Richard Shaffer

Radiation Oncologist specialising in Benign Radiotherapy Training for Radiation Oncologists (see for details)

[Richard Shaffer @DrRShaffer]

@ASTRO_org Ok. Would be interesting to know the follow up time and specific response details. It’s particularly important in primary RT in this context as it may rule out (or at least limit) future postop radiotherapy.

[Richard Shaffer @DrRShaffer]

Average age: Iranian trial = 77 years (Dutch trial = 65y, Russian = 40y). Grade of OA (Kellgren Lawrence): Iran = 1-3, Russian = 0-2, Dutch = 1-3. RT dose-fractionation: Iran 3Gy/6#, Russian 4.5Gy/10#, Dutch 6Gy/6#. Main concerns with the (negative) Dutch trials = pain duration > 5 years in most patients, so that patients were never likely to respond to radiotherapy. Secondary issues - a lot of erosive arthritis, suboptimal RT dose

[Richard Shaffer @DrRShaffer]

You CAN start a benign radiotherapy program on your own

The biggest problem with doing that?

No-one takes you back to basics
- The things we all should know
- The things we learned 20 years ago
- Like how joints actually move

It’s the fundamentals that catch people out

This is what separates clinical confidence from "winging it"

(Yes - we've all done it at some point)

Take the elbow

Until a couple of years ago, I hadn’t examined an elbow in 25 years

Most people remember
- Biceps = flexion
- Triceps = extension
- But how about ROTATION?!

That’s a different story

Forearm rotation isn’t simple
- The radius spins near the elbow
- Then arcs around the ulna at the wrist
- The ulna? It stays still

The radius does all the work
- Supination = bones side by side
- Pronation = the radius crosses the ulna
- That’s how you turn a doorknob or flip your palm

But trauma or surgery can trigger heterotopic bone
- It bridges the radius and ulna
- And blocks that rotation completely
- That’s why postop RT is used to prevent prevent heterotopic bone growth

But if you don’t understand the anatomy…
- You won’t understand the loss of motion
- And you won’t place your fields correctly

This is why we go back to basics.

Because we need them for real clinical mastery

👉 DM me or visit https://t.co/9iY1wogqFZ for more information

[Richard Shaffer @DrRShaffer]

@PDBrownOnc **head in hands**

[Richard Shaffer @DrRShaffer]

@EvanThomas84 @ASTRO_org @aapmHQ @DrewMoghanaki @jryckman3 @joshuapalmermd @DrRajuRaval @Raj_Singh_MD Feels very familiar!

[Richard Shaffer @DrRShaffer]

@DrChowdharyMD @SprakerMDPhD @AcceleratorsRO @KoneruMd Really enjoyed listening to this

[Richard Shaffer @DrRShaffer]

@DrChowdharyMD @EmoryMedicine @WinshipAtEmory @MohammadKhanMD @soumon_rudra Looks like a great event!

[Richard Shaffer @DrRShaffer]

Another RCT showing the effectiveness of LDRT for osteoarthritis

[Alireza Javadinia @Javadinia_AR]

@KoneruMd Our recent trial showed that low dose rate radiotherapy can significantly decrease the pain and improve performance score and quality of life in patients with knee osteoarthritis (https://t.co/O1BxCgms2C)

[Richard Shaffer @DrRShaffer]

I love teaching

But this is the best thing

Always hoping you're doing something right

"The course in Dusseldorf Germany was one of the best courses I have ever been to in my life. I learned a tremendous amount of information and technique for treating benign diseases with radiation. The material was practical, the lectures were easy to learn from and follow. I highly recommend it to those wishing to add treatment of benign disease into their practice."
- Ari Katerelos, Radiation Oncologist, California

👉 DM me or go to https://t.co/9iY1wogYvx for details of future courses

[Richard Shaffer @DrRShaffer]

@KoneruMd Really interesting - thank you for sharing. It does make me think more and more that we need a non-invasive treatment that actually preserves the joint... oh yes - we already have one in low-dose radiotherapy!

[Bobby Koneru, MD @KoneruMd]

🚨 if you have Osteoarthritis, would you get steroid injections into your joint after hearing this?

Sign me up for LDRT: pain reduction, slows progression of #osteoarthritis

[Richard Shaffer @DrRShaffer]

Just sitting down writing letters from my benign radiotherapy clinic

Some are simple cases but some are surprisingly complex

I thought that by doing benign RT that it would stop stimulating my brain

Previously I mainly treated brain and urological tumours, with all the attendant complications, both medical and emotional

But in fact once you really get into the subject there are just as many interesting things to work out

In one clinic I've
- Requested an MRI of a finger as the "Garrod's pad" turned out to be significant bony swelling on examination
- Requested specific MRI sequences for recurrent Ledderhose disease of the foot after radiotherapy
- Reassured a patient that the new lump after radiotherapy for Dupuytren's disease is in fact a ganglion
- Talked in detail about eccentric exercises, orthotics and reloading for a patient with Achilles tendinopathy who I'm treating with radiotherapy
- Dealt with a patient with type 1 diabetes with pain that is likely to be from a combination of osteoarthritis, Dupuytren's and triggering, and trying to work out whether/how I can help

This is lifelong learning!

For me this is more challenging than treating my 1000th prostate radiotherapy patient

So are you ready to start your journey into this strange new world?

Send me a DM saying I'M READY and lets chat!