Radiology to radiation oncology

[medgator]

I can say confidently that one thing the Earth doesn't need more of is people.

The one's already here are doing a very fine job destroying it.

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[OTN]

I can say confidently that one thing the Earth doesn't need more of is people.

The one's already here are doing a very fine job destroying it.

The Earth has been around for a very, very long time. It cares not about humans and never will.

I'm honestly surprised to read such anti-humanist posts on a board about oncology. If you think there are too many humans on the planet why are you trying to save some of them?

 

[Chartreuse Wombat]

I can say confidently that one thing the Earth doesn't need more of is people.

The one's already here are doing a very fine job destroying it.

Globalization has peaked and the process of deglobalization is soon to become evident and this will lead to shortages and the birth rate will continue to fall. The population will peak in a decade or two and then decline. Unofficial reports from China suggest that this is already happening.

I don't agree with the apocalyptic approach of most environmentalists. Nuclear power is the answer to many of our energy problems and for so many to oppose the cleanest most renewable energy (i.e. nuclear) gives the game away that they are not serious about the problem.

 

[medgator]

The Earth has been around for a very, very long time. It cares not about humans and never will.

I'm honestly surprised to read such anti-humanist posts on a board about oncology. If you think there are too many humans on the planet why are you trying to save some of them?

You think we've had zero impact on the planet and biodiversity? Hard disagree

Climate change is Anti-humanist

 

[deleted1111261]

The Earth has been around for a very, very long time. It cares not about humans and never will.

I'm honestly surprised to read such anti-humanist posts on a board about oncology. If you think there are too many humans on the planet why are you trying to save some of them?

Seriously.

Half of my twitter feed is anti humanist nonsense.

 

[deleted1111261]

You think we've had zero impact on the planet and biodiversity? Hard disagree

Climate change is Anti-humanist

You think human beings and development are anti human ?! To even cause pollution, you’ve improved the lives of millions.

I don’t understand this anti life sentiment.

I guess we could be like that one indigenous Brazilian dude that just died, the last of his tribe. Doesn’t seem very fun, tho

 

[medgator]

You think human beings and development are anti human ?! To even cause pollution, you’ve improved the lives of millions.

I don’t understand this anti life sentiment.

I guess we could be like that one indigenous Brazilian dude that just died, the last of his tribe. Doesn’t seem very fun, tho

No one is saying to be anti life, but to try and at least acknowledge how we impact our planet and humanity going forward isn't a terrible thing is it? Is responsibility and sustainability for the planet anti human? I'm guessing the folks in Maldives and Pakistan would say not

 

[OTN]

You think we've had zero impact on the planet and biodiversity? Hard disagree

Climate change is Anti-humanist

On a human timeframe? Humans have had a huge impact on the planet and biodiversity.

On a geological timeframe? Humans will have zero impact on the planet and biodiversity.

 

[elementaryschooleconomics]

This thread took a hard turn, who started this chaos???

[reads back]

 

[deleted1116990]

I wouldn't worry about burning the evil dinosaur goo, personally, as the way our policies are going, we will be putting Brawndo on crops any day now.

 

[evilbooyaa]

You guys.... keep this on-topic to the discussion at hand or warnings will be handed out and thread will be closed. A discussion of humanistic efforts and climate change (and it's always related ties to politics) will not be tolerated on this thread. If you want to discuss it, start a new thread so that I can lock it when it inevitably devolves into political ****ery.

 

[odyssey2]

Feel free to DM me. A lot of my friends from med school, and close friends in general, are radiologists.

Would you say most of them are happy with their choice?

 

[redalert]

Sounds like you're an R1 at a presumably top DR program given your stats. Radiology is tough and it's not uncommon for junior residents to think about quitting. I would advise against switching to rad onc but if you really hate DR that much and want to treat cancer, you can switch into IM the med onc. I know of a few who switched into IM after 1 year of DR who are now happy fellows in an IM subspecialty.

 

[theradiator]

Sounds like you're an R1 at a presumably top DR program given your stats. Radiology is tough and it's not uncommon for junior residents to think about quitting. I would advise against switching to rad onc but if you really hate DR that much and want to treat cancer, you can switch into IM the med onc. I know of a few who switched into IM after 1 year of DR who are now happy fellows in an IM subspecialty.

Yes, please stay in a field that does not perform suicidal non-inferiority studies on its own modality.

 

[Sheldor]

Yes, please stay in a field that does not perform suicidal non-inferiority studies on its own modality.

Is even crazier if you propose some equivalent studies that radiology could do, that would mimic what our leaders have done:

Phase II trial comparing q3 month followup CT's vs q6 month

Phase III comparing laryngoscopy and neck palpation vs 12 week PET, non-inferiority study

 

[Clean7795]

Is even crazier if you propose some equivalent studies that radiology could do, that would mimic what our leaders have done:

Phase II trial comparing q3 month followup CT's vs q6 month

Phase III comparing laryngoscopy and neck palpation vs 12 week PET, non-inferiority study

I hate to be that guy but most large scale radiology studies on incidental findings aim to reduce the number of follow ups (Fleischner criteria, TI-RADS, etc.).

It just so happens there's a healthy amount of research from radiologists and non-radiologists on areas to improve (and increase) imaging volumes.

 

[Sheldor]

I hate to be that guy but most large scale radiology studies on incidental findings aim to reduce the number of follow ups (Fleischner criteria, TI-RADS, etc.).

It just so happens there's a healthy amount of research from radiologists and non-radiologists on areas to improve (and increase) imaging volumes.

Are there randomized trials in the post cancer treatment setting exploring q3 month, q4 month, q6month follow up scans? Problem with our field is that went do non-inferiority studies in things that will clearly not show a difference and therefore reducing our treatments. I can't imagine radiology has done (please correct me if I'm wrong) a study comparing q3month and q4 month. Almost certainly the study would show that q4 month is "non-inferior" to q3 month and for post cancer treatment the number of CT's I order would drop by 25%.

 

[deleted1111261]

Are there randomized trials in the post cancer treatment setting exploring q3 month, q4 month, q6month follow up scans? Problem with our field is that went do non-inferiority studies in things that will clearly not show a difference and therefore reducing our treatments. I can't imagine radiology has done (please correct me if I'm wrong) a study comparing q3month and q4 month. Almost certainly the study would show that q4 month is "non-inferior" to q3 month and for post cancer treatment the number of CT's I order would drop by 25%.

I don't think radiologists are the ones really interested in this. The people that order the tests are the ones that care. Rads is at the receiving end and unlike us, they don't cut themselves off at the knees.

My friend who is an academic h&n radiologist said that his world was simply not informed by RCTs and EBM. He sees what he sees. I tried to find examples that would contradict him, but basically he was right. All the studies are for the clinicians. He interprets studies and that is that.

 

[brushbeamscanning]

Theoretically if all these ctDNA/minimal residual disease assays become better validated then they could be used to reduce imaging frequency and serve as a trigger for imaging once a patient has a detectable biomarker.

 

[medgator]

Theoretically if all these ctDNA/minimal residual disease assays become better validated then they could be used to reduce imaging frequency and serve as a trigger for imaging once a patient has a detectable biomarker.

Big time. From what we are seeing now, it looks like a real threat imo... Months earlier

 

[RickyScott]

Supposedly photon counting Ct will be a big deal in radiology but don’t know much about them.

 

[Sheldor]

Theoretically if all these ctDNA/minimal residual disease assays become better validated then they could be used to reduce imaging frequency and serve as a trigger for imaging once a patient has a detectable biomarker.

Big time. From what we are seeing now, it looks like a real threat imo... Months earlier

Though, this was kind of my point. Are radiologists PI's on these studies? Pretty sure not! I guess my complaint wasn't so much that there are studies exploring and or comparing radiation vs alternatives, but they are spearheaded, run and championed by Radiation Oncologists themselves!

Also agree, ctDNA could be game changer from an imaging perspective.

 

[TheWallnerus]

I don't think radiologists are the ones really interested in this. The people that order the tests are the ones that care. Rads is at the receiving end and unlike us, they don't cut themselves off at the knees.

My friend who is an academic h&n radiologist said that his world was simply not informed by RCTs and EBM. He sees what he sees. I tried to find examples that would contradict him, but basically he was right. All the studies are for the clinicians. He interprets studies and that is that.

I remember on my radiology rotation one of the radiologists being like “they (the docs ordering scans) order pizza from me; occasionally I ask if they want pepperoni”

 

[brushbeamscanning]

Though, this was kind of my point. Are radiologists PI's on these studies? Pretty sure not! I guess my complaint wasn't so much that there are studies exploring and or comparing radiation vs alternatives, but they are spearheaded, run and championed by Radiation Oncologists themselves!

Also agree, ctDNA could be game changer from an imaging perspective.

To be fair it's a technology also championed by the incoming NCI director (surgical oncologist by training)

 

[communitydoc13]

Breast is so weird. We have these sites with reflexive q3month-q6month or annual f/u imaging and in breast, you can have an obviously terrible biology breast CA and you have to fight to justify systemic staging imaging even in locally advanced disease (are they afraid of finding metastatic disease). While there is fairly liberal use of breast MRI at diagnosis leading to excess in-breast biopsies, there is no expectation for serial brain imaging in subsets of breast CA with ~40% chance of developing brain mets.

In breast, medoncs already use marginal tumor markers to trigger f/u imaging.

 

[maxxor]

Though, this was kind of my point. Are radiologists PI's on these studies? Pretty sure not! I guess my complaint wasn't so much that there are studies exploring and or comparing radiation vs alternatives, but they are spearheaded, run and championed by Radiation Oncologists themselves!

Also agree, ctDNA could be game changer from an imaging perspective.

ctDNA may be great for reducing routine follow ups but it doesn’t eliminate imaging. Still gotta find the tumor once it grows back to be a threat…

Unless of course you are arguing that ctDNA then eliminates all locally guided therapies, then both radonc and surgonc are very much in trouble.

 

[TheWallnerus]

Breast is so weird. We have these sites with reflexive q3month-q6month or annual f/u imaging and in breast, you can have an obviously terrible biology breast CA and you have to fight to justify systemic staging imaging even in locally advanced disease (are they afraid of finding metastatic disease). While there is fairly liberal use of breast MRI at diagnosis leading to excess in-breast biopsies, there is no expectation for serial brain imaging in subsets of breast CA with ~40% chance of developing brain mets.

In breast, medoncs already use marginal tumor markers to trigger f/u imaging.

Doc… Shouldn’t We Be Getting Some Tests?

 

[Reaganite]

Big time. From what we are seeing now, it looks like a real threat imo... Months earlier

Had some patients on a small n=30 trial for a while. All recurrence predicted by ctDNA several months prior to imaging. Nobody with - ctDNA has had clinical failure so far.

 

[temujim]

Doc… Shouldn’t We Be Getting Some Tests?

20+ years later still unaware of any surveillance test, whether lab or imaging, demonstrating an improvement in survival with early detection.

 

[Sheldor]

ctDNA may be great for reducing routine follow ups but it doesn’t eliminate imaging. Still gotta find the tumor once it grows back to be a threat…

Unless of course you are arguing that ctDNA then eliminates all locally guided therapies, then both radonc and surgonc are very much in trouble.

Of course we would, but if ctDNA final data looks like initial data, it will drastically reduce the volume. For example, if one is getting ctDNA and can rely on it, why would you get imaging at all if it stays at 0? Additionally, even if you get imaging "just in case," why would you get it as often? Even a drop from q3 month to q6 month represents a 50% decrease in radiology volume for whichever disease site we are talking about. I could also see a world where they were followed with ctDNA and only got imaging if it changed, which is hard to fathom, but not out of the realm of possibility.

 

[Palex80]

Of course we would, but if ctDNA final data looks like initial data, it will drastically reduce the volume. For example, if one is getting ctDNA and can rely on it, why would you get imaging at all if it stays at 0? Additionally, even if you get imaging "just in case," why would you get it as often? Even a drop from q3 month to q6 month represents a 50% decrease in radiology volume for whichever disease site we are talking about. I could also see a world where they were followed with ctDNA and only got imaging if it changed, which is hard to fathom, but not out of the realm of possibility.

Think of all the colorectal patients after surgery….