Clinical director, Vice Chair of education, Professor of Radiation Oncology @ Cleveland Clinic. Tweets mine.
Cleveland, OH
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Burnout & moral injury in medicine have affected so many health care workers. As a mid-career physician, here’s what I’ve learned to combat it - I hope others find it to be helpful.
In Search of Joy and Meaning in Modern Medicine @JCOOP_ASCO ascopubs.org/doi/pdf/10.1200…
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Rahul Tendulkar, MD retweeted
Virtually walking the halls at #ASTRO2026 as a medical oncologist, I keep coming back to the same thought: radiation oncology is quietly rewriting what “definitive local therapy” can look like.
The unveiling of Accela from @SiemensHealthineers is more than another linac. Single-breath-hold SBRT, multi-site treatments in ~60 seconds, imaging-to-beam-off in under 90 seconds. Speed that actually changes biology and logistics, not just throughput. Patients spend less time on the table. Targets have less chance to move. Adaptive workflows become practical rather than aspirational.
What strikes me most as a simple.medonc is the accumulating evidence that SBRT is matching surgery in more and more settings: early lung cancer, localized prostate (PACE-A data here this week), selected oligometastases, small HCC. Every time we add a tumor type to that list, we spare someone anesthesia, a wound, weeks of recovery, and the cascade of complications that still follow even “minimally invasive” operations.
Surgery will always have its place. But the risk-benefit conversation is shifting. For older, frail, or multi-morbid patients, the ones I see every clinic day, the non-invasive option is no longer a consolation prize. It is often the more thoughtful one.
The field is not just getting more precise. It is getting faster, smarter, and more humane. That is worth paying attention to, even from the medical oncology side of the hallway. Well done my fellow radoncs!!
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Come learn about the best program ever! There might be some special treats 😃
🚨Medical students attending #ASTRO2026 — come meet us!!
Join @ClevelandClinic Radiation Oncology for a meet & greet to learn more about our program, meet our residents and faculty, and hear what life is like at Cleveland Clinic!
🗓️Sunday, Sept. 27 | 3:15-4:15pm
📍Booth 1635
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Rahul Tendulkar, MD retweeted
🚨Medical students attending #ASTRO2026 — come meet us!!
Join @ClevelandClinic Radiation Oncology for a meet & greet to learn more about our program, meet our residents and faculty, and hear what life is like at Cleveland Clinic!
🗓️Sunday, Sept. 27 | 3:15-4:15pm
📍Booth 1635
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Rahul Tendulkar, MD retweeted
I’ve learned that the choice is not simply between prestige and money. This generation of physicians may be willing to trade prestige for better financial opportunities, and some may be willing to trade financial gain for passion, and purpose. But what they are increasingly unwilling to trade away is autonomy, quality of life, and the feeling of being valued.
Prestige may attract people, purpose may keep them but respect, autonomy, and being valued are what make them stay.
Very thoughtful article. Academic medicine needs to figure out how to right the ship. More talent are leaving academics for private or industry opportunities. The question to ask now is, “Does prestige of academics even matter to the new generation? opmed.doximity.com/articles/…
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Come learn about the best program ever!!!!! 🎉
🚨Medical students interested in #radonc please join us virtually to meet our amazing residents and learn all about CCF Rad Onc and the upcoming application cycle! We’re so excited to meet you! ☢️🌟
RSVP HERE: bit.ly/4wSwKhd
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Rahul Tendulkar, MD retweeted
🚨 GETUG-AFU 18: Does RT dose escalation improve survival in high-risk prostate cancer?
Phase III | N=505
High-risk non-metastatic prostate cancer
Long-term ADT + 80 Gy vs 70 Gy EBRT
📈 At 9.5-year median follow-up:
• 10-y PFS: 83.6% vs 72.2%
HR 0.56, p<0.0001
• 10-y OS: 77.0% vs 65.9%
HR 0.61, p=0.004
• 10-y prostate cancer-specific survival: 95.6% vs 90.0%
HR 0.48, p=0.009
✅ No meaningful increase in grade ≥3 toxicity:
Acute 24% vs 25%
Late 8% vs 7%
⚠️ Important caveat: only 92 progression events occurred vs 197 planned, and the 10-year PFS analysis was post hoc. OS and cancer-specific survival therefore need cautious interpretation.
Verdict: Strong long-term signal supporting adequate RT dose escalation with long-term ADT in high-risk disease, but not a clean licence to extrapolate 80 Gy conventional fractionation into every modern hypofractionated regimen.
@ASCO @oncoalert #ProstateCancer #RadOnc
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Rahul Tendulkar, MD retweeted
🚨Medical students interested in #radonc please join us virtually to meet our amazing residents and learn all about CCF Rad Onc and the upcoming application cycle! We’re so excited to meet you! ☢️🌟
RSVP HERE: bit.ly/4wSwKhd
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Rahul Tendulkar, MD retweeted
From our paper redjournal.org/article/S0360…, RE vertebral body compression fracture (VCF) after spine SBRT —
tl;dr: The risk of VCF requiring intervention (kypho or stabilization) at 2y post spine SBRT was 11% for 24x1, 3.1% for 10x3, and 2% for 9x3.
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Let's keep adding context, but from a different angle:
EviCore was formally created in 2014/2015 through a merger of MedSolutions and CareCore National.
The oldest EviCore radiotherapy guidelines I personally have archived is from 2019. I believe this was close to, if not THE first...but they make this difficult to find (for obvious and shady reasons).
But we can say with certainty that EviCore themselves deemed LDRT for osteoarthritis "medically necessary" at least as far back as 2019.
So what changed?
Well, though LDRT started its journey of rediscovery in America in 2020/2021, it was still relatively unknown to the public and uncommonly performed in American clinics.
Because LDRT, you know, actually works - more and more of us started to offer it, and patients have the ability to like...talk to each other.
In my own practice, for example, I have never once advertised. All of my LDRT patients are word of mouth self-referrals, or referrals from local doctors after they saw me treat their other patients.
Naturally, as this happened across the country, the public took notice.
In 2025, the radiotherapy professional society ASTRO made benign disease/LDRT the theme of their yearly conference.
As you can see from the Google Trends data, Americans searching for "low dose radiation therapy" really took off in early 2025 - and kept going.
Recently, this culminated in an article appearing on NBC's "Today" website, authored by @LaVarsovienne.
It was a classic, feel-good story of LDRT literally making a person, well...feel good.
This article was published on June 16th, 2026, at 1:08PM.
As seen in the Google Trends data, June 2026 is currently the absolute pinnacle of public interest in LDRT.
Which makes sense. "Today" is a massive, international platform. A lot of people saw it.
Almost certainly the people at EviCore saw it.
Which is why the PDF metadata of EviCore's latest guidelines - the one where they abruptly reverse course on LDRT - is extremely interesting.
What are the chances that this PDF was created on June 17th, 2026, at 11:13AM?
As in: 22 hours after one of the biggest platforms in the world runs a story on the benefits of LDRT, the largest benefits manager in the country creates the PDF of their newest guidelines, reversing course on covering this exact treatment, after explicitly covering it for nearly a decade?
Based on a fraudulent AI slop meta-analysis paper?
Really?
I mean sure, it COULD be a coincidence.
Or it could be that EviCore had already drafted most (all?) of this new version, saw this "Today" article drop on a Tuesday, internally said "nope, shut it down", and within 24 hours created this nonsensical non-coverage.
That's quite a coincidence for a company known to utilize their own AI platforms to make immediate, slash-and-burn decisions.
Within that context, it could be considered a consistent pattern of behavior.
Has anyone re-read that @statnews investigation into EviCore lately? The one from last year?
It's certainly compelling!
Continuing on with added context:
The reason this one paper matters so much is its recency. EviCore has, for many years now, deemed LDRT for OA as medically necessary.
To reverse course means new information must have become available between their last version and this one.
This Hammadeh paper was published in September 2025, which means it technically predates the guidelines from February 2026 covering LDRT, but...we'll just say EviCore didn't find it in time for those guidelines.
Unfortunately, it's not "new" data to justify this reversal, it's just a meta-analysis. But it has a convenient conclusion (if you're an insurance company).
Alright, we can skip over the publishing Round Robin AI Ring the authors have going and just head right to the first graphic. Table 1.
So, Table 1, second column. Several of the study design labels are incorrect - RCTs listed as cohort, retrospectives listed as RCTs, etc.
Ultimately, not SUPER problematic.
But uh, the next column is. The number of patients for each study in the third column.
Those are not anywhere close to the patient populations actually used in those studies. The difference is severe (Hermann 2021 is listed as 160, actual is 25; Keller 2013 is actually over a thousand, listed as 120, etc).
Well that's not good.
And then we get to "Duration of Complaints". Somehow, mysteriously, all of these studies enrolled patients with 9.5-11.1 years of symptoms prior to treatment.
Obviously...wildly incorrect as well.
But the best are the final two columns which are outcomes. Second to last is pain, last is function.
It sure is weird that, for a meta-analysis claiming LDRT has no effect, that each and every study allegedly used in their analysis ALL show an improvement in pain and functional status.
Now, normally I would expect a meta-analysis to conclude positive treatment effect if, you know, each and every included study showed a benefit in multiple domains.
Obviously...those results aren't what the original manuscripts themselves concluded (because, for example, they might have measured outcomes completely differently...).
Oh and I totally forgot the column that somehow claims each included study miraculously enrolled 38-44% males. All of them.
Crazy!
The one outlier is the final study, Fazilat-Panah et al, 2025.
If you look at the history of this Hammadeh paper, it was submitted originally in March 2025 and accepted in July 2025.
The Fazilat-Panah paper was published online in March 2025.
Obviously, Hammadeh and friends couldn't have included the Fazilat-Panah paper with their original submission - they wouldn't have known about it.
So one of the reviewers (hard to imagine this paper had reviewers, but whatever) must have asked them to include this newly published paper as a revision.
But that Fazilat-Panah paper is excellent: it's a double-blind sham-controlled RCT showing a tremendous benefit of LDRT.
Thus, when Hammadeh plugged that paper in and re-ran his AI tool...that's what caused the the calculated I² to be a massive 96%.
My assumption is the AI tool hallucinated much of the original data towards "no benefit". But when this Fazilat-Panah paper data was included after the fact with the real results - the heterogeneity went off the rails.
No paper should be published with an I² of 96%.
So, I assume no reviewer actually read this paper after it was re-submitted as a revision. Then the editors rubber-stamped the AI trash, and boom!
@evicorehc and their AI scraping algorithm programmed to find any and every reason for denial uncovered this gem and here we are today.
Who doesn't love science and medicine in 2026?
(probably the suffering patients getting treatments denied don't love it, but EviCore hasn't ever cared about that before, and neither has @SpringerNature)
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Rahul Tendulkar, MD retweeted
I’ve treated over 1,000 patients with low-dose radiation for benign musculoskeletal conditions. Effective this November, EviCore will classify the treatment as not medically necessary for nearly all of them.
Some context on how EviCore got here.
In 2019, EviCore’s own published criteria stated: “Policy: Radiation therapy is medically necessary” for plantar fasciitis and osteoarthritis, citing response rates near 80% with durability at 48 weeks. That position held through early 2026. The new guideline describes the same literature as a “paucity of evidence.” No reconciliation of the two positions has been published.
The cited sources don’t support the reversal either. The DEGRO guideline EviCore references recommends LDRT for refractory Kellgren 2–3 knee OA and grades plantar fasciitis radiotherapy at evidence level 1b, recommendation A. The 2024 VA evidence review found uncertainty on specific outcomes, not nonnecessity, and its literature search ended April 2023. The review is currently being updated as you are reading this.
Since that cutoff: a randomized, multicenter, sham-controlled trial presented at ASTRO 2025 showed 70% response with 3 Gy versus 42% with sham (p=0.014) in knee OA — the study design the earlier skepticism specifically called for. And the American Radium Society published multispecialty Appropriate Use Criteria, developed with rheumatologists and orthopedic surgeons, defining when LDRT is and isn’t appropriate.
I’ve applied strict evidence standards in my own AUC work, including voting against favorable ratings when randomized controlled data was lacking. This isn’t a plea for blanket coverage. It’s a request for basic consistency: an evidence review should account for the strongest available trial, accurately represent its cited sources, and explain what changed.
The patients affected are refractory with failed conservative care, often not surgical candidates. Categorical noncoverage removes even individualized review for the exact population every cited guideline identifies as appropriate.
Comment and appeal pathways are open through the November effective date. Our societies are engaged. If you treat these patients, now is the time to document and submit.
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Welcoming Cliff Robinson as Vice President of Clinical Research at Varian - Deepak Khuntia
@SBRT_CR
oncodaily.com/career/deepak-…
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Excited to share the results of the #ARTO trial. After a median f-up of 53 months, Adding SBRT to abiraterone + ADT significantly improved overall survival (HR 0.55). @dicataldovanes1 @BarbaraJereczek @Ric_Campi @ChadTangMD @TheLancetOncol @ESTRO_RT
authors.elsevier.com/a/1nM82…
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Rahul Tendulkar, MD retweeted
To learn more about how today's radiation therapy is used to safely treat and cure cancers and other issues, visit speedoflightfoundation.org/p…
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Rahul Tendulkar, MD retweeted
Sharing more widely how low dose radiation therapy is used for other health issues like tennis elbow, plantar fasciitis, osteoarthritis and more.....thank you @TODAYshow for bringing this info to more people. Great work #radonc @RTendulkarMD !!
ASTRO & Radiation Therapy in the news:
today.com/health/mind-body/l…
Learn more about Radiation Therapy: ow.ly/aZqc50ZcOVe
Read about Functional Radiation Medicine: ow.ly/OxAy50ZcOVh
@TODAYshow @RTendulkarMD @CleClinicMD
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Rahul Tendulkar, MD retweeted
ASTRO & Radiation Therapy in the news:
today.com/health/mind-body/l…
Learn more about Radiation Therapy: ow.ly/aZqc50ZcOVe
Read about Functional Radiation Medicine: ow.ly/OxAy50ZcOVh
@TODAYshow @RTendulkarMD @CleClinicMD
Amy Lewis was considering surgery for her lateral epicondylitis when she tried a painless remedy that most people might associate with cancer treatment: radiation, but given in tiny doses. today.com/health/mind-body/l…
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Outstanding, funny & memorable roast from our chief resident @KateRadOnc during our graduation celebration for @JKocsisMD @AniBommireddy @EDaviesMD! 🙏 for your dedication & leadership as chief resident! 👏🐱@RTendulkarMD @SamuelChaoMD @ShaunaRadOnc @ARRO_org #CleClinicCancer
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Rahul Tendulkar, MD retweeted
Congratulations to @AniBommireddy for receiving the @RSNA Roentgen research award and @EDaviesMD for receiving the Jerrold P. Saxton Award for Clinical excellence! @RTendulkarMD @ARRO_org #CleClinicCancer
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Rahul Tendulkar, MD retweeted
Wonderful to celebrate our graduating #radonc residents @EDaviesMD @AniBommireddy @JKocsisMD who will be taking their talents to @BayCare, @DukeRadOnc & @CleClinicMD, respectively! 🎊 The department is very proud of them! @RTendulkarMD @ARRO_org #CleClinicCancer
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Rahul Tendulkar, MD retweeted
General Omar Bradley called it the most dangerous mission of D-Day. He was not wrong.
At 6:30am on June 6, 1944, 225 Army Rangers approached a 100-foot sheer cliff face on the Normandy coast called Pointe du Hoc.
Their mission: climb it.
The cliff was vertical. The Germans were at the top with full visibility of everyone below. As the Rangers fired grappling hooks upward, the Germans cut the ropes. Shot the men hanging on them. Dropped grenades over the edge onto the climbers beneath.
The Rangers kept climbing.
It took roughly 40 minutes. Men fell. Men were shot off the ropes. The ones behind them grabbed the ropes and kept going.
They reached the top.
Then came the gut punch: the massive 155mm artillery guns they had been sent to destroy were gone. The Germans had moved them inland before the invasion. The entire mission had been sent to destroy guns that weren't there.
Most commanders would have regrouped and called it done.
The Rangers fanned out. Two miles inland, they found the guns, hidden in an orchard, already aimed at Utah Beach and loaded to fire. They destroyed every one with thermite grenades.
Then they dug in. Cut off, with almost no ammunition, no reinforcements, and no resupply, 225 men held Pointe du Hoc against relentless German counterattacks for two full days.
When relief finally arrived, only 90 Rangers could still stand and fight.
Their names are carved on a memorial in Normandy. Most Americans today cannot name a single one.
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🚨 REPORT: 82% of physicians are now employed by hospitals or corporate entities. Nearly two-thirds of practices are no longer physician-owned.
This outcome should not surprise anyone.
For more than a decade, Medicare payment cuts, mounting administrative burden, growing insurer oligopolies, and policies that disadvantage independent practices have made this outcome entirely predictable.
If lawmakers want more competition, lower costs, and better access to care, preserving independent practice must be part of the conversation.
No single reform will reverse decades of consolidation. But policymakers can start by fixing Medicare, fixing prior authorization, expanding physician-owned hospitals, and strengthening antitrust enforcement.
Dive into the full study 👉
physiciansadvocacyinstitute.…
@AANSNeuro @CNS_Update @spinesection @AANSCNStrauma @painsection @councilsns @physicianhosp
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