Luis Carrascosa

If your doctor doesn’t have time to answer your questions, perhaps he/she shouldn’t be your doctor #radonc #bcsm #lcsm

@drbeckta @SprakerMDPhD @Icro_Meattini @Sushilberiwal @CShahMD I use SGRT with DIBH on APBI with VMAT. I do create an ITV and add 5mm for PTV

Answer: Other This is why I prefer FAST and FAST-Forward over APBI. In actual, physical reality, you cannot standardize a PTV expansion for APBI. Why? Because of motion of breathing. Now, you implied "continuous" SGRT, which is something I don't have access to. Theoretically, it could account for breathing motion - but you would have to plan it that way up front. I'll go out on a limb and assume A) Most RadOncs don't practice in a place with continuous SGRT, and B) Even those who do likely don't use it right. Of course, by strict defintions, if you are accounting for motion upfront - i.e., doing a 4D scan or equivalent - you would be making an ITV from that data, not a PTV. So now I want to know: who's out here making ITVs for APBI, as would be best? And then the poll should be: what's your ITV-to-PTV expansion?

A Clinical Q for Rad Onc Breast APBI, 30 Gy in 5 fractions prescribed to PTV, delivered with *daily CBCT and continuous SGRT* CTV = Clips/Seroma + 10 mm What is your PTV expansion? @Icro_Meattini @Sushilberiwal @CShahMD

@drmoneymatters Follow the money. Goes to med staff fund for each individual hospital in my experience

Hospital credentialing for telemedicine is a disaster! Why does every little hospital in a health system requires separate credentialing? Who is disrupting this?

@toddscarbrough @ASTRO_org Our dues at work. Like they didn’t have anything more important to do with their time (which we pay for), such as fixing the mess they have created. Sorry to see you have had to waste your time having to respond to such nonsense.

So silly BE THAT AS IT MAY... An attorney's response re: @ASTRO_org's letter ~Peace & love~

@drbeckta @evicorehc Evilcore!

Ah this is my favorite argument I've had with @evicorehc too. For those who are unaware, they choose to define 2D vs 3D as "generating a DVH". Literally all TPS products in current use generate a DVH by default. The "peer" claims their hands are tied due to policy...

@PDBrownOnc @AcceleratorsRO Agree very interesting and helps put things in perspective.

Interesting @AcceleratorsRO podcast on supervision. podcasts.apple.com/us/podcast/the…

@KColvett There is a guy doing BID for many weeks with photons at 100-110 cGy per fraction for melanoma, breast, prostate, GBM, and anything else he can, claiming it’s “gentler”, maybe gentler to his bank account . Rad onc being given a bad rep due to a few profit motivated bad actors

Proton boys down the road advised 33 fx of protons for a 3 mm basal cell ca on the chin. I gave five fx with 50 kvp. Spot’s gone (naturally) and cosmesis is ideal. Probably came in at 1% of the charges. This goes way past unethical and into criminal/sinful. Bastards.

@toddscarbrough @CNN @astro @cnn sledgehammer special treatment procedure

NEWSFLASH: Feb 20, 2024 @CNN Recommending Special Treatment Procedure CPT 77470 in *ALL* Radiotherapy Cases @ASTRO take note!

@SprakerMDPhD Agree, that is why I’m part of a physician led group where I have experienced what good MD leadership can accomplish

@flradonc I think its important for organizations that claim to represent doctors to have a doctor in the top leadership role. Not an administrator who used to lobby for insurance companies or hospitals.

The new ASTRO CEO should be an MD.

@A_Dove5 @jryckman3 Please share if possible

Hello #radonc Twitter community, I'm reaching out to see if anyone has a one-page summary on the application of low dose radiation therapy for treating osteoarthritis or plantar fasciitis. I've just completed filming an informative commercial highlighting RT's… 1/2

@EvanThomas84 @AnthemBCBS @ASTRO_org @the_RSS @ISRSy @JohnRAdler @DrewMoghanaki @OSUWexMed @DalmBrian @VarianMedSys @ZapSurgical @Accuray Which proves peer review is just a waste of time

@AnthemBCBS @ASTRO_org @the_RSS @ISRSy @JohnRAdler @DrewMoghanaki @OSUWexMed @DalmBrian @VarianMedSys @ZapSurgical @Accuray @AnthemBCBS This afternoon, your medical director reviewed the literature prior to our peer to peer, and we had a very pleasant discussion, and he approved the treatment. Thank you!

1/N @AnthemBCBS just denied authorization for #SRS for one of my patients with medically refractory OCD. But I’m sure it’s an honest lack of awareness! 🧠💡 “Breaking the Chains of OCD: The Promise of Stereotactic Radiosurgery” - A thread on a groundbreaking treatment for those battling severe OCD. #MentalHealthAwareness #OCDTreatment

@MorrellMDmph @VPrasadMDMPH @AaronGoodman33 Wait, did you really think XRT is only used for malignancy?

@VPrasadMDMPH @AaronGoodman33 Wait, did we really radiate malignancy-free brains… without a control arm?

Like all great studies.... .... no control arm

@Edgar_Balsells Ya te acurruchichaste lo del dinerario

Muy acomodados con su macroeconomía estable a base de remesas a ver que dicen los del poder dinerario ahora

@ParikhSimul @evicorehc Evilcore would like for us to tape the forehead and use a lead block for the eye and hope for the best like we did in the 90’s (and before), that is what 2D is!! It is a shame they even utter the words 2D in late 2023. wake up #radonc

@jmmrad @seanmmcbride @ParikhSimul @MWeismanMD @ASTRO_org @DigiaimoRon @WashURadOnc Dr. Michalski, I respect your work, we have met a couple of times. Very different academic vs private practice. We need to act as a specialty to improve RadOnc recognition and valuable role

@flradonc @seanmmcbride @ParikhSimul @MWeismanMD @ASTRO_org @DigiaimoRon @WashURadOnc Nice to meet you Dr. Carrascosa! I get your point, relationship w referring is critical. We equip our trainees w knowledge to prescribe and manage associated toxicity or complications. Whether they choose to make it part of their practice depends on many factors, as you highlight

@ParikhSimul @jmmrad @seanmmcbride @MWeismanMD @ASTRO_org @DigiaimoRon @WashURadOnc Exactly, we need to help each other at the specialty level rather than looking down on some

@jmmrad @seanmmcbride @ParikhSimul @MWeismanMD @ASTRO_org @DigiaimoRon @WashURadOnc I get your point, but this is academic arrogance a la ASTRO. Do you think every #radonc can do that without burning referral sources??

@ParikhSimul @MWeismanMD @ASTRO_org @DigiaimoRon @WashURadOnc we administer all ADT for our prostate patients, incl 2nd gen like abi/pred, apa, daro, etc. Adminster RPTs for CRPCa, manage toxicities and dose mods. Also, on trials administer PARPi. We do the hydrogel, markers, and even TP biopsies for patients that need them.

@ProtonStorey @jryckman3 @NCCN @ASTRO_org @ACRORadOnc I’m willing to be proven wrong. And also wiling to help

@flradonc @jryckman3 @NCCN @ASTRO_org @ACRORadOnc They are very open to adding this as a specific effort in my initial discussions. NCCN really drives so many payment decisions.

Equity in specialty representation on @NCCN is vital across all disease sites. 4 #RadOnc 11 #SurgOnc 21 #MedOnc It's unjust to expect underrepresented specialists to do more heavy lifting to make up for imbalances. The solution? Balanced representation across specialties.

@ProtonStorey @jryckman3 @NCCN @ASTRO_org @ACRORadOnc Astro assist? I would be shocked

@jryckman3 @NCCN I think this is a place where @ASTRO_org and / or @ACRORadOnc could maybe assist by helping to work on our access to these panels. And certainly the members we have, need to have it as a priority item to push from the inside.

@toddscarbrough Like the guy in Florida treating prostate BID because it’s more gentle- to his checkbook

Hypofrac RT for prostate cancer #radonc? Not this Halloween. Scary BOO. Disapproving BOO. oregonurology.com/radiation-ther…