Rad Onc Twitter

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sirspamalot said:
I still have no idea how/why VMAT actually* works. I mean, yeah, its insane to think a rotating gantry with moving leaves is doing its thing. Like magnetic forces, its witchcraft. Its just a magic box and the Physics Wizard tells me "go forth my child" and we do.

That is all.
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At least you’re being truly honest.
 
hard rock 80s GIF

(OA has entered the chat...)
 
taserlaser said:
Not this again lol. German comparative cohort published for LDRT and Covid

Treatment of COVID-19 pneumonia with low-dose radiotherapy plus standard of care versus standard of care alone in frail patients​

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It's not German! It's
matador torero GIF by jsot


TheWallnerus said:
Damn that’s actually a hell of a positive study.
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No, it's not. Allow me to dissect it.


1. The primary endpoint was not met.

2. Bear in mind this great imbalance in the baseline characteristics.

1680717076850.png



Now, what is a CURB-65 score?

CURB-65 - Wikipedia

en.wikipedia.org en.wikipedia.org
CURB-65, also known as the CURB criteria, is a clinical prediction rule that has been validated for predicting mortality in community-acquired pneumonia and infection of any site.

The risk of death at 30 days increases as the score increases:

0—0.7%
1—3.2%
2—13.0%
3—17.0%
4—41.5%
5—57.0%

The really bad COVID cases were more than twice as common in the Control cohort than in the LD-RT cohort.
Why?
Because they chose to match the control group based only on age, gender, comorbidities, and SAFI values.
 
Last edited:
Palex80 said:
It's not German! It's
matador torero GIF by jsot



No, it's not. Allow me to dissect it.


1. The primary endpoint was not met.

2. Bear in mind this great imbalance in the baseline characteristics.

View attachment 368927


Now, what is a CURB-65 score?

CURB-65 - Wikipedia

en.wikipedia.org en.wikipedia.org
CURB-65, also known as the CURB criteria, is a clinical prediction rule that has been validated for predicting mortality in community-acquired pneumonia and infection of any site.

The risk of death at 30 days increases as the score increases:

0—0.7%
1—3.2%
2—13.0%
3—17.0%
4—41.5%
5—57.0%

The really bad COVID cases were more than twice as common in the Control cohort than in the LD-RT cohort.
Why?
Because they chose to match the control group based only on age, gender, comorbidities, and SAFI values.
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I stand corrected - sorry Spaniards. Thanks for the commentary
 
So curious: what was the last competitive year of radonc graduates? I’m considering only hiring graduates that came out before that year. Hospitals can low-ball a new grad and get the cheapest person, but as a PP I want the best possible candidate.
 
thesauce said:
So curious: what was the last competitive year of radonc graduates? I’m considering only hiring graduates that came out before that year. Hospitals can low-ball a new grad and get the cheapest person, but as a PP I want the best possible candidate.
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I'm guessing the first year (2019) they had 30+ unfilled pretty much marks the transition.

The Residency Training Landscape - ASTRO Blog- American Society for Radiation Oncology (ASTRO) - American Society for Radiation Oncology (ASTRO)

A look at the overall training and oversight system that trains medical students to provide specialized care as a licensed physician.
www.astro.org www.astro.org
 
thesauce said:
So curious: what was the last competitive year of radonc graduates? I’m considering only hiring graduates that came out before that year. Hospitals can low-ball a new grad and get the cheapest person, but as a PP I want the best possible candidate.
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That seems a bit arbitrary. If pre residency credentials are important to you, you will have their CV. You can tell if they’re someone who was well qualified/would have matched in peak years.
 
Not sure if you guys do outreach to PCPs regarding PSA screening but new data just dropped, 21 year Dutch cohort of ERSPC.

pubmed.ncbi.nlm.nih.gov

A Detailed Evaluation of the Effect of Prostate-specific Antigen-based Screening on Morbidity and Mortality of Prostate Cancer: 21-year Follow-up Results of the Rotterdam Section of the European Randomised Study of Screening for Prostate Cancer - Pub

Prostate-specific antigen-based prostate cancer screening reduces metastasis and mortality. Longer follow-up shows fewer invitations and diagnoses needed to prevent one death, a positive note towards the issue of overdiagnosis.
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov

To prevent one prostate cancer death you need to invite to screen 246 and diagnose 14. To prevent one case of Mets it is 121 and 7. This compares favorably to colonoscopy, mammograms etc.

No benefit seen in those starting enrolled after age 70 (note not the same as continuing screening after age 70). I actually think this understated the benefit, as the median age at enrollment was over 61. If you enroll all 50-55 year olds as they become eligible this will likely magnify the benefit. Plus the usual caveats of PSA contamination in control arm and noncompliance with biopsy. A big chunk of the prostate cancer deaths in the screening arm are those who only attended one screening event or who were recommended biopsy but didn’t receive.
 
Palex80 said:


How many wRVUs for 0 fractions for breast cancer? 🤣
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You get a few for the consult.

And then, of course since we are the real oncologists, we continue seeing the unirradiated breast cancer patients the rest of their lives. Good RVUs for that. We weigh in on hormone therapy side effects and black cohosh and switching medications and that sort of stuff (we do not Rx, but write excellent notes about what should be Rx’d). Med oncs defer to our opinions on these things in the USA.
 
TheWallnerus said:
You get a few for the consult.

And then, of course since we are the real oncologists, we continue seeing the unirradiated breast cancer patients the rest of their lives. Good RVUs for that. We weigh in on hormone therapy side effects and black cohosh and switching medications and that sort of stuff (we do not Rx, but write excellent notes about what should be Rx’d). Med oncs defer to our opinions on these things in the USA.
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You forgot the "/s" at the bottom of your paragraph
 
The problem with the MGMA and SCAROP data is that they often scale production to 1.0 FTE. But, it's not always clear which data is scaled and which isn't.

The SCAROP data I have from a few years ago shows ~11,000 wRVUs scaled to 1.0 FTE but closer to 8,000 actually produced among clinical faculty greater than 0.7 FTE.

@Dan Spratt Any comment on the above? Do you have the full datasets and if so would you mind sharing?
 
thesauce said:
So curious: what was the last competitive year of radonc graduates? I’m considering only hiring graduates that came out before that year. Hospitals can low-ball a new grad and get the cheapest person, but as a PP I want the best possible candidate.
Click to expand...

Last competitive year was those who matched in 2018 and thus will be graduating this year (2023). I think 2024 graduates would be fine, but I'd be wary of 2025 and onward graduates.
 
metview said:
Last competitive year was those who matched in 2018 and thus will be graduating this year (2023). I think 2024 graduates would be fine, but I'd be wary of 2025 and onward graduates.
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Hate to paint with broad strokes but definitely have to question the folks who consciously decided to match into this specialty this decade
 
metview said:
Last competitive year was those who matched in 2018 and thus will be graduating this year (2023). I think 2024 graduates would be fine, but I'd be wary of 2025 and onward graduates.
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If the 2018 cohort had any sense there should be less of them. I know a few that jumped ship to do something else
 
Nothing specific against any applicant of course, but:

2024 Class: Graduates were competitive
2025 Class: God help us
 
thesauce said:
So curious: what was the last competitive year of radonc graduates? I’m considering only hiring graduates that came out before that year. Hospitals can low-ball a new grad and get the cheapest person, but as a PP I want the best possible candidate.
Click to expand...
Hospitals and dept chairs are not just lowballing new grads, but also their mature and mid-career faculty.

One mid-career doctor I know told me that his Chairman advised him to start looking for a new place, because his salary cost the same as 2 new grads. It's just simple math to the business people.

Nobody's work is truly irreplaceable. Even Steve Jobs once got fired from Apple.
 
IonsAreOurFuture said:
Hospitals and dept chairs are not just lowballing new grads, but also their mature and mid-career faculty.

One mid-career doctor I know told me that his Chairman advised him to start looking for a new place, because his salary cost the same as 2 new grads. It's just simple math to the business people.

Nobody's work is truly irreplaceable. Even Steve Jobs once got fired from Apple.
Click to expand...

Maybe that’s why many of these mid and late career academics have left for industry. I can name at least 5 I’ve worked with in the past and there are probably more out there. Many of them don’t even work with anything radiation related when they leave.

So not only are you turning out grads like crazy, you are scaring away any remaining talent further pushing down any possibility of innovation the field (but let’s be honest probably not much going on anyway) and admin is actively Pershing a penny wise pound foolish approach to HC.

After the initial novelty has worn off, I’m sure the new grads are will be thrilled to learn that the decision to hire them was primary to replace an “expensive” older doctor. Hurray Meritocracy!
 
Fpg1245 said:
Maybe that’s why many of these mid and late career academics have left for industry. I can name at least 5 I’ve worked with in the past and there are probably more out there. Many of them don’t even work with anything radiation related when they leave.
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This is perhaps the most frightening part of the oversupply issue. They’re replacing high-quality faculty (and community docs) with low-quality new grads. Our field doesn’t have a f—- chance.
 
thesauce said:
This is perhaps the most frightening part of the oversupply issue. They’re replacing high-quality faculty (and community docs) with low-quality new grads. Our field doesn’t have a f—- chance.
Click to expand...

Brain drain and a Money drain. Radiation will not be allowed to win on any front.
 
thesauce said:
So curious: what was the last competitive year of radonc graduates? I’m considering only hiring graduates that came out before that year. Hospitals can low-ball a new grad and get the cheapest person, but as a PP I want the best possible candidate.
Click to expand...
Based on personal experience w/ residents, I would have no hesitation to hire up until residents graduating in 2025. After that YMMV
 
Palex80 said:
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As an Ortho who is has no idea how rad/onc works, what is the low dose radiation treatments he is doing as compared to a standard hand X-ray?

I’ve never seen or heard anything in the ortho literature about using radiation for OA. I could see maybe plausible in a RA patient not responding to meds but run of the mill OA seems to be a stretch

I’m my training, we used to consult rad/onc for post op complex/revision elbow Orif or acetabular orifs to prevent HO. The rad/oncs halfway through my residency told us the risk of developing a sarcoma was unacceptably high and told us to switch to NSAIDs instead. We completely changed our protocols and never consulted them again.
 
Miles Gloriosus said:
The rad/oncs halfway through my residency told us the risk of developing a sarcoma was unacceptably high and told us to switch to NSAIDs instead. We completely changed our protocols and never consulted them again.
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Yeah that actually sounds like something a Rad-Onc would 100% say - God I hate ROs. Are you at a big academic center?
 
A as
Miles Gloriosus said:
As an Ortho who is has no idea how rad/onc works, what is the low dose radiation treatments he is doing as compared to a standard hand X-ray?

I’ve never seen or heard anything in the ortho literature about using radiation for OA. I could see maybe plausible in a RA patient not responding to meds but run of the mill OA seems to be a stretch

I’m my training, we used to consult rad/onc for post op complex/revision elbow Orif or acetabular orifs to prevent HO. The rad/oncs halfway through my residency told us the risk of developing a sarcoma was unacceptably high and told us to switch to NSAIDs instead. We completely changed our protocols and never consulted them again.
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Risk of sarcoma much lower if it even exit sta than major perioperative risk from reop due to HO.
 
Fpg1245 said:
I hate being right.
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I turned down an HO consult last week at my big academic center… 16 yo healthy girl in a car accident who broke her hip. Not a huge fan HO ppx on folks under 40 unless they have a spinal cord injury… and benign ortho is not a huge fan of me. Sometimes saying no is the right thing to do.
 
Lamount said:
I turned down an HO consult last week at my big academic center… 16 yo healthy girl in a car accident who broke her hip. Not a huge fan HO ppx on folks under 40 unless they have a spinal cord injury… and benign ortho is not a huge fan of me. Sometimes saying no is the right thing to do.
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This is true but to alter your protocols so that you never consult them again is idiotic unless Ofcourse you work in a peds hospital.
 
Fpg1245 said:
This is true but to alter your protocols so that you never consult them again is idiotic unless Ofcourse you work in a peds hospital.
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That’s true. It def has a role… just most of the consults at my hospital are BS -thoughtless pushy trauma surgeons who don’t want HO dinging their numbers, even if it means blasting the pelvis of a college student who fell off the bleachers with 7-8 Gy. 25% of the consults are legit.
 
Lamount said:
I turned down an HO consult last week at my big academic center… 16 yo healthy girl in a car accident who broke her hip. Not a huge fan HO ppx on folks under 40 unless they have a spinal cord injury… and benign ortho is not a huge fan of me. Sometimes saying no is the right thing to do.
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Usually ortho won’t consult for something like that. Why was there an increased risk here for HO? Treated several kids in residency who had some kind of spastic neurological condition and developed recurrent HO in elbows and knees.
 
Miles Gloriosus said:
The rad/oncs halfway through my residency told us the risk of developing a sarcoma was unacceptably high and told us to switch to NSAIDs instead
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The number of patients reported getting HO XRT in the medical literature is in the thousands! The number of patients reported as having radiation-related sarcoma after HO XRT in the literature is close to e^(2iπ).
 
Lamount said:
That’s true. It def has a role… just most of the consults at my hospital are BS -thoughtless pushy trauma surgeons who don’t want HO dinging their numbers, even if it means blasting the pelvis of a college student who fell off the bleachers with 7-8 Gy. 25% of the consults are legit.
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100%. I recall refusing to treat a 16 yo for HO as a resident. Ortho yelled at my attending who folded. Counted it as a peds case for my ACGME numbers.
 
RickyScott said:
Usually ortho won’t consult for something like that. Why was there an increased risk here for HO? Treated several kids in residency who had some kind of spastic neurological condition and developed recurrent HO in elbows and knees.
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The surgeon opted for a “posterior approach”, which increases risk of HO. That’s what happened to her last patient, so she said. Then she told me that she “strongly prefers that her adolescent patient get RT”. I explained that, unfortunately, she doesn’t get a say.

This is just one of 4 BS consults I have fielded from this particular surgeon… I have started helping colleagues reply to her because I am more comfortable dealing with her silliness.
 
TheWallnerus said:
The number of patients reported getting HO XRT in the medical literature is in the thousands! The number of patients reported as having radiation-related sarcoma after HO XRT in the literature is close to e^(2iπ).
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Yeah… about that, what is the median age of the patients on those retrospective reviews? It’s a completely reasonable tx for someone in their 60s.
 
Lamount said:
I turned down an HO consult last week at my big academic center… 16 yo healthy girl in a car accident who broke her hip. Not a huge fan HO ppx on folks under 40 unless they have a spinal cord injury… and benign ortho is not a huge fan of me. Sometimes saying no is the right thing to do.
Click to expand...

The vast majority of those that need prophylactic RT for HO are young patients. It’s been done on thousands of patients a year for decades. Risks are absolutely negligible.
 
thesauce said:
The vast majority of those that need prophylactic RT for HO are young patients. It’s been done on thousands of patients a year for decades. Risks are absolutely negligible.
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Agree. Youngish person thing.
Would generally do without hesitation.
There is a risk stratification I found
 
RealSimulD said:
Agree. Youngish person thing.
Would generally do without hesitation.
There is a risk stratification I found
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thesauce said:
The vast majority of those that need prophylactic RT for HO are young patients. It’s been done on thousands of patients a year for decades. Risks are absolutely negligible.
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How do you define who "needs" it? Someone with a history of HO in the past/spasticity/spinal cord injury? Sure... worth considering. Accidental traumatic injury... nope.
 
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