Rad Onc Twitter

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I completely believe the peer reviewer would have given whole brain because I have been directly criticized by peers for wasting machine time treating multiple brain mets with SRS. Had to see it with my own eyes to realize how common it was. I have zero respect for doctors who don't treat their patients the way they would treat their own family members or want themselves treated. My favorite was the evicore reviewer who told me he would treat a solitary vertebral met with 30 in 10 AP-PA if the patient were his brother when I directly asked that question. Sadly, I expect it from them.
 
MidwestRadOnc said:
I completely believe the peer reviewer would have given whole brain because I have been directly criticized by peers for wasting machine time treating multiple brain mets with SRS. Had to see it with my own eyes to realize how common it was. I have zero respect for doctors who don't treat their patients the way they would treat their own family members or want themselves treated. My favorite was the evicore reviewer who told me he would treat a solitary vertebral met with 30 in 10 AP-PA if the patient were his brother when I directly asked that question. Sadly, I expect it from them.
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Seen this way too many times in practice

There’s the way it is and the way it ought to be.
 
thecarbonionangle said:
What would it take to get rid of medicare advantage?
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An act of Congress. Which won't happen because MA has been a traditional profit center for big insurance. Humana, United, Cigna lobbyists aren't going to let that go away even if times have been tougher for them lately.

Easy profit denying care through these third party intermediaries enforcing arbitrary medical necessity guidelines which differ between each company and from the NCCN guidelines
 
medgator said:
An act of Congress. Which won't happen because MA has been a traditional profit center for big insurance. Humana, United, Cigna lobbyists aren't going to let that go away even if times have been tougher for them lately.
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Uniparty. Biggest budget items after SS are medicare and defense. There are a handful of massive corporations that benefit from this spending. So with ROCR, what Jeff Michalski wants to happen doesn't really matter. What do the above companies want to happen? That's probably what will happen. Although I'm still confused as to exactly what that is.
 
MidwestRadOnc said:
"wasting" machine time or automatically whole-braining anything more than 2 or 3 mets?
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4 is more the limit of the patience of the physicist and Dosimetrists rather than the technical Limit from what I can see
 
MidwestRadOnc said:
I completely believe the peer reviewer would have given whole brain because I have been directly criticized by peers for wasting machine time treating multiple brain mets with SRS. Had to see it with my own eyes to realize how common it was. I have zero respect for doctors who don't treat their patients the way they would treat their own family members or want themselves treated. My favorite was the evicore reviewer who told me he would treat a solitary vertebral met with 30 in 10 AP-PA if the patient were his brother when I directly asked that question. Sadly, I expect it from them.
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I hear ya, I have seen more than one patient get whole brain 30 Gy in 10 fx for a solitary brain met within the last decade. It's still out there.

Re Evicore, there is a paper showing less risk of hospitalization after 3D conformal RT for spine mets compared to APPA, if that helps you next time.
 
Fpg1245 said:
4 is more the limit of the patience of the physicist and Dosimetrists rather than the technical Limit from what I can see
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There is the single-isocenter, multiple-target method by Fiveash et al at UAB that Varian commercialized as "Hyperarc".

You can treat one met or 20, the linac time involved is the same, only the MLC work harder - it's fun to watch those MLC dance as they treat 20 brain mets in 5 minutes.
 
TheWallnerus said:
Also known as contouring a (admittedly discontiguous) PTV and running an IMRT plan on it. Just sayin’ 😉
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Yep, that's how I do it too, I just contour a single GTV to include all mets, add 1mm PTV, and hand it off to dosi for SBRT planning from there.

Much simpler than the old days on gamma knife of naming, contouring, planning and treating every lesion individually.
 
IonsAreOurFuture said:
Yep, that's how I do it too, I just contour a single GTV to include all mets, add 1mm PTV, and hand it off to dosi for SBRT planning from there.

Much simpler than the old days on gamma knife of naming, contouring, planning and treating every lesion individually.
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I feel like gk was quicker and more efficient depending on how old the source was
 
IonsAreOurFuture said:
I hear ya, I have seen more than one patient get whole brain 30 Gy in 10 fx for a solitary brain met within the last decade. It's still out there.

Re Evicore, there is a paper showing less risk of hospitalization after 3D conformal RT for spine mets compared to APPA, if that helps you next time.
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They won't care. Arbitrary medical usage guidelines that answer to no one

When the secondary analysis of rtog 0617 came out in the jco stating IMRT should routinely be used, the great docs at Evilcore were still making me send 3D plan comparisons to IMRT in stage 3 nsclc with snarky comments like "that was unplanned subgroup analysis" blah blah blah. This happened for years until right before covid and they finally changed their "guidelines"
 
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IonsAreOurFuture said:
There is the single-isocenter, multiple-target method by Fiveash et al at UAB that Varian commercialized as "Hyperarc".

You can treat one met or 20, the linac time involved is the same, only the MLC work harder - it's fun to watch those MLC dance as they treat 20 brain mets in 5 minutes.
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Impressive. But can you contour 20 Brain Mets in a bar after enjoying a few scotches?
 
Gfunk6 said:
Impressive. But can you contour 20 Brain Mets in a bar after enjoying a few scotches?
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I don't drink, so that's not a problem...but, having an hour to concentrate uninterrupted and maintaining focus on not contouring sloppily after the first 10, that is the challenge.
 
I think this is an EGFR or ALK mutation pt; continue systemic therapy and observe is another valid option
 
drowsy12 said:

x.com

x.com x.com
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Off the heels of a court challenge to the NSA.

The TMA seems especially active not sure I can say the same for other medical associations. Mine is certainly comatose.

Guess I shouldn’t be surprised coming from a state like Texas
 
Fpg1245 said:
Off the heels of a court challenge to the NSA.

The TMA seems especially active not sure I can say the same for other medical associations. Mine is certainly comatose.

Guess I shouldn’t be surprised coming from a state like Texas
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Again the enemy here are the large non profits
 
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OTN said:
Yes, but if you're aspiring to be an academic radonc, showing off your ability to Rock Star up everyone on Twitter isn't insignificant when it comes to looking for a job.
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good point. And such bootlickers almost always willing to stab a colleague in the back..
 
OTN said:
Yes, but if you're aspiring to be an academic radonc, showing off your ability to Rock Star up everyone on Twitter isn't insignificant when it comes to looking for a job.
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Spot on. I don't hold any of this against trainees.

Being a true believer, not being cynical about your institution (or field) and being effusive in your praise of elders are all qualities that we don't select for here on SDN! They all help regarding young academic careerists (not a bad thing).

We tend towards data driven libertarianism (at least intellectually) and skepticism. This is enough to scare away some potential employers!
 
communitydoc13 said:
We tend towards data driven libertarianism (at least intellectually) and skepticism.
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absolutely. When thought about from a politics perspective, SDN is basically Reason Magazine or maybe Breitbart (the latter more of the Dare you to Reply thread, the former is probably more fair from a data-driven but libertarian POV)
 
communitydoc13 said:
Spot on. I don't hold any of this against trainees.

Being a true believer, not being cynical about your institution (or field) and being effusive in your praise of elders are all qualities that we don't select for here on SDN! They all help regarding young academic careerists (not a bad thing).

We tend towards data driven libertarianism (at least intellectually) and skepticism. This is enough to scare away some potential employers!
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This is a nice thing to do for a very early career person, trainee, and/or someone looking to build their social media presence as a professional. I feel like the exposure is an even trade for the work. By dumb social media stats, it is a lot of exposure (given our small field).

Everything is so transactional now, I do not know why physicians continue to just give away their time for free to so many undeserving (and unappreciative) people. ASTRO would never let you have anything for free, why let them have your time for free?

I once suggested they offer these individuals free registration, not a popular idea.
 
NotMattSpraker said:
This is a nice thing to do for a very early career person, trainee, and/or someone looking to build their social media presence as a professional. I feel like the exposure is an even trade for the work. By dumb social media stats, it is a lot of exposure (given our small field).

Everything is so transactional now, I do not know why physicians continue to just give away their time for free to so many undeserving (and unappreciative) people. ASTRO would never let you have anything for free, why let them have your time for free?

I once suggested they offer these individuals free registration, not a popular idea.
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They balked at “free” registration? Ridiculous.
 
NotMattSpraker said:
This is a nice thing to do for a very early career person, trainee, and/or someone looking to build their social media presence as a professional. I feel like the exposure is an even trade for the work. By dumb social media stats, it is a lot of exposure (given our small field).

Everything is so transactional now, I do not know why physicians continue to just give away their time for free to so many undeserving (and unappreciative) people. ASTRO would never let you have anything for free, why let them have your time for free?

I once suggested they offer these individuals free registration, not a popular idea.
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I am not sure young orthopedic or urology trainees would find it equally worthwhile pursuing “exposure” in those fields? Their is an air of desperation when jobs in decent locations are increasingly hard to come by that it would motivate trainees to splash themselves across social media.
 
RickyScott said:
I am not sure young orthopedic or urology trainees would find it equally worthwhile pursuing “exposure” in those fields? Their is an air of desperation when jobs in decent locations are increasingly hard to come by that it would motivate trainees to splash themselves across social media.
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Are you really questioning whether people want exposure? This has always been the case, anytime, anywhere - but certainly in the USA in 2024. Doctors are no exception.
 
drowsy12 said:
Are you really questioning whether people want exposure? This has always been the case, anytime, anywhere - but certainly in the USA in 2024. Doctors are no exception.
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The implication is that young radoncs are desperate for a decent job/location so they need to expose themselves, and this is true. No ortho/urology group or department would give a rats -ss if a trainee was a social media “ambassador”. I am sure there are plenty of radonc chairs who see bootlicking as very desirable quality in a candidate.
 
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Somehow I don’t think these people are going to be competing with me for solo hospital employed jobs in the Midwest cornfields. I’m not personally too worried about their fluffed up CVs of extracurriculars. They can have the coastal academic satellite RVUcontour-monkey jobs, all of them.
 
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