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Palex80 said:
"Disseminated Oligometastasis"

I am going to trademark this.
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Oligomets is like the funhouse distortion room at a carnival. Perspective is everything.

1717423999708.png
 
I was just looking at the choices for ASTRO president: Neha Vapiwala vs Constantine Mantz. It is depressing these are the best choices we have. Really the treat the wrong side dude? Or am i thinking of someone else? How do we not have better choices for “leadership”?
 
RickyScott said:
Mantz is flat out grifter
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Also was granted immunity by the federal government to testify in a criminal antitrust trial...the immunity was required because, you know, "antitrust" - by definition - requires multiple parties and...well, we can all connect the dots.

At least we can say only 50% of this year's ASTRO Presidential Candidates have been investigated by the FBI?
 
elementaryschooleconomics said:
Also was granted immunity by the federal government to testify in a criminal antitrust trial...the immunity was required because, you know, "antitrust" - by definition - requires multiple parties and...well, we can all connect the dots.

At least we can say only 50% of this year's ASTRO Presidential Candidates have been investigated by the FBI?
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I can't believe Mantz is running.
I mean I hope Vapiwala just posts the link to the wrong site tx case. That should end the election quickly.
 
thecarbonionangle said:
I was just looking at the choices for ASTRO president: Neha Vapiwala vs Constantine Mantz. It is depressing these are the best choices we have. Really the treat the wrong side dude? Or am i thinking of someone else? How do we not have better choices for “leadership”?
Click to expand...

Keep in mind that these are show elections. Both candidates are hand picked by the insiders at Astro to run. The membership are then told to elect one of two pre approved candidates to give the thing an air of legitimacy. This is why something like <10% of membership bothers to vote. Everyone knows it makes no difference.
 
That's what they do in Hong Kong. They have "free and fair elections" for candidates hand picked by the communist party.

I have personal experience with both candidates and will likely sit this one out.

Though if one of them wants to come to SDN, start doxxing everyone, and make wild claims and accusations about our members, I'll definitely vote for that candidate. It was quite fun the last time an ASTRO president elect did that.
 
Neuronix said:
That's what they do in Hong Kong. They have "free and fair elections" for candidates hand picked by the communist party.

I have personal experience with both candidates and will likely sit this one out.

Though if one of them wants to come to SDN, start doxxing everyone, and make wild claims and accusations about our members, I'll definitely vote for that candidate. It was quite fun the last time an ASTRO president elect did that.
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Hopefully they will call said doxxed members places of work as well and harrass them through their employers.
 
Neuronix said:
That's what they do in Hong Kong. They have "free and fair elections" for candidates hand picked by the communist party.

I have personal experience with both candidates and will likely sit this one out.

Though if one of them wants to come to SDN, start doxxing everyone, and make wild claims and accusations about our members, I'll definitely vote for that candidate. It was quite fun the last time an ASTRO president elect did that.
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This does seem like the worst choices so far I have seen since I have been voting. I knew Jeff M would be a total disaster and was very dissapointed he won. Neha V. did the super modest ACGME thing which was “something” but overall disappointing. It is hard to believe Mantz is a legitimate candidate. Total joke! I may have to hold my nose and vote against CM.
 
thecarbonionangle said:
I was just looking at the choices for ASTRO president: Neha Vapiwala vs Constantine Mantz. It is depressing these are the best choices we have. Really the treat the wrong side dude? Or am i thinking of someone else? How do we not have better choices for “leadership”?
Click to expand...
The best option is to fill out ASTRO's exit survey and express your discontent, which is what I just did.
 
TheWallnerus said:
THE WRONG BOOB WAS PICKED

This headline could apply either to Mantz's therapeutic misadventure or if we elect him as ASTRO President.
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Not making this up, I swear. I got a patient in clinic yesterday from a few hours away who asked me for a radiosurgery opinion because:

"I googled the guy they sent me to, and he treated the wrong breast."

Not a great look for ASTRO when they're putting him up for the presidency.
 
Neuronix said:
Not a great look for ASTRO when they're putting him up for the presidency.
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I think it's perfectly emblematic of ASTROs problems with membership and connecting with those ROs outside of the academic industrial complex.

Quite frankly mantz is the kind of insular candidate that is going to get through the nomination process and keep leading the organization to nowhere
 
medgator said:
I think it's perfectly emblematic of ASTROs problems with membership and connecting with those ROs outside of the academic industrial complex.

Quite frankly mantz is the kind of insular candidate that is going to get through the nomination process and keep leading the organization to nowhere
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It is shocking that during these times of controversy, serious issues with our field the cabal said to themselves, “yeah this is our guy”. It is very telling of ASTRO. Our field has a truly astounding level of corruption. Another 21C guy.
 
thecarbonionangle said:
It is shocking that during these times of controversy, serious issues with our field the cabal said to themselves, “yeah this is our guy”. It is very telling of ASTRO. Our field has a truly astounding level of corruption. Another 21C guy.
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This is how everything works in the world. I don't know why we are all so shocked that our silly little specialty would be immune from overt corruption and f*ckery. Like that's only for federal politics/three-letter-agency bureaucrats, latin american dictators beholden to drug cartels, and billionaire investment bankers screwing over the little guys or something.
 
RickyScott said:
Pretty sure Jason Bekta's podcast mentioned that Mantz owns patents on proprietary billing software for bundled payments.
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We have entered into a physician employment agreement with Constantine A. Mantz, dated effective as of July 1, 2003 and as amended, pursuant to which Dr. Mantz serves as our Chief Medical Officer and provides medical services as a radiation oncologist. The employment term commenced on July 1, 2003 and is a five-year term with automatic one-year extensions thereafter unless either party provides the other 90 days' prior written notice of its intention not to renew the employment agreement. Dr. Mantz is currently entitled to receive an annual base salary of $1,620,000

In addition, Dr. Mantz is entitled to receive an annual production incentive bonus of up to $1,000,000 based on a pro rata share of 19.0% of the collections of professional fees (as defined) over and above physician salaries, benefits, coverage and other defined reductions with respect to the Company's radiation oncology centers and certain other ancillary services provided in the Lee County, Florida local market.

1.6M in 2003 is 2.7M in 2024. That's what most of us are making, right?


Dr. Dosoretz is entitled to use the Company's corporate jet in the conduct of business on behalf of the Company and up to 300 hours of usage per year for personal use.

300 hours of personal usage of the jet? Man, I only get like 50 in my contract. Lucky.
 
MidwestRadOnc said:
We have entered into a physician employment agreement with Constantine A. Mantz, dated effective as of July 1, 2003 and as amended, pursuant to which Dr. Mantz serves as our Chief Medical Officer and provides medical services as a radiation oncologist. The employment term commenced on July 1, 2003 and is a five-year term with automatic one-year extensions thereafter unless either party provides the other 90 days' prior written notice of its intention not to renew the employment agreement. Dr. Mantz is currently entitled to receive an annual base salary of $1,620,000

In addition, Dr. Mantz is entitled to receive an annual production incentive bonus of up to $1,000,000 based on a pro rata share of 19.0% of the collections of professional fees (as defined) over and above physician salaries, benefits, coverage and other defined reductions with respect to the Company's radiation oncology centers and certain other ancillary services provided in the Lee County, Florida local market.

1.6M in 2003 is 2.7M in 2024. That's what most of us are making, right?


Dr. Dosoretz is entitled to use the Company's corporate jet in the conduct of business on behalf of the Company and up to 300 hours of usage per year for personal use.

300 hours of personal usage of the jet? Man, I only get like 50 in my contract. Lucky.
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300 hours x $10,000 per hour for a G4 = $3M a year additional comp for those playing along at home. Maybe it was a smaller jet, say $6500/hr, which would be $1.95M. (Prices per current UberJet pricing).
 
RickyScott said:
Pretty sure Jason Bekta's podcast mentioned that Mantz owns patents on proprietary billing or actual software for bundled payments.
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You rang?

https://doi.org/10.6084/m9.figshare.25985284.v1

This particular patent was abandoned in 2016, right around the time of the first 21C bankruptcy.

Of note, he provisionally filed in September of 2012:

1717695340413.png


About 1 month after ROCR Original Flavor was announced with Humana:

https://www.businesswire.com/news/home/20120808006089/en/21st-Century-Oncology-and-Humana-Break-New-Ground-with-Case-Rate-Reimbursement-Agreement
 
MidwestRadOnc said:
We have entered into a physician employment agreement with Constantine A. Mantz, dated effective as of July 1, 2003 and as amended, pursuant to which Dr. Mantz serves as our Chief Medical Officer and provides medical services as a radiation oncologist. The employment term commenced on July 1, 2003 and is a five-year term with automatic one-year extensions thereafter unless either party provides the other 90 days' prior written notice of its intention not to renew the employment agreement. Dr. Mantz is currently entitled to receive an annual base salary of $1,620,000

In addition, Dr. Mantz is entitled to receive an annual production incentive bonus of up to $1,000,000 based on a pro rata share of 19.0% of the collections of professional fees (as defined) over and above physician salaries, benefits, coverage and other defined reductions with respect to the Company's radiation oncology centers and certain other ancillary services provided in the Lee County, Florida local market.

1.6M in 2003 is 2.7M in 2024. That's what most of us are making, right?
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He probably had to shake his couches pretty hard to get the $5,000 in pocket change to pay his therapeutic misadventure fine.
 
thecarbonionangle said:
I was just looking at the choices for ASTRO president: Neha Vapiwala vs Constantine Mantz. It is depressing these are the best choices we have. Really the treat the wrong side dude? Or am i thinking of someone else? How do we not have better choices for “leadership”?
Click to expand...
It's like they really just wanted Keole followed by Vapiwala (or vice-versa), so they basically put in a garbage candidate that no self-respecting human with a soul would actually vote for to all but secure Vapiwala the win.

If Vapiwala loses, that should make SWRO/#MeToo start a twitter riot.

I don't have any beef with Vapiwala but I also had no beef with Keole before he came to SDN and acted a fool so... fool me once, shame on you, fool me twice, shame on me?

george bush GIF
 
evilbooyaa said:
It's like they really just wanted Keole followed by Vapiwala (or vice-versa), so they basically put in a garbage candidate that no self-respecting human with a soul would actually vote for to all but secure Vapiwala the win.

If Vapiwala loses, that should make SWRO/#MeToo start a twitter riot.

I don't have any beef with Vapiwala but I also had no beef with Keole before he came to SDN and acted a fool so... fool me once, shame on you, fool me twice, shame on me?

george bush GIF
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they should have run Kachnic...
 
evilbooyaa said:
It's like they really just wanted Keole followed by Vapiwala (or vice-versa), so they basically put in a garbage candidate that no self-respecting human with a soul would actually vote for to all but secure Vapiwala the win.

If Vapiwala loses, that should make SWRO/#MeToo start a twitter riot.

I don't have any beef with Vapiwala but I also had no beef with Keole before he came to SDN and acted a fool so... fool me once, shame on you, fool me twice, shame on me?

george bush GIF
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whats the vapiwala back story?

i guess i have had experiences with a rad onc at a storied institution, >20 yr tenure, big leadership position.
 
radoncftw said:
whats the vapiwala back story?

i guess i have had experiences with a rad onc at a storied institution, >20 yr tenure, big leadership position.
Click to expand...

I don't know of any crimes she's committed... She seemed reasonable to try to at least increase minimums as ACGME head. Nobody will ever be happy but she made non-zero progress in that vein...
 
evilbooyaa said:
I don't know of any crimes she's committed... She seemed reasonable to try to at least increase minimums as ACGME head. Nobody will ever be happy but she made non-zero progress in that vein...
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I am sure she is sympathetic to the obvious issues, but her ultimate goal is to probably to become the dean at penn (she is very involved in the medical school) I don’t see her going out on a limb, but she won’t actively work to undermine the field.
 
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Looks like it was the prior physician who planned the radiation to the wrong breast, not Mantz. He signed off on it, so I guess he’s ultimately responsible, sucky situation for patient and practice.

www.wfla.com

Florida doc fined for ordering radiation therapy on wrong breast

A Florida doctor was ordered to pay almost $9,000 after he supervised radiation therapy for a patient’s breast cancer. The problem? He ordered radiation therapy for her left breast, but the c…
www.wfla.com
 
beamteam7 said:
Looks like it was the prior physician who planned the radiation to the wrong breast, not Mantz. He signed off on it, so I guess he’s ultimately responsible, sucky situation for patient and practice.

www.wfla.com

Florida doc fined for ordering radiation therapy on wrong breast

A Florida doctor was ordered to pay almost $9,000 after he supervised radiation therapy for a patient’s breast cancer. The problem? He ordered radiation therapy for her left breast, but the c…
www.wfla.com
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It says the other physician left the practice and he assumed her care. It wasnt like he just signed off since she was out of town that week. Definitely not the worst radiation error that has happened. Judgment seems quite a bit lower than would be expected perhaps in other states
 
beamteam7 said:
Looks like it was the prior physician who planned the radiation to the wrong breast, not Mantz. He signed off on it, so I guess he’s ultimately responsible, sucky situation for patient and practice.

www.wfla.com

Florida doc fined for ordering radiation therapy on wrong breast

A Florida doctor was ordered to pay almost $9,000 after he supervised radiation therapy for a patient’s breast cancer. The problem? He ordered radiation therapy for her left breast, but the c…
www.wfla.com
Click to expand...

StIGMA said:
It says the other physician left the practice and he assumed her care. It wasnt like he just signed off since she was out of town that week. Definitely not the worst radiation error that has happened. Judgment seems quite a bit lower than would be expected perhaps in other states
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He signed off on it. Sounds like he OTV’d her at least 5 times prior to the error being found, so he would have seen wrong side erythema. And would have been signing wrong side port films and/or IGRTs (this was a PMRT case).

So, when you get handed another case, check the H & P, path, imaging, op notes, etc. Can be a lot of work, but it’s necessary.

Another interesting question is which was the correct side, and which side got submitted to the insurance company. Insurance companies will allow IMRT for left sided ENI but not right side. GenesisCare does *a lot* of breast IMRT.
 
TheWallnerus said:
He signed off on it. Sounds like he OTV’d her at least 5 times prior to the error being found, so he would have seen wrong side erythema. And would have been signing wrong side port films and/or IGRTs (this was a PMRT case).

So, when you get handed another case, check the H & P, path, imaging, op notes, etc. Can be a lot of work, but it’s necessary.

Another interesting question is which was the correct side, and which side got submitted to the insurance company. Insurance companies will allow IMRT for left sided ENI but not right side. GenesisCare does *a lot* of breast IMRT.
Click to expand...
not to start a breast is the worst discussion, but insurance covers right sided IMRT for RNI
 
Ray D. Ayshun said:
not to start a breast is the worst discussion, but insurance covers right sided IMRT for RNI
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I haven’t checked Evicore in a while, but here’s United (and they tend to mirror Evicore); right breast ENI not covered. But regardless, incorrect DVHs and plans got submitted to the insurance company to show IMRT necessity (and it’s highly likely IMRT was used).

IMG_1322.jpeg
 
TheWallnerus said:
I haven’t checked Evicore in a while, but here’s United (and they tend to mirror Evicore); right breast ENI not covered. But regardless, incorrect DVHs and plans got submitted to the insurance company to show IMRT necessity (and it’s highly likely IMRT was used).

View attachment 387838
Click to expand...
My thought as well. Original genesis doc could have lied to obtain imrt coverage and actually intended to treat the other breast. These kind of games happen all the time. I know of case where academic center used a single left microscopic involved axillary node to justify left breast protons w/regional eni, but then just treated the left breast alone instead with protons. (The proton dvh with eni was used to justify protons, but that actual plan omitted eni)
 
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RickyScott said:
My thought as well. Original genesis doc could have lied to obtain imrt coverage and actually intended to treat the other breast. These kind of games happen all the time. I know of case where academic center used a single left microscopic involved axillary node to justify left breast protons w/regional eni, but then just treated the left breast alone instead with protons.
Click to expand...
Well this is somewhat feasible. Some cases require zero clinical info/notes if the prior auth worksheet makes the case for IMRT med nec (as left breast ENI would with some insurance companies). Otherwise clinicals have to be sent in, and in that case the op note and path and mammograms wouldn’t match the rad onc consult note or plan (making lying more difficult).
 
TheWallnerus said:
He signed off on it. Sounds like he OTV’d her at least 5 times prior to the error being found, so he would have seen wrong side erythema. And would have been signing wrong side port films and/or IGRTs (this was a PMRT case).

So, when you get handed another case, check the H & P, path, imaging, op notes, etc. Can be a lot of work, but it’s necessary.

Another interesting question is which was the correct side, and which side got submitted to the insurance company. Insurance companies will allow IMRT for left sided ENI but not right side. GenesisCare does *a lot* of breast IMRT.
Click to expand...
This is what bothers me.

I'm a very busy generalist. It's extremely easy to miss things - not only is it human nature, medicine only gets more complex and the systems we're forced to use are...not efficient.

But I've treated many, many women (and a handful of men) for breast cancer. I've used basically every regimen out there, from conventional to APBI, 3D to IMRT.

I'm extremely aggressive about prophylactic skin care regimens, and I've been fortunate enough to have clinic staff join me over time who are just as aggressive. As a result, I currently see the least amount of radiation dermatitis in breast than I ever have before. It's awesome.

But the one thing I have never seen is a conventional breast have NO skin changes. Even with strict skin care regimens, there will be SOME amount of erythema.

I can imagine the various points of failure in my own clinic that might lead to something like this...but it's a lot. Several people and systems would all need to make the same mistake, but it could happen.

It's just...while we all know patients who have had bilateral breast cancers, with one breast diagnosed and treated 10 years ago, then the other breast gets diagnosed and treated now, yes?

But that's not common. I would say out of the ~150ish breast patients I treat per year, I get a bilateral breast patient maybe once every month or two, synchronous or metachronous. My point being - the vast majority of breast cancer patients only have a history of surgery on ONE breast.

So let's assume Mantz never cross checked the original information. Let's assume he assumed the breast that was being treated was the correct breast. Let's also assume, for whatever reason, the patient did not find it strange and did not say anything when the breast she didn't have surgery on started having side effects, but the other one did.

The radiation therapists treating this patient every single day never once noticed the surgery scar was on the OTHER breast?

Like...you don't need to even have access to any medical charts, electronic or paper, for this one. It's entirely possible that, for whatever reason, this particular patient had had procedures on both breasts at the same time. I personally treat patients like that a few times a year.

But they're uncommon.

So playing the odds here, every single day the radiation therapists set this patient up for a treatment to the breast that didn't have a surgical incision?

Am I missing something? I feel like I'm missing something.
 
elementaryschooleconomics said:
This is what bothers me.

I'm a very busy generalist. It's extremely easy to miss things - not only is it human nature, medicine only gets more complex and the systems we're forced to use are...not efficient.

But I've treated many, many women (and a handful of men) for breast cancer. I've used basically every regimen out there, from conventional to APBI, 3D to IMRT.

I'm extremely aggressive about prophylactic skin care regimens, and I've been fortunate enough to have clinic staff join me over time who are just as aggressive. As a result, I currently see the least amount of radiation dermatitis in breast than I ever have before. It's awesome.

But the one thing I have never seen is a conventional breast have NO skin changes. Even with strict skin care regimens, there will be SOME amount of erythema.

I can imagine the various points of failure in my own clinic that might lead to something like this...but it's a lot. Several people and systems would all need to make the same mistake, but it could happen.

It's just...while we all know patients who have had bilateral breast cancers, with one breast diagnosed and treated 10 years ago, then the other breast gets diagnosed and treated now, yes?

But that's not common. I would say out of the ~150ish breast patients I treat per year, I get a bilateral breast patient maybe once every month or two, synchronous or metachronous. My point being - the vast majority of breast cancer patients only have a history of surgery on ONE breast.

So let's assume Mantz never cross checked the original information. Let's assume he assumed the breast that was being treated was the correct breast. Let's also assume, for whatever reason, the patient did not find it strange and did not say anything when the breast she didn't have surgery on started having side effects, but the other one did.

The radiation therapists treating this patient every single day never once noticed the surgery scar was on the OTHER breast?

Like...you don't need to even have access to any medical charts, electronic or paper, for this one. It's entirely possible that, for whatever reason, this particular patient had had procedures on both breasts at the same time. I personally treat patients like that a few times a year.

But they're uncommon.

So playing the odds here, every single day the radiation therapists set this patient up for a treatment to the breast that didn't have a surgical incision?

Am I missing something? I feel like I'm missing something.
Click to expand...
If I’m reading the news report correctly, she had bilateral mastectomy (recon status unmentioned), but the disease was unilateral and confined to the right. However they planned left sided PMRT.
 
This is typical boomer rad onc stuff. 5 minute consult for breast. Never discuss skin care. RTT are afraid of boomer because he has a tendency to yell and fire people who ask questions. Etc. Seen it
 
TheWallnerus said:
I haven’t checked Evicore in a while, but here’s United (and they tend to mirror Evicore); right breast ENI not covered. But regardless, incorrect DVHs and plans got submitted to the insurance company to show IMRT necessity (and it’s highly likely IMRT was used).

View attachment 387838
Click to expand...
They will if you submit a plan comparison dvh supporting medical necessity
 
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