Rad Onc Twitter

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medgator said:
Assuming good PS, life expectancy, and a single level of disease, with acute onset neuro sx sure.
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LOL, what fantasy world are you living in? They ALWAYS call Neurosurgery - even if the patient is in rigor mortis. I think it is an unbreakable tenet of modern medicine.
 
Gfunk6 said:
LOL, what fantasy world are you living in? They ALWAYS call Neurosurgery - even if the patient is in rigor mortis. I think it is an unbreakable tenet of modern medicine.
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I think our neurosurgeons have beat down the hospitalists enough that the hospitalists are afraid of them. So on these bad KPS cases they call rad onc first and say "defer neuro consult to rad onc" to avoid their wrath. I'm probably too timid/nice to try to shift that paradigm.
 
BobbyHeenan said:
I think our neurosurgeons have beat down the hospitalists enough that the hospitalists are afraid of them. So on these bad KPS cases they call rad onc first and say "defer neuro consult to rad onc" to avoid their wrath. I'm probably too timid/nice to try to shift that paradigm.
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That's sad. Radonc should never be seeing a spinal case without/before NSG except in the most hopeless cases.
Dex/NSG consult and full spinal MRI should all be done before calling me

NSG can do things we can't - like urgently remove a tumor
Midnight treatments are pure theatrics
 
metallica81788 said:
That's sad. Radonc should never be seeing a spinal case without/before NSG except in the most hopeless cases.
Dex/NSG consult and full spinal MRI should all be done before calling me

NSG can do things we can't - like urgently remove a tumor
Midnight treatments are pure theatrics
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almost 100% of the time the MRI and dex is on board, so there is that.
very often they're called. but there have been many times I've had to call neurosurg to get a formal opinion before we treated.

I have never done a midnight treatment.
Definitely some saturdays and some first thing in AM or make staff stay late. But If I get called at midnight, I'm looking at scans remotely and figuring things out first . I"m not bringing staff in for a midnight case.
 
metallica81788 said:
That's sad. Radonc should never be seeing a spinal case without/before NSG except in the most hopeless cases.
Dex/NSG consult and full spinal MRI should all be done before calling me

NSG can do things we can't - like urgently remove a tumor
Midnight treatments are pure theatrics
Click to expand...
It’s like there should be a randomized trial of neurosurgical decompression versus radiation for symptomatic spine mets or something
 
TheWallnerus said:
It’s like there should be a randomized trial of neurosurgical decompression versus radiation for symptomatic spine mets or something
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I think patients should receive protons… no trials needed. I’ll just make ads telling patients this type of treatment has pinpoint accuracy and show some pretty pictures compared to your toxic photons but leave you to explain the rationale with your patients!
 
That's one helluva attending to want to come in and treat at midnight. We never did that even in training...though there was a rumor that went around it would happen if it was a peds case, which is a very, very acceptable reason to turn on a linac at 3 am.
 
Wile E Coyote Wtf GIF by Looney Tunes


What I think of when I request for Nsurg to help me with that cord (de)compression problem..
 
RO28 said:
That's one helluva attending to want to come in and treat at midnight. We never did that even in training...though there was a rumor that went around it would happen if it was a peds case, which is a very, very acceptable reason to turn on a linac at 3 am.
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It's a resident. Might've been a rad onc attending in Egypt before coming over to repeat his residency, but yeah no attending is gonna virtue signal that hard.... I don't think.
 
evilbooyaa said:
It's a resident. Might've been a rad onc attending in Egypt before coming over to repeat his residency, but yeah no attending is gonna virtue signal that hard.... I don't think.
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sure...but if they're treating the attending has to be there...right....(maybe)?!
 
Ray D. Ayshun said:
i think outcomes would be improved if we could optimize time to neurosurgery deferral.
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yes in training this sometimes would go on for days. turns on the NSGY intern --> senior--->chief ---> attending game of telephone could take a long time. that or my attending would pick up the phone and explain to the NSGY attending "RT ain't going to fix bony retropulsion"
 
StIGMA said:
WashU has residents do emergent treats without supervision
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I guess inpatient treatment doesn’t really reimburse anyway so ya have the resident do it

IMO there is no such thing as an overnight emergency in rad onc. giving dex has a much faster effect than RT. If they truly require immediate/emergent decompression whether in the brain or spine, they should be going to surgery unless it’s lymphoma/myeloma. Even then, give dex and we’ll sim first thing tomorrow
 
FindMeOnTheLinks said:
I guess inpatient treatment doesn’t really reimburse anyway so ya have the resident do it

IMO there is no such thing as an overnight emergency in rad onc. giving dex has a much faster effect than RT. If they truly require immediate/emergent decompression whether in the brain or spine, they should be going to surgery unless it’s lymphoma/myeloma. Even then, give dex and we’ll sim first thing tomorrow
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If Medicare you are correct, would come out of DRG which the hospital would likely never allow, was surprised however to learn that if anything else though including Medicare advantage, could be billed separately
 
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I am going to repeat myself.
forums.studentdoctor.net

What is your Boomer/Mendoza Line?

what is the line you use for when you consider someone a boomer dinosaur? I saw a patient this week who saw another rad onc at the local regional hospital before coming to us for treatment. i looked up the rad onc and he was about 12 years out of practice - but he wanted the patient to get a...
forums.studentdoctor.net forums.studentdoctor.net

I don't start emergency treatments on Friday anymore. I call this the "weekend filter".
Every patient with a superior vena cava syndrome that I didn't treat on Friday and didn't survive the weekend, is a patient that wouldn't have survived the weekend anyway even if I had treated on that Friday. Prove me wrong.
 
Palex80 said:
I am going to repeat myself.
forums.studentdoctor.net

What is your Boomer/Mendoza Line?

what is the line you use for when you consider someone a boomer dinosaur? I saw a patient this week who saw another rad onc at the local regional hospital before coming to us for treatment. i looked up the rad onc and he was about 12 years out of practice - but he wanted the patient to get a...
forums.studentdoctor.net forums.studentdoctor.net

I don't start emergency treatments on Friday anymore. I call this the "weekend filter".
Every patient with a superior vena cava syndrome that I didn't treat on Friday and didn't survive the weekend, is a patient that wouldn't have survived the weekend anyway even if I had treated on that Friday. Prove me wrong.
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Technically, that's nonfalsifiable... much like the claim that you are all in my imagination. Nonetheless, I appreciate the oncologic reasoning
 
CT read from a port site met I treated in September:

IMPRESSION:
1. Surgical resection of the lesion adjacent to the right 10th rib since the
7/6/2022 exam. No residual enhancing tissue or new lesion identified.
2. Stable left lower lobe pulmonary nodule and other chronic findings as above.

I do enjoy when they think we did surgery.
 
Ray D. Ayshun said:
CT read from a port site met I treated in September:

IMPRESSION:
1. Surgical resection of the lesion adjacent to the right 10th rib since the
7/6/2022 exam. No residual enhancing tissue or new lesion identified.
2. Stable left lower lobe pulmonary nodule and other chronic findings as above.

I do enjoy when they think we did surgery.
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1671734729718.png
 
Ultimate hack to avoid overnight consults:

Work in rural community hospitals without Neurosurgeons on staff so the ER doc's MDM is "transfer to higher level of care", and "consult RadOnc" only happens after a lot of care coordination breaks down...and by then the sun is shining, birds are chirping, and I get to play the "reverse Uno" card and yell at some far off surgeon for trying to punt the case.

Sure, the Indian food might only exist in the Walmart frozen food section where these hospitals exist...but it's a price I'll pay every time.
 
elementaryschooleconomics said:
Ultimate hack to avoid overnight consults:

Work in rural community hospitals without Neurosurgeons on staff so the ER doc's MDM is "transfer to higher level of care", and "consult RadOnc" only happens after a lot of care coordination breaks down...and by then the sun is shining, birds are chirping, and I get to play the "reverse Uno" card and yell at some far off surgeon for trying to punt the case.

Sure, the Indian food might only exist in the Walmart frozen food section where these hospitals exist...but it's a price I'll pay every time.
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I intentionally ordered biryani last week as I pretty much always go for something made in the tandoor. It was good, but not great. I'm not really sure how to see it be great. It must be the restaurant?
 
Ray D. Ayshun said:
I intentionally ordered biryani last week as I pretty much always go for something made in the tandoor. It was good, but not great. I'm not really sure how to see it be great. It must be the restaurant?
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Aga’s in Houston is legit for paki/ind food.
 
Ray D. Ayshun said:
I intentionally ordered biryani last week as I pretty much always go for something made in the tandoor. It was good, but not great. I'm not really sure how to see it be great. It must be the restaurant?
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I always wonder about this too. Full disclosure is that I don't consider myself of even average knowledge regarding food/drink.

Which is how I fit in at places too small for Neurosurgeons...
 
Ray D. Ayshun said:
I intentionally ordered biryani last week as I pretty much always go for something made in the tandoor. It was good, but not great. I'm not really sure how to see it be great. It must be the restaurant?
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Tandoor - n Indian vs biryani - s Indian.

That's like going to Minnesota for Nashville hot chicken?
 
medgator said:
Tandoor - n Indian vs biryani - s Indian.

That's like going to Minnesota for Nashville hot chicken?
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It wasn't bad, the biryani, but I'm not sure if I can imagine having such an amazing experience I'd miss it. I have eaten sushi that made my eyes water. Nashville hot chicken is perhaps a bad example as it's really more of a media creation. It's not really complex, or even worth talking about. But that's just me. Otoh, I have had meh ceviche, and I have had ceviche I'd say wàs worth flying somewhere for. Perhaps Biryanis like that, but it seems to have more to do with the spices than freshness of the ingredients, and I'm not able to imagine how it would become transcendent. I'll be sure to seek the real stuff out next time I'm in a metropolis, though I do live somewhere with a relatively reputed food scene. A couple Beard award winners in the last year or two.
 
Mandelin Rain said:
Damn. Went for the kill shot.

Industry sponsored trials like this or SpaceOAR or Intraop XRT must be read with an extremely critical, crossing into suspicious, intention.
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Excellent statistical lesson by UTR.

Funny how Dr. Speers owns stock in PFS Genomics but no one on Twitter seems to have an issue with that this time around.

I wonder why this was so problematic for Dr. Kishan, even though as far as I can tell he does not own stock in Viewray. Weird how that seems to happen with some people but not others. 🤔

There are some absolute garbage people in our field.
 
NotMattSpraker said:
Excellent statistical lesson by UTR.

Funny how Dr. Speers owns stock in PFS Genomics but no one on Twitter seems to have an issue with that this time around.

I wonder why this was so problematic for Dr. Kishan, even though as far as I can tell he does not own stock in Viewray. Weird how that seems to happen with some people but not others. 🤔

There are some absolute garbage people in our field.
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Diff between owning small amt of stock in viewray and owning the patent for the product. This biomarker sounds like a get rich quick scheme.
 
NotMattSpraker said:
Excellent statistical lesson by UTR.

Funny how Dr. Speers owns stock in PFS Genomics but no one on Twitter seems to have an issue with that this time around.

I wonder why this was so problematic for Dr. Kishan, even though as far as I can tell he does not own stock in Viewray. Weird how that seems to happen with some people but not others. 🤔

There are some absolute garbage people in our field.
Click to expand...
Some guys just have that honest look, I guess.
 
RickyScott said:
Diff between owning small amt of stock in viewray and owning the patent for the product. This biomarker sounds like a get rich quick scheme.
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Well, I believe all of Rad Onc should be working a lot more with industry. The conflict itself is part of the new reality and I don't have a problem with it beyond being highly suspicious of anything Dr. Spears says about POLAR or Dr. Kishan says about MR-based prostate SBRT. It comes with the territory.

It's just interesting how the clown show that is LP felt the need to put one on blast and basically no one is talking about the POLAR conflicts. And yes, totally agree that a clinical trial and a black box biomarker built on retrospective data are different levels of quality in science.
 
My prediction:

The authors/Speers will not address the issues, instead demanding 5'UTR submit a formal letter to the editor in the journal and/or dox him/herself before actually addressing the concerns.
 
The gene selection in POLAR makes no biologic sense. Agree w/ other points. Would not fund a grant on that kind of research. Unfortunately the bar to publish this sort of thing is low and the ‘experts’ in it have a biased interest in supporting it
 
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