I am currently a radiation oncology resident. My friends in dermatology residencies have brought it to my attention that superficial x-ray treatments for non-melanoma skin cancers are coming back into popularity. Apparently it was the rage in the 1960's and 70's. There are a couple of companies that are marketing these new small orthovoltage machines to dermatologists for around 200k with a company to outsource the physics. They bill simulations and treatment with the same CPT codes that we use. I did not realize that someone other then a radiation oncologist could deliver ionizing radiation, even at superficial kv energies, for the treatment of cancer. Is there an exemption because it is superficial? Do you not even need an exemption? Is it depenedent on the state and if so what states do not require a radiation oncologist? Can anyone do it? Could a neurosuregeon treat a patient with Gammaknife without a radiation oncologist? Thanks.
superficial x-rays
- Thread starter Bequerel
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Don't know about the rest of your paragraph, but definitely a no to this, unless they want the NRC knocking on their door.
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Superficial X-Ray machines are great and lots of fun!
We have one in our clinic and use for treating calcaneal spur, rheumatoid/psoriatic arthritis in the fingers and keloids.
They are also great for elderly patients, you wouldn't like to put on your linac table to treat some nasty basalioma or SCC in an unpleasant region like the head.
Not many patients on the machine, usually about 2 per week or so.
Our dermatologists also use the machine under our supervision, but they are only allowed to treat with up to 20kV, everything above that belongs to us. It's actually fun to see some of the fractionation schedules they use to treat superficial melanoma with 20kV, like 5 x 12 Gy; one fraction per week.
We have one in our clinic and use for treating calcaneal spur, rheumatoid/psoriatic arthritis in the fingers and keloids.
They are also great for elderly patients, you wouldn't like to put on your linac table to treat some nasty basalioma or SCC in an unpleasant region like the head.
Not many patients on the machine, usually about 2 per week or so.
Our dermatologists also use the machine under our supervision, but they are only allowed to treat with up to 20kV, everything above that belongs to us. It's actually fun to see some of the fractionation schedules they use to treat superficial melanoma with 20kV, like 5 x 12 Gy; one fraction per week.
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One of the local derm practices where I am recently acquired the Sensus machine. It does not require an authorized user and is not fall under CON regulation. They do not have any on-site physics. I had our billing people look into this. The codes used for SRT sim and tx are rarely used codes (billed <10 times in the state in 2011), and do not overlap with those used for more complex treatments in Rad Onc. I don't think that it is influencing referrals either, as they are using it almost excusively for patients who previously would have had surgery. I cautioned them about the very superficial depth and absence of geometric penumbra with SRT, but I'm not sure that they understood the physics of this discussion (scary!). Definitely an encroachment on our territory, but far less concerning in my estimation than a neurosurgeon doing SRS.
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looks like they are hiring in SoCal now....
"Radiation Oncologist for multiple dermatology based radiatoin facilities in the Southern California area. PT or FT.
BC or BE"
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This is probably Xoft which is technically (non-isotope) brachytherapy and requires Rad Onc supervision. ROs are not needed with Sensus as TarHeel noted above.
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