Rad Onc Twitter

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
It would be nice to know the final language of the bill being introduced. Is it the same as what we saw previously?
Members don't see this ad.
 
Members don't see this ad :)
Who is expecting supervision requirement in it?

Alternatively, an accreditation requirement, but the accreditation itself will require supervision.
 
  • Like
Reactions: 1 user
Mandelin Rain said:
It would be nice to know the final language of the bill being introduced. Is it the same as what we saw previously?
Click to expand...
We didn't even get to see a draft bill - unless you saw something in person?

There were the two PDFs back in the June 2023 surprise announcement that described ROCR (one was a technical document, one was an overview).

So in grand total, public-facing, there was the announcement with the two PDFs and the short pre-recorded "webinar", along with the little FAQ.

There was the fake Town Hall.

There was the ~60 minute non-recorded Advocacy Breakfast at the 2023 conference.

There was the PRO paper in January 2024.

And...that's it. They obviously went around and had closed, one-on-one Zoom meetings with individual departments.

They kept asking for feedback and it's unclear what became of that. I know when I was personally in one of the closed ASTRO/RadOnc Department Zoom meetings with them a few months ago, they claimed they had changed something based on feedback, which I won't say in public yet because I want to see if it's true or not.

This is absolutely bizarre, even for ASTRO, who is capable of only doing bizarre things.

From surprise announcement to introduction in the House as a standalone bill: 11 months, only one truly public and "live" presentation.

Strong work ASTRO, strong work.
 
  • Like
Reactions: 2 users
Mandelin Rain said:
Who is expecting supervision requirement in it?

Alternatively, an accreditation requirement, but the accreditation itself will require supervision.
Click to expand...

They already require supervision now. Assuming this requirement remains in ROCR, and ACRO/ACR/ASTRO align as they have, you will be penalized for doing general supervision.

The accreditation requirement is one of my biggest problems with ROCR and has been my main message to my reps. It is legislating that our practices fund ACRO, ASTRO, and ACR in perpetuity. This requirement also seems against the spirit of the Sherman Act (sprit, bc not a lawyer) and the feds would be interested in 3 societies aligning to guarantee themselves income and the ability to penalize the entire country if we dont follow their arbitrary programs.
 
  • Like
Reactions: 6 users
NotMattSpraker said:
They already require supervision now. Assuming this requirement remains in ROCR, and ACRO/ACR/ASTRO align as they have, you will be penalized for doing general supervision.

The accreditation requirement is one of my biggest problems with ROCR and has been my main message to my reps. It is legislating that our practices fund ACRO, ASTRO, and ACR in perpetuity. This requirement also seems against the spirit of the Sherman Act (sprit, bc not a lawyer) and the feds would be interested in 3 societies aligning to guarantee themselves income and the ability to penalize the entire country if we dont follow their arbitrary programs.
Click to expand...
Doesn't CMS require radiology facilities to be ACR accredited in order to get paid? Heard that long ago...
 
NotMattSpraker said:
I believe just for some services and the requirements on the practice are no where near the burden of RO accreditation.
Click to expand...

That accreditation requirement is nuts if it's in there. Our group cover a number of sites, some accredited, some not...and I see zero difference in quality.

Can often mean you need to hire more staff to help meet it/do the paperwork and just wait until the prices for accreditation skyrocket when it's mandated. As mentioned it's also a back door supervision requirement, because some of the accrediting bodies have demanded direct supervision to meet their standards.
 
  • Like
Reactions: 4 users
1716310670475.png
 
  • Like
  • Wow
Reactions: 2 users
Members don't see this ad :)
Chartreuse Wombat said:
Love the mask
Click to expand...
I don't know Fumiko (she's probably awesome) but this is a Brooklyn hipster look. I like Brooklyn hipsters...creative, not terribly greedy, emphasis on local sourcing and an ethic that emphasizes not being as egregious a consumer as many Americans. Very open minded regarding queerness.

Brooklyn hipsters should never go for protons. Maybe this is just a wealthy Manhattanite masquerading as a Brooklyn hipster?

But the bullet points are telling... and hyperbolic.

Will ROCR improve access to lifesaving radiation? How?

Prior auth sucks...and I agree with moving to a bundled payment model...but prior auth has not killed a single patient of mine.
 
  • Like
Reactions: 2 users
elementaryschooleconomics said:
It's about as evidenced-based as the financial toxicity data at this point
Click to expand...

- always wears an N95 mask
- always uses bolus for CW irradiation
- never lets a breast patient wear deodorant
- gives a DRE to every prostate cancer followup
- knows freestanding RT is more costly than academic Manhattan center RT
- loves ECGs
- always, always chooses wisely
 
  • Love
  • Haha
  • Like
Reactions: 6 users
TheWallnerus said:
- always wears an N95 mask
- always uses bolus for CW irradiation
- never lets a breast patient wear deodorant
- gives a DRE to every prostate cancer followup
- knows freestanding RT is more costly than academic Manhattan center RT
- loves ECGs
- always, always chooses wisely
Click to expand...
Perfect rad onc!!
 
  • Like
Reactions: 1 user

x.com

x.com x.com

Urology even trying to own IR procedures. I’ve got to think if rad onc had even half the ownership culture of urology we wouldn’t be giving up radiopharm and going the employed route in droves.
 
  • Like
Reactions: 5 users
grenz said:

x.com

x.com x.com

Urology even trying to own IR procedures. I’ve got to think if rad onc had even half the ownership culture of urology we wouldn’t be giving up radiopharm and going the employed route in droves.
Click to expand...
Every rad onc in ‘Merica could have the option of being independently wealthy if they all had the option of buying a linac from Varian or ‘Lekta!
 
  • Like
Reactions: 2 users
grenz said:

x.com

x.com x.com

Urology even trying to own IR procedures. I’ve got to think if rad onc had even half the ownership culture of urology we wouldn’t be giving up radiopharm and going the employed route in droves.
Click to expand...

Half is about all I would want. Crazy to me that we have local urologists trying to treat metastatic prostate cancer, giving concurrent chemo for bladder, etc, etc.
 
  • Like
Reactions: 3 users
I always (for as long as I was aware of it) thought PAE would be a good adjunct after definitive XRT in prostate ca.
 
drowsy12 said:

x.com

x.com x.com
Click to expand...

Starts out with a misunderstanding of how PE tries to make money in medicine (no one would ever intentionally create a 'toxic asset' in order to turn it around and sell it that's not how any of this works- sure, they may saddle it with a ton of debt which is then paid back to the PE firm a la Red Lobster real estate, but they weren't planning on prepping Red Lobster for a sale), then says we should all ask around about ROCR to see if we support it.
 
Last edited:
  • Like
Reactions: 1 user
grenz said:

x.com

x.com x.com

Urology even trying to own IR procedures. I’ve got to think if rad onc had even half the ownership culture of urology we wouldn’t be giving up radiopharm and going the employed route in droves.
Click to expand...
Radiopharmaceuticals are too niche to move the needle for us, how about we do the low hanging fruit like stopping the push to eliminate rt and reduce fractions while we overtrain in the specialty?

Uro and derm are damn good about keeping a lid on how many they train every year. Biggest thing we can do to effect change is control our own supply.
 
Last edited:
  • Like
Reactions: 5 users
Palex80 said:
View attachment 387277

New fear unlocked.
Click to expand...
Stop contributing to IO-hesitancy with your fear mongering!

We freak out over rare one offs with IO yet if you try and discuss or publish any events even remotely critical of c*vid v*x you’re STILL an anti-science quack.

Suspect this website will get censored soon for contributing to proton and spaceOAR hesitancy along the same lines.
 
  • Haha
Reactions: 1 users
  • Haha
  • Like
Reactions: 6 users
Gfunk6 said:
Ex vivo priming of the immune system to fight cancer???? What an incredibly novel concept! Such an idea surely hasn’t existed since the 1990s and, since then, produced incredible breakthroughs that we see every day like . . . Provenge.
Click to expand...

Immune modulation by any way we can think to do it has been tried dozens of times in glioblastoma.

It's still being promoted as leading edge, revolutionary, high impact publications, etc...

It's gotten to the point where some centers do single arm only or have patients come cash pay for immune modulation or vaccines.

Do we even want to know if it works or not if it draws patients?

That last sentence brought to you in conjunction with proton therapy.
 
  • Like
  • Haha
Reactions: 9 users
Neuronix said:
Immune modulation by any way we can think to do it has been tried dozens of times in glioblastoma.

It's still being promoted as leading edge, revolutionary, high impact publications, etc...

It's gotten to the point where some centers do single arm only or have patients come cash pay for immune modulation or vaccines.

Do we even want to know if it works or not if it draws patients?

That last sentence brought to you in conjunction with proton therapy.
Click to expand...
You both forgot the vitamin C infusions. Secret sauce that ties everything together
 
Neuronix said:
Immune modulation by any way we can think to do it has been tried dozens of times in glioblastoma.

It's still being promoted as leading edge, revolutionary, high impact publications, etc...

It's gotten to the point where some centers do single arm only or have patients come cash pay for immune modulation or vaccines.

Do we even want to know if it works or not if it draws patients?

That last sentence brought to you in conjunction with proton therapy.
Click to expand...
noticed a number of pts recently paying out of pocket for vaccines in germany
 
  • Like
Reactions: 1 user

x.com

x.com x.com

This is too bad. CURB suggested a possible benefit in the oligoprogressive setting. Wonder what we will see in the final pub
 
  • Sad
Reactions: 1 user
1717269094656.png


Excuse me?

Multiple courses of SBRT over 6 months? With no limits?

And at 6 months we stop? So, the met that pops up at 6 months + 1 day was also not subjected to the intervention, where‘s the difference?

I suggest we should also then change the endpoint from PFS to BMFFS (bone marrow failure free survival)?

🤣🤣🤣
 
  • Like
  • Hmm
Reactions: 2 users
Palex80 said:
View attachment 387458

Excuse me?

Multiple courses of SBRT over 6 months? With no limits?

And at 6 months we stop? So, the met that pops up at 6 months + 1 day was also not subjected to the intervention, where‘s the difference?

I suggest we should also then change the endpoint from PFS to BMFFS (bone marrow failure free survival)?

🤣🤣🤣
Click to expand...
My pest exterminator charged me $100 to get rid of my rat infestation. One month later, there were even more rats! I complained, but he told me it was unfair because those “new” rats were obviously not “subject to his intervention.” He asked me for $100/month for the next six months and told me that would be best.
 
  • Like
  • Haha
  • Love
Reactions: 8 users
Gfunk6 said:
My pest exterminator charged me $100 to get rid of my rat infestation. One month later, there were even more rats! I complained, but he told me it was unfair because those “new” rats were obviously not “subject to his intervention.” He asked me for $100/month for the next six months and told me that would be best.
Click to expand...
Oligoprogression. That is the key indication… and the endpoint should be freedom from needing to escalate systemic therapy and/or freedom from G3+ progression/tx related tox, because those are the best reasons to treat a metastatic patient with a locally ablative therapy.
 
  • Like
Reactions: 4 users
Oligoprogression >>>>> consolidation all day long I'm not surprised this trial was negative. I would also add "ability to take a break from systemic treatment" as another endpoint, as we've seen a bit in prostate cancer.
 
  • Like
Reactions: 4 users
Sounds like patients could have had up to 25 Mets as well. Geez

x.com

x.com x.com
 
  • Like
Reactions: 1 user
medgator said:
That's pretty much the limit for the hardcore cns SRS academic folks in the US for brain srs I think isn't it?
Click to expand...
Likely.

I would however feel more comfortable SRSing 25 brain mets, compared to SBRTing 8 liver mets, 10 lungs mets and 7 bone mets simultaneously.
 
  • Like
Reactions: 4 users
You must log in or register to reply here.
Next unread thread

Similar threads

P
Rad Onc oral boards
Replies
10
Views
1K
Barcelona PSG
B
D
Is rad onc job market … rebounding?
2 3 4 5
Replies
220
Views
8K
drowsy12
D
Gfunk6
Rad Onc? Burnt Out?
Replies
36
Views
2K
thecarbonionangle
thecarbonionangle
Gfunk6
Big Rad Onc performing TH consults
Replies
20
Views
2K
IonsAreOurFuture
I
TheWallnerus
Rad onc supervision, the epilogue
2 3
Replies
102
Views
7K
dozitgetchahi
D
Top