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Darshan

Hey everyone, welcome to another episode of DarshanTalks. As you might know, already, I am your host Darshan Kulkarni. It's my mission to help patients trust the products they depend on. As you may know, I'm an attorney. I'm a pharmacist and I advise companies with FDA regulated products. So if you think about drugs, wonder about medical devices, consider cannabis or obsess over pharmacy. Just the podcast video. I do these podcasts because they're a lot of fun. And because I find myself learning something new each time, but it'd be really nice that someone's actually listening. So if you'd like what you hear, please like leave a comment, please subscribe, you can find me but by reaching out on DarshanTalks on Twitter, or just go to our website at DarshanTalks, calm. Our podcast today. Our podcast today is one of those rare podcasts I know nothing about. about the topic area walking into To be fair, I like to always act like I know nothing because I find out learn something more. But I'm at a significant disadvantage that Luckily, we have someone who can help us. Our guest today is a medical physicist. So for those of you who know what that is, kudos to you. And I'd be curious how you actually found out and do you work in the area? Have you always known so I expect if you're a physician, you probably know and work with medical physicists, if you're a nurse in the area you probably do. But a pharmacist, I didn't have as much of an opportunity to do that. So I'm going to care about today's discussion. Our guest today is is a consulting medical physicist in the Philadelphia area. His name is Chandler Kota and we are excited to talk to you Chandler Welcome, welcome to being on the podcast. How are you?

Chandra

Thank you Darshan, it's a pleasure being on your podcast. I've listened to a few of them. And I've learned a lot as well listening to a podcast. It's a very interesting format, and I'm glad to be on it.

Darshan

Thank you. Thank you. So um, so let's start with the basics. What? What is medical physicist?

Chandra

Alright, so medical physicist, this question we get asked this question a lot of times and it relates back to you like, the best explanation we can give us it's in terms of pharmacists. Oh, interesting. Yeah, yeah. So, but let me step back a little and point out that x rays, and radiation is widely used in the healthcare sector these days, both in diagnostics and treatments. And incidentally, radioactivity, and x rays were discovered by physicists and physicists have always worked with physicians and leveraging these technologies trying to benefit patients. So physicists have long history of working with doctors in healthcare sector, in developing X ray machines, X ray imaging techniques, CAT scan machines, radiation treatment machines, and MRI machines, and so on and so forth. So it's a very niche field. And that's why you haven't heard of that. I think there's probably five to 10,000 Medical physicists in the whole of us, so it's very small. And we could say that they are segmented into different specialties, even that small field is full of sub specialized. So the main switch specialties are radiation oncology, where we treat the cancer patients with radiation techniques. The other one is diagnostic radiology, where the medical physicists support X ray departments and imaging departments in hospitals and freestanding centers, in getting imaging programs up and ready and making sure they're performing to the best quality. The other one is nuclear medicine, which is slightly different than regular radiology imaging. And there is medical physicists who specialize in that. One more as magnetic resonance imaging, it's it's a different kind of radiation. So that that needs a different kind of education, and it's a specialty as well. And finally, I would like to include health physicists in there, although they're not technically medical physicists, they do have background in radiation and they deal more with the radiate health, safety aspects of radiation. So those are the specialties. So the first few that I described like it turns out, like I was surprised myself and I found out medical physicists in radiation therapy, imaging, a nuclear medicine. They're certified by the American Board of Radiology, which is the same board that certifies radiologists and radiation oncologists. And since you're certified by that board, we are also listed in the ABMs like the American Board of Medical Specialties, which is one of the few non physician groups to be listed in there. So I would say that medical physicists in general, have a role similar to the pharmacists are very important back end role supporting physicians taking care of patients, oftentimes they don't get recognized or talked about, like as much as physicians to

Darshan

this is really interesting because several things pop up in my mind, the first thing I'm thinking about is the fact that when you're looking at medical physicists, you're describing more of a health role, as opposed to an invention role. Is that necessarily how it goes? Like, is it physics? Is it physicists, or what I actually thought I'll be honest, like, I thought a lot of what you were discussing would land up being something an engineer does, but you're saying not his entire other field

Chandra

of nuts go to this is a purely clinical role. So you might have some physicists who enter the field, but don't get certified or might have other research interests who would work in the industry side. Okay, but I am what's comes to consider a clinical radiation therapy physicists, we have very intimate relation with the patient and patient processes.

Darshan

Hmm, I had no idea that actually blows my mind. So thank you.

Chandra

So it's similar to hospital pharmacist, like who might be in the oncology department and dispensing drugs. We are in the radiation oncology department. Actually, it's it's very interesting. If I can explain to you it's it's pretty cool. I don't know if you know much about radiation therapy, but the way it works is it's personalized, and it's targeted. It's all these buzzwords, we hear these days about medical oncology being personalized and targeted therapies. We've been doing it for a long time, but it's personalized and targeted in a very different way. Okay, so as you know, like a lot of tumors in patients, they patients with cancers, like there is a multiple modalities of treatment in general. In general these days, it's not one thing cures all. So there is the surgeons who are the surgical oncologists like they might cut a tumor out. Then there is my radiation oncologists who can also affect the tumor in a similar way like they can ablate humans, similar to surgeons. And then there is medical oncologists who, who are very different in the sense that they use drugs and the basic tenants of medicine like and the classic medicine to treat these tumors, which is very different than the other two specialties. So in radiation, what we do is, we first locate the tumor and space like inside of the patient, that's usually done using CAT scans and MRI these days, MRI scans. And then we have these big fancy machines like which produce x rays, which are 1000s of times more powerful than x rays that you use for X ray imaging, or CAT scans. And these x rays are then pointed towards the tumor in a very special way and targeted right at the tumor in and tried to spare everything else around it. So you could say like, we are designing a treatment on the fly like in a very personalized and targeted way for every patient who comes into the department. And there's a whole team that does that. So the physicians, they have deep knowledge of what kind of radiation dosage to give them and how it affects the surrounding organs and their tolerance limits and such. And then the physicists are responsible for executing the technical part of the treatment. So once the doctor doctor prescribes that we have to work with the physicians trying to figure out how to design the treatment using complex computer software and then deliver that suicide treatment on that machine like in a very complex fashion. And it all has to be done with a very very high precision of a few millimeters. So it's physical targeting of radiation in real time while the patient may be moving or trying to lay still but organs inside the patient are moving so it's a very different way of delivering the treatment. I lost your audio

Darshan

Sorry, I muted is trying to be good because there are noises outside the door. But But I have to ask how do you even do it because the part that throws me off is you're talking on millimeters and you cells are even smaller than that millimeters is you're just trying to catch as much of it as possible and the body is moving, the person's moving or everybody's moving you still trying to still be

Chandra

good Like everything else in life all all advancements are incremental, right? Like it's really didn't come here like out of nowhere. So way back like when they started this treatments like me that like right after the discovery of X rays like I think they figured out like x rays are harmful for patients like if given in high enough quantities, they can kill cells. So it's it's, it's it's a very double edged sword, certainly very careful like in using them. So in the olden days, like the machines were very crude, they were not very fancy, so there wasn't much targeting going on. So they would use fairly open fields like we call like a large beams of radiation, and they were directed towards the tumors. And they could only treat superficial tumors because energy of the X rays they could produce was relatively low, and they could not go too deep into the patient's body. So they could treat superficial tumors. And then it turns out, like the skin is the most sensitive organ, right, like cells in the skin first before they go into the boy. So they were limited by skin toxicity of how much how they could deliver the radiation. So it turned out like they could do two units like it's the unit is called gray like it's if you do too gray a day, they figured out like the skin could tolerate, if they did any higher, you would just cause the radiation burned right away. So then they started like the standard became like two gray day like times, let's say roughly 3030 days, or 30 fractions or 30 treatments. So that's more or less like with some variations, that was a standard for a long, long time. And then with the advent and the 60s, I think other technologies are developed for other uses, like radiation producing technologies like pliers, trans and magnetrons. That's, that's a very technical field. There are desert for it during World War Two or something so but then like using those technologies, we are able to produce really high beams of X rays in a relatively compact machine that can fit in a room that's like maybe twice the size of a normal CAT scan room or such. So if you ever had a CAT scan or an MRI, you see like, it's like a 30 feet by 30 feet room where you'd be able to fit a machine in there. These machines produce x rays, which are very energetic so they can pass through anything. So the rooms have to be adequately shielded. So they're made to be make special rooms inside of hospitals for these machines. And the radiation does not come out of the room. And because these x rays are so powerful, nobody else can be in the room and the radiation is being delivered. So the patient's positioned on a table, and the machine moves around the patient and gives the radiation. And since it moves around, it's able to target the radiation, the radiation gets focused at the tumor from multiple directions. So the tumor gets the most radiation and then like as you go away from the tumor, radiation dose falls off. So that's how you're able to do it. But even then, like we weren't able to define the radiation dose as precisely as we can do now. And those are all incremental advances. So right now the way we handle motion is we can, we can look at how the patient's breathing from outside and we can kind of look at the skin movement, or things we put on the patient's body and find a correlation to what's happening inside the patient. That's one we have. There is a newer machine that's just a few years old, which combines magnetic resonance imaging technology and radiation technology. And using that you can actually see, you can do an MRI during while you're treating the patient and you see everything moving in real time. And the radiation would target just the tumor that you want to treat. And if the tumors out of its position, the beam would stop the radiation would not be delivered and wait for the tumor to come back into position and the radiation will start again. So that's the latest technology.

Darshan

To me this seems like a field that's dying for artificial intelligence because it will be able to compensate in real time. But it sounds when I hear you Your face is saying no now but

Chandra

well it's it's nearly I'm a big proponent of new technologies, right? Like I love cool stuff like being a physicist, like we want to use technologies and for patient benefit and such. But AI gets thrown around so much like it's I'm guilty of it myself. When you write stuff or do thoughts, like write articles, or like write for grant proposals, you want to throw a URL there, everybody throws in a bit careful.

Darshan

Yeah, I can 100% appreciate that to me as a as a person who's not in the, in your yes part of the industry. To me, it just seems like physical targeting is probably the easiest thing for AI to go at. Not not anything else. But I imagine it's a lot more complex than yeah Isn't the

Chandra

targeting? I think like and then then it's people who work fast with complex machines that can make it work? Well it's it's similar to think about like a robot or a surgeon using a robotic surgery system, right? Like, it's still that expertise, like on our hands on expertise in performing the procedure that helps in that, like, it does make a difference. I mean, like, we can look at the imaging in real time, but like, oftentimes, you're trying to push what you can do in the field with the technology that you have, right? So going back to what I described earlier, like radiation till about 2000, maybe late 90s, was given him 30 treatments of two gray age, the control of the we can, the tumor controls were modest, like for some kinds of tumors that were really good, but others not as much. But then, like some pioneering physicians figured out like, what if we flip the coin and do maybe few fractions, maybe three or five fractions or treatments, and instead of two gray, we do 20 gray per fraction? Now, you might ask, How is that possible, because I mentioned the skin bones before. But because these allergies, these x rays nowadays are more energetic, they go through and reach the tumor without burning the skin too badly. That's the way the physics of these beams works. And and what they realized is, if you're able to target the radiation carefully to the tumor, to these high levels of those dosage, like let's say 20 gray, and have it fall off relatively quickly before it reaches other organs of critical organs, you're able to get local controls, which are much, much higher and more significant for patient cancer control. So this is most useful when tumors are relatively small in size. So we are able to go in and do these procedures. And we like to call these ablative procedures because at that those level like 20 gray, in a single treatment, most of the tumors killed, right. And we do three or four treatments repeat them because sometimes like you know, similar to pharmacology, the use, you can ease yourself first, right, the resistance can stay behind. So it's the same thing and radiation they call radio resistance cells. So for whatever reasons, maybe there is not enough oxygenation in the area or such like some cells do survive the first fractions. So by the time you're done with the third fractional fourth fraction, you would kill most of them. And you're able to control this tumors like 90 95%. So it's very significant that we like to joke in the field that if radiation were a drug, like it would be on CNN all day long, it's for some of these advances that we've seen in the last few years.

Darshan

But what I'm hearing you say without saying it is that you're able to get 95 to 95%. But that means you still have to go in either after that with either drugs or surgery normally the remaining 5%

Chandra

Well, statistics is a very difficult thing to explain to people, right. But COVID has made it a lot easier for for us in the healthcare field to explain statistics, because everybody's getting said everybody's been getting such a big dose of statistical lessons and on TV, right? So it is a 95% like local control. What does it mean? So if you take 100 patients and you give them this treatment, 95% of them would have the tumors welcome. Oh,

Darshan

you're talking about curing the self tilray?

Chandra

No, no, not on an individual patient. I meant like local control the tumor itself. Okay, got it. Got it.

Darshan

Got it got it got. Oh, that's really interesting. I didn't realize it.

Chandra

That's it's it's very significant year. Yeah. So another thing I wanted to point out is radiation in general debate involves the use of radiation. From a reimbursement perspective, it's it's considered the use of a device. It's very fixed reimbursement model. No matter how fancy we get to get with it, or how better we are able to help patients. We don't get paid anymore. It's it's in fact, we get paid less because you're doing fewer treatments now than before.

Darshan

Hmm. But yeah, one of the questions that that jumps out at me, that's a really interesting argument. These machines are very, very expensive. And what I'm hearing you say is that tic change is incremental and technology's incrementally improving, including the new MRI devices come with it. If I was a hospital and I just spent I make I have no idea what these things cost, let's assume they cost $5 million.

Chandra

I'm sorry, roughly, that's the right ballpark here.

Darshan

Let's say I spent $5 million right now, I'm not spending $5 million on another 10 to 15 years of I can help it. Because I'm get I'm still getting reimbursed the exact same amount of money, why would I upgrade, if not, if anything is going down. So that's good, bring these treatments and these improvements to patients, when hospitals appropriately are going, I don't want to invest into this.

Chandra

That's gonna it's a very challenging situation like, it's it's also made difficult by the fact that I, I'm sure you're never seen an ad on TV for radiation, right? It's sometimes like, sometimes some vendors might advertise their special techniques, or you might have seen CyberKnife or proton therapy or something. But in general, like it's not something that's advertised, it's very difficult to directly educate patients on their options. And relative to their, their their cancer diagnosis, like the different options that are available. And patients had to rely on their health care professionals to guide them like to pick out the best options. But your question is a very interesting and important one, like, we really don't make more by adopting new technologies necessarily. Sometimes we do like if the technology is significant enough, like you go to CMS, and they will give you a new billing code or something, and then you might make a little more, but that takes a long time. So for people to innovate in our space is very difficult, because you try to make a come up with an innovation that could that could significantly impact like local control of tumors, and yet you cannot provide or justify a revenue model. If you want to go the startup route or find some venture capital, it's very hard to do. Because to get a new quote from CMS, like takes many years like

Darshan

there are some CMS reimbursement strategies, I've been involved in them in the medical device world with another client of mine. So there are some strategies, but it's difficult. And and when you have CMS, which is paying for 80 to 85% of all billing, it becomes really hard to go well, maybe these other people will pay and I do like a value based pricing, which I don't see why. If I was CMS, I don't see why pay more for it. But But you still see improvements happening. So explain that part to me. So the incentive isn't there. But improvements are still happening. So how are they? Or why are they still happening? And relatedly? who's buying, because let's be honest, every hospital or at least the vast majority of hospitals that need this type of service, probably already have it in place. Like if you have radiation oncologist, you probably have an MRI machine, you have a CyberKnife, proton therapy, all that stuff already in place. So are you are you going if I was selling a device like this, would I go to you and go build one more suite, and we can give you something new, which sounds kind of more expensive, and you're not just buying the device, you're selling the expansion as well, this is a much harder thing to do. How do you sell that? Well, like

Chandra

it's it's even though it's not advertised, like I mentioned, the word does get out to patients, let patients these days seek out information. That's what we're seeing, like, they go on the internet and the secret information. And let's say, you talked about the MRI plus the linear accelerator, that is what that's what those machines are called that retreat with linear linear accelerators. If you talk about one of those machines, that the newer ones that come combines the two, the companies, of course, would advertise like on their own like, and they would promote their technologies and put out like white papers and such. And when people with cancer diagnosis, they Google their treatment options, they might come across these machines and these kinds of treatments. When they go to the healthcare providers, they would ask about them, and would would ask to be treated on these machines if possible.

Darshan

But again, I'm thinking of myself, as a patient, I'm already going Wait, I have cancer, I have this I have that I'm already processing my disease state. Now we're asking them, not only do you have a process of disease to give to advocate for a device that you don't know what the risks and benefits are, and people are already in the drug world, they save pharmaceutical companies advertise too much. And then again, the pharmacy companies, maybe I can see an argument for cost of drugs is going higher. But in the case of something like like what you described, it's the price is going lower, at least from a reimbursement perspective. So I would imagine if I was the oncologist, I'd go, No, we don't have that device. But we have this one and now I'm not going to sit and review and research that new device because I just want to get treated. I want to get Better I want to go back to my life. What has been your experience? Do you usually when patients come to you? Or they're already convinced, and they're now coming to you going? Treat me? Or are they? Are they doing it in a different way where they're saying, I have these options? I could go to Penn or Drexel or Jefferson, since we're both in the Philadelphia area? Or should I be flying to Mayo Clinic? getting something done? Hmm. How do you deal with those questions? Do they come up to you

Chandra

or don't want to clarify a couple of things, first thing is likely, we don't directly deal with patients. So similar to a hospital pharmacist who would play a strong supporting role for the physician, we are more on the back end side of things like although I'm aware of how things work in my department in radiation oncology, having said that, it's a self governing field, right medicine to a large extent. So like when when when you come up with a new technology, like I described, like it's called stereotactic ablative radiation therapy. So because it's ablating, the tumor. The people write papers, and there is clinical trials that go on like comparing surgery, which is other alternative, like to some of the early stage tumors, when they're small, and localized and focal. And when the clinical trials come out, and the results seem promising and good, like eventually, they get adopted into standards and guidelines. And once they're in the guidelines, like most physicians, like to follow guidelines, it's for a standard of care. So that's one one way of getting adopted. On the financial where it is a challenge. Yes, that's what most hospitals like us not for profit. But the bigger centers, they will still do things because the right thing for the patient, they'll still make a small profit on the whole process, maybe not as much as they were making before. But but but if you're in a hospital, and physicians have the freedom to practice medicine, as they see fit, and they want to follow the standard of care, they're able to do that in the not for profit hospitals a lot more easily than in other situations. So eventually, it gets adopted into into the community and becomes the standard of care

Darshan

channel that I could keep asking so many questions. But I'd like I said, I aim for, give me 15 to 20 to 25 minutes over, I have so many more questions. So what I'm going to do at this moment is ask you, based on the discussions we've had, what is it question you'd like to ask the audience?

Chandra

Well, I'd like to ask the audience have a question as much as a comment, like to just recognize that we are behind the frontline physicians and nurse practitioners that you encounter there is a whole army of people who have spent a lot of time studying and working in different professions that you may or may not be aware of taking care of your medical needs, it's just to have that awareness will be very nice for those people to feel acknowledged and recognized.

Darshan

And I'll take the question for a while I take the comment a bit further. Did you know of this army is a question that goes along with it. Did you know about medical physicists? Or did you assume that was just the doctors and nurses because for me this was an educational experience. I didn't know that someone else was helping the physicians. So thank you for that. Sure.

Chandra

And also I'd like to further add a follow up comment that it's it's I would not say that it's it's it's lacking among the general public, even among the hospital professionals. We know very little about other specialties, like just in oncology. Like I mentioned, there are three distinct big specialties and other smaller ones like the surgical oncology, there's medical oncology, that is diagnostics. There is radiation oncology is an interventional oncology. And each of those has so many different specialists within those areas. Working for the patient, like it's one of the things I'm working on right now is trying to understand and maybe write a small book or something about all these different specialists, like who spent their lifetime and their careers doing what they do.

Darshan

Well, we should bring you on when you got that book wreck not because there's any reason because these are things you you, you discover, understand appreciate at a time, you're not able to appreciate those things. So that sounds really great. Um, another question. Well, as you know, we do a rapid fire round. Are you ready? Sure. What did you learn this month?

Chandra

This month, I've learned that patients are increasingly going on the internet and going on social media to be their own advocates. So I'm learning that there is so many people With interesting ideas, doing interesting things. For example, there is patient hackathons going on where patients are willing to put up that data on the internet and invite anybody in the world with some expertise, who wants to join in and volunteer information for them, like how it might help them. So there seems to be a growing disconnect between healthcare providers in the traditional health hospital setting or the healthcare setting, and what's happening in the real world. So it's, it's very interesting, it's amazing what's happening, and I have no idea where it's gonna go.

Darshan

I thought really interesting. I didn't know that people are volunteering their own data. That's a fascinating, terrifying from privacy standpoint, but fascinating from a biohacking standpoint. So

Chandra

you're looking at it this way, right? Like it's it's it's it's, it's fair to say that cancer is becoming like more of a chronic condition, like the survival is increasing significantly for many indications. And the longer people live, like, it's very difficult for individual providers to know like what to do like after extended survival, because we all learn what we know best during our residency periods. And once you're practicing for several years and decades, you need, it's hard to keep up with the field, there's so many changes coming on. So patients, in some ways have to seek that information out themselves, like what the best treatment options might be for them.

Darshan

being your own advocate. Now, that's amazing and 100% true. And quite, I appreciate you bringing it up and telling me about it. Here's another question, based on what's the most memorable thing that's happened this week for you? Um,

Chandra

I'm not sure I would call it memorable. But it's it's very interesting. Like I have a new puppy now like it's, and in trying to raise this puppy like, I can't, I can't just get over the fact how similar it is to raising a child that's I'm not seeing a difference between a human child and a puppy like other than the language, it's it's amazingly similar behavior, is it? Seeing that kind of behavior like makes me wonder like, it's it's we got to get back to nature and like more holistic approach to life, you know, it's, instead of relying on being a technology enthusiast myself, like it's, it's, I would say, like, technology is good, but sometimes, like nature has its own way of helping us deal with things.

Darshan

100%. So so as you know, at this point, I like to summarize our podcast. So during this conversation, we landed up talking about what our medical physicists, you talked about the five different branches, if you will, for lack of a better term, the amount of medic medical physicists necessarily would almost branches around medical, medical, physical stuff. Physics stuff, radiation, oncology, diagnostic radiology, nuclear medicine, MRIs, and health physicists, first of all, did I get that part? Right? Yeah. I just want to make sure I'm, I'm not summarizing something that's inaccurate.

Chandra

These are the ones that I mentioned, because they all have separate specialty boards and board certifications. Yeah.

Darshan

And you actually pointed out that they are part of the American Board of Radiology. And yeah, it'd be a mess as well, which is, which is fascinating, because I didn't know that

Chandra

there are physicists a lot. But other ones Oh,

Darshan

there you go. And then then you've got you talked about the difference between radiation and drugs in that we've been taught in the case of drugs. We think personalization and targeting is so revolutionary. And you guys have been doing this for four decades with a 95% success rate sometimes.

Chandra

But Joe's fans of Yeah, those successors are more recent, but we've been targeting for for a long time. Yeah,

Darshan

yeah. And then you talked about, we talked a little bit about size, we're focusing on literally millimeters and you're adjusting for internal external movement, which I thought was fascinating. And then you talked a little bit about challenges in a technology and improvements coming through because of reimbursement concerns of considerations. We then spoke a little bit about basically, radiation dosage and to Gray's which is the daily max that we messaged me tend to aim for, but obviously there are new ablation therapies and stuff that are changing and revolutionising the way we look at that now. And one of the things that in retrospect is obvious, but I didn't fully understand was always taught radiation causes mutation, did not realize radiation actually kills necessarily as well. I thought it would be a slow death. What I'm hearing you say is no, it's it's immediate if we're given enough radiation,

Chandra

right, I think the mutation is at very low doses. So like So when you hear about radiation, you might hear it about CAT scans causing radiation and such like those are like really, really small doses of radiation. And those might cause and cause mutations. But the therapy doses that they give are the two gray level and the ablative one, or the 20, gray level, or 10 to 20 gray that's quite potent leather could actually cause several mechanisms within the cell that would cause them to cause them to die relatively quickly.

Darshan

Before I hang up on one question that that sort of, I don't know, I can't reconcile. On one hand, you're focusing all the radiation on one or two millimeters. On the other hand, we're clearing out the rest of the room. If we if we know that we're focusing the radiation, why does the rest of room need to be clear,

Chandra

we're focusing the radiation to the tumors like to within one or two millimeters of the tumor surroundings and because because of the properties of what we call like x rays, or like their photons, or their correlates, or gamma rays is similar, because of the nature of their properties and how the radiation dose falls away from the tumor. And the machines that begin it with that it doesn't fall away quickly enough. So that's a challenge. So that's where the protons would come in, like protons are different than photons of particles. So they have much defined edges. But it's it's a lot more challenging to deliver protons with this life targeting for moving targets. So that's that's a limitation. But eventually, somebody is going to combine an MRI machine with a proton machine. And that's the best of both worlds. So

Darshan

stay tuned. That's what's coming up for next at some point, I guess.

Chandra

Since I worked a little bit with the MRI machine at reading hospital. And one of the things we realized was things that we previously thought didn't move moved as well. Everything moves inside the body constant, the patient could be laying perfectly still from the outside, but everything moves on the inside. And when you're doing this really high doses in relatively short time, it makes a difference.

Darshan

Absolutely. Gentlemen to ask, Where can people reach you if they have questions?

Chandra

I'm on LinkedIn. So it's like if they just type my name in I should be

Darshan

perfect. So they'll find you on LinkedIn. And thank you so much. Again, you can find me DarshanTalks on Twitter, or you can find me or she's looking at my website at darsan talks calm, and this was absolutely wonderful to have an agenda. I hope you'll consider coming on again, once you've written that book, because that sounds like an amazing book. Right? And I look forward to having you on. So thanks again.

Chandra

Thanks again. Thanks a lot for putting getting me on the show. I appreciate it.

Chandra

This is the DarshanTalks podcast, regulatory guy, irregular podcast with host Darshan Kulkarni. You can find the show on twitter at DarshanTalks or the show's website at DarshanTalks.com

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