Recent content by BobbyHeenan

THe future and the second and third order effects of this whole thing are hard to predict. I just operate from the heuristic that if the people writing/endorsing this are not actually participating in it, then I don't like it. It's simple, but as Walter Sobchak says, the beauty in this...

I can't remember, was it in the original draft?

yup. I think after all the massaging of the data I've decided that in practical terms with the gel we are looking at a slight drop in % chance they'd need APC coagulation of proctitis (say from ?high single digits to low single digits?) and go from 0% to 1-2% chance of a major major problem.

I get why big rad onc would want protons excluded...but why the superficial thing? Is that just to keep the derm lobby out of this? That's nuts.

There you go. The people writing the bill excluded themselves from any outcome related to this. No skin in the game.

I just quickly skimmed it......re: protons.... this is all I see on protons (from page 29) in reference to some sort of 7-year period/re-evaluation...I can't tell if protons are included now and may come out later, or if not included now but may be put in later.

this bolded above im not a fan of. If they are going to demand accreditation then they should allow for other entities to get involved to introduce more competition/variability/etc...otherwise those three can control prices and have power over things like supervision, staffing, etc.

That accreditation requirement is nuts if it's in there. Our group cover a number of sites, some accredited, some not...and I see zero difference in quality. Can often mean you need to hire more staff to help meet it/do the paperwork and just wait until the prices for accreditation skyrocket...

I still use 5mm on nodes because I'm worried more about toxicity than elective nodal benefit I guess. Hard to be dogmatic on this stuff IMO. I also will under cover if adjacent bowel I'm worried about in elective areas.

Good question. ?shifts to align to prostate that pulls the nodal CTV further into bowel? Though I guess that phenomenon still occurs if you have a sequential plan too? I do this regimen but that is one of the reasons I don't like some of these SBRT/elective nodal/SIB treatments that boost...

Looks like there's more of a difference in stances between ACRO and ASTRO than was implied on the ASTRO town hall, where my sense was these two organizations were more "in agreement."

Tracks with my anecdotal experiences. I've struggled with these cases and ones where we decided to SBRT I've had a number of regional nodal failures. It's so tempting in the PSMA era to just shoot at what you see....but more is lurking... I'd be curious to see if cases with longer disease...

I probably couldn't resist the urge to edit the doc's volumes... "just take off a little off the top on that CTV, no one will notice..." "why TF is this doc treating elective nodes on this palliative pancreas plan...let's just tighten up that margin there, he won't notice...."

We had a dosimetrist not too long ago and I sat down at her computer to work on a plan. SHe had her laptop open beside it as well and I looked at the screen and it wasn't our planning system and I thought I was stroking out. I put it together and she was remote planning another hospital and...

Everything went up in price after covid....except medicare reimbursement.