Rad Onc Twitter

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TheWallnerus said:
Part time in America is still very sporadic. Mostly because of real and/or imagined supervision issues. As the real continues to become no longer real, and boogeyman stories lose their bite, part time will become much more common.
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Also the issue if tying full employment to insurance. Some places do not give same benefit to part time workers
 
MidwestRadOnc said:
As stage 3s or 1s?

I’ve seen a system that basically SBRTs anything remotely active on pet. Evaluating nodes and attempting biopsy? Nobody got time for that. Rad oncs eager to do it too. What was PPV of nodules picked up on the screening trials? Don’t ask questions…
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its kind of wild how casually this is said but yet surprises none of us

there's some really ****ty cancer care out there.
 
TheWallnerus said:
Oh for sure. It happens. But this is the trend:

View attachment 383182
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Great figure.

Two things can be true. Its good to do lung screening and you can say it should generate and increase of about 2-5% in lung cancer diagnosis. Also that many of those patients get SBRT. An employed RO can impress their leadership by working on lung screening and it also is working on "something that increases center volumes".

Its also true that it's not going to save Rad Onc and people need to get to the acceptance phase of grieving on that. If we are over supplied, it just pressures screening programs to operate like this:

MidwestRadOnc said:
As stage 3s or 1s?

I’ve seen a system that basically SBRTs anything remotely active on pet. Evaluating nodes and attempting biopsy? Nobody got time for that. Rad oncs eager to do it too. What was PPV of nodules picked up on the screening trials? Don’t ask questions…
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Its satisfying to reassure and observe a patient that doesn't need treatment, unless someone is yelling at you to "grow the practice".

If that chair guy would just learn about global warming... gah
 
drowsy12 said:
its kind of wild how casually this is said but yet surprises none of us

there's some really ****ty cancer care out there.
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I got fed up seeing patients without tissue diagnosis and patients were told “biopsy could collapse your lung”

So cool. Maybe they can rewrite nccn guidelines.
 
MidwestRadOnc said:
I got fed up seeing patients without tissue diagnosis and patients were told “biopsy could collapse your lung”

So cool. Maybe they can rewrite nccn guidelines.
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I discuss it with pulm and CT surgery. Most of the time they tend to be reasonable. A lot of areas are difficult to reach by ENB and when a pt has really bad bullous COPD it can be risky to hit one of those bullae.

I document the heck out of things including the pt consent and discussion of why we are skipping the bx, but if the rationale is sound and the imaging and clinical history fits I see no problems skipping the bx.

Supposedly in Japan, they skip bx quite often and they reportedly treat surgery and sbrt the same
 
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medgator said:
I discuss it with pulm and CT surgery. Most of the time they tend to be reasonable. A lot of areas are difficult to reach by ENB and when a pt has really bad bullous COPD it can be risky to hit one of those bullae.

I document the heck out of things including the pt consent and discussion of why we are skipping the bx, but if the rationale is sound and the imaging and clinical history fits I see no problems skipping the bx.

Supposedly in Japan, they skip bx quite often and they reportedly treat surgery and sbrt the same
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Smoker, growth on consecutive CT scans, PET avid, relatively low-risk location.... BEAM ON!

Seriously, though. I have no qualms treating without biopsy if above factors met.
 
Easier to collect rvus when you just sbrt everything that walks in the door.

Maybe it’s right sometimes maybe it’s not. But always easier that way. Literally never heard an answer for a lung nodule in tumor board with the question of “can you sbrt that?” with anything other than an enthusiastic YES I SURE CAN!
 
1709131404104.png


These people.
 
elementaryschooleconomics said:
View attachment 383272

Can we make this an official ASTRO webinar? I'd go!

Oh wait - why not a plenary at this year's conference?

I'd actually pay the $7000 to register if that was on the schedule!
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That's really asking a lot of ASTRO's regulatory team to make them suppress a session each year from the ASTRO on-demand content.
 
OTN said:
You know what I'm gonna go ahead and say it - I'd rather that patient receive adjuvant APBI with the Livi protocol than hormone therapy.
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That wasn't what my meme was suggesting! I love the Livi treatment.
OTOH, the purpose of endocrine therapy is not exclusively local control. ABPI is (in that patient population). Will the ultimate LC and OS differ in either group? I doubt it, regardless of the different mechanism.
 
MidwestRadOnc said:
That wasn't what my meme was suggesting! I love the Livi treatment.
OTOH, the purpose of endocrine therapy is not exclusively local control. ABPI is (in that patient population). Will the ultimate LC and OS differ in either group? I doubt it, regardless of the different mechanism.
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Exactly. If practicing best evidence based medicine in a T1N0 ER+ elderly breast cancer case, a rad onc should oversee AT MOST 5 days of wrong site treatment.
 
TheWallnerus said:
Exactly. If practicing best evidence based medicine in a T1N0 ER+ elderly breast cancer case, a rad onc should oversee AT MOST 5 days of wrong site treatment.
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Great. More fraction shaming. There's no difference between you and big, academic radonc preaching about wrong site omission.
 
Ray D. Ayshun said:
Great. More fraction shaming. There's no difference between you and big, academic radonc preaching about wrong site omission.
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We need to stop fraction shaming and make laterality shaming a thing.
 
Where are the DEI folks when you need them?
These policies are rooted in antisitusnoninversus-normality and systemic inequalities to the heterotaxic or otherwise lateroanatomic challenged leading to disparate outcomes and inherent bias from physicians who see "just another right breast cancer."
 
drowsy12 said:

x.com

x.com x.com
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I really agree with that take.

We need nuance and guard rails. With minimal supervision reqs big hospital system or PE will abuse the system and minimize rad onc value.

I’m not sure it’s a “safety” thing but I think subjectively that a doc in the building 4 days a week is superior to 1-2.

With that said, treating a prostate at 7 am and the doc rolls in at 8 seems fine to me too.

We’ve got a rule for 77427 that has to be seen in a 5 treatment block…why not a physically present for at least 67% of beam on time?

I don’t know, just shooting at the hip. As much as I hated us turning a linac off while I was in the OR days…I am terrified of a 100% virtual supervision world. Maybe I’m entering boomer territory?!?!
 
BobbyHeenan said:
I really agree with that take.

We need nuance and guard rails. With minimal supervision reqs big hospital system or PE will abuse the system and minimize rad onc value.

I’m not sure it’s a “safety” thing but I think subjectively that a doc in the building 4 days a week is superior to 1-2.

With that said, treating a prostate at 7 am and the doc rolls in at 8 seems fine to me too.

We’ve got a rule for 77427 that has to be seen in a 5 treatment block…why not a physically present for at least 67% of beam on time?

I don’t know, just shooting at the hip. As much as I hated us turning a linac off while I was in the OR days…I am terrified of a 100% virtual supervision world. Maybe I’m entering boomer territory?!?!
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If you were born in any year with a 19 in front, you’re a boomer. Sorry to be the one to have to tell you this. The good news, at least you’re able to afford a home!
 
BobbyHeenan said:
I really agree with that take.

We need nuance and guard rails. With minimal supervision reqs big hospital system or PE will abuse the system and minimize rad onc value.

I’m not sure it’s a “safety” thing but I think subjectively that a doc in the building 4 days a week is superior to 1-2.

With that said, treating a prostate at 7 am and the doc rolls in at 8 seems fine to me too.

We’ve got a rule for 77427 that has to be seen in a 5 treatment block…why not a physically present for at least 67% of beam on time?

I don’t know, just shooting at the hip. As much as I hated us turning a linac off while I was in the OR days…I am terrified of a 100% virtual supervision world. Maybe I’m entering boomer territory?!?!
Click to expand...

Yea not sure we have to be there all the time but on the face of it, it seems preferable to have a doc onsite or at least a NP / PA. Can’t there just be an exception for rural areas? Is there more job security if we have to be there to force hospitals to ensure coverage? Are the cons mostly related to rural areas?
 
seper said:
I’ve lost what the current debate is about. But I know our kin: there are numerous sickos out there who would not think twice about virtually supervising 300 patients under the beam
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I would have 3000 in different states while working remotely in Cancun! I would use an AI generated avatar to represent me, no other docs, just NP’s and PA’s.
 
BobbyHeenan said:
I really agree with that take.

We need nuance and guard rails. With minimal supervision reqs big hospital system or PE will abuse the system and minimize rad onc value.

I’m not sure it’s a “safety” thing but I think subjectively that a doc in the building 4 days a week is superior to 1-2.
Click to expand...

Totally agree. Lots of discussion among friends and this is my take. It's not a safety thing, but we do more than supervise linacs.

BobbyHeenan said:
I am terrified of a 100% virtual supervision world. Maybe I’m entering boomer territory?!?!
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I will be really angry if this happens. I don't want that job and I like being a Rad Onc. I just don't want society presidents to make up lies to "protect" me from one hell while creating another.

We physicians, the people who have to sign off on everything, COULD prevent that future if we stand up for ourselves.

Very pleased to see lots of people speaking out on X today.
 
BobbyHeenan said:
I really agree with that take.

We need nuance and guard rails. With minimal supervision reqs big hospital system or PE will abuse the system and minimize rad onc value.

I’m not sure it’s a “safety” thing but I think subjectively that a doc in the building 4 days a week is superior to 1-2.

With that said, treating a prostate at 7 am and the doc rolls in at 8 seems fine to me too.

We’ve got a rule for 77427 that has to be seen in a 5 treatment block…why not a physically present for at least 67% of beam on time?

I don’t know, just shooting at the hip. As much as I hated us turning a linac off while I was in the OR days…I am terrified of a 100% virtual supervision world. Maybe I’m entering boomer territory?!?!
Click to expand...
Honestly some comments in that twitter thread convinced me that rad onc just doesn’t get how good we have it. Like how hard is it to set parameters around practice supervision, on site 80% of beam on hours and available within 30 minutes the remainder. Or something. Just set a guideline then pay people to do their got-dam job like we’ve done the last 50 years. We already have one of the lowest in person patient care obligations of any other specialist. No nights. No weekends. No inpatient service. Minimal call. And people refuse to see that they are pursuing a marginal near term benefit (don’t have to show up in clinic when your clinical obligations are already so much less onerous than nearly any other physician) while in the medium to long term an ever dwindling number of profiteers can soak up more and more billing for themselves? No freaking thank you. We deserve better than this. I mean i’m lazy af and EVEN I recognize this as a bridge too far. I hope we all will enjoy the process of self elimination as a specialty because that’s where it will end up if the supervision guidelines are too lax.

*i edited this post after i got a little less mad*
 
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Like what other profession would willingly advocate to be a party to its own destruction in such a transparent and shortsighted way? Can you imagine if for
example all of a sudden civil engineers were like, nah, we good fam, no need for us to be on site for construction, go ahead build and test your own bridge, call us if there’s a problem, we’ll be at the bar? You can’t because literally every other professional in the world is out there advocating for why what they do matters. Not advocating for why they never really needed to do it in the first place.

eta word choices
 
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pikachu said:
Like what other profession would willingly advocate to be a party to its own destruction in such a transparent and shortsighted way? Can you imagine if for
example all of a sudden civil engineers were like, nah, we good fam, no need for us to be on site for construction, go ahead build and test your own bridge, call us if there’s a problem, we’ll be at the bar? You can’t because literally every other professional in the world is out there advocating for why what they do matters. Not advocating for why they never really needed to do it in the first place.

eta word choices
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I envy my staff who get to go to lunch or get to experience sunshine.

The leaders in our field are literally the worst kind of people. They advocate for less fractions and omission, strong supporters for the use of protons when there are no proven benefits but yet double down on the things that don’t make sense.
 
pikachu said:
Honestly some comments in that twitter thread convinced me that rad onc just doesn’t get how good we have it. Like how hard is it to set parameters around practice supervision, on site 80% of beam on hours and available within 30 minutes the remainder. Or something. Just set a guideline then pay people to do their got-dam job like we’ve done the last 50 years. We already have one of the lowest in person patient care obligations of any other specialist. No nights. No weekends. No inpatient service. Minimal call. And people refuse to see that they are pursuing a marginal near term benefit (don’t have to show up in clinic when your clinical obligations are already so much less onerous than nearly any other physician) while in the medium to long term an ever dwindling number of profiteers can soak up more and more billing for themselves? No freaking thank you. We deserve better than this. I mean i’m lazy af and EVEN I recognize this as a bridge too far. I hope we all will enjoy the process of self elimination as a specialty because that’s where it will end up if the supervision guidelines are too lax.

*i edited this post after i got a little less mad*
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This take is true, but not in agreement with ASTRO's approach to policy. You have to look at the whole picture. Talk to some people that work for these leaders and see if they are happy. These people are not carving out a utopian future for you, they are working to increase the reach and power of university networks.

We do deserve better... than self serving boomers lying every month on one or another topic to the next generation of this field.
 
seper said:
I’ve lost what the current debate is about. But I know our kin: there are numerous sickos out there who would not think twice about virtually supervising 300 patients under the beam
Click to expand...

This is my concern if the requirement is abolished.
 
End virtual direct supervision. Keep general for hospital based practices. This is not hard. A full time rad onc can be on site 3-4 days a week managing in person visits, sims, and otvs, and stereos. The other days the staff can man the ship with the regular daily treatments and the MD is tied to a phone to answer any acute issues with a properly trained RN or midlevel in clinic. Anybody who has a problem with this fundamentally doesn’t understand or care about single doc rural practices. At the very least there should be a carve out for these practices.

I am going to be very pissed if the 2019 general supervision change is deep sixed as collateral damage for taking out Covid virtual direct. This seems like a backhanded way to end general at hospital based.
 
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