liradonc

@KoneruMd @ASTRO_org Important, because as per Bridge Oncology, LDRT will no longer be covered for OA by Evicore and Aetna starting November. I’m curious as to how this is even possible…

We just found out our work will be presented at the ASTRO 2026 Plenary Session. Not a poster. Not a breakout. The Plenary. Low-dose radiotherapy for knee osteoarthritis with sustained clinical benefit, MRI-confirmed outcomes, 13-year randomized data. Stay tuned. @ASTRO_org

@TylerSbrt7 Great thread. Are you using crib+ to counsel against surgery in patients who are otherwise candidates for RP?

12 🔎Early detection must find crib+ #ProstateCancer ⚠️Crib+ may need multimodal treatment 🤔Crib- GG2 may be the new GG1

🚨The sequel is here!! The other 👞 drops. Cribriform morphology in ProtecT — now in prostatectomy specimens #ProstateCancer #radonc #UroSoMe @UroToday @APCCC_Lugano @PCF_Science @OncoAlert 🧵1️⃣

@jryckman3 @TonyFelefly @PDBrownOnc @JoachimYahalom @brandon_imber @NCCN For TN and Her2neu+ specifically I mean

@jryckman3 @TonyFelefly @PDBrownOnc @JoachimYahalom @brandon_imber @NCCN Agree, guidance is limited. But I’ve not been offering RT in this setting based on ASTRO refresher course

Editorial PCNSL Low dose WBRT: · Better cognitive outcomes (due to better CNS control?) · >60yo OS benefit · Consider LD-WBRT if not good transplant candidate · LD-WBRT is a modern consolidative therapy Contact your NCCN Reps to fix guidelines sciencedirect.com/science/articl…

@DrMedPhys @MadMen_AMC @aapmHQ @medicalphysics Rewatching Mad Men now. I thought I had dreamt this 😂

Noticed a vintage Varian ad on @MadMen_AMC last night. Apparently Draper was a fan of med phys. @aapmHQ @medicalphysics @VarianMedSys

@Alan_Couzens Any specific advice for diabetics for increasing exercise tolerance? (Aside from maintaining good glucose control).

The game is simple: 1/ Find your courses. 2/ Set your heart rate cap. 3/ Progressively improve your times at that cap. 🏃‍♂️ Some days you win. Some days you lose. But, like Vegas, so long as you win more than you lose, you come out on top! 🎰

@CanesDavid Have seen it go to 3+4=7, which is...quite the change

Does anything signal the need pathology second opinion quite like Gleason 3+5=8?

This is exactly what happened in 1974 -- we have tried permanent daylight saving time before, and the House repealed it after a few months by a vote of 383-16 because it was widely hated. But some people refuse to learn history. joshbarro.com/p/this-week-in…

@KoneruMd Do you order MRI for patient selection?

Not every arthritic knee is a good candidate for low dose radiotherapy. The ones that respond best usually show a specific pattern, on imaging and on exam. On MRI, I'm looking for signs of active inflammation, not just wear and tear: → Bone marrow edema → Synovitis → Effusion These suggest the joint still has an inflammatory driver we can influence. LDRT works on inflammation, not on bone that has simply worn away. On physical exam, I'm ruling out mechanical causes of pain first: → Meniscal tears with locking or catching → Ligamentous instability → Significant malalignment driving focal overload If the pain is mechanical, radiation isn't going to fix that. That patient needs a different conversation, sometimes ortho, sometimes PT, sometimes both. Patient selection is the difference between a treatment that works and a treatment that just gets tried. The more precise we get about who responds, the more we can honestly say LDRT belongs earlier in the disease course, not as a last resort before joint replacement. That's the work right now. Getting the selection criteria right, and being honest when the answer is "not you."

@DrewMoghanaki @AmLungCSI Sigh, I feel like we’re going in circles washingtonpost.com/style/2026/07/…

Please share this with everyone you know who smokes or used to smoke cigarettes. It might save their life! @AmLungCSI mythsmashers.nikvj.org

@drjohnm Is there anyone you would recommend get a CAC scan?

A) We don’t know how he died. It could have been PE after a long flight B) There’s a 90% chance that Mr Graham had coronary calcium based on age C) There’s exactly zero evidence that intervention on coronary disease absent acute symptoms prevents MI or death. D) Mr Gerstner understands business and I laud him for invest America, but he and many of his colleagues fundamentally misunderstand heart disease

@RadOncDoc_Niema Can the radiologists use a still of this to point out relevant findings?

Other specialties blaming #radonc whenever there’s a side effect

@TylerSbrt @kluwemdphd No other adverse features. Agree, reluctant to commit to long term ADT based on an MRI finding.

@liradonc @kluwemdphd Never long term. 0 vs 4-6, depending on other factors (eg, would add ADT if cribriform/IDC or high Decipher, assuming healthy patient with long life expectancy)

Clear SVI on MRI and PSMA PET. How do you document stage? Poll 👇🏼

@TylerSbrt @kluwemdphd What duration ADT are you using for low volume 3+4 dz with clear ECE, on MRI only? Unusual situation but have seen it more than once.

@kluwemdphd Yeah, that’s a mistake. And sometimes long-term ADT!

@oncodaily @jryckman3 @MuzamilArshad18 why am I still seeing this? Shouldn't your original tweet be deleted?

We do recognize the misinterpretation that the title could cause and we sincerely apologize for the faulty title. The article was never supposed to damage anyone’s reputation, but rather highlight a healthy argument and critical appraisal around a major topic in oncology. We will update the title on our website to highlight our intentions. Thank you for calling it out.

Dong Nguyen Calls Out Jeff Ryckman on Misinformation Regarding PROTEUS Study @DongNguyeb @jryckman3 oncodaily.com/voices/dong-ng…

@SprakerMDPhD @drbeckta @jryckman3 Agreed, don’t plan to order one any time soon. Just thought it was interesting that some thought leaders implied that they do.

@drbeckta @liradonc @jryckman3 The boards answer! The ABR would be so jacked. I would order one if a patient came to me for LDRT but osteosarcoma was also in the differential. This hasn't come up, even for me.

What says @hjluks ? 🧐

@KoneruMd @jryckman3 @hjluks @SprakerMDPhD

@liradonc @jryckman3 @hjluks MRI is very valuable. There is so much we simply can’t see on a plain film…but ultrasound may become a valuable tool for MSK that is currently underutilized.

@SprakerMDPhD @jryckman3 @drbeckta Sounds appropriate. But I did have a patient who had a complete response in one knee, and no response in the other. Similar X-rays findings in both knees. Wondering if MRI would have told a different story.

@jryckman3 @liradonc @drbeckta I saw the MRI comments and was just surprised. Guideline diagnosis and LDRT trial enrollment have both been clinical and x-ray based. Data doesnt really support using MRI to select for injection either. Should be considered only occasionally useful until proven otherwise?

@SprakerMDPhD @jryckman3 @drbeckta Yes to the podcast 😊

@jryckman3 @liradonc Ha, I have so many thoughts. Probably needs an updated podcast with @drbeckta 😀 MRI not wrong, just feels spendy to select for LDRT. Check out ultrasound for identifying synovitis, too. I went down a fun POCUS regulatory rabbit hole once. Hard for the average RO to do it.

@jryckman3 I thought MRI was overkill as well. But between @hjluks opinion and something @KoneruMd said on LinkedIn: “ On MRI, I'm looking for signs of active inflammation, not just wear and tear: → Bone marrow edema → Synovitis → Effusion”, I wonder

Of course! I typically see traditional OA as we do not currently have Rhuem at my network site. Once we do get Rheum, I will reach out, and I'm sure I will start to see more inflammatory pictures once RA, PsA, gout, CPPD, infection, etc, are ruled out. Generally speaking, I'm comfortable with clinical OA and a concordant X-ray showing OA. I haven't used an MRI in these settings, but I would consider it if radiographs are equivocal, or there is suspicion of true inflammatory arthritis (synovitis, tendosynovitis, early erosions not yet visible on film). Perhaps U/S would be a more practical first step (consider MRI for larger joints), though, as it would show active synovitis and erosions well in the hands. The claim that inflammatory OA responds better to LDRT is mechanistically plausible but not well proven After thinking about it for a bit, I have seen perhaps 1-2 cases of hand inflammatory OA over the past few years affecting PIP/DIPs with abrupt onset, marked pain, soft-tissue swelling, erythema, stiffness, and mildly elevated CRP, with radiographic sunchrondral erosions and cortical destruction. These cases did have great responses. Apparently, the inflammatory OA picture can be difficult to distinguish from RA, though the DIP joint predilection and absence of MCP involvement help to distinguish. But if any doubt, I would send to Rheum to help differentiate, as the lion's share of my workload is cancer, and I prefer to phone a friend with unusual clinical benign pictures, even though LDRT may still be beneficial in such scenarios. I know some people may advocate for MRI in the setting of LDRT for OA to determine response or phenotype, but I think this may be overkill; I remain open-minded and willing to reconsider, as always. Interested in @SprakerMDPhD's take here as well