out.of.the.basement / radiation.medicine

Episode Four (part...one?) of the “Real World LDRT” miniseries (sponsored by Xstrahl) gets more into the evidence behind LDRT. Specifically, the two RCTs out of the Netherlands published a few years back showing that LDRT had no benefit in osteoarthritis. So...couple small problems with that. Namely, the trials had less than 30 patients in each arm, used too high of a dose, used only half the standard treatment, and...oh, yeah. In the LDRT arm in one of the trials, 2/3rds of the patients had >5/10 pain for >15/30 days per month despite analgesics/therapy for >5 years. That's VERY severe pain, by any definition. ...and: One of the primary outcome criteria was "greater than 50% relative improvement in pain/function AND >20 points in absolute improvement" on their specific measurement tool. ...and: "...both studies were powered to detect a large effect of low-dose radiation therapy. Using the primary outcome, allowing for a 15% dropout rate, [they] aimed to include 27 patients per group, assuming an expected difference of 40% in the proportion of responders between the low-dose radiation therapy and sham intervention groups, 80% power and 5% α level, and that 40% of the sham intervention group would be responders..." Is there any intervention on Planet Earth that would show a positive signal with a design like this? Please. Please. Please stop citing these trials. *** Brought to you in part by Xstrahl, modern manufacturers of orthovoltage devices. Visit them at ⁠⁠⁠⁠https://xstrahl.com/⁠⁠⁠⁠ *** OOTB, produced by Photon Media, is made possible by Cold Light Legacy, a 501(c)(3) nonprofit that thrives on community support. jason@coldlight.org --- Support this podcast: https://podcasters.spotify.com/pod/show/radmed/support

On April 5th, 2024, ASTRO held an actual, honest-to-goodness "town hall" style virtual meeting with ~200 members of the Radiation Oncology community showing up to make their voices heard. Yowza. There's a reason this took me over a week to make and clocks in at almost two hours. Buckle up for a very special Cold Light episode as we "watch the watchers" and explore the topic of virtual supervision discussed in a virtual meeting. *** OOTB, produced by Photon Media, is made possible by Cold Light Legacy, a 501(c)(3) nonprofit that thrives on community support. jason@coldlight.org --- Support this podcast: https://podcasters.spotify.com/pod/show/radmed/support

Episode Three of the “Real World LDRT” miniseries (sponsored by Xstrahl) is everyone's favorite topic: coding and billing! [insert the sounds of a gleeful studio audience here] The secret sauce is to remember you can bill it like normal (ideally, 2D or "complex isodose"). The radiotherapy CPT codes are disease agnostic (no, they're not just for cancer - heard that one before). But importantly - as doctors primarily treating cancer, we don't realize how massive the burden of osteoarthritis is for the American population. The even more secret sauce? LDRT is, by far, the most economical treatment option to both the patient, and the healthcare system as a whole. Remember: 3 Gy in 6-every-other-day fractions, assess at 12 weeks, and deliver a second identical course if necessary/desired. It really is that easy. *** Brought to you in part by Xstrahl, modern manufacturers of orthovoltage devices. Visit them at ⁠⁠⁠https://xstrahl.com/⁠⁠⁠ *** OOTB, produced by Photon Media, is made possible by Cold Light Legacy, a 501(c)(3) nonprofit that thrives on community support. jason@coldlight.org --- Support this podcast: https://podcasters.spotify.com/pod/show/radmed/support

Episode Two of the “Real World LDRT” miniseries (sponsored by Xstrahl) is all "meat and potatoes", as the kids used to say (back when FDR was president). I start with a high-level overview of the laboratory evidence for LDRT, followed by how to get your first patient and what you say to them when they ask "how does this work??" Hint: it's like NSAIDs and prednisone, just a different pathway. We then explore my favorite CTSIM setups and target volumes/PTVs. Remember: 3 Gy in 6-every-other-day fractions, assess at 12 weeks, and deliver a second identical course if necessary/desired. It really is that easy. Find the presentation/slides for this episode at: Beckta, Jason (2024). Getting started with radiation therapy for arthritis - mechanisms, getting your first patients, setups, treatment planning. https://doi.org/10.6084/m9.figshare.25546417.v1 *** Brought to you in part by Xstrahl, modern manufacturers of orthovoltage devices. Visit them at ⁠⁠https://xstrahl.com/⁠⁠ *** OOTB, produced by Photon Media, is made possible by Cold Light Legacy, a 501(c)(3) nonprofit that thrives on community support. jason@coldlight.org --- Support this podcast: https://podcasters.spotify.com/pod/show/radmed/support

Episode One, Part Two of the “Real World LDRT” miniseries (sponsored by Xstrahl) circles back to the 1940s and the extraordinary flaws of the "linear no threshold" (LNT) model of radiation risk. We explore backroom deals, handshake science, corporate greed, regulatory capture, hormesis, OSHA violations, putting radium in the throats of 2.5 million children...you know, the regular, everyday stuff. Why? Because a common hesitation to deploying LDRT for arthritis is the risk of the treatment itself causing cancer. Spoiler alert: there has never been a case of secondary malignancy from therapeutic radiation below a magical threshold dose. And LDRT stays below that threshold. Don’t believe me? That’s why this miniseries exists! Relevant papers and sources at ⁠http://u.pc.cd/OhN⁠ Brought to you in part by Xstrahl, modern manufacturers of orthovoltage devices. Visit them at ⁠https://xstrahl.com/⁠ OOTB, produced by Photon Media, is made possible by Cold Light Legacy, a 501(c)(3) nonprofit that thrives on community support. jason@coldlight.org --- Support this podcast: https://podcasters.spotify.com/pod/show/radmed/support

Kicking off the “Real World LDRT” miniseries sponsored by Xstrahl, Episode One/Part One takes us all the way back to 1895 and Wilhelm Roentgen aiming his newly discovered “X-rays” at his wife’s hand. Within 3 years, radiotherapy was treating arthritic conditions in Europe before coming to America in 1906. By 1930, the scientific literature contained more than 6,000 patients treated by LDRT for arthritis (and other degenerative inflammatory conditions) - with orthovoltage techniques accounting for most (if not all) reports. Today, a common concern preventing the use of radiotherapy for arthritis in every practice in America is the alleged “lack of evidence”...an odd complaint for one of the only therapies in use for ~125 years with tens of thousands of patients experiencing excellent outcomes. Don’t believe me? That’s why this miniseries exists! Relevant papers and sources at http://u.pc.cd/OhN Brought to you in part by Xstrahl, modern manufacturers of orthovoltage devices. Visit them at https://xstrahl.com/ OOTB, produced by Photon Media, is made possible by Cold Light Legacy, a 501(c)(3) nonprofit that thrives on community support. jason@coldlight.org --- Support this podcast: https://podcasters.spotify.com/pod/show/radmed/support

On January 9th, 2024, a blog post announced some groups were interested in protecting Medicare reimbursement. Neat. OOTB, produced by Photon Media, is made possible by Cold Light Legacy, a 501(c)(3) nonprofit that thrives on community support. jason@coldlight.org --- Support this podcast: https://podcasters.spotify.com/pod/show/radmed/support

"If we are to have any hope of advancing rational beliefs against the riptide of myside bias, primitive intuitions, and mythological thinking, we must safeguard the credibility of these institutions. Experts such as public health officials should be prepared to show their work rather than deliver pronouncements ex cathedra. Fallibility should be acknowledged: we all start out ignorant about everything, and whenever changing evidence calls for changing advice, that should be touted as a readiness to learn rather than stifled as a concession of weakness." - Reason To Believe, January 2023 OOTB, produced by Photon Media, is made possible by Cold Light Legacy, a 501(c)(3) nonprofit that thrives on community support. jason@coldlight.org --- Support this podcast: https://podcasters.spotify.com/pod/show/radmed/support

"If we are to have any hope of advancing rational beliefs against the riptide of myside bias, primitive intuitions, and mythological thinking, we must safeguard the credibility of these institutions. Experts such as public health officials should be prepared to show their work rather than deliver pronouncements ex cathedra. Fallibility should be acknowledged: we all start out ignorant about everything, and whenever changing evidence calls for changing advice, that should be touted as a readiness to learn rather than stifled as a concession of weakness." - Reason To Believe, January 2023 OOTB, produced by Photon Media, is made possible by Cold Light Legacy, a 501(c)(3) nonprofit that thrives on community support. jason@coldlight.org --- Support this podcast: https://podcasters.spotify.com/pod/show/radmed/support

Finally. The time has come to discuss "the changes". On November 1st, 2019, CMS announced that hospital outpatient procedures would be moving to "General Supervision". Of course, this broke our dogma, which...well, we don't deal with that well. Then, the PHE brought us "virtual direct supervision" with real-time A/V communication. In Episode Three of the Supervision Series, we cover the switch from direct to general, the specious argument that "IGRT is diagnostic", the specious argument that "you can't bill for professional work done off-campus", and the final two supervision cases in Radiation Medicine: the Maryland case (settled for...$300,000) and a previously unknown Kentucky case (technically ongoing, but the judge was kind enough to write lengthy opinions pre-emptively agreeing with everything I've ever said). OOTB, produced by Photon Media, is made possible by Cold Light Legacy, a 501(c)(3) nonprofit that thrives on community support. jason@coldlight.org --- Support this podcast: https://podcasters.spotify.com/pod/show/radmed/support

Finally. The time has come to discuss "the changes". On November 1st, 2019, CMS announced that hospital outpatient procedures would be moving to "General Supervision". Of course, this broke our dogma, which...well, we don't deal with that well. Then, the PHE brought us "virtual direct supervision" with real-time A/V communication. In Episode Three of the Supervision Series, we cover the switch from direct to general, the specious argument that "IGRT is diagnostic", the specious argument that "you can't bill for professional work done off-campus", and the final two supervision cases in Radiation Medicine: the Maryland case (settled for...$300,000) and a previously unknown Kentucky case (technically ongoing, but the judge was kind enough to write lengthy opinions pre-emptively agreeing with everything I've ever said). OOTB, produced by Photon Media, is made possible by Cold Light Legacy, a 501(c)(3) nonprofit that thrives on community support. jason@coldlight.org --- Support this podcast: https://podcasters.spotify.com/pod/show/radmed/support

In Part One, we discussed definitions...for an hour. A literal hour. Yowza. Now, we're going to talk about the consequences. Specifically, the qui tam ("whistleblower") cases, and my (least) favorite journalist Walt B. over there at that newspaper in NYC. This is definitely going to take at least one more episode, so...enjoy Part Two of "I want to speak to your supervisor"! OOTB, produced by Photon Media, is made possible by Cold Light Legacy, a 501(c)(3) nonprofit that thrives on community support. jason@coldlight.org --- Support this podcast: https://podcasters.spotify.com/pod/show/radmed/support

Ah, the enigmatic topic of supervision in Radiation Medicine. Are we beholden to direct supervision? General supervision? Virtual direct supervision through the use of real-time audio/visual communication? Is there are problem with site of service? "Incident to" billing? Does anyone really know? Rather than create another 10-hour monolith, this episode is Part One of...well at least two episodes, exploring one of the most controversial topics in our field. OOTB, produced by Photon Media, is made possible by Cold Light Legacy, a 501(c)(3) nonprofit that thrives on community support. jason@coldlight.org --- Support this podcast: https://podcasters.spotify.com/pod/show/radmed/support

Have you ever heard the phrase "there's not a supply problem, there's a distribution problem"? Did you grow up in an urban area, go to school in an urban area, perhaps train and practice in an urban area? Have you ever held your head up a little higher talking about how you're a "specialist at the main campus" when trying to get records from an "outside hospital"? In this special Thanksgiving episode inspired by listening to my Photon Friends interview David Chang, we "pierce the veil" on being in the "small market". OOTB is produced by Photon Media, a project of the 501(c)(3) nonprofit Cold Light Legacy. jason@coldlight.org --- Support this podcast: https://podcasters.spotify.com/pod/show/radmed/support

It's easy to forget how quickly things are forgotten. The zeitgeist of the Medicine World feels shared when you're in med school and residency, and there's an assumption that it will always be the way you remember it. Of course, this is not true, and it can quickly lead to folks "talking past each other". If you're a resident, med student, or just an observer: do you hear the phrase "an institution cannot love you back" and are confused as to why it seems like you're supposed to know what that means? This episode is for you! OOTB is produced by Photon Media, a project of the 501(c)(3) nonprofit Cold Light Legacy. jason@coldlight.org --- Support this podcast: https://podcasters.spotify.com/pod/show/radmed/support

The NRMP did their weird thing where they release "preliminary" Match application statistics which...I don't quite understand why they do that, but whatever. I originally planned on exclusively talking about emergent properties and mental frameworks around paradox without bringing up our RadOnc baggage, but alas, the universe doesn't care about plans. For the slides with all the various details and statistics and citations: http://u.pc.cd/TGs7 OOTB is produced by Photon Media, a project of the 501(c)(3) nonprofit Cold Light Legacy. jason@coldlight.org --- Support this podcast: https://podcasters.spotify.com/pod/show/radmed/support

The previous episode on this story clocks in at 2 hours and...14 minutes and 55 seconds. It's insanely dense, and I left out many, many details. This is the final 15 minutes, which will hopefully convince you to stick through the full episode. The link to the slides is below! From the humid swamps of Florida to the halls of legislation, discover how this bizarre saga has implications for us all. https://doi.org/10.6084/m9.figshare.24312775.v1 --- Out of the Basement is produced by Photon Media, a project from the 501(c)(3) nonprofit Cold Light Legacy. coldlight.org | @drbeckta --- Support this podcast: https://podcasters.spotify.com/pod/show/radmed/support

This wasn't what I set out to make. This wasn't the story I expected to tell. In 2012, 21st Century Oncology and Humana created an alternative payment model that appears to be the inspiration for ROCR. As both the 21C/Humana and ASTRO/ROCR models share the same author(s), it's strange we haven't heard about it. From the humid swamps of Florida to the halls of legislation, discover how this bizarre saga has implications for us all. https://doi.org/10.6084/m9.figshare.24312775.v1 --- Out of the Basement is produced by Photon Media, a project from the 501(c)(3) nonprofit Cold Light Legacy. coldlight.org | @drbeckta --- Support this podcast: https://podcasters.spotify.com/pod/show/radmed/support

What if I told you that...I agree with the 2023 ARRO survey results presented at this year's San Diego conference? What if I told you that the survey supports my Red Journal "Letter to the Editor" about the Workforce Study? How in the world am I not changing my opinion on the oversupply issue despite personally experiencing the benefits of the current job market? Am I writing these descriptions like a Buzzfeed article now? --- Earn free CME for this episode: https://earnc.me/E9XHPi www.becktamd.com www.photonmedia.org Twitter: @drbeckta --- Support this podcast: https://podcasters.spotify.com/pod/show/radmed/support

- ASTRO President, discussing ROCR, during the Advisors to the President [Biden] on the National Cancer Program meeting, 9-7-2023 The inaugural "President's Cancer Panel" meeting took place recently and boy...that was something. Lots of concern over rural cancer care - from people not engaged in rural cancer care. Coincidentally, I am actually involved in rural cancer care. Join me for another riveting "reaction"-style episode on...federal policy regarding national Healthcare concerns! --- Earn free CME for this episode: https://earnc.me/E9XHPi www.becktamd.com www.photonmedia.org Twitter: @drbeckta --- Support this podcast: https://podcasters.spotify.com/pod/show/radmed/support