Rad Onc Twitter

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I forgot the original thread talking about @qtpai's article was closed, but we can all bask in his wisdom on Twitter:

IMG_2320.jpeg


Kevin, do you feel Tucker was unjustly fired? I need closure!
 
elementaryschooleconomics said:
I forgot the original thread talking about @qtpai's article was closed, but we can all bask in his wisdom on Twitter:

View attachment 371991

Kevin, do you feel Tucker was unjustly fired? I need closure!
Click to expand...
PhD MS? The most prestigious degree goes at the end, though perhaps he's saying something. Has he gotten his PhD yet? No comment on the fact that just as some jobs are harder than others, so are some med schools.
 
Ray D. Ayshun said:
PhD MS? The most prestigious degree goes at the end, though perhaps he's saying something. Has he gotten his PhD yet? No comment on the fact that just as some jobs are harder than others, so are some med schools.
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Yeah there's a lot to unpack there...he's certainly playing the game more aggressively s/p Fox News.
 
elementaryschooleconomics said:
I forgot the original thread talking about @qtpai's article was closed, but we can all bask in his wisdom on Twitter:

View attachment 371991

Kevin, do you feel Tucker was unjustly fired? I need closure!
Click to expand...
This is exactly like when Steppenwolf swings his weapon and Superman gets in the way and shatters his axe with ice breath and Steppenwolf is all like "wtf just happened omg" and Superman goes "NOT IMPRESSED." Kevin Bass PhD MS is not impressed with med school.

 
I don't know what medical student do third year at this point, but yeah it wasn't too tough.

Show up. "Pre-round" on "your" few patients. Kill a cup of coffee until attending shows up. Run up ahead of the rounding team. Find charts at nursing station (most difficult step) and load them on wheeled cart. Answer a few, typically easy pimp questions at each patient's door while the patient awkwardly listens and stares at you. Unload charts with orders flagged at the HUC station. Repeat.

[okay boomer]
 
Mandelin Rain said:
I don't know what medical student do third year at this point, but yeah it wasn't too tough.

Show up. "Pre-round" on "your" few patients. Kill a cup of coffee until attending shows up. Run up ahead of the rounding team. Find charts at nursing station (most difficult step) and load them on wheeled cart. Answer a few, typically easy pimp questions at each patient's door while the patient awkwardly listens and stares at you. Unload charts with orders flagged at the HUC station. Repeat.

[okay boomer]
Click to expand...
So true …
 



I don‘t get it. What is the famous inventor of the Hellmann sauce doing at ASCO? 🤣
 
For me new prostate cancer is usually a 30 min, range 15-60. Not much difference between fav int and high risk. Fav int have to include AS as part of talk. High risk needs staging and ADT and considering brachy boost part of talk. I’m in a very educated area and most patients want to talk about focal also, which I don’t currently offer. Now more talk about genomics which I
rarely use except for outliers. I keep it faster by scheduling everyone for a second visit 1-2 weeks later after they’ve had time to process and the first visit is “just for the basics”


Unless low volume GG1, who gets the active surveillance and see you in 6 months and don’t even mention treatment.

The problem is it’s usually a 15 min slot 🙁.
 
*puts on haters cap*

So we’re doing VMAT on a humerus head bone met in a patient with a white out /collapsed /drown R lung and stage 4 cancer now?

If only they had a financial toxicity expert at MSKCC.

*my mistake - she’s in Canada now. VMAT away my Canadian friend.

 
BobbyHeenan said:
*puts on haters cap*

So we’re doing VMAT on a humerus head bone met in a patient with a white out /collapsed /drown R lung and stage 4 cancer now?

If only they had a financial toxicity expert at MSKCC.

*my mistake - she’s in Canada now. VMAT away my Canadian friend.

Click to expand...

Should be quick to contour and plan. Set iso. Select golfball tool. Click once. Use a single arc with pretty much no constraints. What is this?
 
BobbyHeenan said:
*puts on haters cap*

So we’re doing VMAT on a humerus head bone met in a patient with a white out /collapsed /drown R lung and stage 4 cancer now?

If only they had a financial toxicity expert at MSKCC.

*my mistake - she’s in Canada now. VMAT away my Canadian friend.

Click to expand...


Ray D. Ayshun said:
Should be quick to contour and plan. Set iso. Select golfball tool. Click once. Use a single arc with pretty much no constraints. What is this?
Click to expand...
Raises hand

Why would we use arcs to palliate a humeral head met… no need to “shine” any beamlets into lung and mediastinum… I hope to God there was no entrance beams coming from the opposite side of body and into the opposite humeral head to get to the treated humeral head

AP/PA best?
 
Ray D. Ayshun said:
Should be quick to contour and plan. Set iso. Select golfball tool. Click once. Use a single arc with pretty much no constraints. What is this?
Click to expand...
"This" has to be a joke, no? And for what it's worth, many of us could do consult, sim, and treat within an hour (2 tops) in a case like this.
 
BobbyHeenan said:
*puts on haters cap*

So we’re doing VMAT on a humerus head bone met in a patient with a white out /collapsed /drown R lung and stage 4 cancer now?

If only they had a financial toxicity expert at MSKCC.

*my mistake - she’s in Canada now. VMAT away my Canadian friend.

Click to expand...

From my understanding, she’s saying the therapist did either the contours or the plan which is a bigger issue.

What the f**k is a clinical specialist radiation therapist?
 
Reaganite said:
"This" has to be a joke, no? And for what it's worth, many of us could do consult, sim, and treat within an hour (2 tops) in a case like this.
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From me or them? Definitely from me. I'm not really sure what the point was for them. I'm generally all about imrt/vmat. This is a scenario where ap/pa is clearly better, but perhaps they had their reasons.
 
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Gfunk6 said:
This reminds me of a funny story. Literally my first day of residency I was assigned to the GU service. The attending tells me that he has a prostate clinic scheduled for the morning, that I should start seeing patients and he will get there soon.

The first patient was an engineer who walked in with a huge stack of published prostate research papers which were neatly arranged, annotated, and highlighted. He sees me instead of the famous attending he was supposed to see and starts asking questions. He soon realizes that I don't know jack **** about radiation so he asks me, "How long have you been doing this?"

I say, "It's my first day."

The look of sheer terror mixed with disgust on his face was amazing to see - fortunately my attending saved my ass shortly thereafter.
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This happened to me too. Still does where I practice.... and I just send them along to said famous attending so they can answer all the questions for the nth time 😊
 
RO28 said:
This happened to me too. Still does where I practice.... and I just send them along to said famous attending so they can answer all the questions for the nth time 😊
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Those photons coming from the "premium" machines designed by "famous" radiation oncologists really do matter.

#ncis gibbs GIF by CBS
 
RO28 said:
Ya know, I'm okay with this...it means I don't have to pretend to care about the packet of journal articles and graphs they brought in
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At least they have data. My patients bring in twitter feeds and tik tok videos.
 
DoctwoB said:
For me new prostate cancer is usually a 30 min, range 15-60. Not much difference between fav int and high risk. Fav int have to include AS as part of talk. High risk needs staging and ADT and considering brachy boost part of talk. I’m in a very educated area and most patients want to talk about focal also, which I don’t currently offer. Now more talk about genomics which I
rarely use except for outliers. I keep it faster by scheduling everyone for a second visit 1-2 weeks later after they’ve had time to process and the first visit is “just for the basics”


Unless low volume GG1, who gets the active surveillance and see you in 6 months and don’t even mention treatment.

The problem is it’s usually a 15 min slot 🙁.
Click to expand...

You talkin' bout radiation? Or referring all your non low-risk patients reflexively to a Radiation Oncologist?
 
RO28 said:
Ya know, I'm okay with this...it means I don't have to pretend to care about the packet of journal articles and graphs they brought in
Click to expand...
Sir i encourage you to seek a second opinion
 
Urologists always seem to think they can “talk” about radiation. They “talk” to them about our modality in bladder and prostate and not surprisingly they chose surgery. No need to see a rad onc, you know. I loved that latest Lancet trimodality vs surgery paper. Some specialists are allergic to “data”.
 
thecarbonionangle said:
Urologists always seem to think they can “talk” about radiation. They “talk” to them about our modality in bladder and prostate and not surprisingly they chose surgery. No need to see a rad onc, you know. I loved that latest Lancet trimodality vs surgery paper. Some specialists are allergic to “data”.
Click to expand...

I really wish NCCN and/or CoC accreditation standards would include - patients were seen (or offered) rad onc appointment for all localized prostate and bladder cases.

I believe Australia has started this type of push/movement. Would love to see it here. It would massively increase clinic demands, but would absolutely shift the % of patients choosing xrt over surgery.
 
thecarbonionangle said:
Urologists always seem to think they can “talk” about radiation. They “talk” to them about our modality in bladder and prostate and not surprisingly they chose surgery. No need to see a rad onc, you know. I loved that latest Lancet trimodality vs surgery paper. Some specialists are allergic to “data”.
Click to expand...
At least that's still in the guidelines. What about the shysters freezing it or doing hifu upfront?
 
evilbooyaa said:
You talkin' bout radiation? Or referring all your non low-risk patients reflexively to a Radiation Oncologist?
Click to expand...

I do give the full unbiased (IMO) radiation spiel and offer rad-onc referral to all patients. About half my patients end up with some form of radiation, either brachy or xrt or combo. Of those that opt for surgery, about half accept the radonc referral to dive further into it, about half are deadset.
 
thecarbonionangle said:
Urologists always seem to think they can “talk” about radiation. They “talk” to them about our modality in bladder and prostate and not surprisingly they chose surgery. No need to see a rad onc, you know. I loved that latest Lancet trimodality vs surgery paper. Some specialists are allergic to “data”.
Click to expand...

I'm sure there are a lot of urologists pushing poor information about radiation. I know I've seen many radoncs pushing incorrect information about surgery.
 
DoctwoB said:
I'm sure there are a lot of urologists pushing poor information about radiation. I know I've seen many radoncs pushing incorrect information about surgery.
Click to expand...
In the words of BHO to Mitt, “please proceed!”
 
DoctwoB said:
I'm sure there are a lot of urologists pushing poor information about radiation. I know I've seen many radoncs pushing incorrect information about surgery.
Click to expand...
I tell them that if they have surgery, they won't be able to have surgery in the future. Other things they won't be able to have include erections and dry underwear. In all seriousness, I just defer toxicity discussion to the surgeon in the rare instance the local urologist who doesn't operate hasn't already told them what to do.
 
thecarbonionangle said:
In the words of BHO to Mitt, “please proceed!”
Click to expand...

Like i'm sure with urologists giving poor information about radiation, it has more to do with how the information is presented.

"I was told if i had surgery i would be incontinent forever / never have an erection again / dramatically shorten my penis." Is the usual one i've heard.

All possible side effects, but neglecting to mention the probabilities of recovery, the nuances of partial recovery, the fact that shortening goes away over time with no difference compared to xrt 2 years post op. Now granted, I am hearing this from the patient, maybe the radonc gave a reasonable discussion about risks of SUI and timecourse and degree of recovery and "I WILL LEAK FOREVER" is all they took away.

Likewise Urologists could say post xrt "there is a real chance it will cause cancer / you will have a lot more trouble holding your pee and have accidents and wake up 10 times a night to pee / have chronic diarrhea and bowel symptoms"

Correct side effects presented incorrectly or misleadingly is essentially the same as just lying.
 
DoctwoB said:
Like i'm sure with urologists giving poor information about radiation, it has more to do with how the information is presented.

"I was told if i had surgery i would be incontinent forever / never have an erection again / dramatically shorten my penis." Is the usual one i've heard.

All possible side effects, but neglecting to mention the probabilities of recovery, the nuances of partial recovery, the fact that shortening goes away over time with no difference compared to xrt 2 years post op. Now granted, I am hearing this from the patient, maybe the radonc gave a reasonable discussion about risks of SUI and timecourse and degree of recovery and "I WILL LEAK FOREVER" is all they took away.

Likewise Urologists could say post xrt "there is a real chance it will cause cancer / you will have a lot more trouble holding your pee and have accidents and wake up 10 times a night to pee / have chronic diarrhea and bowel symptoms"

Correct side effects presented incorrectly or misleadingly is essentially the same as just lying.
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Doubt anybody lying tbh. I think asking a patient what the other doctor REALLY told them is a form of the telephone game.
 
sirspamalot said:
Most urologists do not represent radiation in a rational fair manner.. unless of course.. they own linacs. Then of course, radiation seems like a gift from the skies compared to surgery.
Click to expand...

You should see how urologists with linacs love bladder preservation all of a sudden. I have seen it. It was quite humorous.

DoctwoB hope you take nothing personal, we are glad you come here. You are unique among urologists re rad onc though.
 
Most community urologists in my area are judicious and none own linacs. I am all for younger men (60 down) with intermediate risk pCa getting surgery. There may be cases for high risk as well (particularly in the 50 y/o crowd). There is a lot of gray zone.

I have found some fairly prominent academic centers in my region to be markedly overaggressive with surgery in men around 70 with high risk or very high risk disease. These men always come back to me however. Recovery in these men can be hard. The community urologists have no interest in dealing with this.
 
thecarbonionangle said:
Urologists always seem to think they can “talk” about radiation. They “talk” to them about our modality in bladder and prostate and not surprisingly they chose surgery. No need to see a rad onc, you know. I loved that latest Lancet trimodality vs surgery paper. Some specialists are allergic to “data”.
Click to expand...

Thoracic oncologists from every specialty including RO have been a little embarrassing on Twitter these days. I mean no offense, my opinion mannnnnn.
 
sirspamalot said:
Most urologists do not represent radiation in a rational fair manner.. unless of course.. they own linacs. Then of course, radiation seems like a gift from the skies compared to surgery.

Ufc 217 Sport GIF by UFC
Click to expand...
Same with neurosurgeons… all of a sudden SRS is a great option compared to surgery when they can bill out the same.

Maybe the saving grace is to have all docs receive technical billing (oh wait there’s stark law). It’s funny how only in medicine, we are unable to give incentives. Out in the real world, business deals are done and nobody blinks an eye.
 
RadOncDoc21 said:
Same with neurosurgeons… all of a sudden SRS is a great option compared to surgery when they can bill out the same.

Maybe the saving grace is to have all docs receive technical billing (oh wait there’s stark law). It’s funny how only in medicine, we are unable to give incentives. Out in the real world, business deals are done and nobody blinks an eye.
Click to expand...
Just need everyone under the same tax ID and you're golden
 
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