Rad Onc Twitter

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TheWallnerus said:
A rectum not a penis

Right?

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ben stiller weiner GIF


EDIT: I can't stop staring at this picture trying to figure out what's happening.

Best I can tell is it's either an uncircumsized penis with a prostate in the general location of where the testes should be with a very anterior/inferior bladder -or- a prostate replacing the cervix in a woman with a vestigial tail.

Really odd stuff.
 
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fiji128 said:
I personally looked/interviewed for this back in residency. The big red flag for me was you were basically expected to be the brachytherapy nurse and handle all the scheduling/coordinating stuff the nurse would typically be responsible for. Very busy but mostly all prostate with some few other more exotic things. I was told mskcc does not do a lot of non vag cylinder gyn because they don't allow getting the XRT portion out of the system. Additionally, I was told that pedigree obsessed mskcc has never hired any of their rad onc fellows. Many of the previous fellows seemed to get what I would consider average normal type jobs after completing training. So I would say it was very/exceptionally exploitative in nature and probably viewed internally as a way to save money on salary (fellow would be paid less then a nurse). In exchange you would gain experience, some pedigree and maybe a research project to put on the CV. This was just my own personal impression. I'm sure there are others out there that will sing it's praises.
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lolwut @ bolded
 
fiji128 said:
I personally looked/interviewed for this back in residency. The big red flag for me was you were basically expected to be the brachytherapy nurse and handle all the scheduling/coordinating stuff the nurse would typically be responsible for. Very busy but mostly all prostate with some few other more exotic things. I was told mskcc does not do a lot of non vag cylinder gyn because they don't allow getting the XRT portion out of the system. Additionally, I was told that pedigree obsessed mskcc has never hired any of their rad onc fellows. Many of the previous fellows seemed to get what I would consider average normal type jobs after completing training. So I would say it was very/exceptionally exploitative in nature and probably viewed internally as a way to save money on salary (fellow would be paid less then a nurse). In exchange you would gain experience, some pedigree and maybe a research project to put on the CV. This was just my own personal impression. I'm sure there are others out there that will sing it's praises.
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Not allowing outside EBRT is weird and is basically shooting yourself in the foot, of you want to be a useful and busy brachy program
 
A_DeMichele said:
Not allowing outside EBRT is weird and is basically shooting yourself in the foot, of you want to be a useful and busy brachy program
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I think that is actually code for
“Brachy alone doesn’t pay enough for it to be worth our time”
Doubt there is any other reason

And on a side note the failure of leadership to get decent reimbursement for brachy and radiopharm is awful
 
Mandelin Rain said:
EDIT: I can't stop staring at this picture trying to figure out what's happening.

Best I can tell is it's either an uncircumsized penis with a prostate in the general location of where the testes should be with a very anterior/inferior bladder -or- a prostate replacing the cervix in a woman with a vestigial tail.

Really odd stuff.
Click to expand...
It's a transgender thing!
 
This just in…

MDACC medical physicist calls ASTRO Skin Cancer Guidelines touting the superior cosmetic outcomes with radiotherapy “fake news”

(Disclaimer: I am being exceedingly hyperbolic/clickbaity)

 
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OTN said:
25% of patients in the study had a low POLAR score fyi. I do like the further confidence in knowing what I'm doing in these patients will actually provide benefit. 25% is a little lower than I would have assumed/feared.
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Possibly, but these tests get better every year. They are already starting to report dna methylation.
 
OTN said:
25% of patients in the study had a low POLAR score fyi. I do like the further confidence in knowing what I'm doing in these patients will actually provide benefit. 25% is a little lower than I would have assumed/feared.
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If 50% of all breast cancer patients are age 62 or older, the number needed to treat for local control from RT in that group… and I’m about to be generous… is around 6. (Even higher above age 70.) I believe in the next 20 years we will figure out who the 5 out of 6 women are that don’t need the treatment.
 
TheWallnerus said:
If 50% of all breast cancer patients are age 62 or older, the number needed to treat for local control from RT in that group… and I’m about to be generous… is around 6. (Even higher above age 70.) I believe in the next 20 years we will figure out who the 5 out of 6 women are that don’t need the treatment.
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Doubt it, although indications for XRT will definitely continue to decline.

Recurrences just don't work this way. The concordance between women with genetically identical breast cancers in terms of recurrence is not going to be 100%. You can never figure out exactly who will recur.

But, the trend will continue to be to accept some amount of local recurrences and emphasize effective salvage.
 
communitydoc13 said:
Doubt it, although indications for XRT will definitely continue to decline.

Recurrences just don't work this way. The concordance between women with genetically identical breast cancers in terms of recurrence is not going to be 100%. You can never figure out exactly who will recur.

But, the trend will continue to be to accept some amount of local recurrences and emphasize effective salvage.
Click to expand...

The close enough for government work mentality continues.
 
theradiator said:
Springtime for the company selling POLAR assays that never have to show improved overall survival and are never subjected to non-inferiority design.
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Proof of principle. It is exceedingly obvious much of adjuvant xrt across disease sites will be “personalized” by ctdna, ngs etc . Maybe it happens this year, or in 5-10 years. Field needs to lube up.
 
RadOncDoc21 said:
Hence why I’m jumping on the please just let me give patients five fractions bargain with the med oncs now.
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Lol. Honestly I don’t bargain with my med oncs. You don’t like the plan then don’t send them. I’m tired of trying to ingratiate myself with them. The 5 fraction thing is a joke. If they don’t think it’s beneficial then guess what I don’t wanna sit here and haggle with them.
 
RickyScott said:
Proof of principle. It is exceedingly obvious much of adjuvant xrt across disease sites will be “personalized” by ctdna, ngs etc . Maybe it happens this year, or in 5-10 years. Field needs to lube up.
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If there are circulating tumor cells? Wouldn’t that mean that systemic control is in jeopardy and not nessesary local control .
 
Fpg1245 said:
Lol. Honestly I don’t bargain with my med oncs. You don’t like the plan then don’t send them. I’m tired of trying to ingratiate myself with them. The 5 fraction thing is a joke. If they don’t think it’s beneficial then guess what I don’t wanna sit here and haggle with them.
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I’ve degraded myself the moment I entered medical school. It’s been all downhill since!
 
Fpg1245 said:
If there are circulating tumor cells? Wouldn’t that mean that systemic control is in jeopardy and not nessesary local control .
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It’s circulating tumor dna, not cells. The dna can be released when cells die, maybe in exosomes etc. not sure all the mechanisms of dna release from the tumor. Podcast with radonc involved in development.
 
Moonbeams said:
I posted this on the private forum, but if you do the math, on a per patient basis that is extraordinarily high compensation for your effort. I don't think you will do much better anywhere else even if you are eating into tech. I have heard of very rural places with low census paying 600-700 to manage something like 10. But these are rare now and in sparsely populated areas in the west (think western North Dakota), and the VA will be in a much better location!

The glaring downside would be the work schedule. That is a 9-3 3-day a week job. I wouldn't consider it without a 4 day workweek and ability to leave whenever they are done treating. If you are expected to sit there 8-5 M-F with nothing to do, I think my soul would rot.
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Not a radonc but spouse works at the VA and trained at one so quite familiar.

The biggest cons are that pay is generally lower, hours generally aren’t too flexible, and you need to have the personality to go along and get along in the VA system. Generally speaking I’ve actually found they do a good job and the “making sure patients get good/safe care” front but less good on the “you lost your badge so prepare to spend 50 hours of your life trying to get a new one” front.

Pros
Great benefits. Not as good as Kaiser or when the Va was in its heyday but still good. Basically 1 or 1.1% of your top 3 salary per year worked. So put in 30 years, retire at 600k/year (since salary will gradually increase over 30 years) and you’ll get 200k/year for life.
Plus 401k matching up to 5%. Plus tons of holidays, time off, and sick leave which is basically time off. Insurance has a ton of options, but you do pay some out of pocket as opposed to other places. You also get to keep your health insurance when you retire which is huge

Great patients

Great job security

No insurance or prior auth hassles. The formulary is the formulary.

A lot of ways to be less clinical. You’re tired of 5 days of clinical time? Get a QI project or other admin stuff that buys down your clinical FTE. Almost every VA doc I know isn’t full time clinical, they have .2 or .4 FTE or various fluff/meetings. Boring? Probably. But very easy.
 
RickyScott said:
It’s circulating tumor dna, not cells. The dna can be released when cells die, maybe in exosomes etc. not sure all the mechanisms of dna release from the tumor. Podcast with radonc involved in development.
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Oh jeez. Well I guess we’re all ****ed.
 
If I came in to the hospital in the middle of the night for a rad onc emergency it would necessitate many other emergency consults because most of the doctors that know me would have a heart attack.
 
RickyScott said:
Of course, The radonc can come in and give dex and order mri/consults. I meant turn on the linac in the middle of the night. I have never done that.
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i also have not treated overnight ever. i also don't know how to turn the linac on. leave that to the therapists.

in the community - seems like hospitalists and ER docs realize that the Rad Onc consult can almost always wait till the AM. In residency, I got consulted overnight all the time, sometimes even for bone met palliation.
 
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