Dr. Nadim Nasr

So we're a little bit different. I mean, we're a hospital-based group in the sense that we contract out to the hospital to do all their radiation professional services, but the technical fees still go to the hospital, including a lot of the technical fees for the equipment, the medications, the gels, and things like that. So that's a loop through the hospital process.

But we're, of course, conscious of that. Where our challenges come in are some of the insurers in the area will not cover a spacer, or at least not initially. And so in those cases, what we've started doing is placing the fiducial markers, planning the patient, and then if it looks like there's absolutely a need for spacing because of compromise on either coverage or

But we're, of course, conscious of that. Where our challenges come in are some of the insurers in the area will not cover a spacer, or at least not initially. And so in those cases, what we've started doing is placing the fiducial markers, planning the patient, and then if it looks like there's absolutely a need for spacing because of compromise on either coverage or

But we're, of course, conscious of that. Where our challenges come in are some of the insurers in the area will not cover a spacer, or at least not initially. And so in those cases, what we've started doing is placing the fiducial markers, planning the patient, and then if it looks like there's absolutely a need for spacing because of compromise on either coverage or

or rectal dose, then we'll go ahead and make a request to put in the spacer. So those are the challenges that we face on our end.

or rectal dose, then we'll go ahead and make a request to put in the spacer. So those are the challenges that we face on our end.

or rectal dose, then we'll go ahead and make a request to put in the spacer. So those are the challenges that we face on our end.

You know, with SBRT, generally from the time of fiducial and spacer placement till treatment is about at most three to four weeks in our practice. And my experience is the spacers really held its shape and integrity very well. I've not had any problems with that. And even back when we were doing longer courses of IMRT, I didn't even see any issues even up to about two months out.

You know, with SBRT, generally from the time of fiducial and spacer placement till treatment is about at most three to four weeks in our practice. And my experience is the spacers really held its shape and integrity very well. I've not had any problems with that. And even back when we were doing longer courses of IMRT, I didn't even see any issues even up to about two months out.

You know, with SBRT, generally from the time of fiducial and spacer placement till treatment is about at most three to four weeks in our practice. And my experience is the spacers really held its shape and integrity very well. I've not had any problems with that. And even back when we were doing longer courses of IMRT, I didn't even see any issues even up to about two months out.

at least with spacer. So my experience has really been that it does maintain its integrity and shape.

at least with spacer. So my experience has really been that it does maintain its integrity and shape.

at least with spacer. So my experience has really been that it does maintain its integrity and shape.

Large prostates, it absolutely matters. But again, it matters on the particular anatomy. Is it a large prostate with some separation between the prostate and the rectum, or is it one of those prostates where the rectum is draped across the backside and on top of the prostate? Obviously, if somebody has a large prostate or they have higher risk disease, we are putting them on ADT.

Large prostates, it absolutely matters. But again, it matters on the particular anatomy. Is it a large prostate with some separation between the prostate and the rectum, or is it one of those prostates where the rectum is draped across the backside and on top of the prostate? Obviously, if somebody has a large prostate or they have higher risk disease, we are putting them on ADT.

Large prostates, it absolutely matters. But again, it matters on the particular anatomy. Is it a large prostate with some separation between the prostate and the rectum, or is it one of those prostates where the rectum is draped across the backside and on top of the prostate? Obviously, if somebody has a large prostate or they have higher risk disease, we are putting them on ADT.

And again, if they're having a lot of urinary symptoms or they have a large prostate, I will put them on ADT for a couple months before treating them versus if they don't really have any of that, we'll go ahead and start ADT and then within a few weeks treat them.

And again, if they're having a lot of urinary symptoms or they have a large prostate, I will put them on ADT for a couple months before treating them versus if they don't really have any of that, we'll go ahead and start ADT and then within a few weeks treat them.

And again, if they're having a lot of urinary symptoms or they have a large prostate, I will put them on ADT for a couple months before treating them versus if they don't really have any of that, we'll go ahead and start ADT and then within a few weeks treat them.

I have not had an issue with re-spacing. I have had the issue of having to re-scan and re-simulate for planning just to confer. And I think the longest we had was about a three-month gap, and it still looked very good. I mean, I think it was a little bit small. I compared it back to what we had seen before.