new use for radiation?

[putter]

https://medicine.wustl.edu/news/deadly-heart-rhythm-halted-noninvasive-radiation-therapy/

game changer? Cardiology encroaching on the use of radiation vs radiation oncology potentially expanding its scope? man is it interesting.

There's a handful of benign stuff right now that rad oncs see (i.e trigem neuralgia, AVMs, heterotropic ossification, duputreyns contractures) on a pretty rare basis. Talking to an older staff today, he said they used to look at radiation for inflammatory conditions (ex. rheumatoid, ank spond) decades ago and obviously those results turned out negative. Makes you wonder though if there are other things that people just haven't thought of yet

radiation cardiologists and cardiac radiation fellowships anyone? hahaha! Having seen what cardiology did to cardiac sx., wouldn't be surprised if they tried taking this under their scope too (assuming this does end up being a game changing therapy of course, still many many years of research to be done before we can even remotely consider this in clinical practice)

 

[penguin92]

read about this yesterday, really cool. You're right in that i think this is years away from being considered in clinical practice. We don't know what the long term side effects are. these 5 patients though had really exhausted all their options up to this point

LOL don't know about cardio encroaching on our turf, would like to think that rad oncs would keep RT, especially stereotactic delivery, under their scope. I mean cardiology is a long enough road in canada from what my internal med friends tell me

[thestar10]

Radiation is already used in cardiology. Coronary brachytherapy (although not SOC) has existed for a while. http://interventions.onlinejacc.org/content/9/12/1266

Honestly, if I was a patient with refractory VT I would want to be managed by a cardiologist and not a rad onc lol. I think this will likely become a multidisciplinary approach with both specialties highly involved. That being said, in the highly unlikely scenario, it wouldn't be disastrous if cardio took this from us as this is probably 0.001% of our entire scope. 

As a Rad Onc resident, I'm fine not managing patients with deadly heart rhythms :)

[penguin92]

agreed, probably will end up being a multidisciplinary thing if it ever does become a thing. Although its nice to think that our scope could potentially broaden in the future

doubt we'd ever actually need to "manage it" per se, radiation effect takes time so anyone with an acute episode would get absolutely no benefit from rad oncs and would stay under cardio with their amio drips 

[Edict]

On 12/15/2017 at 0:37 PM, putter said:

https://medicine.wustl.edu/news/deadly-heart-rhythm-halted-noninvasive-radiation-therapy/

game changer? Cardiology encroaching on the use of radiation vs radiation oncology potentially expanding its scope? man is it interesting.

There's a handful of benign stuff right now that rad oncs see (i.e trigem neuralgia, AVMs, heterotropic ossification, duputreyns contractures) on a pretty rare basis. Talking to an older staff today, he said they used to look at radiation for inflammatory conditions (ex. rheumatoid, ank spond) decades ago and obviously those results turned out negative. Makes you wonder though if there are other things that people just haven't thought of yet

radiation cardiologists and cardiac radiation fellowships anyone? hahaha! Having seen what cardiology did to cardiac sx., wouldn't be surprised if they tried taking this under their scope too (assuming this does end up being a game changing therapy of course, still many many years of research to be done before we can even remotely consider this in clinical practice)

 

Cardiology sees the patients and so likely will have some hand in it, but it does remain to be seen who ends up doing it. 

[rmorelan]

On 12/19/2017 at 9:07 PM, Edict said:

Cardiology sees the patients and so likely will have some hand in it, but it does remain to be seen who ends up doing it. 

Cardiology does have a rip of rather ruthlessly taking anything do to with the heart as their domain so I would not be surprised if it is them. Not just with cardiac surg - all forms of cardiac imaging (echo, MRI, CT, nuclear....) they do all of that as well. They control the patient flow so can direct the stuff internally. They historically will work interdisciplinary until they acquire internally the skill, and then they take it over. This isn't about them being "evil" or anything - they just know their turf and don't like people playing in their sandbox. 

[Lactic Folly]

And developing a special name for the modality when applied to the heart is part of that shift in identity - e.g. echocardiography, another name for ultrasound of the heart. Interesting article on this in JACR recently.