Rad Onc Twitter

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what im hearing on streets is many see the mri linac as the first of a domino rally. Next is head and neck proton vs photon. word is it will be seen as unethical to give these patients photon after the trial reports

the fix is in, and we're being left holding the bag.
 
RealSimulD said:
I didn’t find that much different between the two. Someone want to enlighten me?
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Acr doesn't seem as anti PP radiation as an organization so we stuck with that one. Ditto for acro. Otherwise, i don't think it really matters.

At one point acr Astro did it together:

1645128852843.png
 
jondunn said:
what im hearing on streets is many see the mri linac as the first of a domino rally. Next is head and neck proton vs photon. word is it will be seen as unethical to give these patients photon after the trial reports

the fix is in, and we're being left holding the bag.
Click to expand...

I've heard precisely nothing about the MRI linac study from any of my colleagues or referring physicians, outside of this board. It will, at least in my local market, move the needle precisely zero percent. I would expect the same from a proton vs photon study showing mild changes in toxicity, which is what I would expect.

EDIT: Locally, pediatric patients are treated with photons rather than being referred for protons, despite my best efforts to change that, so I wouldn't put too much weight in "unethical" concerns changing practice patterns unfortunately.
 
RealSimulD said:
I didn’t find that much different between the two. Someone want to enlighten me?
Click to expand...

Our clinic went with ACR as well, but there's not a terrific difference between the two. The only value I found was that there was talk about the VA requiring these kind of accreditations for their fee-basis referrals.
 
Everything like accreditation and continuing CME etc is just low key ripoff. It’s impossible to keep track of it all. We have layers upon layers upon layers of useless things like this in medicine. Not a single law firm in America needs to be accredited to have one of its attorneys appear before a federal judge.
 
TheWallnerus said:
Everything like accreditation and continuing CME etc is just low key ripoff. It’s impossible to keep track of it all. We have layers upon layers upon layers of useless things like this in medicine. Not a single law firm in America needs to be accredited to have one of its attorneys appear before a federal judge.
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What I don’t understand is why affiliated of places like mdacc etc get accredited. What the hell does it add to the affiliation?
 
Our by laws at Multicare said that we needed something like ACR / APex, but the wording made it sound like if I designed my own internal QA program, that would suffice. I presume most cancer programs are worded similarly and the easiest way is to pay for one of the program
 



A colleague forwarded to me an email yesterday from Viewray which seems to be very active in advertising the trial results.

Apparently, Viewray is investing heavy in clinical trials for prostate. The email lists 4 trials looking at prostate cancer treatment with MRI-Linacs. ALl of them focusing on SBRT / shorter schedules on their machine.
 
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Palex80 said:



A colleague forwarded to me an email yesterday from Viewray which seems to be very active in advertising the trial results.

Apparently, Viewray is investing heavy in clinical trials for prostate. The email lists 4 trials looking at prostate cancer treatment with MRI-Linacs. ALl of them focusing on SBRT / shorter schedules on their machine.
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Props to them for doing what proton vendors have refused to do
 
I haven't caught up on this thread in awhile, so I apologize if this was said elsewhere regarding accreditation -

Unrelated to the internet, I had this conversation with some people involved in both APEx and ACRO accreditation processes. I'm not familiar with the ACR-specific one (if one exists).

My take away was that ACRO's accreditation is entirely EMR-based, meaning it's just reviewing charts, no site visit or anything (not sure if this is just a COVID thing or if this has always been true). APEx involves "looking" at aspects of the facility (either in-person or, currently, virtual, as far as I can tell).

Though I've been apart of both APEx and ACRO accreditation at different facilities, and this does seem true. I haven't like, independently confirmed this through their official resources. I apologize if this is incorrect.

APEx seems far more rigorous though, having done both.
 
elementaryschooleconomics said:
. I'm not familiar with the ACR-specific one (if one exists).
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It does exist, and in fact is the oldest around. They do require a site visit and review of charts. We've been acr accredited for over a decade and so was where i trained

ACR Partnered with Astro before they broke off and decided to create Apex. I posted the acr-astro logo earlier in this thread when they had a combined program
 
elementaryschooleconomics said:
I haven't caught up on this thread in awhile, so I apologize if this was said elsewhere regarding accreditation -

Unrelated to the internet, I had this conversation with some people involved in both APEx and ACRO accreditation processes. I'm not familiar with the ACR-specific one (if one exists).

My take away was that ACRO's accreditation is entirely EMR-based, meaning it's just reviewing charts, no site visit or anything (not sure if this is just a COVID thing or if this has always been true). APEx involves "looking" at aspects of the facility (either in-person or, currently, virtual, as far as I can tell).

Though I've been apart of both APEx and ACRO accreditation at different facilities, and this does seem true. I haven't like, independently confirmed this through their official resources. I apologize if this is incorrect.

APEx seems far more rigorous though, having done both.
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ACR is a bear for the physics staff. I have been through it.
 
elementaryschooleconomics said:
Based on how things are going, we can just change the labels on this graph to "number of Radiation Oncologists in America" and "indications for the use of radiation therapy in America":

View attachment 350452
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In the words of a car salesman when you try to trade in a car whose value is less than what you owe: “you’re upside down”
 
Gfunk6 said:
Maybe we ought to call out these RO reviewers on social media? Interesting strategy . . .
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I've thought about it, but I just can't bring myself to do it yet. I think in this particular case - with the glib response he got from the reviewer - this was a reasonable thing to take to Twitter.
 
elementaryschooleconomics said:
I've thought about it, but I just can't bring myself to do it yet. I think in this particular case - with the glib response he got from the reviewer - this was a reasonable thing to take to Twitter.
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Sunshine is one of the best disinfectants.

I am totally of a mind that all P2P calls should be recorded and immediately posted to the web (w HIPAA scrubbing). Would be a “project” but I picture media outlets and politicians listening in and being shocked and worried about themselves and their family. Matt’s phone call today would have been an excellent debut for such a thing.
 
Some of the reviewers who work for academic institutions would especially not want their names out there for their chair and colleagues to see!

I could name names but I wont
 
Most P2P reviewers I speak to are generally sympathetic but basically say, "I can't authorize your proposed treatment because this piece of paper from the insurance company tells me to say no." The fact that they are Rad Oncs is meant only to offer a whiff of professional respectability. It may as well be the janitor who cleans the office after hours telling you the same.*

*I don't mean to impugn janitors or compare them to EvilCore employed physicians.
 
If you're a full time academic are you able to work for evicore? How does that work, like a part time job for extra money on the side?
 
maxxor said:
Unless you own the technical, it's the same 1.96 wRVU for radiopharm administration (CPT 79101) as Lutathera.

And as an aside, if you are so clumsy that you might get this stuff on your shoes, you really shouldn't be doing this. *CRINGE*
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And if you happened to have to worry about the drug as well, you'll realize it has nothing in common with technical as it relates to generating revenue on a Linac..

You have to be responsible for paying for the drug and hope that the auth/reimbursement process works out perfectly to make a small margin on it

Basically get to deal with the crap med oncs worry about on a regular basis in private practice
 
medgator said:
And if you happened to have to worry about the drug as well, you'll realize it has nothing in common with technical as it relates to generating revenue on a Linac..

You have to be responsible for paying for the drug and hope that the auth/reimbursement process works out perfectly to make a small margin on it

Basically get to deal with the crap med oncs worry about on a regular basis in private practice
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6% margin at that.
 
jondunn said:
Yes

Anyone can work part time for them.
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I've worked for 2 different universities and both had a policy of pre-approving side hustles like that.
Besides, your colleagues will hate you and competitors in town will howl
 
seper said:
I've worked for 2 different universities and both had a policy of pre-approving side hustles like that.
Besides, your colleagues will hate you and competitors in town will howl
Click to expand...

I have talked to multiple, some of them multiple times. but yes, I think they sign up knowing that they will have enemies, but the money is worth it.
 
maxxor said:
Unless you own the technical, it's the same 1.96 wRVU for radiopharm administration (CPT 79101) as Lutathera.

And as an aside, if you are so clumsy that you might get this stuff on your shoes, you really shouldn't be doing this. *CRINGE*
Click to expand...
I got some strontium on my shoes once. Had to wait like 6 months to get them ba
Ck.
 
Evicore and uhc policy for sarcoma both give relatively clear instructions on how to get imrt approved. If you quote their own words and meet their criteria they are usually forced to approve. Both policies for sarcoma state imrt will be approved if a clinically meaningful reduction in normal tissue sparing can be achieved with imrt as demonstrated on a plan comparison. Clinically meaningful usually means only the imrt plan can meet some quantec constraint. Occasionally they will also allow rtog constraints. This is all spelled out in detail in their imrt policies which are freely available to all providers. Lets be honest: not every extremity sarcoma needs imrt. There are well lateralized sarcomas of the extremities where simple fields offer great bone and skin strip sparing. Would be interested in seeing spraker's case.
 
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