Rad Onc Twitter

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"some pain in my throat"... Wait until treatment starts...
 
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heartisinradonc said:
Out of 10 and thats being generous. Every female rad onc I know is married to a low T chubby baldy.
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WTF? Chubby baldies just have excess T converted peripherally to other things. Everybody knows chubby baldies are packing.

...the opposite of competitive body builders.
RadsWFA1900 said:
They’re ideal for them. They don’t protest or question. They know they can’t do any better and the women will basically have all the power.
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The old **** language eh? Nah, this isn't how it works. The ****s are the one's working out constantly, maybe wearing "Grunt Style" clothing and posting gun collections. The chubby bald guy has skills like Anthony Bridgerton, is focused on fam and has a loyal wife.
 
Palex80 said:


I read that and I was like...

View attachment 352971


It's called Internal Mammary Radiation Therapy for a reason...

Internal Mammary Radiation Therapy



Ok, ok, I'm just trolling now...
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Why are we so scared to use IMRT for breast? WTF? You're out here feathering electron/photon junctions, but won't bill IMRT in all but the most extreme circumstance? The proton people would fracture her ribs in a second.
 
Palex80 said:


I read that and I was like...

View attachment 352971


It's called Internal Mammary Radiation Therapy for a reason...

Internal Mammary Radiation Therapy



Ok, ok, I'm just trolling now...
Click to expand...

In America if you use IMRT for breast cancer it’s fraud. Paul Wallner and Louis Potters wrote a great editorial about it. But if you have a proton unit, we allow that for breast cancer with bells on.
 
Mandelin Rain said:
Why are we so scared to use IMRT for breast? WTF? You're out here feathering electron/photon junctions, but won't bill IMRT in all but the most extreme circumstance? The proton people would fracture her ribs in a second.
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As someone who trained well into this century I can certainly tell you which one I prefer and am more comfortable with... and which one has better skin toxicity
 
Mandelin Rain said:
Why are we so scared to use IMRT for breast? WTF? You're out here feathering electron/photon junctions, but won't bill IMRT in all but the most extreme circumstance? The proton people would fracture her ribs in a second.
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From a very high up big name person I heard that in the early days of IMRT everyone “mass colluded” to throw shame on breast IMRT because no one wanted the golden goose to be completely totally used, and later have IMRT reimbursement go down, with such a common malignancy. And hence it became fashionable to not only hate on breast IMRT but also be able to shame people for using breast IMRT as only being interested in money. There are several papers from mid 2000s that showed private practices were billing Medicare for breast IMRT much more than academic centers. This was one of the early things that continued to widen the gap between Big Rad Onc and Little Rad Onc. “See there… they’re greedy.” Never mind that randomized trials of breast IMRT were appearing around then too.
 
TheWallnerus said:
In America if you use IMRT for breast cancer it’s fraud. Paul Wallner and Louis Potters wrote a great editorial about it. But if you have a proton unit, we allow that for breast cancer with bells on.
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I can almost guarantee you that when wallner and potters wrote that editorial that they did not really understand what imrt was. At the tine Jim Metz was fond of questioning imrt for post prostatectomy, stating that “there was no defined target”. I can promise you that a lot of the senior guys who speak eloquently and decisively abt radiation technology today, if you drill down, wouldn’t do so well on a wunderlich test.
 
Mandelin Rain said:
Why are we so scared to use IMRT for breast? WTF? You're out here feathering electron/photon junctions, but won't bill IMRT in all but the most extreme circumstance? The proton people would fracture her ribs in a second.
Click to expand...

Because of the shaming from academics and the scolding from Eviclowns in their 5M south florida mansions?

I don't have DIBH on all my machines. Sometimes I can't do DIBH. VMAT works well. When the alternative is putting a tangent through the LAD or pulling the tangent in and underdosing breast near chestwall, which is what I typically see done. Somehow that's fine. VMAT. No. Bad rad onc. Bad.
 
OTN said:
It's what you see when you treat breast cancer with protons
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Since switched to modern fx (2.66 or higher), limited V105 instead of focusing on maximal dose, cover with 95/95, it is like a complete change from when I started practice. If you're seeing significant skin toxicity, you're doing it wrong. Protonists ** are playing with fire, putting on registry and calling it better. This needs to be stopped, but it won't be.

** Let's call them protonists now.
 
RealSimulD said:
Since switched to modern fx (2.66 or higher), limited V105 instead of focusing on maximal dose, cover with 95/95, it is like a complete change from when I started practice. If you're seeing significant skin toxicity, you're doing it wrong. Protonists ** are playing with fire, putting on registry and calling it better. This needs to be stopped, but it won't be.

** Let's call them protonists now.
Click to expand...
on-par with 60Gy/30 Fx for a bone met. maybe worse
 
Mandelin Rain said:
Why are we so scared to use IMRT for breast? WTF? You're out here feathering electron/photon junctions, but won't bill IMRT in all but the most extreme circumstance? The proton people would fracture her ribs in a second.
Click to expand...

I don't get the lack of IMRT enthusiasm from breast academics either.
There is that UMICH paper for improved heart toxicity with it (combined with DIBH) which I believe was randomized and has cardiac outcome (?spect or echo) showing benefit.
I start with a 3D plan, but I'll be damned if the IMRT plans just aren't better and I'll switch to IMRT if the plan looks better.

I guess I can see the concern for more low dose scatter, but I don't worry too much about that in an older person.
 
How does the lung v20 look with your VMAT plans?
 
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