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TheWallnerus said:
Wow I have known doctors allegedly to have committed massive fraud and nothing ever happened to their license. This must be salacious.

Bill Hader Popcorn GIF by Saturday Night Live
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It’s a joke. I know of one that has killed a half dozen people through incompetence/apathy and nothing happened other than him amassing a nearly 9 figure wealth from booming in the golden days.
 
Perhaps I just missed it, but ABR-MOC no longer requiring SA-CME? Glad that grift is over.
 
I continue to get conflicting reports on this. I was just told that like 75 CME are required plus a QC project and OLA. This was from the ABR.

1707766105532.png

Technically, no SA-CME as you say, but I think a lot of people conflate that with all we gotta do is OLA.
 
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The QC project can also be participation in a qualifying activity, correct?

ABR

Previous: Overview Next: PQI Projects Available
www.theabr.org www.theabr.org

I think most people do at least one of them, even if just by accident.

Realistically, it's attend a couple tumor boards, review a handful of charts prospectively, answer some of the easiest questions ever, and most importantly... PAY YOUR DUES.

Which honestly, is probably about right for MOC.
 
Mandelin Rain said:
The QC project can also be participation in a qualifying activity, correct?

ABR

Previous: Overview Next: PQI Projects Available
www.theabr.org www.theabr.org

I think most people do at least one of them, even if just by accident.

Realistically, it's attend a couple tumor boards, review a handful of charts prospectively, answer some of the easiest questions ever, and most importantly... PAY YOUR DUES.

Which honestly, is probably about right for MOC.
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I think like 10 tumor boards in 3 years is good. I was thinking ola would be good enough as all of this is a joke. 3 tumor boards a year?
 
There is a weird requirement that you need SA-CME if you do not comply with OLA (which was around well before they discontinued required SA-CME for all). I think you can choose to not comply with OLA and take an exam instead (???) and maybe you also need to do SA-CME if you choose that route. As others said, the ABR did away with the required PQI project, and now allow for "Documentation of individual active participation in any of the activities in the table on this page meets the criteria for Continuing Certification (MOC) Part 4 requirements."


ABR

Previous: Overview Next: PQI Projects Available
www.theabr.org www.theabr.org
 
radiaterMike said:
There is a weird requirement that you need SA-CME if you do not comply with OLA (which was around well before they discontinued required SA-CME for all). I think you can choose to not comply with OLA and take an exam instead (???) and maybe you also need to do SA-CME if you choose that route. As others said, the ABR did away with the required PQI project, and now allow for "Documentation of individual active participation in any of the activities in the table on this page meets the criteria for Continuing Certification (MOC) Part 4 requirements."


ABR

Previous: Overview Next: PQI Projects Available
www.theabr.org www.theabr.org
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"Local or national leadership role in a national/international quality improvement program, such as Image Gently, Image Wisely, Choosing Wisely, or other similar campaign"

🤮
 
RickyScott said:
My guess is that is how most countries operate. Wouldn’t surprise me if USA had higher percent of 3d vs peers.
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I doubt that Canada and UK do IMRT for > 5% of breast cases. Here, breast IMRT keeps creeping up
 
seper said:
I doubt that Canada and UK do IMRT for > 5% of breast cases. Here, breast IMRT keeps creeping up
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With EZ fluence/forward planning, I get plenty of whole breast plans that look great without the need for imrt, even when treating regional nodes. The imrt plans that treat regional nodes can dump plenty of dose into the other breast/cw, even heart if you aren't careful with avoidance structures

Outside of apbi vmat, not really seeing the role for it routinely TBH
 
seper said:
I doubt that Canada and UK do IMRT for > 5% of breast cases. Here, breast IMRT keeps creeping up
Click to expand...
Hmm. IMPORT is an acronym for intensity modulated partial organ radiotherapy which I guess is how the majority if not plurality of their (the Brits) patients are treated.

What’s that? IMPORT is not “true” IMRT? Well. Americans don’t speak true English. Canadians sure as hell don’t. 😉

 
medgator said:
With EZ fluence/forward planning, I get plenty of whole breast plans that look great without the need for imrt, even when treating regional nodes. The imrt plans that treat regional nodes can dump plenty of dose into the other breast/cw, even heart if you aren't careful with avoidance structures

Outside of apbi vmat, not really seeing the role for it routinely TBH
Click to expand...

Have heard this before.
Would love to see the data that exceeding the B-51 contralateral breast constraints matter for, especially, 60+ yo women. The biggest risk for developing a contralateral breast cancer is already having had cancer (the biologic argument), which dwarfs the theoretical risk of a late radiation-induced malignancy.
Mean heart dose < 3 Gy easily achievable with VMAT. As opposed to putting a tangent directly through the LAD but still with a beautiful heart mean. What are we trying to achieve?

Unless you have a great reason to treat the medial breast, IMPORT-LOW suggests you don't need to if you are very concerned about contralateral breast dose.

If you need to treat IMNs, the IMRT plans almost always are better than wide tangents, or god forbid electron matches. Yet we have breast-only rad oncs that still claim IMRT is basically malpractice for breast and will instead be totally "cool" with super hot and cold spots with electron/photon plans. There is the basically moral panic of IMRT treating a somewhat variable skin target. Yet, it is standard in anal and vulvar?

Toxicity is way better with inverse planned IMRT even with nitpicky FiF.

I honestly don't get it. We are not treating with 2004's IMRT. It's been 2 decades.
Edit: Glad it's becoming less of an issue with most getting 5 fraction APBI with IMRT. I hate doing whole breast tangents + boost now. Can usually get IMRT approved for PBI or when treating nodes, which is where most of the cases are falling. The 16-20 fraction breast only is pretty rare now.
 
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medgator said:
Inverse planning has to be a component to bill it as imrt I thought
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Yea again. Take a tool like EZFluence and you can have weird abstract conversations about whether that’s inverse or not.

They know better than to participate in rad onc’s psychopathology. They just help you make nice homogeneous plans that may or may not identify as IMRT.
 
Palex80 said:
View attachment 383004

Choosing wisely
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You guys laugh, but can you really treat a right iliac met with SBRT that is 3 cm from bowel with your antiquated non-Reflexion linacs?

And even if you could, the dose fall-off from your non-Reflexion POS is far inferior*

*Does not account for the fact that you have to inject the patient with a whole body radioactive tracer on five consecutive days
 
Gfunk6 said:
You guys laugh, but can you really treat a right iliac met with SBRT that is 3 cm from bowel with your antiquated non-Reflexion linacs?

And even if you could, the dose fall-off from your non-Reflexion POS is far inferior*

*Does not account for the fact that you have to inject the patient with a whole body radioactive tracer on five consecutive days
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the crazy thing is that this isn't even that automated. You can see the FDG avid lesion, but they clearly contoured more of a "CTV" including the adjacent bone.

Seems like a waste of time for everyone. Rather have a diagnostic PET, contour upfront, and then be there for machine verification on each SBRT Fx (takes 1 minute most of the time).

Only upside would be if the billing for this is much higher than conventional linac-based SBRT. That would be nice, especially if its protected from cuts like protons
 
radoncftw said:
Only upside would be if the billing for this is much higher than conventional linac-based SBRT. That would be nice, especially if its protected from cuts like protons
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Just don't see it happening. Even big pharma couldn't prevent CMS from starting to negotiate on drug pricing. Used to only be allowed for the VA
 
thesauce said:
This is so crazy stupid
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I almost feel like I'm been gaslighted here. COH must know that every community doc fuses PET (Pylarify, Detectnet or other) to help delineate target when appropriate.

The CTV margins for SBRT non-spine bone are themselves somewhat contentious (just review a consensus paper regarding this).

Where is the value? Collectively, we have gone completely apeS#i! about branding without substance. Do they even believe in what they are doing?
 
thesauce said:
This is so crazy stupid
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Agreed. You'd have to treat have a million patient trial to demonstrate a benefit here (which is probably 0.0001%)

I'd feel way more confident fusing an MRI of the pelvis than using Reflexion
 
StealthTech said:
Agreed. You'd have to treat have a million patient trial to demonstrate a benefit here (which is probably 0.0001%)

I'd feel way more confident fusing an MRI of the pelvis than using Reflexion
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Haha what is the 0.0001%?

I could imagine one patient sometime having PET avid disease that does not yet have a CT correlate but its also not a false positive.

BgRT is gonna be siiiick for that guy!
 
communitydoc13 said:
Where is the value? Collectively, we have gone completely apeS#i! about branding without substance. Do they even believe in what they are doing?
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Perhaps they are working on these "easy" cases to test the machine. However, if this is the case, they should do this in a trial, due to the apparent novelty. Is this the case?

I could imagine the Reflexxion to hold some potential in HNSCC, (N)SCLC or cervical cancer, when using FGD.
Perhaps delivering some kind of SIB to particularly FDG-avid areas within the tumor?
But it doesn't seem that's what they are planning to do with it...
 
Palex80 said:
Perhaps they are working on these "easy" cases to test the machine. However, if this is the case, they should do this in a trial, due to the apparent novelty. Is this the case?

I could imagine the Reflexxion to hold some potential in HNSCC, (N)SCLC or cervical cancer, when using FGD.
Perhaps delivering some kind of SIB to particularly FDG-avid areas within the tumor?
But it doesn't seem that's what they are planning to do with it...
Click to expand...
Owning a Reflexion will be a mandatory requirement as part of the ASTRO palliative care network certification.
 
Palex80 said:
View attachment 383004

Choosing wisely
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New radiation device company dripping with pharma dollars that went through the trouble of getting their own specific (temporary) code. I'm sure they're doing easy stuff right now, likely at the request of their physics team, before trying more complicated things like mobile tumors in the lung, liver, etc, or more experimental stuff like hypoxic dose escalation for HN or what have you. But I don't doubt it's coming.

Sure this is twitter hype for the uninitiated, but that's the audience. If Terry is smart, and I'm sure he is, he'll be parading every rad onc naive hospital admin through over the next 6 months so they can "see the magic". And then hopefully squeeze ever more dollars and resources out of the COH bean counters.

And the almost uniform response of SDN so far is to take a **** on them? This stuff isn't a danger to private practice. My patients aren't gonna get on a plane for this. But if any of reflexion tech ultimately works and we treat more patients because of it, then only good for the field. Or we can turtle up and get buried by systemics in a self-fulfilling prophecy?
 
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