Rad Onc Twitter

  • Thread starter Thread starter deleted1002574
  • Start date Start date
This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
RealSimulD said:
Dan is super polarizing.

But, if this is true, and I have no reason to believe it isn't, it is a good look and the right thing to do.

The fact that it is celebrated is an indictment of all the other chairman who do so little.

He's a tough personality at times, but he is doing a lot of good in our world. Faculty getting paid properly. Growing research infrastructure. Taking interest in resident education.

Sometimes the good leaders aren't the ones you want to get a beer with or be friends with. He's relentlessly singleminded, we've spoken a fair amount. Two completely different human beings. We are never gonna share biryani together or high five at at Wolverines game, but I respect a chairman that sees patients and takes call.

My chairman in residency doing any of the above? HAHAHAHAHAHAHHAHAHAHAHAHHA, I cannot type enough laughter.
Click to expand...

Didn’t they expand their residency?
 
Neuronix said:
I can't get our surgeons to do any SRS for functional disorders outside of a small minority of trigeminal neuralgia cases. They want to ablate everything with a needle.
Click to expand...
So poach them from your own follow-ups...

What are your surgeons gonna do, refer elsewhere?

Your institution won't allow that.

Academia: where your neighbor can get popped for violating the Sherman antitrust act, but you're in the clear!
 
elementaryschooleconomics said:
So poach them from your own follow-ups.

What are your surgeons gonna do, refer elsewhere?

Your institution won't allow that.

Academia: where your neighbor can get popped for violating the Sherman antitrust act, but you're in the clear!
Click to expand...

The overlap of functional disorders with malignancy patients is pretty small.

Also, SRS requires a surgeon to sign off and so they can get their billing. If they don't agree, there won't be a case or at least there will be a big departmental political issue that I will lose.
 
elementaryschooleconomics said:
So poach them from your own follow-ups...

What are your surgeons gonna do, refer elsewhere?

Your institution won't allow that.

Academia: where your neighbor can get popped for violating the Sherman antitrust act, but you're in the clear!
Click to expand...
If you're at a GK program, not sure how you get the pt on the schedule with the frame on (really important in TN/functional cases imo) without neurosurgeon buy in
 
Neuronix said:
The overlap of functional disorders with malignancy patients is pretty small.

Also, SRS requires a surgeon to sign off and so they can get their billing. If they don't agree, there won't be a case or at least there will be a big departmental political issue that I will lose.
Click to expand...
medgator said:
If you're at a GK program, not sure how you get the pt on the schedule with the frame on (really important in TN/functional cases imo) without neurosurgeon buy in
Click to expand...
Man, just when I get a little fuzzy on why I never wanted to be associated with big institutions and/or working at main campus...SDN will bring the memories flooding back.
 
Neuronix said:
The overlap of functional disorders with malignancy patients is pretty small.

Also, SRS requires a surgeon to sign off and so they can get their billing. If they don't agree, there won't be a case or at least there will be a big departmental political issue that I will lose.
Click to expand...
Maybe design the trial as needle ablation vs. SRS followed by needle ablation? They won't be cut out... and would get to bill twice for the experimental arm.
 
dieABRdie said:
Maybe design the trial as needle ablation vs. SRS followed by needle ablation? They won't be cut out... and would get to bill twice for the experimental arm.
Click to expand...

Interesting concept. First thoughts are that it would be a tough randomization to get patients to agree to. Also not sure if insurance would pay for both procedures.
 
temujim said:
Saddest part is your department doesn't have your back.
Click to expand...
Not to belabor a single point (although I will).

This sort of scenario is exactly what happens when you have longstanding chairs instead of rotating chairs.

The chair knows that the most important thing for their career is their relationship with other departments and admin. They are also aware of departmental hierarchies within the institution.

Meanwhile, the resident or junior faculty is almost entirely beholden to the chair (who has often been there forever).

Rotating chairs changes this dynamic remarkably. Because the chair is first and foremost a working doc.
 
communitydoc13 said:
Not to belabor a single point (although I will).

This sort of scenario is exactly what happens when you have longstanding chairs instead of rotating chairs.

The chair knows that the most important thing for their career is their relationship with other departments and admin. They are also aware of departmental hierarchies within the institution.

Meanwhile, the resident or junior faculty is almost entirely beholden to the chair (who has often been there forever).

Rotating chairs changes this dynamic remarkably. Because the chair is first and foremost a working doc.
Click to expand...

Would there be an election for a new chair every few years? Like the faculty vote on it? I can see that process becoming quite fraught as well.
 
Fpg1245 said:
Would there be an election for a new chair every few years? Like the faculty vote on it? I can see that process becoming quite fraught as well.
Click to expand...
Eff no!! Being a chair should be a duty not a privilege. In many good basic science departments, where the profs are grant driven researchers, being a chair is something that all senior faculty begrudgingly do.

All associate profs on up have to do it. I would say full profs but some of these departments are so asymmetric that they have a bunch of assistant profs and only a couple full profs who aren't emeritus.

2 year terms. (Don't want to keep to docs away from their true calling longer than that).

Edit: You will get the occasional lunatic chair. But it's only 2 years. All long term chairs become dissociated from the true needs of their departments.
 
ASTRO straight up deleted the workforce sesh from existence today. Nice.

IMG_0049.png
 
TheWallnerus said:
ASTRO straight up deleted the workforce sesh from existence today. Nice.

View attachment 377566
Click to expand...

Haha I hope it comes back, it’s a great session.

This revisionist/newspeak stuff has happened at least 5 separate times in the past two years… that I know of: The SCAROP survey, proton model policy, ROCR “town hall”, ROCR breakfast tickets, and now the deleted session.

I really love so many of the rad onc individuals I meet, but the culture of ASTRO just sucks.
 
NotMattSpraker said:
Haha I hope it comes back, it’s a great session.

This revisionist/newspeak stuff has happened at least 5 separate times in the past two years… that I know of: The SCAROP survey, proton model policy, ROCR “town hall”, ROCR breakfast tickets, and now the deleted session.

I really love so many of the rad onc individuals I meet, but the culture of ASTRO just sucks.
Click to expand...
Incredible.
 
The Zune.

I'm surprised the folks that built the MRI-Linac didn't come up with a catchy name for a soon to be obsolete, completely out of touch with users reality, product like that.
 
I think Reflexion falls into the same category- machine with nifty technology that will provide no (for the vast majority of patients who would get radiation) to marginal (for select few) benefit, with costs (upfront and maintenance) that will price out 99% of radiation oncology practices. Both have added hassles as well (RTT training, magnetic safety for MR-LINAC and handling radioactive materials for Reflexion). Reflexion will probably fall before the proliferation of their machines though.
 
radiaterMike said:
I think Reflexion falls into the same category- machine with nifty technology that will provide no (for the vast majority of patients who would get radiation) to marginal (for select few) benefit, with costs (upfront and maintenance) that will price out 99% of radiation oncology practices. Both have added hassles as well (RTT training, magnetic safety for MR-LINAC and handling radioactive materials for Reflexion). Reflexion will probably fall before the proliferation of their machines though.
Click to expand...
Reflexion = just because you can treat 10 mets at the same time, doesn't mean you should.
 
Neuronix said:
What's the most brain mets you've stereoed in single session? I'm up to 50. How's that for dreaming big? 😀
Click to expand...
Also known as single fraction WBRT. But you were sober while contouring, right?
 
medgator said:
Integral brain dose?
Click to expand...

Depends on the size of the mets and technique. For 50 tiny mets on linac it's about 4-5 Gy mean brain - GTV.

Gfunk6 said:
Also known as single fraction WBRT. But you were sober while contouring, right?
Click to expand...

Contouring 30+ targets always makes me wish I was drunk....
 
Neuronix said:
Depends on the size of the mets and technique. For 50 tiny mets on linac it's about 4-5 Gy mean brain - GTV.



Contouring 30+ targets always makes me wish I was drunk....
Click to expand...
I'm really happy to see that I'm not the only one wasting my life drawing 50 tiny brain mets. Fun fact - We've been using Varian HyperArc software but it often starts crashing above 30-something targets so our physicist solves this by strategically chunking targets together.

Neuronix, there's a decent chance we may not be right but at least we're not alone.
 
Palex80 said:

View attachment 377660

View attachment 377661



This may actually impact OS!

If you treat patients with a typical prognosis of a few months, one week earlier, you increase OS.
Click to expand...
Nice use case arguably better than others previously shown and no question UTSW has been steadfast in pushing the boundaries for advanced RT.

They ignore frontal lobe doubts such as do we really need such a high BED for lung, breast or prostate. They don’t say these patients have poor survival so what is the point and still innovate. But for the real world, does this justify hiring such a large team of physicists and therapists?
 
Palex80 said:

View attachment 377660

View attachment 377661



This may actually impact OS!

If you treat patients with a typical prognosis of a few months, one week earlier, you increase OS.
Click to expand...

It’s easy to dunk on this stuff. But if you consider that in 5-10 years this sort of seamless treatment delivery stuff will just be considered normal and part of our workflow, and people won’t remember a time before - then it has to start somewhere
 
drowsy12 said:
It’s easy to dunk on this stuff. But if you consider that in 5-10 years this sort of seamless treatment delivery stuff will just be considered normal and part of our workflow, and people won’t remember a time before - then it has to start somewhere
Click to expand...
I agree.
It‘s highly likely, that same day imaging, planning and treatment will become s.o.c.
I didn‘t mean to dunk on anyone.

The Dutch have published FAST-METS already


I find bone mets the „better“ indication for same day procedures, than hippocampal-sparing (which continues to be a matter of debate!) WBRT.
 
Last edited:
You must log in or register to reply here.

Similar threads

uchihastan
Rad Onc vs. Heme/Onc
Replies
18
Views
2K
medgator
M
B
Rad Onc Procedures and RVUs
Replies
35
Views
5K
CurbYourExpectations
CurbYourExpectations
D
Saving Rad Onc
2
Replies
60
Views
6K
RickyScott
R
TheWallnerus
Rad Onc is in a dark place
Replies
13
Views
2K
RickyScott
R
D
Future of rad onc job market
2
Replies
58
Views
9K
BobbyHeenan
B
Top