Rad Onc Twitter

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thecarbonionangle said:
Many say the future will be proton with carbon boosts to regions of hypoxia identified by PET through BGRT
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After reading the final APM rules, I will be exclusively treating prostate patients with protons on my new clinical trial evaluating, um, dose escalation and range uncertainty, whatever the proton equivalent of 8100 cGy in 45 is, followed by a brachytherapy boost based on, uh, ASCENDE stuff.

You can hire someone off Fiverr to help with billboards right?
 
elementaryschooleconomics said:
After reading the final APM rules, I will be exclusively treating prostate patients with protons on my new clinical trial evaluating, um, dose escalation and range uncertainty, whatever the proton equivalent of 8100 cGy in 45 is, followed by a brachytherapy boost based on, uh, ASCENDE stuff.

You can hire someone off Fiverr to help with billboards right?
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There's a rule in modern medicine: you (the doc) will never make more money than you do today. I guess this is coming true for rad onc too. Rad onc will never be as awash in money as it is today. In 5 years all of rad onc will be under bundled payments, Medicare to private. Investing in that proton machine is too risky!
 
There’s always money in the banana stand. All about who you know and who you pay off. Grifters grift.
 
Sometimes, we need a good laugh.

So, these are the non-radiation people (I don't know any of them, maybe a colorectal surgeon and some rad tech).
Anyway, they were talking about "inverse square law" lol...

PS: ha...the magic 6-foot social distancing during the pandemic!

 
Radonc90 said:
Sometimes, we need a good laugh.

So, these are the non-radiation people (I don't know any of them, maybe a colorectal surgeon and some rad tech).
Anyway, they were talking about "inverse square law" lol...

PS: ha...the magic 6-foot social distancing during the pandemic!

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I am triggered on mathematical, political, and physical levels
 
Radonc90 said:
Sometimes, we need a good laugh.

So, these are the non-radiation people (I don't know any of them, maybe a colorectal surgeon and some rad tech).
Anyway, they were talking about "inverse square law" lol...

PS: ha...the magic 6-foot social distancing during the pandemic!

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The math checks out though. Seems legit. 😉
 
TheWallnerus said:
I am triggered on mathematical, political, and physical levels
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"What happens beyond six feet?"
"Well you have a pretty significant drop between 5 and 6 feet, but beyond 6 feet, exposure stays just about the same!"

What prompted them to make this video?? Is it a social-distancing analogy? I'm so confused :laugh:

If only someone knew about this at Chernobyl and told the firefighters to stand 7 feet away. This reminds me of the NEJM article about RadOnc excess expenditures between 2002-2009: percentages are a helluva drug.
 
elementaryschooleconomics said:
"What happens beyond six feet?"
"Well you have a pretty significant drop between 5 and 6 feet, but beyond 6 feet, exposure stays just about the same!"

What prompted them to make this video?? Is it a social-distancing analogy? I'm so confused :laugh:

If only someone knew about this at Chernobyl and told the firefighters to stand 7 feet away. This reminds me of the NEJM article about RadOnc excess expenditures between 2002-2009: percentages are a helluva drug.
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Technically, as this was setup as a scenario where 100% exposure is at 1 ft, or whatever, and 2.5% at 6 ft, it's not like you can go much lower than 2.5%. This has the makings of a dose de-escalation trial: beyond 6 ft, there is no significant difference...
 
Ray D. Ayshun said:
Technically, as this was setup as a scenario where 100% exposure is at 1 ft, or whatever, and 2.5% at 6 ft, it's not like you can go much lower than 2.5%. This has the makings of a dose de-escalation trial: beyond 6 ft, there is no significant difference...
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no you can.
 
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elementaryschooleconomics said:
"What happens beyond six feet?"
"Well you have a pretty significant drop between 5 and 6 feet, but beyond 6 feet, exposure stays just about the same!"

What prompted them to make this video?? Is it a social-distancing analogy? I'm so confused :laugh:

If only someone knew about this at Chernobyl and told the firefighters to stand 7 feet away. This reminds me of the NEJM article about RadOnc excess expenditures between 2002-2009: percentages are a helluva drug.
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Yeah, idk what *******ery that video is supposed to be. Are they making fun of PAs for being stupid? Does the person who posted it actually think that's how radiation works (in which case, the person running the TikTok account, potentially the twitter user who posted it, is the *******)? Is it some joke about 6 feet and social distancing?

So many questions, but the amount of brain cells I lost from watching that video once make me never want to watch or listen to it ever again.
 
She's describing a point source like a brachy seed. For external beams, I believe you would use the inverse square correction factor which would account for your ssd or sad. If she is talking about shielding in the or, the difference between 5 and 6 feet from the source is probably small, meaning that stepping back 1 more foot isn't going to lower your dose significantly so I would recommend wearing lead or leaving the room. I would not conclude that these distances make exposure safe.
 
elementaryschooleconomics said:
View attachment 345378

Implications of medical board certification practices on family planning and professional trajectory for early career female radiation oncologists

Look at these incredibly reasonable recommendations:

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Given how logical these recommendations are, I anticipate frothy screams from the Old Guard, who will do everything in their power to make sure the status quo is maintained.
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Yes, and no. The recommendations are kind of obvious. This "equity" justification is a little much. For instance, "via individualize pathways" seems a bit antithetical to the entirety of structured medical training. Ultimately, it's semantics to me, but a little obnoxious that to get a reasonable approach to our board certification process it's necessary to make these end around plays as opposed to just not being dickheads.
 
Ray D. Ayshun said:
Yes, and no. The recommendations are kind of obvious. This "equity" justification is a little much. For instance, "via individualize pathways" seems a bit antithetical to the entirety of structured medical training. Ultimately, it's semantics to me, but a little obnoxious that to get a reasonable approach to our board certification process it's necessary to make these end around plays as opposed to just not being dickheads.
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Generally speaking, I agree. But, that specific part of the recommendation is saying that individuals should be allowed to sit for boards earlier. We have to allow for individual differences. A program director should know if a specific PGY is ready to take physics earlier, and if the candidate requests to do so, I don’t see the problem with this. It’s not saying change the curriculum. It’s saying, “Betsy is thinking of starting a family; she feels prepared for her radbio exam as she has a PhD in it. We think it’s reasonable for her to take it a year early.” This is the just the sort of thing that is pro-resident.
 
RealSimulD said:
Generally speaking, I agree. But, that specific part of the recommendation is saying that individuals should be allowed to sit for boards earlier. We have to allow for individual differences. A program director should know if a specific PGY is ready to take physics earlier, and if the candidate requests to do so, I don’t see the problem with this. It’s not saying change the curriculum. It’s saying, “Betsy is thinking of starting a family; she feels prepared for her radbio exam as she has a PhD in it. We think it’s reasonable for her to take it a year early.” This is the just the sort of thing that is pro-resident.
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Sorry, I don't have an issue with that idea at all. Would've loved the opportunity and it's fair. My issue is with the idea that the principle of individualized pathways is really a thing in a field where there are different levels of schooling and training that are requisite. Simply letting someone sit for the exam earlier doesn't fit this for me. As I said, it's semantics to me, but this fits the greater societal move to not do things because they're straightforward and reasonable, but rather to prevent guilt and outrage.
 
Ray D. Ayshun said:
Sorry, I don't have an issue with that idea at all. Would've loved the opportunity and it's fair. My issue is with the idea that the principle of individualized pathways is really a thing in a field where there are different levels of schooling and training that are requisite. Simply letting someone sit for the exam earlier doesn't fit this for me. As I said, it's semantics to me, but this fits the greater societal move to not do things because they're straightforward and reasonable, but rather to prevent guilt and outrage.
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I think maybe it’s because we are in a “raw” time with these words. Frankly, switching “equity” for “equality” in every instance as many are doing is ridiculous. But, there are some things where we need to focus on “equality” (like everyone in the department is given lunch break so they can have the cake that a patient gave), while other times we should focus on equity (like making sure to tell George to cut each piece equally, instead of always giving Edith a 2x slice, because he has the hots for her).
 
RealSimulD said:
I think maybe it’s because we are in a “raw” time with these words. Frankly, switching “equity” for “equality” in every instance as many are doing is ridiculous. But, there are some things where we need to focus on “equality” (like everyone in the department is given lunch break so they can have the cake that a patient gave), while other times we should focus on equity (like making sure to tell George to cut each piece equally, instead of always giving Edith a 2x slice, because he has the hots for her).
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I guess I'm just saying I'm frustrated there appears to be a need for a nuanced sociological argument to make these changes. My desire is that the valid and acceptable argument for making this change is akin to asking someone to put headphones in if they're gonna listen to music at a starbucks.
 
Ray D. Ayshun said:
I guess I'm just saying I'm frustrated there appears to be a need for a nuanced sociological argument to make these changes. My desire is that the valid and acceptable argument for making this change is akin to asking someone to put headphones in if they're gonna listen to music at a starbucks.
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Fair point. But, no other argument worked. It’s 2021, and women still don’t have the basic ideas presented. Remember, they used to get told “take it next year, suck it up”. What didn’t they do in the past to make powers that be adjust? I’d say unfortunately they had to go to “this”….
 
RealSimulD said:
Fair point. But, no other argument worked. It’s 2021, and women still don’t have the basic ideas presented. Remember, they used to get told “take it next year, suck it up”. What didn’t they do in the past to make powers that be adjust? I’d say unfortunately they had to go to “this”….
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Agreed. My frustration isn't with the writers so much as with the fact that, as you say, it has come to this as a necessary mechanism for trying to get obvious problems fixed. I think sure, the reasons for not making this change sooner are due to a lack of empathy. More deeply, that is a product of leadership that thinks we're asking for things just to be annoying as opposed to giving us the benefit of the doubt. Which is why we find ourselves in a situation, throughout society, where we have to be unreasonable to accomplish the reasonable.
 
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Ray D. Ayshun said:
Sorry, I don't have an issue with that idea at all. Would've loved the opportunity and it's fair. My issue is with the idea that the principle of individualized pathways is really a thing in a field where there are different levels of schooling and training that are requisite. Simply letting someone sit for the exam earlier doesn't fit this for me. As I said, it's semantics to me, but this fits the greater societal move to not do things because they're straightforward and reasonable, but rather to prevent guilt and outrage.
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The problem with individualized training is it is a nightmare to schedule. ACGME has been pushing surgical training to become milestone based and using milestones for advancement to next PGY year rather then time + adequate evaluations. This in theory makes sense, it matters a lot more that you can do surgery X safety then you have been a resident for 4 years. The problem is that now instead of 4 residents/year with 4 skill-level appropriate rotations each year, you have 6 PGY-2s, 2 PGY3s, etc with the same number of senior level rotations to cover. Then the 3s graduate, and you either are over your allotment and have to dilute everyones experinece, or take fewer juniors, perpetuating forward the screw up in scheduling.
 
Planned conception and birth of both children around board exams. Covid definitely threw a huge curveball. The first oral boards postponement was few days before the due date of second child. Excerpts from actual conversations I had with my wife.
- What if the baby comes early and I'm in Arizona?
-- That would be horrible.
- Should I just postpone until May?
-- No, that would be worse. I need you to get this over with. Maybe we can just induce a week early, so at least you will be here for the birth.
- And then immediately leave you and the kids to take the test? Seems really stressful for both of us.
--Hmmm, let's think about this some more.

Ultimately, the decision was made for us, but how crappy to even have that conversation...
 
Many of the issues with training can be solved with a very simple guiding principle:
-Your service shouldn't depend on you having a resident in clinic.

Everything from scheduling boards to maternity/paternity leave, to trainees getting help when they need it can all be addressed so much easier when the world doesn't stop if they need to take a break. Don't get me wrong, residents should be busy and have responsibility... but that doesn't mean they need to sacrifice their humanity -they will have an entire career to do that haha
 
Since a common theme I have seen on the Google (Reddit) Residency Spreadsheet, Twitter, and real life from people when denying issues in RadOnc is "those internet trolls, so disgruntled, they hate Radiation Oncology and probably aren't even doctors", here are some of the published write-in examples from our actual colleagues from Table 1 of the PRO paper. It's probably behind a paywall for a lot of folks, and I think it's important to know that the issues discussed on SDN are NOT just misanthropic hyperbole, but widespread concerns that many are afraid to openly discuss for fear of retaliation:

1636153620336.png


1636153668634.png


1636153717293.png


As a side note, it is clear that Practical Radiation Oncology is probably the strongest/most progressive platform in the traditional academic space in terms of advocating for the health of RadOnc, specifically as it pertains to trainees and the training pathway. Given its current and former Editor-in-Chief, I would expect nothing else, as those two have consistently been a positive force in this specialty.
 
elementaryschooleconomics said:
Since a common theme I have seen on the Google (Reddit) Residency Spreadsheet, Twitter, and real life from people when denying issues in RadOnc is "those internet trolls, so disgruntled, they hate Radiation Oncology and probably aren't even doctors", here are some of the published write-in examples from our actual colleagues from Table 1 of the PRO paper. It's probably behind a paywall for a lot of folks, and I think it's important to know that the issues discussed on SDN are NOT just misanthropic hyperbole, but widespread concerns that many are afraid to openly discuss for fear of retaliation:

View attachment 345409

View attachment 345410

View attachment 345411

As a side note, it is clear that Practical Radiation Oncology is probably the strongest/most progressive platform in the traditional academic space in terms of advocating for the health of RadOnc, specifically as it pertains to trainees and the training pathway. Given its current and former Editor-in-Chief, I would expect nothing else, as those two have consistently been a positive force in this specialty.
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I’m going to post that and credit you ESE
 
elementaryschooleconomics said:
Since a common theme I have seen on the Google (Reddit) Residency Spreadsheet, Twitter, and real life from people when denying issues in RadOnc is "those internet trolls, so disgruntled, they hate Radiation Oncology and probably aren't even doctors", here are some of the published write-in examples from our actual colleagues from Table 1 of the PRO paper. It's probably behind a paywall for a lot of folks, and I think it's important to know that the issues discussed on SDN are NOT just misanthropic hyperbole, but widespread concerns that many are afraid to openly discuss for fear of retaliation:

View attachment 345409

View attachment 345410

View attachment 345411

As a side note, it is clear that Practical Radiation Oncology is probably the strongest/most progressive platform in the traditional academic space in terms of advocating for the health of RadOnc, specifically as it pertains to trainees and the training pathway. Given its current and former Editor-in-Chief, I would expect nothing else, as those two have consistently been a positive force in this specialty.
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Boards are another reason to avoid this dumpster fire of a specialty currently. If nothing changes, it speaks volumes
 
RealSimulD said:
I’m going to post that and credit you ESE
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I hope people actually take a couple minutes this weekend and read the paper. It's an important and insightful articulation of alarming features in our training pathway and early career experience. Juxtaposing what the authors have written with the cheerleading and soothsaying that has occurred on Twitter over the past several years is a great example of the disconnect between the senior leadership and the rest of us.

As @medgator notes, everything written in this paper should be something prospective applicants consider. This is all independent of oversupply, which is independent from the APM, which is independent of the reduction in utilization of radiation therapy. Conversely, nothing is set in stone, and those in leadership positions should consider what they can do to improve factors affecting the health of Radiation Oncology as a career for physicians in America. The actual practice of RadOnc is fascinating and incredibly rewarding. However, the system we've built around it - the training programs, the entity we have chosen to imbue with power to "certify" people, the certification process itself - none of this has to be permanent and unchanged. We are constantly trying to improve the system of medicine, from Flexner to removing Step 2 CS - I would like to believe RadOnc is a "work in progress", and the best is yet to come!

As a side note, I look forward to the tone-deaf response to this paper from "the usual suspects" in the near future, and can't wait to hear the gossip about who threatened who with what in clandestine emails behind-the-scenes.
 
elementaryschooleconomics said:
I hope people actually take a couple minutes this weekend and read the paper. It's an important and insightful articulation of alarming features in our training pathway and early career experience. Juxtaposing what the authors have written with the cheerleading and soothsaying that has occurred on Twitter over the past several years is a great example of the disconnect between the senior leadership and the rest of us.

As @medgator notes, everything written in this paper should be something prospective applicants consider. This is all independent of oversupply, which is independent from the APM, which is independent of the reduction in utilization of radiation therapy. Conversely, nothing is set in stone, and those in leadership positions should consider what they can do to improve factors affecting the health of Radiation Oncology as a career for physicians in America. The actual practice of RadOnc is fascinating and incredibly rewarding. However, the system we've built around it - the training programs, the entity we have chosen to imbue with power to "certify" people, the certification process itself - none of this has to be permanent and unchanged. We are constantly trying to improve the system of medicine, from Flexner to removing Step 2 CS - I would like to believe RadOnc is a "work in progress", and the best is yet to come!

As a side note, I look forward to the tone-deaf response to this paper from "the usual suspects" in the near future, and can't wait to hear the gossip about who threatened who with what in clandestine emails behind-the-scenes.
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All of us were willing to suck it up a decade or two ago for the promised land.... Now no one has to sign up for matching to a hellpit scut program only to have the ABR multi exam gauntlet to deal with as they get closer to practice.

No one

(I really don't think many in the ABR are aware of how much the ground has shifted)
 
thecarbonionangle said:
We need to support our women. If we cannot support them, who can we support?!
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Along the same lines, why do they think they should be pushing for more DEI when we can't even take care of the women in our specialty? Why would any medical student want to come into this dumpster fire? The fact that this study even had to be done to demonstrate that women are getting slighted is a huge indictment on the quality of leadership in our field. Props to Dr. Laura Dover and her colleagues on this study.
 
SubserviantToABR said:
Along the same lines, why do they think they should be pushing for more DEI when we can't even take care of the women in our specialty? Why would any medical student want to come into this dumpster fire? The fact that this study even had to be done to demonstrate that women are getting slighted is a huge indictment on the quality of leadership in our field. Props to Dr. Laura Dover and her colleagues on this study.
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Dr Dover put her neck out on the line a few years ago, and this resultant work is the culmination of decades of bull****. It is a tour de force and damning.

I agree that we need to look out for all of us, before bringing people in that will be at risk of being mistreated by our specialty’s leadership. Remember, their way of addressing board failures was blaming the residents. Their way of “working with” pregnant and breast feeding parents was to suggest “our way or the high way”. To actively recruit those that may be targeted by our specialty leadership if they don’t fit the “old school“ criteria of what a doctor is - I’m sorry to say that this just isn’t the progressive field SoMe #radonc wants to think we are. Yes, maybe the younger folks are. But, look at who’s in charge? So few alternate voices out there.

And so it goes, #wewhocurie is having their moment glorifying #radonc and photos of women and linacs, while Laura and others are pointing out the hypocrisy and deviousness of what is actually happening.

I said it last year - drop the pics. Tell us what your department does for women. Tell us about their leave policy. About mentorship opportunities for research that don’t marginalize women and minorities into the diversity literature. Tell me about your female leadership in your department. Tell us about the time that people actually listened without having you document document document everything before understanding how the department’s choices hurt those that need the most.
 
I have deep respect for Laura Dover and her six co-authors who had the vision to put this together and publish it simultaneously with the yearly #WWC Twitter event.

Right now, my Twitter feed is literally alternating pictures of people holding #WWC signs next to linacs with disturbing first-hand experiences of infertility and professional setbacks. I agree with Simul - there seems to be a lot of departments out there who are quick to say they support diversity, but I'm not seeing much evidence.

Folks were willing to put up with a lot over the last 20 years during the RadOnc Bubble, when we were told we should just be happy that we were deemed worthy to be let into the club. We are now several years into a new era, and the ABR would be wise to adjust the system accordingly.
 
elementaryschooleconomics said:
I have deep respect for Laura Dover and her six co-authors who had the vision to put this together and publish it simultaneously with the yearly #WWC Twitter event.

Right now, my Twitter feed is literally alternating pictures of people holding #WWC signs next to linacs with disturbing first-hand experiences of infertility and professional setbacks. I agree with Simul - there seems to be a lot of departments out there who are quick to say they support diversity, but I'm not seeing much evidence.

Folks were willing to put up with a lot over the last 20 years during the RadOnc Bubble, when we were told we should just be happy that we were deemed worthy to be let into the club. We are now several years into a new era, and the ABR would be wise to adjust the system accordingly.
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Guessing this new era of rad onc (un)desirability will finally force many programs to put up or shut up
 
elementaryschooleconomics said:
I have deep respect for Laura Dover and her six co-authors who had the vision to put this together and publish it simultaneously with the yearly #WWC Twitter event.

Right now, my Twitter feed is literally alternating pictures of people holding #WWC signs next to linacs with disturbing first-hand experiences of infertility and professional setbacks. I agree with Simul - there seems to be a lot of departments out there who are quick to say they support diversity, but I'm not seeing much evidence.

Folks were willing to put up with a lot over the last 20 years during the RadOnc Bubble, when we were told we should just be happy that we were deemed worthy to be let into the club. We are now several years into a new era, and the ABR would be wise to adjust the system accordingly.
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100% agree. The challenge with speaking up for some of us is the machine for which we work. Since I am in a multi-specialty medical group within a really big medical system my voice isn’t going anywhere and it’s making me f*%^ing crazy. And for me, this is where the problem lies. You try and try to push change but you get that little pat on your head over and over again that says “now, now, we hear you but it’s not the time” and you eventually just give up.
 
jondunn said:
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In training, we had a visiting professor who specialized in breast cancer from a Very Fancy Institution in the Midwest. After the lecture, she sat down with the residents and proceeded to tell us why she felt women living >100 miles from her center should and would drive to see her, even if there was a center in their town. Why? Because she did breast tangents better than anyone else.

Also, they had a masseuse, and the patients liked that.

Moral of the story: if you want to provide excellent care, don't focus on patient convenience. Focus on being a PPS-exempt hospital that can afford amenities. That's what matters.
 
When it comes to proton, these people are always moving the needle, folks!

Never forget - they think we are dumb as hell!

 
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