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Dr. Robert  Foote  Md image

Dr. Robert Foote Md

200 1St St Sw
Rochester MN 55905
507 842-2511
Medical School: University Of Utah School Of Medicine - 1984
Accepts Medicare: No
Participates In eRX: No
Participates In PQRS: Yes
Participates In EHR: Yes
License #: 29745
NPI: 1043299506
Taxonomy Codes:
2085R0001X

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Awards & Recognitions

About Us

Practice Philosophy

Conditions

Dr. Robert Foote is associated with these group practices

Procedure Pricing

HCPCS Code Description Average Price Average Price
Allowed By Medicare
HCPCS Code:77301 Description:Radiotherapy dose plan imrt Average Price:$2,430.72 Average Price Allowed
By Medicare:
$1,869.83
HCPCS Code:77418 Description:Radiation tx delivery imrt Average Price:$751.27 Average Price Allowed
By Medicare:
$457.24
HCPCS Code:77290 Description:Set radiation therapy field Average Price:$665.39 Average Price Allowed
By Medicare:
$512.91
HCPCS Code:77470 Description:Special radiation treatment Average Price:$236.54 Average Price Allowed
By Medicare:
$160.41
HCPCS Code:77014 Description:Ct scan for therapy guide Average Price:$169.56 Average Price Allowed
By Medicare:
$98.58
HCPCS Code:77338 Description:Design mlc device for imrt Average Price:$533.27 Average Price Allowed
By Medicare:
$464.49
HCPCS Code:77263 Description:Radiation therapy planning Average Price:$209.46 Average Price Allowed
By Medicare:
$144.81
HCPCS Code:77432 Description:Stereotactic radiation trmt Average Price:$420.47 Average Price Allowed
By Medicare:
$366.09
HCPCS Code:77334 Description:Radiation treatment aid(s) Average Price:$188.36 Average Price Allowed
By Medicare:
$140.78
HCPCS Code:77421 Description:Stereoscopic x-ray guidance Average Price:$107.85 Average Price Allowed
By Medicare:
$65.55
HCPCS Code:77295 Description:Set radiation therapy field Average Price:$239.82 Average Price Allowed
By Medicare:
$208.87
HCPCS Code:77336 Description:Radiation physics consult Average Price:$69.80 Average Price Allowed
By Medicare:
$44.59
HCPCS Code:77263 Description:Radiation therapy planning Average Price:$166.26 Average Price Allowed
By Medicare:
$144.81
HCPCS Code:77300 Description:Radiation therapy dose plan Average Price:$83.27 Average Price Allowed
By Medicare:
$63.94
HCPCS Code:99214 Description:Office/outpatient visit est Average Price:$112.38 Average Price Allowed
By Medicare:
$97.19
HCPCS Code:99203 Description:Office/outpatient visit new Average Price:$111.16 Average Price Allowed
By Medicare:
$97.26
HCPCS Code:99213 Description:Office/outpatient visit est Average Price:$78.00 Average Price Allowed
By Medicare:
$65.71
HCPCS Code:77334 Description:Radiation treatment aid(s) Average Price:$64.92 Average Price Allowed
By Medicare:
$56.59
HCPCS Code:77300 Description:Radiation therapy dose plan Average Price:$32.69 Average Price Allowed
By Medicare:
$28.50

HCPCS Code Definitions

77263
Therapeutic radiology treatment planning; complex
77263
Therapeutic radiology treatment planning; complex
77290
Therapeutic radiology simulation-aided field setting; complex
77295
3-dimensional radiotherapy plan, including dose-volume histograms
77300
Basic radiation dosimetry calculation, central axis depth dose calculation, TDF, NSD, gap calculation, off axis factor, tissue inhomogeneity factors, calculation of non-ionizing radiation surface and depth dose, as required during course of treatment, only when prescribed by the treating physician
77300
Basic radiation dosimetry calculation, central axis depth dose calculation, TDF, NSD, gap calculation, off axis factor, tissue inhomogeneity factors, calculation of non-ionizing radiation surface and depth dose, as required during course of treatment, only when prescribed by the treating physician
77301
Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications
77334
Treatment devices, design and construction; complex (irregular blocks, special shields, compensators, wedges, molds or casts)
77334
Treatment devices, design and construction; complex (irregular blocks, special shields, compensators, wedges, molds or casts)
77336
Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose delivery, and review of patient treatment documentation in support of the radiation oncologist, reported per week of therapy
77338
Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per IMRT plan
77432
Stereotactic radiation treatment management of cranial lesion(s) (complete course of treatment consisting of 1 session)
77470
Special treatment procedure (eg, total body irradiation, hemibody radiation, per oral or endocavitary irradiation)
99213
Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 15 minutes are spent face-to-face with the patient and/or family.
99214
Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 25 minutes are spent face-to-face with the patient and/or family.
99203
Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent face-to-face with the patient and/or family.
77014
Computed tomography guidance for placement of radiation therapy fields

Medical Malpractice Cases

None Found

Medical Board Sanctions

None Found

Referrals

NPI
Doctor Name
Specialty
Count
1093794075
Medical Oncology
495
1003893355
Otolaryngology
281
1487663761
Diagnostic Radiology
163
1245205830
Diagnostic Radiology
150
1346263407
Diagnostic Radiology
139
1255310611
Medical Oncology
114
1962482737
Diagnostic Radiology
113
1215901301
Cardiac Electrophysiology
107
1104802347
Cardiovascular Disease (Cardiology)
104
1083689483
Diagnostic Radiology
98
*These referrals represent the top 10 that Dr. Foote has made to other doctors

Publications

Establishment of practice standards in nomenclature and prescription to enable construction of software and databases for knowledge-based practice review. - Practical radiation oncology
Establishment of standards within a practice and across disease site groups for nomenclatures, prescription formatting, and measured dose-volume histogram (DVH) metrics is a key enabling step for creating software and database solutions to make routine aggregation of dosimetric data for all patients treated in a practice, practical. A process of physician-driven, iterative dialogs coupled with development of technical tools is required to implement the cultural and procedural changes. The cumulative reward for this effort is a database that can be used for defining practice norms, benchmarking against national standards, and tracking dosimetric effects of longitudinal practice pattern changes.A 4-year project was carried out to develop and introduce standardizations, modify processes, and develop computer-based tools for reporting, aggregation, and analysis of prescription and DVH metrics. Physician disease site groups developed 42 target and 81 normal tissue templates. From the database of 32,002 DVH metrics, benchmarking was illustrated for a subgroup of breast (281) and prostate (324) patients treated with conventional fractionation over a 16-month period. Breast patients were segregated according to prescription template used: simple (S, tangents only) vs complex (C, tangents + supraclavicular ± intramammary nodes) and left (S-L or C-L) versus right (S-R or C-R).Prostate patients' median and 50% confidence intervals (CIs) for bladder, stated according to the nomenclature: the percentage of bladder volume receiving doses of ≥40 Gy (V40[%]), V65Gy[%], V70Gy[%], V75Gy[%], and V80Gy[%] were 45.5 (24.9-57.0), 15.6 (9.0-23.8), 7.6 (3.3-13.6), 2.0 (0.0-7.9), and 0.0 (0.0-1.4), respectively. Values for rectum: V50Gy[%], V60 Gy[%], V65Gy[%], V70Gy[%], and V75Gy[%] were 37.1 (27.8-43.5), 21.8 (15.6-25.5), 14.6 (9.6-18.0), 7.7 (1.9-12.3), and 1.0 (0-7.0), respectively. For breast patients, heart:mean Gray values were 1.5 (1.0-2.0), 3.1 (2.2-4.8), 0.4 (0.3-0.7), and 1.1 (0.8-2.2) for S-L, C-L, S-R, and C-R, respectively. Longitudinal, moving window plots of median, 50% CI, and 90% CI for 6-month periods demonstrated the effect of practice changes to reduce heart doses.Standardization was challenging as a practice change, but has resulted in significant improvements for both our clinical and research efforts.Copyright © 2015. Published by Elsevier Inc.
Risk factors for locoregional relapse after transoral robotic surgery for human papillomavirus-related oropharyngeal squamous cell carcinoma. - Head & neck
Factors predicting locoregional relapse after surgery for oropharyngeal squamous cell carcinoma (SCC) were identified in the pre-human papillomavirus (HPV) era. We examined whether traditional indications for adjuvant radiotherapy (RT) or adjuvant chemoradiotherapy (CRT) still correlate with locoregional relapse in HPV-positive patients after transoral robotic surgery (TORS).Retrospective review of oropharyngeal SCC cases identified patients with HPV-positive tumors who did not receive adjuvant therapy after TORS despite intermediate or high-risk features.Median follow-up was 26.7 months (range, 4.9-73.1 months). Five of 25 eligible patients (20%) relapsed at a median 4.8 months (range, 3.2-7.8 months). Two of 18 (11%) intermediate and 3 of 7 (43%) high-risk patients relapsed. Kaplan-Meier 2-year locoregional relapse-free survival estimates for intermediate and high-risk patients were 88% and 57% (p = .078), respectively.Traditional indications for adjuvant RT or CRT were associated with high risk of locoregional relapse in HPV-positive patients treated with TORS alone. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.© 2015 Wiley Periodicals, Inc.
Positioning reproducibility with and without rotational corrections for 2 head and neck immobilization systems. - Practical radiation oncology
The purpose of this study was to evaluate the impact of offline rotational corrections and assess intrafraction motion for head and neck (H&N) cancer patients immobilized with and without a custom neck cushion.Fifty H&N cancer patients were immobilized and imaged with pretreatment and posttreatment cone beam computed tomography (CBCT) for each treatment fraction. Of these patients, 25 had a custom neck cushion added to their immobilization. Each CBCT was registered to the simulation computed tomography offline. Registrations were performed with automatching tools and a matching volume of interest that consisted of a 5-mm expansion around the mandible, occipital bone, C1/C2, and C7/T1. To determine positioning accuracy, the registration was inspected to confirm these bony anatomy structures were contained within a 3- or 5-mm expansion of the simulation position. If not, the registration was repeated with rotational corrections included and re-evaluated. For each fraction, intrafraction motion was also quantified through the difference between the pretreatment and posttreatment CBCT registration coordinates.For translational registrations, the bony anatomy in pretreatment imaging was outside the 3-mm or 5-mm expansion structure, respectively, for 49% and 15% of fractions on average for patients without a custom headrest and for 48% and 13% of fractions on average for patients with a custom headrest. The addition of rotational corrections reduced these numbers to 21% and 4% and to 28% and 6%, respectively. Intrafraction motion was significantly lower for patients immobilized with the addition of a custom neck cushion: 1.0 ± 0.5 mm compared with 1.8 ± 1.6 mm for patients with the standard headrest only (P = .02). This was reflected in posttreatment positioning accuracy, which was significantly reduced in the case of the standard headrest compared with pretreatment imaging (P values of < .001 to .048).Rotational corrections significantly improved pretreatment patient positioning accuracy (P < .001). Intrafraction motion was reduced significantly through the addition of a custom neck cushion and resulted in an increase in posttreatment positioning accuracy for these patients.Copyright © 2015 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.
Head and Neck Cancers, Version 1.2015. - Journal of the National Comprehensive Cancer Network : JNCCN
These NCCN Guidelines Insights focus on recent updates to the 2015 NCCN Guidelines for Head and Neck (H&N) Cancers. These Insights describe the different types of particle therapy that may be used to treat H&N cancers, in contrast to traditional radiation therapy (RT) with photons (x-ray). Research is ongoing regarding the different types of particle therapy, including protons and carbon ions, with the goals of reducing the long-term side effects from RT and improving the therapeutic index. For the 2015 update, the NCCN H&N Cancers Panel agreed to delete recommendations for neutron therapy for salivary gland cancers, because of its limited availability, which has decreased over the past 2 decades; the small number of patients in the United States who currently receive this treatment; and concerns that the toxicity of neutron therapy may offset potential disease control advantages.Copyright © 2015 by the National Comprehensive Cancer Network.
Cost-effectiveness of proton beam therapy for intraocular melanoma. - PloS one
Proton beam therapy is a commonly accepted treatment for intraocular melanomas, but the literature is lacking in descriptions of patient preferences of clinical outcomes and economic impact. In addition, no economic evaluations have been published regarding the incremental cost-effectiveness of proton beam therapy compared with enucleation or plaque brachytherapy, typical alternative treatments. We, therefore, conducted a cost-utility analysis of these three approaches for the treatment of intraocular melanomas.A Markov model was constructed. Model parameters were identified from the published literature and publicly available data sources. Cost-effectiveness of each treatment was calculated in 2011 US Dollars per quality-adjusted life-year. Incremental cost-effectiveness ratios were calculated assuming enucleation as reference. One-way sensitivity analyses were conducted on all model parameters. A decision threshold of $50,000/quality-adjusted life-year was used to determine cost-effectiveness.Enucleation had the lowest costs and quality-adjusted life-years, and plaque brachytherapy had the highest costs and quality-adjusted life-years. Compared with enucleation, the base-case incremental cost-effectiveness ratios for plaque brachytherapy and proton beam therapy were $77,500/quality-adjusted life-year and $106,100/quality-adjusted life-year, respectively. Results were highly sensitive to multiple parameters. All three treatments were considered optimal, and even dominant, depending on the values used for sensitive parameters.Base-case analysis results suggest enucleation to be optimal. However, the optimal choice was not robust to sensitivity analyses and, depending on the assumption, both plaque brachytherapy and proton beam therapy could be considered cost-effective. Future clinical studies should focus on generating further evidence with the greatest parameter uncertainty to inform future cost-effectiveness analyses.
Metabolic tumor volume as a prognostic imaging-based biomarker for head-and-neck cancer: pilot results from Radiation Therapy Oncology Group protocol 0522. - International journal of radiation oncology, biology, physics
To evaluate candidate fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) imaging biomarkers for head-and-neck chemoradiotherapy outcomes in the cooperative group trial setting.Radiation Therapy Oncology Group (RTOG) protocol 0522 patients consenting to a secondary FDG-PET/CT substudy were serially imaged at baseline and 8 weeks after radiation. Maximum standardized uptake value (SUVmax), SUV peak (mean SUV within a 1-cm sphere centered on SUVmax), and metabolic tumor volume (MTV) using 40% of SUVmax as threshold were obtained from primary tumor and involved nodes.Of 940 patients entered onto RTOG 0522, 74 were analyzable for this substudy. Neither high baseline SUVmax nor SUVpeak from primary or nodal disease were associated with poor treatment outcomes. However, primary tumor MTV above the cohort median was associated with worse local-regional control (hazard ratio 4.01, 95% confidence interval 1.28-12.52, P=.02) and progression-free survival (hazard ratio 2.34, 95% confidence interval 1.02-5.37, P=.05). Although MTV and T stage seemed to correlate (mean MTV 6.4, 13.2, and 26.8 for T2, T3, and T4 tumors, respectively), MTV remained a strong independent prognostic factor for progression-free survival in bivariate analysis that included T stage. Primary MTV remained prognostic in p16-associated oropharyngeal cancer cases, although sample size was limited.High baseline primary tumor MTV was associated with worse treatment outcomes in this limited patient subset of RTOG 0522. Additional confirmatory work will be required to validate primary tumor MTV as a prognostic imaging biomarker for patient stratification in future trials.Copyright © 2015 Elsevier Inc. All rights reserved.
Negative Sentinel Lymph Node Biopsy in Merkel Cell Carcinoma is Associated with a Low Risk of Same-Nodal-Basin Recurrences. - Annals of surgical oncology
Controversy exists regarding the predictive ability of a negative sentinel lymph node biopsy (SLNB) and the use of adjuvant radiation in Merkel cell carcinoma (MCC).Retrospective study of patients with MCC undergoing SLNB at Mayo Clinic from 1995 to 2011. Cumulative incidence (CI) of regional recurrence and death from MCC, respectively, were estimated taking into account the competing risk of death from other causes and compared between groups using Gray's test.A total of 111 (74 %) of 150 SLNB were negative and comprised our study group. There were 15 regional recurrences, and the CI of a regional recurrence was 5.1, 15.0, and 16.6 % at 1, 3, and 5 years, respectively, after initial surgery. Nine patients (8 % of all patients) experienced a same nodal basin recurrence after a negative SLNB. Among 14 patients who received nodal radiation, the CI of a regional recurrence was 0 and 9.1 % at 1 and 3 years, respectively, compared to 5.8 and 15.5 %, respectively, among the 97 who did not receive nodal radiation (p = 0.45). Male sex was the only characteristic predictive of regional recurrence after a negative SLNB; the CI at 3 years was 21.3 versus 0 % in men and women, respectively (p = 0.007). Head and neck location was not associated with a higher risk of recurrence or an improvement in regional recurrences after radiation.Same nodal basin recurrences are uncommon after SLNB in MCC, and regional nodal irradiation can be avoided in the setting of successful sentinel lymph node mapping and a negative SLNB.
Angiosarcoma of the scalp and face: the Mayo Clinic experience. - JAMA otolaryngology-- head & neck surgery
The etiology and optimal treatment are unknown for angiosarcoma, an aggressive malignant tumor that affects vascular endothelial cells and can be mistaken for benign lesions such as hemangioma.To determine the treatment outcomes of patients with angiosarcoma of the face or scalp treated with a combination of surgery, radiation therapy, and/or chemotherapy.Retrospective study of 55 patients with angiosarcoma of the face or scalp treated between January 1, 1973, and December 31, 2012, at a tertiary-care academic medical institution.Surgery, radiation therapy, and/or chemotherapy.Locoregional control (LRC), recurrence-free survival (RFS), and overall survival (OS).Fifty-five patients had angiosarcoma localized to the face or scalp. Forty of these patients (73%) received a combination of surgery, radiation therapy, and/or chemotherapy. Eight patients (15%) were treated with surgery alone, 1 (2%) with radiation alone, 5 (9%) with chemotherapy alone, and 1 (2%) with observation alone. Median (range) follow-up for surviving patients was 25.2 (4.7-227.1) months. Five-year LRC, RFS, and OS (95% CI) were 18% (7%-32%), 16% (6%-31%), and 38% (21%-54%), respectively. Of 36 patients with failed treatment, 34 had failure in a local and/or regional site. On univariate analysis, the use of multimodality therapy (vs no multimodality therapy) was associated with higher 5-year LRC (95% CI) (20% [3%-37%] vs 11% [0%-29%]; P = .04), higher RFS (19% [2%-36%] vs 10% [0%-27%]; P = .02), and higher OS (46% [26%-66%] vs 16% [0%-43%]; P = .04). Age 70 years or older (vs <70 years) was associated with lower 5-year LRC (95% CI) (5% [0%-14%] vs 48% [23%-74%]; P = .02) and lower RFS (5% [0%-13%] vs 49% [24%-75%]; P = .04). Radiation therapy (vs no radiation therapy) was associated with higher 5-year LRC (95% CI) (20% [3%-36%] vs 12% [0%-32%]; P = .02) and higher RFS (19% [2%-35%] vs 12% [0%-31%]; P = .004). On multivariable analysis, age younger than 70 years (vs ≥70 years) was associated with improved 5-year LRC (95% CI) (48% [23%-74%] vs 5% [0%-14%]; P = .03) and RFS (49% [24%-75%] vs 49% [24%-75%]; P = .04).Multimodality therapy for angiosarcoma is associated with improved LRC, RFS, and OS. Younger patients with resectable disease undergoing multimodality therapy for angiosarcoma had the best clinical outcomes.
Clinical outcomes of children and adults with central nervous system primitive neuroectodermal tumor. - Journal of neuro-oncology
Central nervous system primitive neuroectodermal tumors (CNS PNETs) predominantly occur in children and rarely in adults. Because of the rarity of this tumor, its outcomes and prognostic variables are not well characterized. The purpose of this study was to evaluate clinical outcomes and prognostic factors for children and adults with CNS PNET. The records of 26 patients (11 children and 15 adults) with CNS PNET from 1991 to 2011 were reviewed retrospectively. Disease-free survival (DFS) and overall survival (OS) were estimated with the Kaplan-Meier method, and relevant prognostic factors were analyzed. For the cohort, both the 5-year DFS and the OS were 46 %. For pediatric patients, the 5-year DFS was 78 %; for adult patients, it was 22 % (P = 0.004). Five-year OS for the pediatric and adult patients was 67 and 33 %, respectively (P = 0.07). With bivariate analysis including chemotherapy regimen (high dose vs. standard vs. nonstandard) or risk stratification (standard vs. high) and age, the increased risk of disease recurrence in adults persisted. A nonsignificant tendency toward poorer OS in adult patients relative to pediatric patients also persisted. High-dose chemotherapy with stem cell rescue was associated with a statistically significant improvement in OS and a tendency toward improved DFS, although the findings were mitigated when the effect of age was considered. Local recurrence was the primary pattern of treatment failure in both adults and children. Our results suggest that adult patients with CNS PNETs have inferior outcomes relative to the pediatric cohort. Further research is needed to improve outcomes for CNS PNET in populations of all ages.
Failure rate of contemporary low-dose radiosurgical technique for vestibular schwannoma. Clinical article. - Journal of neurosurgery
The decline in cranial nerve morbidity after radiosurgery for vestibular schwannoma (VS) correlates with dose reduction and other technical changes to this procedure. The effect these changes have had on tumor control has not been well documented.The authors performed a retrospective review of 293 patients with VSs who underwent radiosurgery between 1990 and 2004 and had a minimum of 24 months of imaging follow-up (90% of the entire series). The median radiation dose to the tumor margin was 13 Gy. Treatment failure was defined as progressive tumor enlargement noted on 2 or more imaging studies. The mean postradiosurgical follow-up was 60.9 ± 32.5 months.Tumor growth was noted in 15 patients (5%) at a median of 32 months after radiosurgery. Radiographically demonstrated tumor control was 96% at 3 years and 94% at 7 years after radiosurgery. Univariate analysis revealed 2 factors that correlated with failed radiosurgery for VS: an increasing number of isocenters (p = 0.03) and tumor margin radiation doses ≤ 13 Gy (p = 0.02). Multivariate analysis showed that only an increasing number of isocenters correlated with failed VS radiosurgery (hazard ratio 1.1, 95% CI 1.02-1.32, p < 0.05). The tumor margin radiation dose (p = 0.22) was not associated with tumor growth after radiosurgery.Distortion of stereotactic MR imaging coupled with increased radiosurgical conformality and progressive dose reduction likely caused some VSs to receive less than the prescribed radiation dose to the entire tumor volume.

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200 1St St Sw Rochester, MN 55905
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