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Insurance fun
Just got a denial for SBRT or even IMRT for a patient with a history of prostate cancer presenting with a single painful met to T5. No other sites of disease. On its face, I would say I am not surprised but the physician doing the peer-to-peer went on to tell me they only approve SBRT or IMRT for isolated bone mets for breast, lung, or melanoma but not prostate. Are they flipping coins to decide what level of evidence is enough? So frustrating. I don't know about anyone else but the number... Insurance fun (Source: Student Doctor Network)
Source: Student Doctor Network - June 16, 2020 Category: Universities & Medical Training Authors: ramsesthenice Tags: Radiation Oncology Source Type: forums

ASCO 2020 - Interesting abstracts
This year's ASCO is virtual. Any interesting abstracts seen? Meeting Library | Meeting Library meetinglibrary.asco.org Proven benefit of IMRT to spare swallowing function in H&N cancer Meeting Library | Meeting Library meetinglibrary.asco.org Randomized dose deescalation after TORS for P16 H&N cancer Meeting Library | Meeting Library ...
Source: Student Doctor Network - May 28, 2020 Category: Universities & Medical Training Authors: Palex80 Tags: Radiation Oncology Source Type: forums

Planning guides for IMRT hippocampal sparing IMRT
Does anyone have some good dosimetry guidelines for hippocampal sparing IMRT WBRT? We are trying to adopt this in our practice given the recent Ph III data and my dosimetrists are having to use 9 Arc plans to meet constraints. As much as I want to adopt this, 9 arcs for whole brains is not feasible for my throughput. Would appreciate input from those who have been able to get this accomplished with less arcs. Thank you (Source: Student Doctor Network)
Source: Student Doctor Network - April 23, 2020 Category: Universities & Medical Training Authors: Tigerstang Tags: Radiation Oncology Source Type: forums

Preferred bladder approach
I feel like definitive bladder is one of the most variable things in terms of how people treat. Dose/fx, fields, empty or full, IMRT or 3D? How do you guys prefer to do it? (Source: Student Doctor Network)
Source: Student Doctor Network - April 13, 2020 Category: Universities & Medical Training Authors: PhotonBomb Tags: Radiation Oncology Source Type: forums

From a Billing Perspective...
In terms of Pro fees only, how many IMRT fractions provides more billing than an SBRT course? Ie. At what point does IMRT pass SBRT? I’m sure someone has done the math before. My Guess is somewhere around 15 frac? (Source: Student Doctor Network)
Source: Student Doctor Network - March 29, 2020 Category: Universities & Medical Training Authors: radoncgrad2019 Tags: Radiation Oncology Source Type: forums

IMRT for esophagus and lung
do you guys routinely utilize IMRT for esophageal and stage III lung cancers for patients with private insurance? If you always do IMRT - do you always submit a 3D comparison plan and what kind of metrics do you make sure to demonstrate to justify IMRT? (v20 percentage drop, etc) thanks (Source: Student Doctor Network)
Source: Student Doctor Network - January 31, 2020 Category: Universities & Medical Training Authors: radoncgrad2019 Tags: Radiation Oncology Source Type: forums

Can we bill out CBCT when we do IMRT?
Can we bill CBCT (77014) when we do IMRT? I know technical doesn't allow it but what about professional? (Source: Student Doctor Network)
Source: Student Doctor Network - January 14, 2020 Category: Universities & Medical Training Authors: XRT_doc Tags: Radiation Oncology Source Type: forums

Voluntary residency contraction and the development of IMRT saved the field in the early 2000s: an analysis of the past 30 years
As an upfront warning: this might be the longest post in the history of Student Doctor Network (probably not true - but this is a dissertation). Something I’ve heard a lot in both real life and online is the sentiment that the “sky has always been falling in Radiation Oncology”. Indeed, there have been concerns over the job market for as long as I can remember. When I was first looking at the field in the late 2000s, it was widely known and freely shared with me that there were tremendous... Voluntary residency contraction and the development of IMRT saved the field in the early 2000s: an analysis of the past 30 ye...
Source: Student Doctor Network - November 25, 2019 Category: Universities & Medical Training Authors: elementaryschooleconomics Tags: Radiation Oncology Source Type: forums

Daily imaging poll
Just want to get a sense of what kind of patients people are doing daily CBCT for when doing IMRT. Head and neck seems standard, CNS, prostate patients. Do you guys standardly do for all lung patients? When you are doing daily CBCT, do you guys get any other 2d images on any of the fractions? (Source: Student Doctor Network)
Source: Student Doctor Network - October 4, 2019 Category: Universities & Medical Training Authors: xrthopeful Tags: Radiation Oncology Source Type: forums

Insurance denial-standard fx low risk prostate
Wondering if this has happened to others...insurance denied 45 IMRT for low risk prostate CA. Only approving 28 fractions...Is breast next? (Source: Student Doctor Network)
Source: Student Doctor Network - March 4, 2018 Category: Universities & Medical Training Authors: Reaganite Source Type: forums

Direct supervision vs personal supervision SRS/SBRT
Question for the group. I understand that “direct supervision” is a gray area in some centers. But, I think we all can agree that the safest way to absolutely avoid fraud charges from CMS is to have a rad/Onc on-site (AKA in the department) while the beam is on. My question concerns Radiosurgery. The provider is in the department and immediately “interruptible for direct supervision” rules to oversee the procedure (just like is typical for IMRT/CBCTs). Do you need to be literally at the... Direct supervision vs personal supervision SRS/SBRT (Source: Student Doctor Network)
Source: Student Doctor Network - February 12, 2018 Category: Universities & Medical Training Authors: firewicket Source Type: forums

Prostate cancer IMRT - no difference between daily IGRT and weekly KV
http://www.thegreenjournal.com/article/S0167-8140(17)32680-4/fulltext Interesting Phase 3 study. All patients received dose escalated IMRT to prostate (78 Gy in 39 fractions) with either daily CBCT (7 mm margins) or weekly orthogs (15 mm! margins). No difference in patient reported toxicity. (Source: Student Doctor Network)
Source: Student Doctor Network - February 11, 2018 Category: Universities & Medical Training Authors: Gfunk6 Source Type: forums

Tomo better than RapidArc
Clinical Outcomes of Several IMRT Techniques for Patients With Head and Neck Cancer: A Propensity Score–Weighted Analysis Filed under "How'd I Miss This." You know you wonder about these things. In your mind you think every IMRT/VMAT treatment machine is just a scalpel: a blade is a blade is a blade. Maybe not? I don't know. The study can't answer the question definitively. But still. Pretty interesting result I... Tomo better than RapidArc (Source: Student Doctor Network)
Source: Student Doctor Network - January 19, 2018 Category: Universities & Medical Training Authors: scarbrtj Source Type: forums

todays wsj
While we beat ourselves up over IMRT/fractionation, it has nothing on the robot: Robot-Assisted Surgery Costs More But May Not Be Better and well written editorial on robotic prostatectomy: Robotic-Assisted Radical Prostatectomy: Who Is Benefiting? | Cancer Network | The... todays wsj (Source: Student Doctor Network)
Source: Student Doctor Network - November 1, 2017 Category: Universities & Medical Training Authors: nkmiami Source Type: forums

PSMA and treatment of micromets
My urologists have started sending like everyone with a rising PSA for PSMA testing. Today I got a referral for these teeny tiny retroperitoneal nodes. Technically, would be amenable to a small IMRT field. I got another referral today for two super small but avid lung nodules. I have no idea what to do with this. Would you guys be SBRTing the lung nodules and treating the LN's?! (Source: Student Doctor Network)
Source: Student Doctor Network - June 17, 2017 Category: Universities & Medical Training Authors: napoleondynamite Source Type: forums