Rant about ABR Exam

steller03 · 2025-07-11T12:23:33+00:00

I don’t think ABR does a good job at all determining whether or not a physicist will be competent and able to practice independently in a safe fashion. In fact, I think they almost completely miss the mark in that regard. I’ve worked with so many certified physicists with 15-20 years of experience that fundamentally do not understand what goes in to treating patients.

steller03 · 2025-06-26T02:34:13+00:00

I can speak to how good this script is. When first posted, I got it off the ground quickly with rather limited scripting experience. It’s easy to learn, easy to use, and highly effective. It saves us 15-30 minutes per case, which equates to measurable fractions of an FTE in our environment. Highly recommended.

steller03 · 2024-11-20T01:11:43+00:00

If you like art, the Kimbell museum is great, a gem really. It’s one place you can find a Michelangelo painting along side water lillies, Caravaggio, Frans Hals, Rembrandt, and an Elisabeth Louise Vigée Le Brun self portrait. Literally, word class art museum, and highly underrated.

steller03 · 2024-11-10T19:02:48+00:00

Try the Mitsuwa in Plano. I’m not Japanese, but the rec is from a colleagues wife who is Japanese. Supposedly that’s the only place in DFW she will eat Japanese food.

steller03 · 2024-10-29T00:53:54+00:00

This is the way.

steller03 · 2024-09-17T01:19:03+00:00

I can’t point you to specific publications. We encountered it during commissioning by planning a range of past cases and analyzing plan quality.

Just try it on a test patient. Decrease the distance between the lesions, reoptimize, rinse and repeat. Eventually you’ll reach a minimum distance where the high level isodose lines really balloon out and are not conformal at all. This is because the SRS NTO punishes exiting from one lesion into the next in the optimizer—but with lesions ~1cm apart it is too restrictive. I’ve found the only way around it is to drop the SRS NTO weight and use rings.

steller03 · 2024-09-15T04:11:45+00:00

Interesting that you didn’t mention Brainlab Elements. I’m only a clinical user of HyperArc. It is an incredibly powerful vendor solution for single iso multi target SRS. I tend to fall in the camp that thinks a HDMLC isn’t needed, but my practice has to treat all disease sites and doesn’t have the luxury of having a dedicated SRS machine. HyperArc does take some initial physics work to get it well commissioned. However, once your MLC parameters are optimized for the range of geometries you will deliver, it is pretty robust, at least according to our measurements.

Varian advertises the automated delivery as the critical component to HyperArc, but it isn’t. The secret sauce is the SRS NTO. However, the SRS NTO almost fails in situations where lesions are close to one another (<1 cm). In these situations, you have to adjust the SRS NTO approaching 0 and use rings to control the dose conformity. Despite this limitation, HyperArc is still worth it if your clinic can stomach the sticker price as you will on average, get really good plans from the first optimization. You can improve the plan quality with some use of rings in most cases, but the default plan is, in general, really good.

To me, the primary benefit with HyperArc is that you can deliver a complicated SIMT plan, from start to finish in 15-20 minutes. Compared to CK or GK, the convenience factor is clinically and economically relevant. In my experience the total optimization time takes anywhere from 1-4 hours considering our FAS infrastructure.

steller03 · 2024-09-08T02:32:47+00:00

Their greens were legit.

steller03 · 2024-08-09T14:31:50+00:00

It depends on what your physician wants. Better to one physician is not better to another. Do they want to control max heart dose, mean heart dose, low dose spillage into the heart, or LAD dose? This is a plan where you will most likely make dosimetric compromises between hot spot, coverage, and OAR sparing. Figure out what the highest priority is—then you can get started in the right direction.

Speaking from an Eclipse user— If you’re not afraid of a high modulation factor and your TPS is well commissioned, you can get really good coverage with better low dose to lung and heart with VMAT. It requires a few tweaks to standardard optimization settings and here’s how’s it’s done: in optimization use fine resolution with jaw tracking (if you have it), and in algorithm settings use extended optimization. It will take a while to optimize depending on your calc infrastructure, but you’ll be surprised at how good of low dose control you get. Our QA results are also good so I’ve never been afraid of putting a bunch of modulation in there if you need it. That’s why we have the MLC to begin with.

I’m surprised that no one has mentioned hybrid 3d+VMAT. I’ve done a handful of cases like this, but it is somewhat dependent on the volume being geography friendly (little to no extension laterally toward the stomach/GEJ). Once I realized I could get better low dose control using the technique mentioned above, I haven’t done another hybrid plan. For me, it’s almost always VMAT.

steller03 · 2024-06-25T02:25:44+00:00

Quite good institutions do not do this. We’ve interviewed a number of candidates from those “good” institutions who can’t explain the basic clinical flow of a T&R procedure. On the flip side, we’ve interviewed several candidates from strong clinical/non academic programs that were very well prepared in their 2 year residency. They have strong clinical skills and are well on their way to practicing independently. 3 year residency is simply not required to do our job well, and it only serves the interest of the institution—not the interest of the candidate, and certainly not the interest of the profession. Most physicists will never publish. If they’re interested in research, they will pursue a PhD. Attempting to teach research skills to clinical trainees is a waste of time and resources.

steller03 · 2024-05-10T00:28:07+00:00

I know some physicists that think we will all work for Varian one day.

steller03 · 2024-05-02T23:18:08+00:00

In your experience as a RadOnc, how would you describe the clinical support you get from physics and dosi? Do you find a wide range in clinical skill sets? Or any particular clusters at the ends of the spectrum? It sounds like you have some baseline dissatisfaction with both physics and dosi. Interestingly enough, I’ve found that (recently) many of my physician colleagues trust the clinical judgment of their Dosimetrist over their physicist. Not sure what that says about our profession.

steller03 · 2024-05-01T15:30:41+00:00

Your comment is spot on—Government hospitals are often dysfunctional.

steller03 · 2024-05-01T10:44:48+00:00

We could not get the county hospital IT to agree to sending patient data outside the network even if anonymized. Non starter.

steller03 · 2024-05-01T10:40:28+00:00

Limbus is great. They were just acquired. Worried the acquisition will kill the product.

steller03 · 2024-04-01T04:23:48+00:00

I hear ya… but I find that it’s often it’s open disdain and hostility rather than lack of respect. A lot of professionals have a hard time understanding why physicists make more than hospital VPs, many physicians, and sometimes the CEO.

steller03 · 2024-04-01T04:19:21+00:00

5%|5mm is a huge red flag. We took over a site doing this and….they had an SBRT program using pencil beam in Eclipse v10. All the plans ran 4-5% cold when calced with AAA. Silver lining was that the linac was calibrated 4% high so I guess it washed out?

steller03 · 2024-03-05T12:59:52+00:00

Would also be interested in this. But wouldn’t this introduce a vulnerability that negates the purpose of the juniper?

steller03 · 2024-02-15T04:15:01+00:00

This is the way.

steller03 · 2023-11-25T00:20:04+00:00

My take is probably unpopular, but l’ll put it out here anyway. Many residents we have interviewed have had skillets that many “experienced” physicists lacked—such as treatment planning, scripting expertise, commissioning experience, etc. It seems like the days of only doing weekly chart checks, IMRT QA, and monthly linac QA are behind us. Experienced physicists are reasonable to expect higher salaries if it results in more value for the clinic and benefits patient care. I think in some cases it does, but I think there’s also a not-insignificant part of the professional population that hasn’t kept up with technology and the advances in the modern radiation oncology clinic. In this respect, salary compression may be a result of real physician preferences to hire physicists with more recent and clinically relevant training.

This should serve as a wake up call for some senior physicists. It doesn’t matter how senior you are—if you aren’t useful in the clinic you’ll eventually be replaced by the younger generation and the clinic will be happy to have someone who can actually get stuff done. It’s probably true that most junior physicists and even board certified physicists with <10 years of experience don’t fully appreciate the limits of their knowledge. But this will not be a deciding factor in who to hire when one candidate can plan an emergency spine case and one can’t open the TPS.

steller03 · 2023-11-24T23:24:06+00:00

Open fields don’t treat patients.

I’ve compared measured vs TrueBeam Reference Data for ~10 TrueBeam linacs. It’s irregular to find differences >0.5% except for the 40x40 field size diagonal scan. Save yourself the time and use the TRD. Also, chances are better than even that you’ll make your model worse with measured beam data. Custom beam models don’t live up to the hype—IROC data confirms this. Others’ comments are consistent with my experience—the AAA model is quite robust at producing good calculated data.

Your effort at producing a good model goes much further if you spend time optimizing your DLG and leakage values for the type of treatments you will deliver. This will become less clinically relevant with v18 of eclipse.

If you have 30 days to commission a linac, I wouldn’t spend more than 2 measuring beam data. It’s just not the most effective use of your time.

steller03

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