Dosimetry

[McConaughey]

How does your dosimetry team function as far as time management and leadership are concerned? Also, curious about turnaround times (dosi planning & MD contours getting done), triage/case assignment, normal tissue contours, relationship with physics, etc.

I know this is a general question given a variety of practice types out there, but I don’t mind hearing about the big picture as well as a few details if you find they improve efficiency. I am in a hospital-based private practice for context. We are growing and it does feel that more structure is needed soon.

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[baculum1]

Contours generally due by 1-2 days after sim. Dosimetry turns around asap and start asap.

 

[radoncgrad2019]

I like to sim the Monday or Friday before a Monday start for most IMRT cases, just to keep things smooth and give plenty of time. Palliatives are different of course. But if you give 5-6 business days for most cases, then when you need a 1-2 day turnaround for some reason (say a hipoocampal sparing plan or something), your planners like you because it's not a habitual thing where you're asking for a rushed plan, and they will make it work/happen for the rushed one.

for majority of curative cases, you can afford the time of scheduling sim 5-6 days before start. I try to stick with it.

 

[radoncgrad2019]

other things - a great physics department begets a great dosimetry group. They go hand in hand. Physics and Dosimetry need to have a good relationship.

there is a lead dosimetrist in our dept who divides up the cases. It's pretty evenly split.

 

[RickyScott]

other things - a great physics department begets a great dosimetry group. They go hand in hand. Physics and Dosimetry need to have a good relationship.

there is a lead dosimetrist in our dept who divides up the cases. It's pretty evenly split.

going to somewhat disagree here. I have noticed that a lot of academic centers have poor dosimetry becasuse they dont pay well and many dosimetrists would rather earn more with less commute in the community. there is really no prestige or "being a thought leader" for a dosimetrist at Harvard, just crappy pay, less flexibility,, worse commute and extra taxes.

In terms of physics, also noticed that clinically most major departments will have only a few if any really good clinical physicisists and a bunch who are mostly idle in the clinic, save one or 2 responsibilities like HDR cylinder.

 

[evilbooyaa]

Sim, plan to start 4-7 business days after depending on machine availability. Physician contours within 1-2 days. Dosimetry ideally ends up showing intiial plan day before it's due or the morning it is due to allow for some tweaking.

 

[msuxrt]

Do you guys generally SIM the same day as consult?

 

[Palex80]

Do you guys generally SIM the same day as consult?

I do not, unless I have to (urgent indication) or the patient demands it.

1. I like to give patients some time to think about the treatment again. I like to obtain the final consent during the first consult, but tell the patients that they still have time and can always still think about it and come back with questions before we actually do anything in terms of planning.
2. I often have "homework" to do after the consult, perhaps I might need some additional imaging/endocscopy I'd like to have to fuse for planning or have to coordinate appointments / treatment start with med onc or hospitalisation, etc.
3. Some patients may not be "ready" to go. I see quite a few post-op cases that need a few weeks to recover from surgery & complete wound healing (GBMs, head&neck, bone mets, etc).


One additional issue is preparation of patients for sim, for example rectal / bladder feeling in case of pelvic RT.
"This concludes our talk for today, it has been nice meeting you. Please follow me to the planning CT room. Is your bladder full and your rectum empty?"

 

[PhotonBomb]

Do you guys generally SIM the same day as consult?

Sometimes I do for SBRT, when patient is from a distance, to make it easier for them

 

[taserlaser]

Sometimes I do for SBRT, when patient is from a distance, to make it easier for them

Exactly. I get a lot of referrals from a wide geographic area and work in I think what is an excellent multidisciplinary clinic. So when biopsies are confirmed patients when they come often get same day surgical consult, RO consult, CT staging, and CT sim if we can squeeze it in with the aim of minimizing multiple appointments. Not always does it work but when it does (often) it can shorten a patient‘s time away from home. But these are more clear indications for RT in definitive management cases.

 

[OTN]

Do you guys generally SIM the same day as consult?

No, because then you have to drop the consult charge unless you add a -25 modifier, which realistically never really can be added. I don't think it's fair to ask us to do work for free, so I do not sim on the same day as consult unless there's an extenuating circumstance (cord compression, etc).

 

[RadOncDoc21]

No, because then you have to drop the consult charge unless you add a -25 modifier, which realistically never really can be added. I don't think it's fair to ask us to do work for free, so I do not sim on the same day as consult unless there's an extenuating circumstance (cord compression, etc).

I agree with this but think this is so dumb we have to think like this. Another one is the v-sim charge or to print out the plan a day after planning is done. If you do the work, why does it matter when it’s done? Another pet peeve of mine is the diagnostic codes, why does billing care more about which quadrant or lobe a cancer is in but don’t really care about the type?

Viva la revolucion!

 

[PhotonBomb]

I agree with this but think this is so dumb we have to think like this. Another one is the v-sim charge or to print out the plan a day after planning is done. If you do the work, why does it matter when it’s done? Another pet peeve of mine is the diagnostic codes, why does billing care more about which quadrant or lobe a cancer is in but don’t really care about the type?

Viva la revolucion!

Huge bonus of APM will be that I can do whatever the **** I want. Daily kv for a bone met? Same
Day consult and sim? Great.

 

[Mandelin Rain]

I usually sim same day as consult because I live in a competitive world and why wait to treat cancer? Wait a few days and they may go elsewhere. I take the hit in the consult reimbursement, but I’m okay with it. Makes no sense, and maybe APM will correct it.

Contours before I go home. I expect people to start as soon as prior authorization is done (4 days max). Again, why wait to treat cancer. Palliative 3D cases start next day or 2 days max. IMRT turnaround is typically 2 days. Same for SBRT. SRS is usually 1 week max.

Push yourself, push your dosimetrist, push your physics. Push your med onc if getting concurrent. Get your patients treated.

 

[xrthopeful]

I usually sim same day as consult because I live in a competitive world and why wait to treat cancer? Wait a few days and they may go elsewhere. I take the hit in the consult reimbursement, but I’m okay with it. Makes no sense, and maybe APM will correct it.

Contours before I go home. I expect people to start as soon as prior authorization is done (4 days max). Again, why wait to treat cancer. Palliative 3D cases start next day or 2 days max. IMRT turnaround is typically 2 days. Same for SBRT. SRS is usually 1 week max.

Push yourself, push your dosimetrist, push your physics. Push your med onc if getting concurrent. Get your patients treated.

love it. my man.

love to push the med onc. my plan is done, why the eff arent you ready to give chemo? find a chemo chair. i did the work, im not waiting a week.

 

[Mandelin Rain]

love it. my man.

love to push the med onc. my plan is done, why the eff arent you ready to give chemo? find a chemo chair. i did the work, im not waiting a week.

Yup. Ordering my referral, a port, and cis/etoposide is a couple dozen clicks in the computer.

I shouldn't be waiting on you. Let’s move it. Their small cell was already diagnosed 5 weeks ago. WTF? Let’s start.

 

[RadOncDoc21]

I hold out to get my number on treatments at an acceptable level for my admins. Then it all drops and then I’ll do the 30 fx palliative bone mets! All about keeping the bosses happy!