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How are you all setting up plantar fasciitis and what sorts of field arrangements?
Calcaneus + bone spurs if it’s localizedHow are you all setting up plantar fasciitis and what sorts of field arrangements?
Calcaneus + bone spurs if it’s localized
Add the sole if diffuse plantar pain
Feet first, immobilized
Laterals
“Haven’t had the guts”I just had a breast follow-up pin me down and promise to try RT for her knee OA. Apparently, I’ve chatter with her about it a couple times in past 2 years after reading this thread but I haven’t had the guts to try this yet. She’s gonna be my first. Are y’all doing 50 cGy x 6 fractions QOD? Do you plan retreat in 12 weeks? I’m seeing different things when reviewing all these threads. Thanks!
Do you give second stage to anyone who doesn’t have complete pain relief?Yes
Mention the re - tx up front, that it’s a two stage treatment, but some patients do not require the second stage
Bill lightly, no IGRT please, don’t want them to take this away. It’s been a godsend
No.Do you give second stage to anyone who doesn’t have complete pain relief?
We are our own worst critics“Haven’t had the guts”
This always mystifies me what a weird affect we have sometimes in rad onc. You don’t need permission from your former PD to give 3 Gy to an arthritic knee. You don’t need to worry about what some rad onc across town is going to think. The radiation police won’t come drag you out of bed. Merrick Garland isn’t going to perp walk you. No one besides rad oncs care what other rad oncs think. You don’t need guts to give a worldwide standard of care medical treatment, just a cerebral cortex.
How does the approval process go for round 2? Do you ask for 12 up front or resim them after 6 for a second course?No.
Some people want all 12 from start. Most want to see how the 6 go. If they have relief, usually wait til it wears off before offering. If they have no relief, then 12 weeks they can restart, but many choose not to. I remain as nonchalant about it - this is purely elective and I never want to feel like a salesman (although there is that aspect of it that exists)
This is what I would like to know. I've done a couple medicare without an issue, but I just had to go to evicore P2P to get an ankle course approved. I am dreading the process for a second course if neededHow does the approval process go for round 2? Do you ask for 12 up front or resim them after 6 for a second course?
We’ve started to ask for 12 up frontThis is what I would like to know. I've done a couple medicare without an issue, but I just had to go to evicore P2P to get an ankle course approved. I am dreading the process for a second course if needed
I explained that the patient met the evicore criteria under benign diesease, using CPT M19.071 (OA of ankle), and wanted to know why the P2P was needed. The response was, "well we can't just let everyone have radiation." I honestly didn't know what to say.We’ve started to ask for 12 up front
I’ve only had one P2P. She wondered why not 5 fx - she was assuming it was treated like a met
Sad. I write notes now with "evicore criteria" in them to prevent p2ps. So far so good.I explained that the patient met the evicore criteria under benign diesease, using CPT M19.071 (OA of ankle), and wanted to know why the P2P was needed. The response was, "well we can't just let everyone have radiation." I honestly didn't know what to say.
The patient clearly had failed all available treatment options, so there was no ground for denial. But that didn't stop them from trying.
"Well we can't just let everyone have radiation." I honestly didn't know what to say.
"Just remember, karma is a b*tch! ""Don't worry. I will make sure you won't get any radiation, when you are in pain."
The response was, "well we can't just let everyone have radiation." I honestly didn't know what to say.
What's a joint replacement go for all-in at this point? 100k?Can't we?
The use of radiation for arthritis in this country would save billions of dollars a year.
The Swiss, but they used different dosing and fractionation than the Germans. In my experience, which mirrors the german one, going from qd to qod improved outcomes. I use 3 gy qod. Swiss study used 6 gy qd.Didnt the Dutch do a study in this years ago and show its BS?
I treat foot and ankle. 50 cgy x 5 fractions.How are you all setting up plantar fasciitis and what sorts of field arrangements?
5? I thought the answer for OA was 0.5 x 6I treat foot and ankle. 50 cgy x 5 fractions.
PF 0.7 x 85? I thought the answer for OA was 0.5 x 6
Lord can we at least keep the SDN dosing standardized
LOL.5? I thought the answer for OA was 0.5 x 6
Lord can we at least keep the SDN dosing standardized
Where did that come from?LOL.
I have switched to 50 x 5 for all my OA.
Sorry Evil.
The German POC study from 2018 states single fraction doses are 0.5 - 1.0 Gy to total doses of 2-8 Gy are being used.Where did that come from?
No, but neither do any other arthritis treatmentsDo we have a huge study showing this is not sorcery? I mean, I know there are smaller +/- studies..
Not for me. Just don't try to sneak IGRT in with it.Asked this in the business section, so will ask here as well for general input. Any particular insurances problematic/impossible to get rt approved for osteoarthritis?
I'm being reasonable. Otoh, healthhelp and AIM make no mention of this, or really any benign disease in their manualNot for me. Just don't try to sneak IGRT in with it.
"Gotta CBCT this knee..."
Any carrier with half a brain can do the math and should be drooling over this vs paying out for a joint replacement!I'm being reasonable. Otoh, healthhelp and AIM make no mention of this, or really any benign disease in their manual
Can't get approved or rejected until you ask...I'm being reasonable. Otoh, healthhelp and AIM make no mention of this, or really any benign disease in their manual
Yeah. In process. Just curious what people have said to healthelp for prior auth should it be rejeacted/require P2P. This could be much ado about nothing. Particularly as AIM and Healthhelp say nothing about treating keloid, plantar/palmar fibromatosis, HO, or other benign diseases in their guidelines.Can't get approved or rejected until you ask...
Have you tried asking for approval yet?
If you do lots of CBCTs you can even drop a fraction!Not for me. Just don't try to sneak IGRT in with it.
"Gotta CBCT this knee..."
Yeah. In process. Just curious what people have said to healthelp for prior auth should it be rejeacted/require P2P. This could be much ado about nothing. Particularly as AIM and Healthhelp say nothing about treating keloid, plantar/palmar fibromatosis, HO, or other benign diseases in their guidelines.
I have treated hundreds, maybe a thousand joints by now. Never been denied.Asked this in the business section, so will ask here as well for general input. Any particular insurances problematic/impossible to get rt approved for osteoarthritis?
Yeah, they accepted it. Thanks.I have treated hundreds, maybe a thousand joints by now. Never been denied.
But that's denying extra anti arthritic healing rays!Not for me. Just don't try to sneak IGRT in with it.
"Gotta CBCT this knee..."
Yeah - seems like a little less effective than hands or kneesanyone treated hips- do they respond?