill to climb to successfully allege anti-trust. Anyone who thinks it would be a criminal or civil offense for rad onc programs nationwide to decrease residency slots has 1) no sense of history and 2) a screw loose.
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More likely 3) benefits from it and needs a shield to hide behind by maintaining the status quo
 
jondunn said:


Seems like this is the party line this year. Will be intersting to see what happens

Anecdotally I have heard from a friend in academics that apps look better this year than 2020
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Not sure what applicant pool he is looking at. I definitely think the quality of applicants are going down.
 
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Fire up the ole Residency Cannon! Why stop at 200 new grads a year when we could have 300? 400? I know Penn State is dying for some residents, who else?

(joke disclaimer: one week of treatment is easier on patients and I fully support it as long as the data continues to demonstrate adequate safety and efficacy, but as this trend continues we do not need to expand our workforce, which I would have imagined at one time to be an obvious statement, but I imagined wrong)
 
elementaryschooleconomics said:
View attachment 346690

Fire up the ole Residency Cannon! Why stop at 200 new grads a year when we could have 300? 400? I know Penn State is dying for some residents, who else?

(joke disclaimer: one week of treatment is easier on patients and I fully support it as long as the data continues to demonstrate adequate safety and efficacy, but as this trend continues we do not need to expand our workforce, which I would have imagined at one time to be an obvious statement, but I imagined wrong)
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Already the standard of care in UK

~60% of *all* breast patients there receive 5 fx treatment

~39% receive 15-20 fractions

~1% receive >20 fractions

(data available on req)

However, prediction: it will never become SOC in US until APM

E.g., <<5% of Medicare patients getting palliative RT get single fx treatment
 
jondunn said:
King Koong on his way to inventing another billing code. This smells like a future grift!

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How does that actually work? The MOBETRON is an FDA approved product for intreaoperative electron RT. Modifying it so that it can deliver FLASH therapy with ultra high dose rate removes that FDA approval, doesn't it? Did they have a spare machine standing around that they modified?
 
Palex80 said:
How does that actually work? The MOBETRON is an FDA approved product for intreaoperative electron RT. Modifying it so that it can deliver FLASH therapy with ultra high dose rate removes that FDA approval, doesn't it? Did they have a spare machine standing around that they modified?
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Mdacc has spare machines, spare residents, and spare attendings

Take a look at their faculty list sometime. They’re almost big enough to join the EU
 
jondunn said:
King Koong on his way to inventing another billing code. This smells like a future grift!

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Clearly 5 fx or 1 fx is too long a course of treatment.

The only way to ensure that more patients get rapid, financially toxic at PPS exempt centers is to move to flash therapy
 
medgator said:
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at least tangentially related

I think this recent article in JCO may become a touchstone, or landmark, or at least be cited a lot, this upcoming decade and beyond

if I have to give a TL;DR...
If you treat most of the mediastinum with RT to ~30 Gy, expect a 3-4% increased absolute heart toxicity risk (at 30 years!); and treating the necks gives a ~2-3% increased stroke risk (at 30 years!). If mean heart dose is <5 Gy, expect a <0.5% increased heart risk (at 30 years!).

 
TheWallnerus said:
at least tangentially related

I think this recent article in JCO may become a touchstone, or landmark, or at least be cited a lot, this upcoming decade and beyond

if I have to give a TL;DR...
If you treat most of the mediastinum with RT to ~30 Gy, expect a 3-4% increased absolute heart toxicity risk (at 30 years!); and treating the necks gives a ~2-3% increased stroke risk (at 30 years!). If mean heart dose is <5 Gy, expect a <0.5% increased heart risk (at 30 years!).

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How do those numbers compare with doxo
 
SneakyBooger said:
#SABCS -- Not a lot about XRT that I could find. This is all I stumbled across:

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On the plus side, oral boards will be real easy in a few years. It's not hard to memorize target volume expansions and OAR constraints for lymphoma, sarcoma, and breast if your answer is "no RT", and your answer for everything else is some minor variation of "five fractions".

Although, maybe they'll add in "palliative" as a new disease site and force everyone to argue about 1, 5, or 10 fractions to bone mets.
 
elementaryschooleconomics said:
On the plus side, oral boards will be real easy in a few years. It's not hard to memorize target volume expansions and OAR constraints for lymphoma, sarcoma, and breast if your answer is "no RT", and your answer for everything else is some minor variation of "five fractions".

Although, maybe they'll add in "palliative" as a new disease site and force everyone to argue about 1, 5, or 10 fractions to bone mets.
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Or, even better, "my institution defers radiation in that scenario and instead uses [targeted drug which costs CMS $1B per year]."
 
RadsWFA1900 said:
He accidentally picked up the ortho applicant pool.
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Or p&mr.... My cousin is PD at a pretty decent sized program and he notes the applicant quality has been ramping up the few years.... Probably at the expense of rad onc... Ain't nothing wrong with plenty of money and relaxation, esp with a much greater variety of biryani options
 
radOresident said:
real stellar quality of care coming from ukentucky from that first article. glad to see mark randall is keeping his faculty up with the times
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It's arguable as to whether this should've been treated to a preop dose, and arguable as to whether this should be called the neck. If you can get past that, I don't see treating this 3D as terribly egregious, particularly with chemo as it looks the esophagus could be avoided pretty well AP/PAish.
 
Ray D. Ayshun said:
It's arguable as to whether this should've been treated to a preop dose, and arguable as to whether this should be called the neck. If you can get past that, I don't see treating this 3D as terribly egregious, particularly with chemo as it looks the esophagus could be avoided pretty well AP/PAish.
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i agree with you

i think spraker is being a little dogmatic

people treat 50 Gy to the SCV with 3D, quite literally every day.
 
Radiation was consulted/presumably started "emergently" per paper. Sure, maybe you could get a nice IMRT plan contoured/planned/QA'd/Insurance Authorized by like day 5 or 7 or something. But the main issue was the clinical brachial plexopathy and as stated, starting 3DCRT wasn't hurting anything. Maybe they had planned an IMRT boost. Who knows?
 
Mandelin Rain said:
Radiation was consulted/presumably started "emergently" per paper. Sure, maybe you could get a nice IMRT plan contoured/planned/QA'd/Insurance Authorized by like day 5 or 7 or something. But the main issue was the clinical brachial plexopathy and as stated, starting 3DCRT wasn't hurting anything. Maybe they had planned an IMRT boost. Who knows?
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Very reasonable to start with 3D if that's what could be started the quickest, unreasonable to treat it the whole way through to 50 imo for an unresectable sarcoma though. Definitely have started symptomatic definitive pts with 3D before switching to imrt a few fractions later just to get them going
 
RickyScott said:
Dosimetry payscale at ucsd. Approaching junior faculty and surpassing “instructors”
View attachment 346867
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Yeah -- regret not going to a 2 year community college for RTT, sliding into dosimetry, and starting at that kind of salary at 21/22. Probably would be ahead of current finances, with way less stress. Wouldn't care that soon enough there will be a good enough algorithms and sufficient GPUs to make dosimetry obsolete since I'd be FIRE at this point.
 
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