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When the story of the fall of ASTRO as an organization is written, SDN won't be mentioned. But it should.
 
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communitydoc13 said:
I have experienced significant pressure (nothing pathologic, just a "this is how we'd do it") from larger places to de-escalate HPV positive OP. Glad that we have not capitulated to date.
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Stark reminder that not all ph II data is ready for prime time. I wasn't enthusiastic for it a year ago.... do I put more stock in a randomized ph II instead for TORS for 50 vs 60?

NotMattSpraker said:
Fair point, but you need to look deeper than just the.number of hours it takes for a doctor to go from sim to contours approved. There are many reasons this could be happening... the doctor could be objectively slow, or maybe the workflow sucks. Maybe they have software UI issues.

Or is it that they are over scheduled? We have so many activities and daily interruptions that are not charted and therefore do not exist to ignorant admin types. I suspect this is one of the most common causes.

The "slow" doctors in the dumpster fire clinic where I used to work were not "slow", they were over scheduled beyond belief and were skipping lunch to get through clinic plus contouring on nights and weekends. On QI meetings, we'd point out that they were over scheduled and it was completely ignored. Triaging or managing volumes were out of the question. Totally not surprising this remains a problem (or so I hear). Keep whipping that workhorse and see what happens. We all know.

It's making me angry just thinking about it.

This sounds nit picky, but I suspect the majority of rad oncs, especially current junior faculty who graduated at peak competitiveness, are not lazy but instead exploited. It should be enraging to all of us that doctors are needled about "clinical efficiency" while we are all working in this current system.

Anyway, the lazy approach is to call the doctor slow and yell at them to be faster or penalize them in some way. That said, telling an admin their approach is lazy is not super successful in my experience either. :rofl:
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There are certainly lots of Rad Oncs at workhorse PP or academic locations that are overworked.

There are also at least a few Rad Oncs who maybe aren't as quick and high quality with their contours.

Not all that is slow is lazy. Not all that is slow is overworked.
 
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evilbooyaa said:
Stark reminder that not all ph II data is ready for prime time. I wasn't enthusiastic for it a year ago.... do I put more stock in a randomized ph II instead for TORS for 50 vs 60?



There are certainly lots of Rad Oncs at workhorse PP or academic locations that are overworked.

There are also at least a few Rad Oncs who maybe aren't as quick and high quality with their contours.

Not all that is slow is lazy. Not all that is slow is overworked.
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Sometimes with contouring, you may not have everything you need after the sim to deliver the contour. Could be waiting on an mri/pet or something else. I have simmed pts, looked at the volume and said “I think I really should get an mri.” Etc.
 
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RickyScott said:
Sometimes with contouring, you may not have everything you need after the sim to deliver the contour. Could be waiting on an mri/pet or something else. I have simmed pts, looked at the volume and said “I think I really should get an mri.” Etc.
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Big issue for us with srs needing outside MRI. CD has to sent via courier or mail
 
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I hate how I work hard to try to reduce misinformation about radiation in my local environment, teaching patients and referrings... and then we have these idiots calling from inside the house.

This is pathetic.
 
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Penn TORS people have always been on the omission side, so I would just ignore his opinion
 
radoncftw said:
Our program used to take us out to lunch.
Of course it was not truly protected - so 1/3 of the residents were either seeing inpatients or on busy services stuck in clinic.
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Now, you get a Tweet!
 
NotMattSpraker said:
View attachment 366177


I hate how I work hard to try to reduce misinformation about radiation in my local environment, teaching patients and referrings... and then we have these idiots calling from inside the house.

This is pathetic.
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To be honest, I think the National Association of Proton Therapy is Underestimating cardiac sparing. Usually I find that our left-sided proton plans are reducing LAD and mean heart dose by 90 to 95%, or more.
 
ChatGPT: "make me a picture of a cereal box called protons"

I'm sorry, as an AI language model, I don't have the capability to create visual images. However, I can describe what a cereal box called "Protons" might look like!

The front of the "Protons" cereal box would likely have a bold, eye-catching design with a science theme. It might feature images of protons or atoms, along with bright colors and graphics. The brand name "Protons" would be prominently displayed, along with a catchy slogan or tagline.

On the back of the box, there might be educational information about protons and atoms, as well as fun science facts and trivia. The ingredients and nutrition information would also be listed, along with serving suggestions and possible recipe ideas.

The cereal itself might be shaped like little balls or spheres, to mimic the shape of atoms. The flavor and color of the cereal could be fruity or sweet, with a playful nod to the science theme. Overall, "Protons" cereal would be a fun and educational way to start the day!

DAL-E sucks too:

(Guess my job is safe for now)
 

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IonsAreOurFuture said:
To be honest, I think the National Association of Proton Therapy is Underestimating cardiac sparing. Usually I find that our left-sided proton plans are reducing LAD and mean heart dose by 90 to 95%, or more.
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Not if you put in a heart block, which you should in the majority of cases. (For most upper outer tumors I expand the lad by 1.5 to 2 cm and don’t contour any ptv over this oar for an imrt plan) Also, the small amount of proton xrt that hits the lad should be in the spread out Bragg peak where it is giving a lot more damage than the nominal dose conveys due to higher let/bed. If protons are fracturing ribs, I hate to think what they do to the lad.
 
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IonsAreOurFuture said:
To be honest, I think the National Association of Proton Therapy is Underestimating cardiac sparing. Usually I find that our left-sided proton plans are reducing LAD and mean heart dose by 90 to 95%, or more.
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That vast majority of breast cancer patients present at stage 0/1 when partial breast should be the treatment. Whole breast RT for almost all stage 0/1 is horrible overkill; partial breast XRT spares heart and LAD much better than whole breast proton even. The amount of whole breast proton treatment of DCIS and Stage 1 disease, even in the age 60 plus crowd, is insane, shameful, or both.
 
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TheWallnerus said:
That vast majority of breast cancer patients present at stage 0/1 when partial breast should be the treatment. Whole breast RT for almost all stage 0/1 is horrible overkill; partial breast XRT spares heart and LAD much better than whole breast proton even. The amount of whole breast proton treatment of DCIS and Stage 1 disease, even in the age 60 plus crowd, is insane, shameful, or both.
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proton centers claim the “need” for whole breast all the time in stage I/dcis so they can justify the protons with comparison plans
 
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RickyScott said:
proton centers claim the “need” for whole breast all the time in stage I/dcis so they can justify the protons with comparison plans
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Comparison plans don't help much if a payor clearly states protons are not covered in breast Ca
 
seper said:
Comparison plans don't help much if a payor clearly states protons are not covered in breast Ca
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Usually, yes… but most payors have an exception clause to cover protons for any diagnosis if comparison plans are subjectively compelling enough to the medical director’s eyes. And Medicare just covers everything. And all Medicare Advantage patients have to do is appeal.
 
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IonsAreOurFuture said:
To be honest, I think the National Association of Proton Therapy is Underestimating cardiac sparing. Usually I find that our left-sided proton plans are reducing LAD and mean heart dose by 90 to 95%, or more.
Click to expand...
Yes, all the dose is delivered to the ribs, instead.
 
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fiji128 said:
Seems strange that OptumCare would actually own and run a oncology center themselves as there is no indication that they even do this type of stuff on their own main website.

Description
Optum Care is seeking for a Board-CertifiedRadiation Oncologist to join our OptumCare Cancer Care Team in Las Vegas NV. This is an outstanding opportunity for a physician who wants to remain clinically active while helping shape the future of cancer care in Southern Nevada. The Cancer Center combines expertise, compassion and understanding. We offer patient-centered care in a professional and compassionate setting. Our goal is to provide every patient and their family with top-quality care, while treating them with the respect and compassion they deserve. The ideal candidate will carry exceptional inter-personal skills with a goal of sharing a vision of unparalleled delivery of care through teamwork, collaboration, innovations, and persistence for excellence.

Position Profile:
-The Radiation Oncologist team consists of 4 Physicians
-Well established referral process with 10 Medical Oncologist as part of the group
-On average 8 to 10 new consults per week
-Pore Linear Accelerator machines
-We offer Brachy Therapy services
-Varian machines and software
-Excellent staff, nurses, and MA’s
-This is a F/T employed opportunity with benefits, 401k with match, UHG Employee Stock Purchase Plan, PTO, CME, and more.
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F/U on this:

Physicians, Hospitals Meet Their New Competitor: Insurer-Owned Clinics Physicians, Hospitals Meet Their New Competitor: Insurer-Owned Clinics
 
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medgator said:
F/U on this:

Physicians, Hospitals Meet Their New Competitor: Insurer-Owned Clinics Physicians, Hospitals Meet Their New Competitor: Insurer-Owned Clinics
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Sounds kinda like Kaiser Permanente. They are an HMO but also have a huge number of physicians working for them and own many locations nationwide.

I don't know if it's changed, but at one point I think that all Kaiser patients had to go to a Kaiser facility for their radiation therapy, even if it was several hours away. Kind of like the VA used to be, before it liberalized community care as a choice for veterans.
 
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IonsAreOurFuture said:
Sounds kinda like Kaiser Permanente. They are an HMO but also have a huge number of physicians working for them and own many locations nationwide.

I don't know if it's changed, but at one point I think that all Kaiser patients had to go to a Kaiser facility for their radiation therapy, even if it was several hours away. Kind of like the VA used to be, before it liberalized community care as a choice for veterans.
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That's correct although they do contract out similar to what the VA when they can't offer a similar service in their designated area.

I believe that was happening in northern California until recently when they built their own and had been advertising positions
 
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IonsAreOurFuture said:
Sounds kinda like Kaiser Permanente. They are an HMO but also have a huge number of physicians working for them and own many locations nationwide.

I don't know if it's changed, but at one point I think that all Kaiser patients had to go to a Kaiser facility for their radiation therapy, even if it was several hours away. Kind of like the VA used to be, before it liberalized community care as a choice for veterans.
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In general Kaiser provides excellent care.
 
RadOncDoc21 said:
Why care about the benefits and risks of protons when people will use them anyway? Science and data are at a critical state in today’s society.
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Clearly oncology is post science and EBM at this point.
 
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TheWallnerus said:
But if you want to treat some arthritis or COVID-y lungs with a gray or two you’d best come with multiple phIII trials with 10 years followup son.
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The double standard when it comes to
Rigor is astounding.
 
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RadOncDoc21 said:
Why care about the benefits and risks of protons when people will use them anyway? Science and data are at a critical state in today’s society.
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can we as a field not take a second to unify and make fun of lymphoma med oncs for this before we initiate the circular firing squad routine?
 
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We all know that chemo has no side effects and is most efficacious on it's own. Ergo, MOAR CHEMO!
 
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temujim said:
can we as a field not take a second to unify and make fun of lymphoma med oncs for this before we initiate the circular firing squad routine?
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I mean look at the advertising… I spend at least 30 minutes explaining to every patient with cancer why they don’t need protons before I can even get started with the consult.

Reminds me of the Cancer Treatment Centers of America playbook!

mdproton.com

Advances in Proton Therapy in the Treatment of Cancer - Maryland Proton Treatment Center

The number of people diagnosed with cancer continues to rise each year. According to the American Cancer Society, 1.9 million new cancer diagnoses were expected in 2022, an increase of 6% from 2020 projections and 10.5% over 2018 figures. While cancer rates continue to climb, advances in...
mdproton.com mdproton.com

www.mdanderson.org

Two-time cancer survivor grateful for a second opinion and MD Anderson

When Bill Middelthon was diagnosed with cancer of the oral tongue, he came to MD Anderson for a second opinion that changed the course of his treatment. A few months later, he became the first patient to receive the NOVA fiducial marker technique for his second cancer diagnosis of prostate cancer.
www.mdanderson.org www.mdanderson.org

protomag.com

A Time for Protons

Proton therapy has been a cutting-edge cancer therapy for decades. Can researchers at last zero in on its best applications?
protomag.com protomag.com
 
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