Rad Onc Twitter

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Mandelin Rain said:
[Aaron Hernandez has entered the chat]
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Literally the only thought my mind had when the idea of "rough Connecticut" came up. I'm sure there is a rough Connecticut (including right next to Yale) but it is obviously not the "underserved" region being targeted.

A "proton desert" refers to a place where people shop at Fresh Market or better yet Dean & Deluca but don't yet have convenient access to protons.

It is interesting is that (presumably due to regulatory environment and strong managed care presence) California has not seen this type of behavior to date.
 
communitydoc13 said:
It's pretty big. If you advertise for remote, you will get a lot of reasonable apps.

The barrier is the institution. Some of these still have ridiculous ideas of who needs to be on site (absolutely no need for dosi to be onsite IMO, particularly if adequate physics staffing). This is coming from a doc mostly on-site advocate.

The above tales of the legacy, incompetent, on-site dosimetrist should not be happening. There is a workforce out there for remote service.

Now it is highly variable, and I do encourage for all remote hires an on-site visit, meeting pertinent folks (physics and docs) face to face, maybe even a few days on site for on-boarding and discussion.

Remote dosi should be at your chart rounds, and your chart rounds should be meaningful.

My 2 cents.
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Still a big fan of hybrid. All of them (gulp) actually enjoy their WFH days but still like being in the office a couple days a day to give input on setups/sims for complex cases
 
communitydoc13 said:
.

It is interesting is that (presumably due to regulatory environment and strong managed care presence) California has not seen this type of behavior to date.
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Many commercial insurers there won't pay for protons esp in low risk PCA afaik, so it isn't just the medi-cal and KP folks putting a quash on it
 
medgator said:
Many commercial insurers there won't pay for protons esp in low risk PCA afaik, so it isn't just the medi-cal and KP folks putting a quash on it
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Still won’t stop the patients from seeing commercials and inquiring about protons. I spend the majority of my days explaining to patients how misleading the academic center is being.
 
NotMattSpraker said:
I am embarrassed with how our field approaches "financial toxicity", "the underserved", and "rural" patients. It is super gross.
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Correct. If there were a way to use radiation for cosmetic purposes for wealthy suburban elites, these same people that spout this nonsense would be all over it.
 
NotMattSpraker said:
Fully agree.

I do think its worth while to have them come a few times a year because meeting people face to face can enhance culture on teams. I've been talking a lot with dosis my institution deals with the existential dread of letting them be remote. They all seem to agree with that.
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Have suggested to my (excellent) dosimetrist(s) that are almost entirely remote that they show up once a month or so. A little harder to fire someone when you know their face.
 
MidwestRadOnc said:
What the dosis are not going to like as their position transistions to remote/WFH, there will be an oversupply and pay will go down. I don’t think these days of having 3 or more jobs paying historically full time wages will last. I’m sure PE is already on it. The cat’s out of the bag that an average rad onc clinic does not require 40 hours a week of full time dosimetry work. There’s a lot of downtime, enough to work other jobs, even. So admins will start to wonder, we are paying them this much why exactly? And they will find themselves doing 2 remote jobs for what they used to get paid for 1 in person.
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We have noticed an opposite trend.

We had dosimetrists go remote because I guess our local pay is less than what they were able to fetch on a national playing field. They came back quick after realizing the difference between in-person comraderie with physician input and the hamster-wheel of work when they are employed by a pay-per-plan setup with little physician input. Pushed to accept what they (the dosimetrist!!) considered inferior plans to get more throughput for their employer
 
CaesarRO said:
We have noticed an opposite trend.

We had dosimetrists go remote because I guess our local pay is less than what they were able to fetch on a national playing field. They came back quick after realizing the difference between in-person comraderie with physician input and the hamster-wheel of work when they are employed by a pay-per-plan setup with little physician input. Pushed to accept what they (the dosimetrist!!) considered inferior plans to get more throughput for their employer
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A lot of varying situations out there. Best dosimetrists I know have remote side gigs and come in 2-3 days week
 
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communitydoc13 said:
Literally the only thought my mind had when the idea of "rough Connecticut" came up. I'm sure there is a rough Connecticut (including right next to Yale) but it is obviously not the "underserved" region being targeted.

A "proton desert" refers to a place where people shop at Fresh Market or better yet Dean & Deluca but don't yet have convenient access to protons.

It is interesting is that (presumably due to regulatory environment and strong managed care presence) California has not seen this type of behavior to date.
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Speaking of CT

www.nytimes.com

I-95 in Connecticut Will Be Closed for Days After Fiery Crash

A gasoline tanker crashed on Thursday, causing a fire that damaged a bridge in Norwalk, Conn. Early Friday morning, commuters were facing clogged roadways, and one school district canceled classes.
www.nytimes.com www.nytimes.com
 
1714983789457.png


So, 25 x 2.5 Gy = 62.5 Gy is well tolerable.


However, isn't there a "hidden" dose escalation when going for hypofractionation with this regime?

Isn't 25 x 2.5 Gy = 62.5 Gy "more dose" than 33 x 2 Gy = 66 Gy?

With ab a/b of 3 Gy, 24 x 2.5 Gy would be equivalent to 33 x 2 Gy (BED 110 Gy).
 
Palex80 said:
View attachment 386301

Potentially practice changing
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Tracks with my anecdotal experiences. I've struggled with these cases and ones where we decided to SBRT I've had a number of regional nodal failures. It's so tempting in the PSMA era to just shoot at what you see....but more is lurking...

I'd be curious to see if cases with longer disease free intervals prior to trial enrollment/initial biochemical failure are ones that do OK with just MDT. Those are ones where I have felt more comfortable with SBRT.
 
Was this trial in post-op patients without prior RT?

I feel like our experience in these cases is also more in patients with prior prostate-only RT with a nodal failure

We've favored ENRT, but I agree with the temptations to treat the node-only. It's nice to have hard numbers to compare the approaches
 
CaesarRO said:
Was this trial in post-op patients without prior RT?
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Patients will all kinds of primary treatment were eligible
a) prostatectomy without adjuvant/salvage prostate bed RT
b) prostatectomy with adjuvant/salvage prostate bed RT
c) primary RT of the prostate

Patients with prior WPRT (either in the setting of primary or postop RT) were excluded.


CaesarRO said:
I feel like our experience in these cases is also more in patients with prior prostate-only RT with a nodal failure

We've favored ENRT, but I agree with the temptations to treat the node-only. It's nice to have hard numbers to compare the approaches
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I've seen both (post resection or post primary RT). Whether or not you prescribe ENI for high-risk localized disease in the context of primary RT and whether or not your urologists perform an EPLND when performing prostatectomies likely influences which patients you end up seeing the most.
 
Palex80 said:
View attachment 386290

So, 25 x 2.5 Gy = 62.5 Gy is well tolerable.


However, isn't there a "hidden" dose escalation when going for hypofractionation with this regime?

Isn't 25 x 2.5 Gy = 62.5 Gy "more dose" than 33 x 2 Gy = 66 Gy?

With ab a/b of 3 Gy, 24 x 2.5 Gy would be equivalent to 33 x 2 Gy (BED 110 Gy).
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Single arm ph II? The conclusion is that it is A SOC. That is a reasonable statement.

The tweeter stating that Hypo is THE SOC is excessive. Shouldn't be hard to do a ph III to prove it's just as safe compared to contemporary conventional fractionated.

Assuming A/b of prostate cancer is 3 in the recurrent setting.... that's a dangerous move!

Palex80 said:
View attachment 386301

Potentially practice changing
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Confirms my practice. To take a potentially curative situation of lymph node recurrence of prostate cancer and put the patient on a palliative pathway by not doing ENRT, does not compute.

3% vs 25% chance of recurrence. I know which one I'd want if I was a patient! Their toxicity data for ENRT vs MDRT was basically the same as well.

Nodal SBRT in someone who has not prevoiusly seen elective nodal RT is not the answer.
 
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No confounding on that one at all...

My low income, low resource, tech illiterate, foreign language speaking patients often can't use that portal.

They're also the ones who need the most help.

What drives me crazy is when the health system says that's the only way to communicate with patients electronically. No text messages, no e-mails, when this is how a lot of people today communicate.
 
Neuronix said:
No confounding on that one at all...

My low income, low resource, tech illiterate, foreign language speaking patients often can't use that portal.

They're also the ones who need the most help.

What drives me crazy is when the health system says that's the only way to communicate with patients electronically. No text messages, no e-mails, when this is how a lot of people today communicate.
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Dead people cannot use the EHR.
 
RickyScott said:
Red journal garbage article of the month:https://www.redjournal.org/article/S0360-3016(24)00626-6/fulltext

the authors are very proud;

x.com

x.com x.com
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Patients who are with it enough to be able to use the internet and proactive in messaging to better than those who don't, News at 11.

On another note, I don't like the current "let's mock the incredibly dorky med student skits" posts going around the internet. Med students doing dorky skits has been around since time began. Good thing for my class the skit will never live on the internet forever.
 
MidwestRadOnc said:
"Sending portal messages to and being sent portal messages from radiation oncology providers were associated with better survival. Future studies should elucidate how best to support patient and provider engagement."

images


Is there even an editor at all? HTF did that meaningless abomination of words get published?
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I noticed the editor in chief and the authors are in the same department.

Probably a coincidence.
 
OTN said:
Patients who are with it enough to be able to use the internet and proactive in messaging to better than those who don't, News at 11.

On another note, I don't like the current "let's mock the incredibly dorky med student skits" posts going around the internet. Med students doing dorky skits has been around since time began. Good thing for my class the skit will never live on the internet forever.
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the mocking is abt DEI. students Dont seem representative of our society. If these were graduating airplane pilots, would some people have issues?
 
The skits were always stupid and a bad look for our profession.
But the reality is that it's too late anyway as our image to the public has been destroyed by pharma making us legal opiate/stimulant/benzo/weed dealers, the hospital lobby pointing the finger at rich doctors as the cause of high healthcare costs, the insurance industry dictating how we practice, and the legal profession completely owning us at every turn. Oh, and of course our own specialty organizations throwing us under the bus, then backing up to make sure we're good and dead. So sure, make all the stupid out-of-touch skits you want, med students! Somehow I don't think med students in China are doing this nonsense and posting on their version TikTok (even if they were allowed).
 
Doctorer said:
All these times I've stressed over elective nodal coverage, when i really should have been encouraging my patients to buy second homes.
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If you were a good doctor you would just refer all your patients to a name brand PPS-exempt cancer center

Those who can't go, I mean why even bother treating them, they're going to have worse outcomes since they're not of sufficient SES to have a good cancer outcome!

/s
 
I can hear your RN, MBA overlord already:

"Hey [first name of physician], you are WAY behind on your EMR inbox patient messages. Didn't you see that new article that answering them improves patient survival? Chop, chop!"
 
thecarbonionangle said:
Generally speaking, it is a good example of the academic incentive to “publish”. If you have to put out things in numbers to get promoted, you end up putting out junk to get promoted.
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It is so small minded that it genuinely makes me sad for the future of our field.

If I was a resident now, I would be working on a skillset to supplement clinical radiation oncology to make sure I stay valuable even if the field does not. Its not for me, but informatics is a very logical choice for many in this field. There are MDs in my organization that serve informatics leadership roles. I have no doubt this will have some demand pretty soon for both academic and community networks, and is easier to combine with clinical than procedural/surgical jobs. It seems like a really cool job overall and you can help a lot of people and other physicians.

Its also kind of a new job and Id guess you could try to even negotiate a bit, wouldnt that be something?

We should be training innovative clinical informatics researchers to do great things in our consolidated data driven future as part of our pivot.

Do something useful for the hospital and stimulating for yourself while you are forced to supervise the linac.

We should not be rewarding generating the easiest possible study out that you can poop out of the university network data warehouse.
 
medgator said:
Should have its own thread honestly at this rate. Weekly/monthly hot garbage out of the IJROBP....

Dumpster Fire GIF by MOODMAN
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I was actually thinking of putting out a top 5 worst articles in the red journal list post on a yearly basis but never got around to it.
 
pikachu said:
Downside is that actually requires you to read the red journal
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To be fair, I didn’t read this pos article. I really doubt the authors are so stupid as to not understand causation/correlation but who knows. My best guess is that they are trying to make some larger point abt disparities and racial/class grievances, and perhaps Zionist oppressors.
 
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evilbooyaa said:
I think an entire thread devoted to just dunking in IJROBP day after day might come off as a bit antagonistic....
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Realistically, what was the last practice changing article you read in the red journal? When was it published? Last 5 practice changing articles? 10?
 
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