Rad Onc Twitter

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jondunn said:
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Two ways of looking at that:
How to miss an owl
1643377424118.png

How to shoot an owl
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I don't condone shooting owls, but for some reason the tweeter opted to equate owls with tumors.
 
Gotta respect the owl. Minerva's owl was her trusted companion, and Minerva was the goddess of as*-kicking and medicine. Good to invoke the owl in medical discussions.

I actually get what he's getting at...

ie2kuuqj7s981.jpg
 
That one's a stretch to me. That resident posts a ton of things to equate whatever is viral in the minute to try to 'relate' it to Rad Onc. Doesn't even make sense as 3D volumes would be larger than IMRT, not smaller...

Silly and useless, but that's what 99% of twitter is for, so no harm no foul to have it posted on Twitter. But, here it is in Rad Onc Twitter thread. Silly and useless, and I wasted my time yet again. Can't say it's off-topic though. But useless it is. And look who posted it. No surprise there.
 
evilbooyaa said:
That one's a stretch to me. That resident posts a ton of things to equate whatever is viral in the minute to try to 'relate' it to Rad Onc. Doesn't even make sense as 3D volumes would be larger than IMRT, not smaller...

Silly and useless, but that's what 99% of twitter is for, so no harm no foul to have it posted on Twitter. But, here it is in Rad Onc Twitter thread. Silly and useless, and I wasted my time yet again. Can't say it's off-topic though. But useless it is. And look who posted it. No surprise there.
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In general, ptv volume as well as delivery accuracy would not vary between imrt and 3d, which is why I don’t understand his post.
 
Neuronix said:
Hahaha that is the fakest of news.
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The forum is devided: pp guys who have been making 500+ for many years and those who will never make near that amount ever. There might be a few stud hoss gods who are pulling this but for most mortals they can keep dreaming. Oversupply and people reading about it is a self fulfilling prophecy. Admins will continue to drive down wages.
 
1643389146205.png

I'm baffled by this post. If he will be your best resident why don't you just sign him up at Harvard? Should we infer that Harvard will not accept a "super star" who happens to hail from a foreign medical school - despite their proclaimed commitment to diversity and equity?

Supreme court = race and gender are factored into nomination for political reasons
Harvard radiation oncology = country of origin important because that would be damaging to their prestige?
 
theradiator said:
View attachment 349159
I'm baffled by this post. If he will be your best resident why don't you just sign him up at Harvard? Should we infer that Harvard will not accept a "super star" who happens to hail from a foreign medical school - despite their proclaimed commitment to diversity and equity?

Supreme court = race and gender are factored into nomination for political reasons
Harvard radiation oncology = country of origin important because that would be damaging to their prestige?
Click to expand...
DHK presides over one of the most diverse departments in nation. Not the best flex
 
evilbooyaa said:
That one's a stretch to me. That resident posts a ton of things to equate whatever is viral in the minute to try to 'relate' it to Rad Onc. Doesn't even make sense as 3D volumes would be larger than IMRT, not smaller...

Silly and useless, but that's what 99% of twitter is for, so no harm no foul to have it posted on Twitter. But, here it is in Rad Onc Twitter thread. Silly and useless, and I wasted my time yet again. Can't say it's off-topic though. But useless it is. And look who posted it. No surprise there.
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Why would the targets be any different for 3D vs IMRT? The target is the target - it doesn’t change based on technique… come on, that was a boomer thing to say, Evil 😉
 
RealSimulD said:
Why would the targets be any different for 3D vs IMRT? The target is the target - it doesn’t change based on technique… come on, that was a boomer thing to say, Evil 😉
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boomer voice: “you dont wanna miss” as they think about their IMRT margins while billing for IGRT which is supposed to prevent a “miss”
 
theradiator said:
View attachment 349159
I'm baffled by this post. If he will be your best resident why don't you just sign him up at Harvard? Should we infer that Harvard will not accept a "super star" who happens to hail from a foreign medical school - despite their proclaimed commitment to diversity and equity?

Supreme court = race and gender are factored into nomination for political reasons
Harvard radiation oncology = country of origin important because that would be damaging to their prestige?
Click to expand...

that guy is a world famous GU med onc. not really his decision or place to know about the intricacies of the rad onc match.

come on folks. what are we doing here. let the med onc give credit to his research mentee.
 
theradiator said:
View attachment 349159
I'm baffled by this post. If he will be your best resident why don't you just sign him up at Harvard? Should we infer that Harvard will not accept a "super star" who happens to hail from a foreign medical school - despite their proclaimed commitment to diversity and equity?

Supreme court = race and gender are factored into nomination for political reasons
Harvard radiation oncology = country of origin important because that would be damaging to their prestige?
Click to expand...
It's actually quite brilliant. You get med students to work for you for free and do your research. And all it costs you is 150 characters you can tweet out from the crapper.
 
also - the meme makes total sense to me. if you don't get it, you either lack self awareness or have not experienced seeing an older rad onc who trained in an older era try to contour a modern IMRT case without turning it into a recreation of what would have been in an older 3D field.

anything that helps retire some of these boomers (actual boomers, not the meme version of a boomer)
 
jondunn said:
also - the meme makes total sense to me. if you don't get it, you either lack self awareness or have not experienced seeing an older rad onc who trained in an older era try to contour a modern IMRT case without turning it into a recreation of what would have been in an older 3D field.

anything that helps retire some of these boomers (actual boomers, not the meme version of a boomer)
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Agree - it makes sense, but in reality the owls should look the same. The volume is the volume, for some reason people don’t get that.

I’d get corrected at Banner about the fields for rectal 3D cases “it should go anterior”. Um, I literally contoured the CTV, the fields are fine. But.. if you did the plan with VMAT with same volume, it was fine…
 
RealSimulD said:
Agree - it makes sense, but in reality the owls should look the same. The volume is the volume, for some reason people don’t get that.

I’d get corrected at Banner about the fields for rectal 3D cases “it should go anterior”. Um, I literally contoured the CTV, the fields are fine. But.. if you did the plan with VMAT with same volume, it was fine…
Click to expand...

Lol yeah exactly have seen the Same discussion come up for rectal
 
RealSimulD said:
Agree - it makes sense, but in reality the owls should look the same. The volume is the volume, for some reason people don’t get that.

I’d get corrected at Banner about the fields for rectal 3D cases “it should go anterior”. Um, I literally contoured the CTV, the fields are fine. But.. if you did the plan with VMAT with same volume, it was fine…
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Treating anything below the owls neck is elective. I was trained to treat owls like stage iii lung. No elective volume.
 
jondunn said:
that guy is a world famous GU med onc. not really his decision or place to know about the intricacies of the rad onc match.

come on folks. what are we doing here. let the med onc give credit to his research mentee.
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I stand corrected. Not a candidate for internal medicine at Brigham and Women's but a perfect candidate for radiation oncology given the match statistics.
 
RealSimulD said:
Why would the targets be any different for 3D vs IMRT? The target is the target - it doesn’t change based on technique… come on, that was a boomer thing to say, Evil 😉
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Ha, fair enough.

I suppose my volumes are not routinely different, but I'm definitely more lax with CTVs and PTVs in terms of carving out of OARs and being super precise with 7mm around pelvic vessels and no more when I'm planning with 3D. What's the point of time-stakingly drawing a super pretty shape for CTV and PTV when the treatment field is just "HERE IS YOUR BOX, SIR, GOOD DAY"

For example, am I going to pain-stakingly measure and double check my CTV as being 7mm (and not 1cm) from the vessels along say the medial aspects for a 3D rectal case before I throw PTV expansions on it? Nah not really b/c who cares if its a little bit bigger, but I might do that for a VMAT rectal case or other pelvic VMAT because of ability to spare the portion between the lateral pelvic lymph nodes with VMAT.
 
evilbooyaa said:
Ha, fair enough.

I suppose my volumes are not routinely different, but I'm definitely more lax with CTVs and PTVs in terms of carving out of OARs and being super precise with 7mm around pelvic vessels and no more when I'm planning with 3D. What's the point of time-stakingly drawing a super pretty shape for CTV and PTV when the treatment field is just "HERE IS YOUR BOX, SIR, GOOD DAY"

For example, am I going to pain-stakingly measure and double check my CTV as being 7mm (and not 1cm) from the vessels along say the medial aspects for a 3D rectal case before I throw PTV expansions on it? Nah not really b/c who cares if its a little bit bigger, but I might do that for a VMAT rectal case or other pelvic VMAT because of ability to spare the portion between the lateral pelvic lymph nodes with VMAT.
Click to expand...
Why are you doing this anyway?

Set the ball contouring tool to 7mm and trace around the vessels, voila.
 
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RealSimulD said:
Agree - it makes sense, but in reality the owls should look the same. The volume is the volume, for some reason people don’t get that.

I’d get corrected at Banner about the fields for rectal 3D cases “it should go anterior”. Um, I literally contoured the CTV, the fields are fine. But.. if you did the plan with VMAT with same volume, it was fine…
Click to expand...
95% of the time, this is true... except for dose-painting
 
evilbooyaa said:
Ha, fair enough.

I suppose my volumes are not routinely different, but I'm definitely more lax with CTVs and PTVs in terms of carving out of OARs and being super precise with 7mm around pelvic vessels and no more when I'm planning with 3D. What's the point of time-stakingly drawing a super pretty shape for CTV and PTV when the treatment field is just "HERE IS YOUR BOX, SIR, GOOD DAY"

For example, am I going to pain-stakingly measure and double check my CTV as being 7mm (and not 1cm) from the vessels along say the medial aspects for a 3D rectal case before I throw PTV expansions on it? Nah not really b/c who cares if its a little bit bigger, but I might do that for a VMAT rectal case or other pelvic VMAT because of ability to spare the portion between the lateral pelvic lymph nodes with VMAT.
Click to expand...
Yeah, not with you. I contour targets for 3D and VMAT just the same
 
Who says the owl is the target? With IMRT often have to contour far more OARs than in the old 3D days. Dose painting with multiple dose levels and PRVs especially in the upper abdomen can get kinda crazy
 
Mandelin Rain said:
Why are you doing this anyway?

Set the ball contouring tool to 7mm and trace around the vessels, voila.
Click to expand...
I hate the brush. Pencil 4 lyfe.

RealSimulD said:
Yeah, not with you. I contour targets for 3D and VMAT just the same
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OK and that's your prerogative, but you know when you treat 3D you're treating a box right
 
I guess it all depends what kind of cases we're imagining. The simple circles remind of when I turn on the GTVs when setting blocks in a palliative case, which I guess isn't exactly 3D
 
RealSimulD said:
I’d get corrected at Banner about the fields for rectal 3D cases
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that's annoying
evilbooyaa said:
OK and that's your prerogative, but you know when you treat 3D you're treating a box right
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Only if you treat four fields, with open square (or rectangle) fields. That's the only way to get a box shaped dose distribution that I know of.
 
TheWallnerus said:
that's annoying

Only if you treat four fields, with open square (or rectangle) fields. That's the only way to get a box shaped dose distribution that I know of.
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AP/PA isn't a box?
3-field RT isn't a box?
Opposed laterals isn't a box?
Wedge pair I suppose isn't a box in the same sense.

I don't necessarily mean a symmetric box.

And I'm not talking about dynamic conformal arcs here. Just your "standard" 3D. Say a 3-field for rectum or other 3D arrangement for pelvic RT. Would include breast tangents as well.
 
I like to know what my target is and how much is covered by how much. That concept isn’t different with 3D vs IMRT. It is different for 2D, that’s for sure. I contour a breast for tangent plans, because how do you know what the V105 truly is if you use the isodose line as the volume. Purist.
 
evilbooyaa said:
There will (almost?) always be more structures in an IMRT plan.
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This is from the Eclipse manual describing irregular surface compensators that produce an "optimal fluence" (using one inverse optimization parameter: the % depth) which "modulates the intensity of each beamlet" using the dose volume optimizer algorithm with which we are all familiar... the same DVO in the graphical GUI inverse optimization space. Many people call it "field in field" or "3D compensator" or "forward planning" etc etc.

Many people have never actually read the manual.

1) Is it intensity modulation of the radiation therapy field?
2) Did it require structure contouring?

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YxGZOZV.png

sbBJjGX.png
 
evilbooyaa said:
AP/PA isn't a box?
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Nope.
evilbooyaa said:
3-field RT isn't a box?
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No.
evilbooyaa said:
Opposed laterals isn't a box?
Click to expand...
No.
evilbooyaa said:
Wedge pair I suppose isn't a box in the same sense.
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Right.
evilbooyaa said:
I don't necessarily mean a symmetric box.
Click to expand...
Oh, by "box" you meant a shape which is not a box 🙂

Like some shape where some sides are flat (planar), but others are non-flat.

Then yes, any beam arrangement makes a box.
 
evilbooyaa said:
AP/PA isn't a box?
3-field RT isn't a box?
Opposed laterals isn't a box?
Wedge pair I suppose isn't a box in the same sense.

I don't necessarily mean a symmetric box.

And I'm not talking about dynamic conformal arcs here. Just your "standard" 3D. Say a 3-field for rectum or other 3D arrangement for pelvic RT. Would include breast tangents as well.
Click to expand...


This is the worst lonely island sketch
 
RealSimulD said:
Explain?
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When doing high dose/ablative treatments with IMRT near serial OARs (i.e. an ultra-central oligomet in the lung), I will utilize dose painting with concentric volumes that pull off of each OAR so that they meet tolerance (i.e. will let esophagus get max 48 Gy/15 fx, bronchus 60-65 Gy/15, Great Vessel 75 Gy/15). I will pump dose into areas that are away from the OAR. These sorts of concave volumes aren't really possible with 3D techniques (3D can't produce concave dose distributions). Thus, if IMRT is is denied in one of these cases, I will treat with 3D, and my "targets" will look different (i.e. I will only have my PTV, and no sub-volumes).

...but your point is well taken. Was just being a wise *** 🙂
 
theradiator said:
View attachment 349159
I'm baffled by this post. If he will be your best resident why don't you just sign him up at Harvard? Should we infer that Harvard will not accept a "super star" who happens to hail from a foreign medical school - despite their proclaimed commitment to diversity and equity?

Supreme court = race and gender are factored into nomination for political reasons
Harvard radiation oncology = country of origin important because that would be damaging to their prestige?
Click to expand...
During peak rad onc Harvard was notorious for giving 6 of 7 spots to Harvard med students year after year. It’s all about exclusion to maintain the veneer of prestige.
 
TheWallnerus said:
Nope.

No.

No.

Right.

Oh, by "box" you meant a shape which is not a box 🙂

Like some shape where some sides are flat (planar), but others are non-flat.

Then yes, any beam arrangement makes a box.
Click to expand...
www.merriam-webster.com

Definition of BOX

a rigid typically rectangular container with or without a cover : such as; an open cargo container of a vehicle; coffin… See the full definition
www.merriam-webster.com www.merriam-webster.com

A box does not have to mean square. I'm not sure if I'm missing your attempted point here. Is it something about divergence making it so it's not a true box with exact 90 degree junctions? But then even 4-field box wouldn't be a box.

All of my examples create a 3D shape that has 4 sides around, one on the top, and one on the bottom. At essentially 90 degree angles to one another. Each of those sides is a rectangle. Hence a box.

When amazon delivers their packages to you in a 3-dimensional card board structure that is rectangular and not a perfect square, what would you call that?

Am I the only one who learned 3D rectal as a '3-field Box'? Anyone know what the walrus is talking about?
 
evilbooyaa said:
Am I the only one who learned 3D rectal as a '3-field Box'? Anyone know what the walrus is talking about?
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I'm talking about more like this:

Q7U8SP3.jpg


A 3 field approach will make a box, true (will need some wedges to make it usable usually). I was too restrictive. You could make a box distribution with a 90 degree wedge pair too; would be trickier to get a usable box dose. If any of the fields axes are more or less than 90 degrees apart you can not get what I'd call a box; if you try a many field 3D approach with square fields, the fields evenly spaced about 360 degrees, you get closer to a cylinder.
 
I don’t think 3 field is a box. 3 field is meant to push dose posteriorly, to heat up the rectum / mre / pre sacral space.

In 4 field, the isodose is at center of the uh “box”, and the dose is equal at points equidistant from the iso.
 
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