out of the basement / radiation medicine

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.

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Brought to you in part by Xstrahl, modern manufacturers of orthovoltage devices. Visit them at ⁠⁠⁠https://xstrahl.com/⁠⁠⁠

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OOTB, produced by Photon Media, is made possible by Cold Light Legacy, a 501(c)(3) nonprofit that thrives on community support.

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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

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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.

[email protected]

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.

[email protected]

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.

[email protected]

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.

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"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.

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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.

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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.

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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.

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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.

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