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The Accelerators (Drs. Matt Spraker and Simul Parikh) discuss critique versus negativity, why Simul quit social media, Student Doctor Network, and engaging in discourse about Radiation Oncology.

This episode is a companion to an episode we recorded in December, but Matt initially decided to hold it back. The episode is a strong, journal club style critique of payer policy article published by the IJROBP that we feel should be retracted.

We encourage you to listen to our "almost lost" episode and additionally read Mark Storey's amazing rebuttal to the IJROBP publication.  

Here we discuss how this contributed to Simul leaving social media, why we initially held back the episode, critique, misanthropy, and our mission for open discussion in Radiation Oncology. 

Here are some links to things we discuss in the episode:

• SDN Thread "Screenshotting Simul"
• A Wikipedia article on Preference Falsification
• Out.Of.The.Basement podcast on the ASTRO "collaboration letter" and propaganda
• Edward Bernays, an American pioneer in public relations and propaganda

The Accelerators Podcast is a production of Photon Media, a division of Cold Light Legacy Company.

If you'd like to support our efforts, please visit the Cold Light Legacy Company to learn more.

Update 12/17/24: Simul is back online with a new substack, check it out here.

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For the first time ever, a lost episode has been found!

The Accelerators (Drs. Matt Spraker and Simul Parikh) recorded a "reaction" episode to a brief report published in December 2023 in the IJROBP shortly after it published.

The article demonstrates that freestanding departments have been slightly slower to implement hypofractionation for treatment of breast and prostate cancers that hospital-based departments. The authors argue that this burdens the healthcare system and propose ROCR as an incentive to drive increased use of these techniques.

In this episode, we discuss this article in detail and share our opinion that the authors examined this issue in a very disingenuous way.

Yet, if you holistically analyze this issue, the data does not support the author's argument.

Is the goal to help readers understand the complexities of our system or were data curated to support implementation of ROCR policy? You'll have to ask the authors. 

Here are some resources we feel are important complements to this episode:

• Out.Of.The.Basement podcast on the ASTRO "collaboration letter" and propaganda
• Out.Of.The.Basement podcast, a rural doctor's thoughts on The ASTRO President speaking at "The President's Cancer Panel"
• Out.Of.The.Basement podcast, on unaddressed significant conflicts of interest among ROCR authors
• Mark Storey's rebuttal to the IJROBP article

The Accelerators Podcast is a production of Photon Media, a division of Cold Light Legacy Company.

If you'd like to support our efforts, please visit the Cold Light Legacy Company to learn more.

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The Accelerators (Drs. Matt Spraker and Simul Parikh) host new Associate Executive Director for Radiation Oncology at The American Board of Radiology (ABR), Dr. Michael Yunes! 

Mike is a community radiation oncologist in Springfield, MA and long time volunteer for the ABR. The transition to his leadership comes after a turbulent period for the Rad Onc board. Communication around the 2018 score anomalies dragged trainee confidence in the ABR to new lows and, soon after, COVID forced the board to complete a rapid redesign of testing. 

More than 5 years later, there are exciting signals of change. The "Orals 2.0" platform seems very well received by examiners and examinees and the board has voted to ramp up the clinical relevance of the qualifying exams in Rad Onc.

Most importantly, Mike is all about transparency and communication. His door is always open, so we invited ourselves in and recorded a podcast. 

We discuss all things Initial Cert: the successful move to virtual oral boards, the written boards and clinical relevance, Angoff'ing, and "crisis management" and communication. 

We close the episode with Simul's lightning round.  Lobster, wine, informatics, 3D printing for benign radiotherapy, Mike's got hobbies!

We hope you enjoy what we hope is the first of many fruitful conversations. 

Physician training and evaluation is a topic near and dear to our hearts; here are some prior episodes from our group related to the ABR.

• TAP, Beckta interviews Matt about boards
• Out.Of.The.Basement, Beckta covers the contentious 2018 ABR initial certification results

Here are some other resources discussed in the episode:

• Beriwal et al., Interdisciplinary debate on the physics test content
• Golden, United States Radiation Oncology Curriculum Development: The Tail is Wagging the Dog
• Warwzuta et al., The rise of negative portrayals of radiation oncology: A textual analysis of media news
• Chimney Rock Winery, a Yunes' family favorite
• See Mike's blog in ABR The Beam

The Accelerators Podcast is a production of Photon Media, a division of Cold Light Legacy Company.

If you'd like to support our efforts, please visit the Cold Light Legacy Company to learn more.

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Welcome to MattPAC*, a new Accelerators pilot concept!

Radiation Oncologist Dr. Matt Spraker aims to introduce important healthcare policy concepts rooted in current events. Each show is designed to be efficient with your time and inspire you to get engaged with advocacy in around 30 minutes. 

In MattPAC #1, Matt covers quality payment programs (QPP). QPPs aim to incentivize "High Quality Care" by adjusting a portion of physician's pay according to performance on quality indicators, measures of healthcare quality. 

We'll discuss the rich history of care quality improvement in radiation medicine and examine how Medicare has approached the QPP with Merit-based Incentive Payment System (MIPS). After, we examine practice accreditation, the QPP approach proposed in ASTRO's ROCR and close with a brainstorm of a better QPP. 

Here are some good resources for further reading on these topics:

• Albert and Das reviews, Quality Assessment in Oncology and Quality Indicators in Radiation Oncology
• MedPAC report, Examining MACRA implementation and the road ahead
• MedPAC report, Moving beyond the MIPs
• GAO Report, Provider Performance and Experiences under the Merit-based Incentive Payment System
• Patel et al., Oncologist Participation and Performance in the Merit-Based Incentive Payment System
• Luh, Radiation Oncology Alternative Payment Model's Impact on Small and Rural Practices
• Jones et al., Merit-Based Incentive Payment System (MIPS) Participation in Radiation Oncology Practices — A Simple Survey
• Chera et al., Improving Quality of Patient Care by Improving Daily Practice of Radiation Oncology
• Coia and Hanks, Quality Assessment in the USA: How the Patterns of Care Study Has Made a Difference 
• Hanks et al., Patters of Care Studies: Past, Present, and Future
• Visit the CMS QPP page for a lot of info: check your participation status, MIPs guides, APMs, and more
• ASTRO ROCR FAQ page

The Accelerators Podcast is a production of Photon Media, a division of Cold Light Legacy Company.

*MattPAC is not a political action committee, it's just a cute name. If you'd like to support our efforts, please visit the Cold

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The Accelerators (Drs. Matt Spraker and Simul Parikh) host the lung cancer legend, Brendon Stiles, MD. He is a Professor of Oncology, Medicine, and Thoracic Surgery at Montfiore and Albert Einstein College of Medicine.

We discuss all things lung cancer: early stage, locally advanced, staging, quality, and more.

The episode is capped with Simul's Lighting Round. Good luck Brendon!

We hope you enjoy this #MedEd instant classic!

Here are (almost?) all the studies and materials we mentioned during the show:

• Brendon's "Old Slide" on patient selection and operability
• Lobar or Sublobar Resection for Peripheral Stage IA Non–Small-Cell Lung Cancer (CALGB 140503)
• Stereotactic ablative radiotherapy with or without immunotherapy for early-stage or isolated lung parenchymal recurrent node-negative non-small-cell lung cancer (I-SABR)
• Stereotactic ablative radiotherapy versus lobectomy for operable stage I non-small-cell lung cancer: a pooled analysis of two randomised trials (STARS-ROSEL)
• Measuring the Integration of Stereotactic Ablative Radiotherapy Plus Surgery for Early-Stage Non–Small Cell Lung Cancer (MISSILE)
• Stereotactic ABlative Radiotherapy Before Resection to AvoId Delay for Early-Stage LunG Cancer or OligomEts During the COVID-19 Pandemic (SABR-BRIDGE)
• Five-Year Survival Outcomes From the PACIFIC Trial: Durvalumab After Chemoradiotherapy in Stage III Non–Small-Cell Lung Cancer
• Phase II Study of Accelerated High-Dose Radiation Therapy with Concurrent Chemotherapy for Patients With Limited Small-Cell Lung Cancer (RTOG 0239)
• Randomized Phase II Study of Preoperative Chemoradiotherapy ± Panitumumab Followed by Consolidation Chemotherapy in Potentially Operable Locally Advanced (Stage IIIa, N2+) Non-Small Cell Lung Cancer (RTOG 0839)
• Neoadjuvant Nivolumab plus Chemotherapy in Resectable Lung Cancer (CheckMate 816)
• Pacific-2 Press Release, AstraZeneca
• Study of Durvalumab Given With Chemoradiation Therapy in Patients With Unresectable Non-small Cell Lung Cancer (MDT-BRIDGE, in progress)
• Society of Thoracic Surgeons quality initiatives

The Accelerators Podcast is a production of Photon Media, a division of Cold Light Legacy Company.

If you'd like to support our efforts, please visit the Cold Light Legacy Company to learn more.

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The Accelerators (Drs. Matt Spraker and Simul Parikh) host Radiation Oncologist and prolific X'er Dr. Dave Chang for a discussion of Small Market Radiation Oncology.

We wax philosophical about the work and life of docs formerly known as #LittleRadOnc: radiation oncologists often under resourced and practicing solo, working miles away from large US cities. 

Dave's personal stories emphasize that the reality of radiation oncology "maldistribution" is a lot more complicated than is often described by city slicker researchers.

Simul and Dave close the episode by discussing practical problems faced by Small Market Radiation Oncology and potential solutions, including... of course... supervision policy!

The only link for this show is the X announcement of Dr. Glaucomflecken's medical school.

The Accelerators Podcast is a Photon Media production. 

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The Accelerators (Drs. Matt Spraker and Simul Parikh) host radiation oncologists Dr. Jona Hattangadi-Gluth and PGY-5 resident Dr. Austin Hopper. Jona is a central nervous system malignancies expert, co-lead of the Central Nervous System Disease Team and Associate Professor of Radiation Oncology at UC San Diego.

In this episode, we discuss Jona's lab's work in understanding the link between brain tumors, radiation (and other) treatments, and neurocognitive toxicity.

We start by discussing Austin's recently presented work that developed an normal tissue complication probability (NTCP) model for radiation dose and attention/processing speed. 

Later, we discuss specific methods used in the NTCP work. How can this work be translated to clinical counseling and practice? 

Also, Matt argues that building NTCP models based on neurocognitive outcomes, such as attention or fine motor control, can be more difficult to model than more simple clinical outcomes such as pneumonitis.

Here are some links to things we discussed during the show:

• Connor et al., 2023. Fine Motor Skill Decline After Brain Radiation Therapy—A Multivariate Normal Tissue Complication Probability Study of a Prospective Trial
• Unnikrishnan et al., 2021. Phase II Clinical Trial of Image-Guided Cognitive-Sparing SRS in Patients With Brain Metastases
• Oscar's Mexican Seafood, Oncology Twitter's favorite fish tacos in San Diego.

The Accelerators Podcast is a production of Photon Media, a division of Cold Light Legacy Company.

If you'd like to support our efforts, please visit the Cold Light Legacy Company to learn more.

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Welcome to MattPAC*, a new Accelerators pilot concept!

Radiation Oncologist Dr. Matt Spraker aims to introduce important healthcare policy concepts rooted in current events. Each show is designed to be efficient with your time and inspire you to get engaged with #RadOnc advocacy in 30 minutes or less.  

In MattPAC #1, Matt covers two current congressional bills that are currently being considered for inclusion into next year's Medicare legislation: HR 2474 and HR3674. These bills seek to link Medicare physician pay to inflation and boost practice expense reimbursement for freestanding practices. The history of Medicare, administration processes, the payment formula, and sites of service are covered for context. 

Here are some good resources for further reading on these topics:

• A paper on how Medicare drove hospital desegregation, especially in the south.
• Power To Heal: Medicare and The Civil Rights Revolution
• How is Medicare Funded?
• Information about Medicare administration and procedures, Wikipedia
• A lot of info on the RUC, AMA
• The medicare physician fee schedule payment formula, MedicalBillersAndCoders.com
• Interesting write up of history of conversion factors, AMA
• Medicare payments are not keeping up with inflation, AMA
• Framework for Rational Medicare, AMA
• AMA letter to congress about these issues, March 2023
• AMA commends MedPAC for recognizing challenges of inflationary environment, April 2023
• HR 2474
• A Primer On Office Based Specialty Care, USPA
• USPA Letter to MedPAC about threats to free standing specialty practices, such as Rad Onc
• 2023 survey of multi-specialty practices regarding Medicare cuts
• HR 3674

The Accelerators Podcast is a production of Photon Media, a division of Cold Light Legacy Company.

*MattPAC is not a political action committee, it's just a cute name. If you'd like to support our efforts, please visit the Cold Light Legacy Company to learn more.

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Friend of the show and GI super friend Dr. Nina Sanford joins The Accelerators (Drs. Matt Spraker and Simul Parikh) to host #RadOnc luminary Dr. Robert Timmerman, MD.

Our discussion concludes with a discussion of proton and adaptive radiotherapy, Wagyu beef, life advice, and Simul's Hot Seat.

Here are a couple of book recommendations from the show: 

• Why We Sleep by Matthew Walker, PhD
• Outlive by Peter Attia, MD

The Accelerators Podcast is a production of Photon Media, a division of Cold Light Legacy Company.

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Friend of the show and GI super friend Dr. Nina Sanford joins The Accelerators (Drs. Matt Spraker and Simul Parikh) to host #RadOnc luminary Dr. Robert Timmerman, MD.

No notes.

It's Bob Timmerman, just listen.

The Accelerators Podcast is a production of Photon Media, a division of Cold Light Legacy.