The Ethos of Noona

[scarbrtj]

Realize the thread title sounds a little like the Legend of Zelda or something, but is anyone (resident, attending, whomever) using Ethos or Noona? Ethos sounds great... "Technology so advanced it will inspire you to reimagine how you’re able to treat each patient in your care." Do I need to reimagine how to treat my patients? Will there be a survival advantage? Do we do the reimagining first and studies later, or studies first and reimagining later. (Do we have good data that CBCT improved survival or lowered toxicity in XRT? I honestly off top of my head don't know, but I know it was in widespread use BEFORE any such data appeared. In rad onc, there's dosimetric/in silico, and clinical/in vivo... the two don't have to go hand in hand, and only the latter matters.) Ethos makes *a lot* of clinical decisions, on its own. Either we accept them, or not; if it turns out they should be accepted at the level of accuracy computers usually obtain, not a big role for intratreatment MD intervention? What's that mean? Re: Noona (or noona?) there's data that patient iReporting can improve survival, esp in lung ca. Although I get a little worried that we may be turning patients into scribes like we've all been turned into scribes; if a patient essentially "writes" their own weekly management note and all's we do is sign it...

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[RickyScott]

Is ethos is just software added on to halcyon or is there any hardware component and about how much does it cost?

 

[scarbrtj]

Is ethos is just software added on to halcyon or is there any hardware component and about how much does it cost?

I'm going to bet it's software, but you get a nice new ETHOS placard on the machine though.

 

[RickyScott]

If cost is substantial, and you are part of apm, won’t be able to charge for all the replanning...

 

[scarbrtj]

If cost is substantial, and you are part of apm, won’t be able to charge for all the replanning...

Then over time those machine prices will come down. From a real tough-eyed view, all the replanning charges being done e.g. w/ MRgRT are being done so with NO externally supported randomized trials showing it changes outcomes. Although, of course, I would be doing the replanning if I had the MRgRT. When you have a hammer you start hammerin' the hell outta everything. "How did I ever even practice without MRgRT?!"

 

[medgator]

Then over time those machine prices will come down. From a real tough-eyed view, all the replanning charges being done e.g. w/ MRgRT are being done so with NO externally supported randomized trials showing it changes outcomes. Although, of course, I would be doing the replanning if I had the MRgRT. When you have a hammer you start hammerin' the hell outta everything.

Varian sold out at the right time....

 

[scarbrtj]

Varian sold out at the right time....

I have a hunch that a good IG-IMRT machine could be made for a price that makes a $500K price tag possible. And the software being used, at the end of the day if we're being honest, is probably not as complex as, say, Fortnite. But hey it's healthcare.

 

[evilbooyaa]

It is imperative that those doing daily replanning publish on the outcomes of those patients. Every single patient treated with daily replan should be on a registry. It's definitely an interesting technology, but at most I expect that it may assist primarily in reducing toxicities rather than improving survival survival compared to say basic daily IGRT.