The Accelerators Podcast

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Dr. Simul Parikh hosts Dr. Austin Dove for a fireside chat about his new review article in the Red Journal on low-dose radiotherapy for osteoarthritis (OA). 

In this episode, Austin reviews the history of low-dose radiotherapy for OA, which includes multiple prospective studies evaluating efficacy and safety of the technique. These studies show that one example, 0.5 Gy x 6 fractions (3 Gy total) delivered every other day is associated with an excellent and durable symptomatic response in a high number of patients with essentially no acute effects. 

Considering 32 million people suffer from osteoarthritis in the US, these data have huge implications for the field. This is similar to the number of patients with prostate cancer treated in the US every year with radiation.

Simul and Austin then discuss the German’s love for placebo pills and call for thoughtful and scientific evaluation of low-dose radiotherapy for OA in the US. 

Later, Austin hypothesizes that low-dose radiotherapy may be used for other etiologies of arthralgia, such as those experienced by patients with breast cancer undergoing hormone therapy. Regardless, Simul and Austin agree that multi-disciplinary collaboration will be required for optimal implementation.

At the end of the episode, Simul holds Austin’s feet to the fire in a mock oral exam and an Accelerators Lightning Round. Memphis BBQ or Nashville Hot Chicken? What is Austin’s backup specialty? And, importantly, is Taylor Swift’s music country?

Here are some other things that came up:

• Pattern of care study from Germany; 15,000 are treated each year with radiation for OA!
• DEGRO - a German radiotherapy organization

Episode art generously donated by Dr. Danielle Cunningham

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Sim orders, documentation, prior auth, oh my! Is it death by 1000 clicks? The Accelerators Podcast (Drs. Anna Laucis, Simul Parikh, and Matt Spraker) host their first industry experts for an intimate discussion on the radiotherapy workflow: David Lindsey (CEO, Oncora Medical and graduating MD/PhD student), Sasa Mutic (SVP, Varian Medical Systems), Jacob Philip (CEO, Medlever), and Nathan Wolfe (CEO, Remote Dosimetrist).

We discuss current challenges such as interdisciplinary communication among dispersed teams, how EMRs are really designed for billing, and how artificial intelligence and automation could close the technology gap between centers in US #RadOnc and around the world.

Then, we discuss how increasing availability of high speed internet, the COVID19 pandemic, and culture change drove the rise of remote dosimetry and other remote work. This leads to a more broad discussion of resource allocation and Varian's effort to reduce treatment start time from an average of 2 weeks to 2 hours. We also discuss a new challenge, the increasing need for radiotherapy re-treatment.

In a short after-show, we discuss the "Cheesecake Factory" model of medicine. Will these workflow improvements help small clinics push back against growing hub-and-spoke networks?

Note: The opinions expressed on this episode do not reflect the opinions of the host's or guest's employers. The guests volunteered their time to participate in the show and their participation on The Accelerators Podcast is not an endorsement of their products. If you saw Simul driving a lambo shortly after this show, it is simply a coincidence. Unfortunately, nobody made any money on this show.

Custom show art generously donated by Dr. Danielle Cunningham.

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#RadOnc legend Dr. Ralph Weichselbaum joins The Accelerators (Drs. Anna Laucis, Simul Parikh, and Matt Spraker) for one of our favorite episodes ever.

We kick off by discussing how to #MedTwitter, the state of technology and proton therapy, and radiation resource allocation. Then we discuss Ralph and Sam Hellman's 1995 paper, Oligometastases, the history of the concept, and where we are headed. This leads to a scientific discussion on the abscopal effect.

We close the show with an epic new segment: the lightning round! We grill Ralph on pizza, the MD/PhD degree, the best cities for conferences, and why #RadOnc would benefit from broadening our scope of work to include delivery of select systemic therapies.

Here are some other things that came up on the show:

• Michigan Radiation Oncology Quality Consortium 
• Ralph and Sam Hellman's (2011) Oligometastases revisited
• Turchan, Pitroda, and Weichselbaum (2021) on radiotherapy and immunotherapy for patients with metastatic disease. 
• Pitroda and colleagues (2018) on molecular subtyping to define an oligometastatic state in colorectal cancer. 
• Tsai and colleagues trial (2021) of SBRT for oligometastases from non-small cell lung cancer and breast cancer.
• Robin Mole's (1953) original description of the abscopal effect.
• Postow and colleagues (2012) NEJM case report of the abscopal effect. 
• Sylvia Formenti's Nature Medicine (2018) paper on radiotherapy plus immune check point inhibitors. 
• Huang and colleagues Nature (2017) paper on T-cell invigoration.
• McNeil, Weichselbaum, and Parker NEJM study (1981) on trade-offs between quality and quantity of life.
  • See also: McNeil, Weichselbaum, and Parker (1978) on the Fallacy of the Five-Year Survival in Lung Cancer.

Podcast art generously donated by Dr. Danielle Cunningham.

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Drs. Anna Laucis and Simul Parikh use the recent criminal case of RaDonda Vaught to launch an introductory discussion of medical errors in #RadOnc. In this informal chat, they discuss important quality and safety concepts and share their experiences with incident learning, safety culture and, of course, Swiss cheese. 

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Dr. Todd Scarbrough and Dr. Nick Zaorsky (http://zaorsky.com/) join Dr. Matt Spraker for a jobs show boost!

In this show we take a deep dive on radiotherapy utilization in the US. We start our exploration by reviewing a recent Cancer publication from Nick's team evaluating facility volumes. By reformatting Nick's data presentation, Todd discovers that utilization exists in a Pareto distribution across centers; most centers are treating a relatively low volume of patients per year.  How does this affect the job market? How does it affect your job?

Also, Simul calls in to speak against training expansion and Todd and Matt shares their thoughts on the changing landscape of radiotherapy utilization for patients with lung cancers. 

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

• Nick’s tweetorial about his team's paper 
• Todd’s tweetorial evaluating Nick’s team's data 
• Todd's tweetorial evaluating medicare payment data
• Todd's tweetorial on radiotherapy utilization for lung cancer 
• The Alabama Band 
• Dr. Join Luh's editorial on how the proposed RO-APM could have impacted small and rural radiotherapy centers.

Show art generously donated by Dr. Danielle Cunningham.

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Drs. Anna Laucis, Simul Parikh, and Matt Spraker jump behind their mics to record a live podcast during the lunch break of day 1 of the 2022 ASTRO Refresher Course.  Yes, we had a live Zoom audience!

In this unplanned and unedited chat, we discuss #RadOnc The NRMP Match 2022 and SOAP results, more on the job market, and Matt's favorite: Prior Authorization!

At the end, we field an audience question on the discordance between job satisfaction survey data, which are overall positive, and anecdotal discussions on and offline, which seem to trend negative.

Podcast art generously donated by Dr. Danielle Cunningham.

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Accelerator Dr. Simul Parikh and friend of the show Dr. Jason Beckta join Dr. Todd Scarbrough as he signs on live from #ACRO2022! 

In this unfiltered, slightly edited chat, they debrief on the job market and discuss the RO-APM, adaptive radiotherapy, breast IMRT, and more! 

And remember folks, #PantsArentReal

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The Accelerators (Drs. Anna Laucis, Simul Parikh, and Matt Spraker) are joined by Drs. Jason Beckta, Emma Fields, Todd Scarborough, and Chirag Shah to discuss the #RadOnc job market.

Join us on an epic journey through the past, present, and future of the job market. We  cover the highly variable written record of the #RadOnc workforce, how patient volumes are changing with hypofractionation, and the what the market will look like in the future.

We close the show with a round robin on advice for young radiation oncologists heading into the field we all love. 

More information on the topics we discussed:

• Dr. Lawrence Davis in 1986: “The manpower crisis facing radiation oncology”
• Dr. Chirag Shah’s letter: “Expanding the Number of Trainees in Radiation Oncology: Has the Pendulum Swung Too Far?”
• "In Regard to Shah"
  • By Dr. Anthony Zietman 
  • By Dr. John Leung
  • By Drs. Dennis Hallahan and Stephanie Perkins 
  • By Dr. W. Robert Lee 
  • By Drs. Paul Wallner and Dennis Shrieve 
• SDN Radiation Oncology Forum 
• Medical School Reddit 
• Dr. Ben Smith's team in 2010: "The Future of Radiation Oncology in the United States From 2010 to 2020: Will Supply Keep Pace With Demand?"
• Dr. Ben Smith's team in 2016: "The Radiation Oncology Job Market: The Economics and Policy of Workforce Regulation"
• Mudit Chowdhary's team in 2019: "The Impact of Graduates' Job Preferences on the Current Radiation Oncology Job Market"
• Follow Nicholas Zaorsky on Twitter
• Updated ACGME Program Requirements for Radiation Oncology and FAQs 
• Dr. Li's team in 2020: "Temporal Trends of Resident Experience in External Beam Radiation Therapy Cases: Analysis of ACGME Case Logs from 2007 to 2018"

Podcast art generously donated by Dr. Danielle Cunningham

**Update**

Dr. Zaorsky comments with a thread of threads, packed with more info for a deeper dive on #RadOnc facility/utilization.

Dr. Fuller tweets a deep pull from the archives.

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In our final episode of 2021, Drs. Laura Dover (@LauraDoverMD), Caleb Dulaney, and Samuel Marcrom from QuadShot News (@QuadShotNews) join the The Accelerators (Drs. Anna Laucis, Matt Spraker, and Simul Parikh) for a scientific year in review! 

The reports of our death are greatly exaggerated; it was a great year in #RadOnc science! Join us as we review our favorite articles of the year and commentate on their impact for #RadOnc.

Caleb’s Pick — The Empire One Trial
Anna's Pick — The Flame Trial
Samuel's Pick — The VISION Trial
Laura's Pick — KROG 0806
Matt's Pick — CCTG SC.24/TROG 17.06
Simul's Pick — SBRT in lieu of systemic therapy for RCC

Happy holidays and happy new year to all, and here's to a great '22!

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In the final part of our Builders series, we all gather around for a fireside chat with #MedEd all-stars Dr. Erqi Pollom and Dr. Jenna Kahn (@JennaMKahn). The Accelerators (Drs. Anna Laucis, Matt Spraker, and Simul Parikh) interview the founders of ROVER, the Radiation Oncology Virtual Education Rotation.

Dr. Pollom is an Assistant Professor of Radiation Oncology (and Neurosurgery) at Stanford University and Dr. Kahn is Assistant Professor of Radiation Medicine at Oregon Health and Science University.

We start by discussing how they launched their innovative distance learning program for radiation oncology trainees; special shout out to their initial resident web masters Utkarsh Shukla, MD and Ryan Hutten, MD! Later we discuss where ROVER might fit in residency education curriculums, the "flipped classroom" (h/t to @HoldDownTheFord), and upcoming ROVER sessions. 

Simul shares his love for hosting medical students and considers starting a residency (just kidding).

Here are some other things we talked about on the show:

• 13 things you didn't know about Costco's Pumpkin Pie
• Simul's amazing Thanksgiving turkey
• Serious Eats: How to Spatchcock a Turkey (YouTube)
• See the entire ROVER support team
• ASTRO's Peer-to-Peer Match Program
• Chartrounds.org