Richard Shaffer

@ASTRO_org Ok. Would be interesting to know the follow up time and specific response details. It’s particularly important in primary RT in this context as it may rule out (or at least limit) future postop radiotherapy.

New in #practicalRO: Outcomes of Primary Radiotherapy for Patients with Widespread or Unresectable Keloids. #radonc tinyurl.com/protstsai

Average age: Iranian trial = 77 years (Dutch trial = 65y, Russian = 40y). Grade of OA (Kellgren Lawrence): Iran = 1-3, Russian = 0-2, Dutch = 1-3. RT dose-fractionation: Iran 3Gy/6#, Russian 4.5Gy/10#, Dutch 6Gy/6#. Main concerns with the (negative) Dutch trials = pain duration > 5 years in most patients, so that patients were never likely to respond to radiotherapy. Secondary issues - a lot of erosive arthritis, suboptimal RT dose

@DrRShaffer Great to see another RCT supporting the role of low dose radiotherapy in managing osteoarthritis. The consistency in outcomes is promising. Were there any notable differences in patient selection or dose regimen compared to earlier studies?

You CAN start a benign radiotherapy program on your own The biggest problem with doing that? No-one takes you back to basics - The things we all should know - The things we learned 20 years ago - Like how joints actually move It’s the fundamentals that catch people out This is what separates clinical confidence from "winging it" (Yes - we've all done it at some point) Take the elbow Until a couple of years ago, I hadn’t examined an elbow in 25 years Most people remember - Biceps = flexion - Triceps = extension - But how about ROTATION?! That’s a different story Forearm rotation isn’t simple - The radius spins near the elbow - Then arcs around the ulna at the wrist - The ulna? It stays still The radius does all the work - Supination = bones side by side - Pronation = the radius crosses the ulna - That’s how you turn a doorknob or flip your palm But trauma or surgery can trigger heterotopic bone - It bridges the radius and ulna - And blocks that rotation completely - That’s why postop RT is used to prevent prevent heterotopic bone growth But if you don’t understand the anatomy… - You won’t understand the loss of motion - And you won’t place your fields correctly This is why we go back to basics. Because we need them for real clinical mastery 👉 DM me or visit rt-abc.com for more information

@PDBrownOnc **head in hands**

Derm Office Image-Guided SRT for squamous cell carcinoma in-situ is Awesome! Personally I prefer daily PET/MRI adaptive planning, MR linac with proton boost for my squamous cell carcinoma in-situ cases, you can never be too precise gentlecure.com

@EvanThomas84 @ASTRO_org @aapmHQ @DrewMoghanaki @jryckman3 @joshuapalmermd @DrRajuRaval @Raj_Singh_MD Feels very familiar!

We’re doing our best #medphys!

@DrChowdharyMD @SprakerMDPhD @AcceleratorsRO @KoneruMd Really enjoyed listening to this

@DrChowdharyMD @EmoryMedicine @WinshipAtEmory @MohammadKhanMD @soumon_rudra Looks like a great event!

Another RCT showing the effectiveness of LDRT for osteoarthritis

I love teaching But this is the best thing Always hoping you're doing something right "The course in Dusseldorf Germany was one of the best courses I have ever been to in my life. I learned a tremendous amount of information and technique for treating benign diseases with radiation. The material was practical, the lectures were easy to learn from and follow. I highly recommend it to those wishing to add treatment of benign disease into their practice." - Ari Katerelos, Radiation Oncologist, California 👉 DM me or go to rt-abc.com for details of future courses

@KoneruMd Really interesting - thank you for sharing. It does make me think more and more that we need a non-invasive treatment that actually preserves the joint... oh yes - we already have one in low-dose radiotherapy!

🚨 if you have Osteoarthritis, would you get steroid injections into your joint after hearing this? Sign me up for LDRT: pain reduction, slows progression of #osteoarthritis

Just sitting down writing letters from my benign radiotherapy clinic Some are simple cases but some are surprisingly complex I thought that by doing benign RT that it would stop stimulating my brain Previously I mainly treated brain and urological tumours, with all the attendant complications, both medical and emotional But in fact once you really get into the subject there are just as many interesting things to work out In one clinic I've - Requested an MRI of a finger as the "Garrod's pad" turned out to be significant bony swelling on examination - Requested specific MRI sequences for recurrent Ledderhose disease of the foot after radiotherapy - Reassured a patient that the new lump after radiotherapy for Dupuytren's disease is in fact a ganglion - Talked in detail about eccentric exercises, orthotics and reloading for a patient with Achilles tendinopathy who I'm treating with radiotherapy - Dealt with a patient with type 1 diabetes with pain that is likely to be from a combination of osteoarthritis, Dupuytren's and triggering, and trying to work out whether/how I can help This is lifelong learning! For me this is more challenging than treating my 1000th prostate radiotherapy patient So are you ready to start your journey into this strange new world? Send me a DM saying I'M READY and lets chat!