Breaking News: The President of the United States confirms the immunogenic effect of FLASH radiotherapy!

[Palex80]

Remarks by President Biden During Tour of Radiation Oncology Department | The White House

Arthur G. James Cancer Hospital and Richard J. Solove Research InstituteColumbus, Ohio 3:49 P.M. EDT Q Sir, is it comforting or is it hopeful or more painful for you to hear about cancer developments like this? THE PRESIDENT: It’s — it’s mostly hopeful because I don’t want to see anybody go...

www.whitehouse.gov

DR. ARNAB: And, Mr. President, with this FLASH therapy, there’s more — much more synergism with immune therapy than with conventional radiation —

THE PRESIDENT: Yeah, I agree with that.

DR. ARNAB: — we’re finding.

THE PRESIDENT: Not that I agree. I don’t mean like — as if I — matters what I agree on.

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[Krukenberg]

Remarks by President Biden During Tour of Radiation Oncology Department | The White House

Arthur G. James Cancer Hospital and Richard J. Solove Research InstituteColumbus, Ohio 3:49 P.M. EDT Q Sir, is it comforting or is it hopeful or more painful for you to hear about cancer developments like this? THE PRESIDENT: It’s — it’s mostly hopeful because I don’t want to see anybody go...

www.whitehouse.gov

DR. ARNAB: And, Mr. President, with this FLASH therapy, there’s more — much more synergism with immune therapy than with conventional radiation —

THE PRESIDENT: Yeah, I agree with that.

DR. ARNAB: — we’re finding.

THE PRESIDENT: Not that I agree. I don’t mean like — as if I — matters what I agree on.

Wow. Well half the country will now think protons and FLASH is fake news. The other half will clamor for it

 

[Lamount]

Wow. Well half the country will now think protons and FLASH is fake news. The other half will clamor for it

That means our field's name recognition and favorability has increased by >45%

 

[RadOncDoc21]

That means our field's name recognition and favorability has increased by >45%

Just when I thought fraction numbers couldn’t get any smaller.

 

[domestique]

Interesting choice of "synergism" over the much more common, if not oversued, "synergy"

 

[TheWallnerus]

Very nice tie-in with the new Justice League movie... we are a field suffused with slightly misleading euphemisms ("knife," "radiosurgery"... neither radio nor surgical... "virtual prostatectomy"... neither virtual nor a prostatectomy... "ablative," "ZAP,") and FLASH is just... super!

 

[Radonc90]

My 2 cents on Biden visit to Ohio State Radonc:

1. Great idea and brought visibility to radonc in general.

2. Biden mentioned Ohio State volume went from 60-70 pts/day (that was probably during the last Chair, and also from Dr Subir Nag's era and pre-ACA) to close to 300 pts/day now.

My personal opinion is that: I understand that Biden tried to defend ACA (Obamacare) and while ACA can increase the volume, my experience is that ACA usually increases the volume by only 5-10%.
In order to jump from 60-70 pts/day ---> close to 300 pts/day, the place had to recruit a whole bunch of specialists (the feeders such as breast surgeons, ENTs, GynOncs etc. etc.).

My point is: to have a 4-fold in crease in pt volume, it has to be something other than ACA.

Does anyone know what happened there during the last say 15 years?

From outside looking in, it seems like a decent program, maybe as good as UCSD. Not sure why some here said Ohio State residency program is so-so...

 

[TheWallnerus]

My 2 cents on Biden visit to Ohio State Radonc:

1. Great idea and brought visibility to radonc in general.

2. Biden mentioned Ohio State volume went from 60-70 pts/day (that was probably during the last Chair, and also from Dr Subir Nag's era and pre-ACA) to close to 300 pts/day now.

My personal opinion is that: I understand that Biden tried to defend ACA (Obamacare) and while ACA can increase the volume, my experience is that ACA usually increases the volume by only 5-10%.
In order to jump from 60-70 pts/day ---> close to 300 pts/day, the place had to recruit a whole bunch of specialists (the feeders such as breast surgeons, ENTs, GynOncs etc. etc.).

My point is: to have a 4-fold in crease in pt volume, it has to be something other than ACA.

Does anyone know what happened there during the last say 15 years?

From outside looking in, it seems like a decent program, maybe as good as UCSD. Not sure why some here said Ohio State residency program is so-so...

300 pts/day is a lot. Assume the average patient treatment length is 4 weeks. To get 300/day under treatment, need to see:
*75 new pts/week, or
*3900 new pts/year
I count 24 ROs on The OSU website. So The OSU ROs see on avg 162 new consults/year.

At U of Wash RO, they see:
*2800 new pts/year
I count 28 ROs on the U of Wash website. So the U of Wash ROs see on avg 100 new consults/year.

The OSU is better than U of Wash by 62%!

 

[Ray D. Ayshun]

300 pts/day is a lot. Assume the average patient treatment length is 4 weeks. To get 300/day under treatment, need to see:
*75 new pts/week, or
*3900 new pts/year
I count 24 ROs on The OSU website. So The OSU ROs see on avg 162 new consults/year.

At U of Wash RO, they see:
*2800 new pts/year
I count 28 ROs on the U of Wash website. So the U of Wash ROs see on avg 100 new consults/year.

The OSU is better than U of Wash by 62%!

Can anyone really confirm 300/day? I have trouble believing this.

 

[TheWallnerus]

Can anyone really confirm 300/day? I have trouble believing this.

Believe it. Prez said it, some academic person at The OSU said it, and it was written on the web. The Trifecta of Truth.

 

[Mandelin Rain]

Interesting choice of "synergism" over the much more common, if not oversued, "synergy"

Next step: SYNERGASM!!!

 

[Ray D. Ayshun]

Believe it. Prez said it, some academic person at The OSU said it, and it was written on the web. The Trifecta of Truth.

How many machines do they have? There must be no other game in town. I don't recall the department being physically large enough to accommodate 300/day.

 

[TheWallnerus]

How many machines do they have? There must be no other game in town. I don't recall the department being physically large enough to accommodate 300/day.

In elementary school I had a friend who said his dad went 25 miles in 5 minutes on his superbike on the freeway. We were young but I knew that meant he must have a bike that can go 300 mph, in traffic. My friend steadily adjusted the distance downward and time upward over future iterations of the story.

 

[Ray D. Ayshun]

Wow. Well half the country will now think protons and FLASH is fake news. The other half will clamor for it

Lucky for me, I live in the half that will consider it fake news. Iow, no biryani.

 

[Ray D. Ayshun]

How many machines do they have? There must be no other game in town. I don't recall the department being physically large enough to accommodate 300/day.

Looked it up. There are like 11 Linacs, a gammaknife, intra-op electrons, and brachy. So they are ABLE to treat 300/day. Hell, they're able to treat twice that. I wasn't aware the ACA was going to make new Linacs cheaper.

*I recognize i'm responding to myself

 

[CaesarRO]

When interviewing they were pretty proud of the fact that they got a huge grant as part of the ACA and had the largest purchase agreement with Varian in Varian's history.

 

[thecarbonionangle]

In 5 minutes, Biden endorsed protons and gave importance to our field, more than the former rad onc FDA commissioner

 

[OTN]

A $100 million grant from the ACA - so my tax dollars went to help build up academic competition, which then turns around and gets to charge multiple x what I do for the same service? Cool, cool, seems fair to me.

 

[TheWallnerus]

A $100 million grant from the ACA - so my tax dollars went to help build up academic competition, which then turns around and gets to charge multiple x what I do for the same service? Cool, cool, seems fair to me.

Now you've got it.

 

[evilbooyaa]

Looked it up. There are like 11 Linacs, a gammaknife, intra-op electrons, and brachy. So they are ABLE to treat 300/day. Hell, they're able to treat twice that. I wasn't aware the ACA was going to make new Linacs cheaper.

*I recognize i'm responding to myself

An anonymous response from someone who works at OSU was sent to me privately, last night, before you did your own research on the matter:

"We have 7 linacs at the main campus and 2 linacs in the breast center.

Best I can approximate, we have somewhere between 270-320 pts on treatment at any given point in time (so 300 is a fair estimate). I think it was a little more pre-COVID. Columbus is a moderately big city (~900k) and the catchment area of OSU includes much of central OH, so there is no shortage of patients."

 

[SubserviantToABR]

An anonymous response from someone who works at OSU was sent to me privately, last night, before you did your own research on the matter:

"We have 7 linacs at the main campus and 2 linacs in the breast center.

Best I can approximate, we have somewhere between 270-320 pts on treatment at any given point in time (so 300 is a fair estimate). I think it was a little more pre-COVID. Columbus is a moderately big city (~900k) and the catchment area of OSU includes much of central OH, so there is no shortage of patients."

Varian had a similar tweet about OSU's volume. Literally had no idea they were that busy. Hopefully, they are leveraging that patient volume for outstanding studies where radiation is included or added to cancer care, versus removing it like Julia White's NRG Oncology BR007 study (what's wrong with RT, Dr. White?!?!).

 

[Ray D. Ayshun]

An anonymous response from someone who works at OSU was sent to me privately, last night, before you did your own research on the matter:

"We have 7 linacs at the main campus and 2 linacs in the breast center.

Best I can approximate, we have somewhere between 270-320 pts on treatment at any given point in time (so 300 is a fair estimate). I think it was a little more pre-COVID. Columbus is a moderately big city (~900k) and the catchment area of OSU includes much of central OH, so there is no shortage of patients."

I stand corrected. Impressive.

 

[RadOncDoc21]

Varian had a similar tweet about OSU's volume. Literally had no idea they were that busy. Hopefully, they are leveraging that patient volume for outstanding studies where radiation is included or added to cancer care, versus removing it like Julia White's NRG Oncology BR007 study (what's wrong with RT, Dr. White?!?!).

View attachment 333357

View attachment 333359

I guess when you have 300 patients a day, you can afford to lose a few fractions here and there.

 

[TheWallnerus]

An anonymous response from someone who works at OSU was sent to me privately, last night, before you did your own research on the matter:

"We have 7 linacs at the main campus and 2 linacs in the breast center.

Best I can approximate, we have somewhere between 270-320 pts on treatment at any given point in time (so 300 is a fair estimate). I think it was a little more pre-COVID. Columbus is a moderately big city (~900k) and the catchment area of OSU includes much of central OH, so there is no shortage of patients."

900K plus likely double that in the catchment area would support ~3800-4000 new patients a year (about 200 new patients a year per 100K); and that many new patients a year can get you ~300/day under treatment. However at ~9 linacs these are very busy linacs! But overall the math is correct. This would be a great place to train with a wide variety of pathologies and tech (and most likely approaches too what with all the attendings). I would not want to be a hospital or freestanding competing w/ THE OSU.

I guess when you have 300 patients a day, you can afford to lose a few fractions here and there.

If you look at The OSU docs' pts-per-doc ratio it seems kind of high vs other academics. Maybe these poor The OSU souls are overworked, and their research to reduce fractions is an attempt to improve their (the docs') QOL?!

 

[SubserviantToABR]

I guess when you have 300 patients a day, you can afford to lose a few fractions here and there.

The few fractions they lose is a lot of fractions we all lose. I think with breast hypofractionation, the opposite question should be asked, putting the burden on endocrine therapy (cost, management, compliance, side effect profile). With 300 patients a day, they should have pretty decent accrual to any study they come up with. Hopefully, it is to demonstrate the value of RT, instead of chopping ourselves at our own knees (which I need to be on to maintain my referral stream).

 

[OTN]

900K plus likely double that in the catchment area would support ~3800-4000 new patients a year (about 200 new patients a year per 100K); and that many new patients a year can get you ~300/day under treatment. However at ~9 linacs these are very busy linacs! But overall the math is correct. This would be a great place to train with a wide variety of pathologies and tech (and most likely approaches too what with all the attendings). I would not want to be a hospital or freestanding competing w/ THE OSU.

If you look at The OSU docs' pts-per-doc ratio it seems kind of high vs other academics. Maybe these poor The OSU souls are overworked, and their research to reduce fractions is an attempt to improve their (the docs') QOL?!

300 patients per day / 9 linacs = 33 1/3 patients per linac. It's all about perspective, as I would not call those "very busy" numbers.

 

[TheWallnerus]

300 patients per day / 9 linacs = 33 1/3 patients per linac. It's all about perspective, as I would not call those "very busy" numbers.

Upper middle class busy.

 

[Ray D. Ayshun]

If you look at The OSU docs' pts-per-doc ratio it seems kind of high vs other academics. Maybe these poor The OSU souls are overworked, and their research to reduce fractions is an attempt to improve their (the docs') QOL?!

This is true, and perhaps explains the disconnect globally. My experience has been 10 on treatment was one of the busier docs at main campus. Most academic chairs may be under the impression that we need 1 radonc for every 8-10 patients on treatment. Hence, there's still an oversupply.

 

[medgator]

This is true, and perhaps explains the disconnect globally. My experience has been 10 on treatment was one of the busier docs at main campus. Most academic chairs may be under the impression that we need 1 radonc for every 8-10 patients on treatment. Hence, there's still an oversupply.

8-10 under treatment would be a side gig to most of us

 

[TheWallnerus]

8-10 under treatment would be a side gig to most of us

In between committee meetings, teaching residents, writing papers, reviewing papers, visiting professorships, diversity training, international conferences, med twittering, and staying caught up on documentation and billing, 10 patients under beam is a lot for an academic!

The majority job classification for US rad oncs now is of course academic.

There you go.

 

[medgator]

In between committee meetings, teaching residents, writing papers, reviewing papers, visiting professorships, diversity training, international conferences, med twittering, and staying caught up on documentation and billing, 10 patients under beam is a lot for an academic!

The majority job classification for US rad oncs now is of course academic.

There you go.

According to KO, he needed an APP so he could find the time to med Twitter between consults