I'm just going to wait just a few minutes here as everyone logs in. My name is Yuri Choi and I am a performance coach for entrepreneurs and high achievers. I'm a speaker, I'm an author of my upcoming book called Creating Your Own Happiness. It's an honor to be here with you guys today on Psych2Go, the largest online mental health magazine and YouTube channel in the world, you guys are in a very, very special place right now. So, so excited to get this started very soon and if you guys are watching this right now, just move your energy a little bit, I'm going to have some of the music going as well as share with me where are you guys logging in from, I would love to know where you guys are logging in from. And this is going to be so fun you guys because as you guys probably know if you've been here before, this is more than just a workshop. This is more than just an opportunity to learn, which it absolutely is and this is an absolute opportunity for all of us to get together in this virtual community, come together, elevate the consciousness, elevate the vibe of this world together. So let's have some fun here guys.  There's India, USA, Colorado, I'm actually from Colorado. I see, whoa, it's going so fast, Indonesia. Yeah, so, all right, you guys. Whoo, all right, welcome. Okay, so you guys are logging in from the Philippines, Pakistan, Singapore, and Nebraska, like I'm just seeing places from all over the world. I am actually logging in here today from South Korea in Seoul. I typically live in actually California, Southern California, so I'll be there soon as well, but I'm here today logging in from across the world from a lot of you guys and it is so amazing to meet you guys here. And really quickly, you guys, by the way, so you are on Psych2Go right now, which is the largest online magazine and mental health YouTube channel in the world. So it's an honor to have you guys here. We have 5.5 million subscribers here and counting. So if you guys have any other friends or anyone that you'd like to share this channel with today, go ahead and do that. We are starting a movement to bring more awareness to mental health and really heal together and that's really the end goal here. Again, if you guys didn't get to hear me because of the music, I saw that it was a little bit loud. My name is Yuri Choi. I am a invited guest here today as a coach who will be doing this workshop and this live stream today. I'm the CEO of Yuri Choi Coaching. I'm a performance coach for entrepreneurs and high achievers, speaker, author, and YouTuber myself. You guys can go ahead and check out the YouTube channel. It will be linked to this channel as well. Besides that, you guys, some really good, some really important announcements from Psych2Go today. First of all, on the behalf of Psych2Go, I want to thank all of you guys because you guys are the ones making this movement happen.  But also, I believe this is such an important cause and all of you guys just being here today, caring about your own mental health and caring about how to heal through that and really learning how to change your mindset and how to live a happier life. This is all really important and crucial part of the movement that we're creating. Thank you for being one of the 5.5 million subscribers. We appreciate literally every single one of you guys. Another quick thing on behalf of Psych2Go, you guys, we read most of the video comments. But as you can really see, it does go by really fast. Sometimes there's an abundance of comments. So I just want to let you know that we're not unable to answer all of them. We try our best and to let you know that we do read all of them, that we do take the time to read all of them. All of your voice and all of your comments matter. But if you guys do have a topic suggestion, feel free to comment your ideas in any video including this one or even email us. By the way, special announcements from Psych2Go. We are still recruiting more animators. You guys, I have personally had the opportunity to meet some of the people from the team of Psych2Go. These are such incredible people. So if you guys are interested as animators, sign up for them. It's going to be in the description box below. And lastly, don't forget to check out the new video. It's going to be called Eight Things You Can Do to Improve Your Mental Health. So just want to plug that in here. And other than that, let's get right into it, you guys. So I see that you guys are logging in from all over the world. And again, it's an honor to be here. And today, what we're going to talk about is actually one of my favorite freaking topics. Like really just thinking about this gets me excited. It's about how to move away from anxiety and fear and move into a place of feeling good, feeling powerful, and perhaps even happy and peaceful. How many of you guys want that level of peace and happiness and feeling good mindset? And let's talk about this for a second. First of all, how many of you guys have felt or even chronically feel in a state of fear or anxiety? If that's a lot of you guys, you're in the perfect place. We're going to talk about all of that today. So let's talk about this.  Let's talk about what fear and anxiety really are. So you guys talk about fear and anxiety, but like what is that? What does that feel like in your body? What does that feel like? Where do you feel that anxiety? Where do you feel that fear in your body?  You know, like I felt really scared when I was about to skydive. Or I felt really scared when, you know, when some certain things happen. But I will say for the majority of the time I live a life free of fear and free of stress. And how many of you guys actually want that? I'm sure a lot of you guys. So if that's the case, please watch till the end because I have some really powerful tips lined up for you guys. Okay, you guys. So and girls and all humans out there. So first of all, what is fear? Fear was created by, you know, within our body within the mechanism of how we live back in the day because it's really a mechanism to help us survive. Fear is in our body because it's a thing. It's a mechanism that helps us survive, right? So back in the day when we were, you know, cavemen, cavewoman, we had this fear response that really helped us, which is when we have this fear in our body, it's because we're being chased by a bear. We're being chased by a tiger. And there is an actual need for us to hyper focus all of our energy from running away from that tiger, running away from that bear, right? And it's actually and let's think about this for a second. Let's actually become grateful for fear for a second because it does serve us. Like if we're getting chased by a bear, it's actually probably a good thing that we feel the sense of fear in our body because what fear does, it, you know, hyper focuses our energy into one thing, which is taking that one action that fight, flight or freeze action that's really going to help us survive. Now, over the course of thousands of years or even longer, we have evolved into powerful, intelligent, conscious human beings, right? And so think about the last time you felt fear. I guarantee it had nothing to do with running away from a tiger or running away from a bear or running away from anything that's really physically threatening your safety. So with that said, think about that. We typically, you know, feel the sense of fear because we, we are in a social situation rather than a physical situation that's actually going to threaten our safety. You feel fear right now. Yeah. So check in with that body. You're not feeling fear of because your physical safety is threatened. So I want to go right into the one of the tips I have for you, which is number one, how to move away from fear and anxiety and step into this place of feeling good. Number one, try on this self talk mantra for yourself. I am physically safe and all is good. I am physically safe and all is good. Why is this important? Because, because fear is a survival response, it reminds us that there is no need for us to fight for survival right now. Sure. Do we sometimes feel fear and anxiety when we have homework to do or when we're going to do on, you know, some kind of presentation or, you know, you're feeling anxiety about what's to come. Okay, I get all that. However, think about the fact that you're most likely physically safe. Now, if you are in a physically dangerous situation, that's a whole different conversation, and maybe your fear response is actually warranted. However, what I'm talking about is when we think about fear, remember that I'm physically safe and all is good. It's like calming your body down a little bit because this reminds us that there's nothing that we have to fight against right now. In fact, everything is imagined, even if the worst case scenario happened in what you're imagining.  Oh my gosh, you know, that person is going to break up with me.  All these fears, all these worries that you have, it's socially constructed fear, meaning it's actually not real. And that physical sensation of fear is not necessary. We can acknowledge that it's happening. And here's the thing, because it's a social construct that is igniting that fear, we get to remember that that's based on the story that we're telling. We're telling ourselves a story that if this happens, I'm going to feel this way. But the truth is, it hasn't happened yet. So you can actually create how you want to feel. You can create how that reality goes in the future. So in fact, there's nothing to worry about.  Even if you're so embarrassed, guess what? That's not going to actually threaten your physical safety. You're going to survive. You're going to be okay. You're going to get over it. We've gone over all the times, all the other times that we felt, you know, we have felt anything like that. Does that make sense, you guys? I'm going to check in with the chat here for a little bit. I know it's late for some of you guys. My bear failed his test. You have no friends. That's a lie.  Yes, yes, yes. Human beings need love. That is true. So think about that, you guys. Think about the fact that you are safe and all is good. All right. So let's go into the second one, which is, I'm going to share this Wayne Dyer quote with you, Dr. Wayne Dyer. He is a spiritual teacher that admire very much. And this is his quote. It makes no sense to worry about things. You have no control over because there's nothing you can do about them. And so why, and why worry about things you do control because you can control them. You can do something about that. So meaning there's no need to control, try to control something that you actually have zero control over. That's only going to set you up to be more stressed. So for example, what's something that you guys, what's something that you guys might be worrying about or stressed about that you don't actually have control over? Like, are you going to have anxiety about the fact that maybe it's going to rain tomorrow? Maybe it's going to snow tomorrow? Well, guess what? I don't think we have a way to change that right now. So why worry? Why not just be? Why not just realize that it's going to happen and we're going to get through it? You're worried about your toxic friend. Okay. Do you have control over your toxic friend? No. No. So why worry?  So just let it be. You don't have to create any stories about what's going on. So and this is another thing we can talk about.  Think about this. What are the facts of what's happening and what are the stories of what's happening? What are the facts of what's happening? What are the stories of what you're creating? So I saw someone that says, you have this anxiety and fear of being judged. Okay. What are the facts of what's happening? Has someone come up to you and said, I'm judging you? Or are you creating the story that they are? And are you, and even if so they judge me, and that's a whole different topic, we can have a whole lot of fun on. Even if they are judging you, do you have control over that? No. So why worry about it? It's happening just like it's going to, it might rain tomorrow. There's nothing I can do. And the story that you might be creating is that because that person's judging me, you know, I'm going to feel less than or I'm going to feel embarrassed or I can't do this. Is that true? Are the facts of what's happening? Or is that a story? And if it's a story, you know, what's cool thing about a story that we're creating in our mind that's giving us anxiety or stress, we can change that story. We simply choose to change the story. What if your new story gets to be, oh, I think that person is judging me. I know that people who judge aren't happy with themselves. So I hope that person ends up happier.  I really hope that that person finds happiness for them. And move on. Or find a way to pour love to them. But this is literally why I don't care about, I care about people. Don't get me wrong.  Because A, I don't have control over it. And B, I know that people who judge others, it actually shows them more about themselves than about me. I know who I am. They don't know who I am. So they choose to create these stories that actually probably is a projection of themselves more than, you know, me. So for example, I remember somebody, I know they were judging this person in front of me based on how they looked. And I know one of you guys said this, like how you look, this is something that you worry about. I remember this person next to me, she was judging the person in front of me. We were in line to get food or something. She's like, that girl needs a burger. She's so skinny. And in that moment, you know what that told me? It had nothing to do with that girl in front of us. She used to do what she wants. But what that told me is that the person who said it was judging her own body. And therefore, she was projecting that other people as a judgment towards other people. But really, I can find out what people are thinking and what people are judging themselves on and jailing themselves in those kind of constructs based on what they're saying about other people, even if they're not saying it about themselves. Would you guys agree? Yeah. So is that landing for you guys? Is that making sense for you guys? If that is, let's say, let's have you guys type in love or yeah, love, love, love. I love that word. Yes, yes, it's good to preach it. Yes. Okay. Amazing. Number three, I'm going to move on to number three, you guys. Love, love, love. Oh my God. Isn't that kind of cool to see words of love all over? How empowering is that? This world gets to be full of love. And by the way, kind of going off tangent, every word has an energetic vibration to its word. So if you think about the word like love, or if you think about the word like hatred or fear, there's like different energies to these words. So by just saying the word like love and seeing it all over our screen, doesn't that feel good? Doesn't that feel good? Oh my gosh. I feel so much love in this shot. It's amazing. So cool. Yes. Can you guys feel that love? Even the word just saying the words love, love, love. Like I feel that energy of love expanding through the screen and I feel it reaching my heart and it expanding me. Love you guys too. Yes. Yes. Yes. Okay. Cool. Anyways, I went off tangent. Okay.  And this is probably one of the key reasons I don't often feel any fear or anxiety. And it's gratitude. Gratitude. Gratitude is so magical, you guys. When I wake up in the morning, before I even get out of bed, I think about all the things I'm grateful for. Here's the thing, you guys. A lot of the things that we are complaining about, worried about in the bigger scheme of things, it's probably not. Not a big deal. And I don't want to undermine what you're going through. I'm not saying your worries and how you feel doesn't matter because it's not at all what I'm saying, but I will give you an example. When my dad was suffering from cancer, those two and a half years that I saw him, bedridden, unable to move, unable to even take himself to the bathroom or eat anything, anything, walk. Oh my gosh, like that was a realization that so many of these worries, so many of these things that I feared or complained about didn't matter. As long as I have my health, I'm still breathing, I'm moving, I have my hands, I have my legs, I have my stomach, I have my nose. Oh my gosh, do I have enough to be grateful for every single day? Like, let that sink in for a second. So every morning before I wake up, even before I open my eyes, I lay there and I say, I think to myself, what am I grateful for? I'm so grateful that I can walk today, I can eat today. I can breathe today, that I'm alive today, that I can do the things I love today. You know, that I, you know, and think about this, if you next time that you start to go into this overthinking place of fear or anxiety, think about this. Let's be grateful that we have a brain that's so like working so well that it goes into overdrive and to thinking about these things. Like, that's not a reality for everybody, you guys even. Yeah. And so let's take a moment right here, right now. Think about three things that you're grateful for. Three things that you're grateful for and put it in your chat. What are you grateful for today? And as you type that into the chat, feel that energy shift in your body. Feel that elevation of energy change, you know, happen in your body. As you like really consciously start to think about, what am I grateful for right now? Notice your energy just expand, notice your heart expand. Do you guys feel that?  I'm grateful for all of you guys today because without you guys, this isn't a community.  Every one of you guys are creating this exact experience. If one of you guys was missing, it would be a completely different experience and know that I'm so grateful for each and one of you guys. Grateful for your body, your home, your family, your wife, how beautiful. Yeah, so much to be grateful for. And let's take this one step further. Think about one thing that you're grateful for because it's an ability or skill that you have. So for example, for me, my superpower that I'm grateful for is that I see each person in their best version of themselves even when they even before they do. I can see and I can talk to every single person for their most divine, their best version of themselves before they even see it for them. So I talk to that version of those people. I get to, you know, hold that vision high for those people. What is something that you get to be grateful for right now today? Ah, you're grateful for your dyslexia, that's beautiful, your creativity, your singing, your learning, all of that. Horseback riding aren't beautiful, empathy. That's incredible. Fill your mind with these thoughts, what you get to be grateful for, what you get to be grateful for about you, what you get to be grateful for for the person in front of you, what you get to be grateful for for your health. I promise when you start to fill your mind with these things constantly, there's not enough room for worries. There's not enough room to fear anything. And the cool thing is, and we can do a whole different video on this, but according to laws of attraction, you attract more of what you're grateful for. So think about this. Imagine that tomorrow, the only thing that stays in your life are the things that you were grateful for today. And let that sink in because even though it may not happen overnight and it may sometimes, but over time, that's what happens. If you are grateful for friends constantly, they will stay. If you're grateful for your singing abilities, it'll get better. And you'll attract more resources and connections that will amplify your singing. If you're grateful for adventure, you'll attract more of them. If you're grateful for psych to go, it's gonna grow. I know, that was a little plugin. But yeah, if you're grateful for your dog, your dog is gonna be there for you and love you even more. So think about that. What you're grateful for today stays. So be mindful what you're grateful for. Be mindful what you fill your thoughts with. And a side note on worries. I don't know if you guys pray or make a request to the universe or any of those things where you intentionally wish for something. The reason that prayers work is because it is infused with powerful emotion, energy. Emotions are energy, right? When we're like, oh, I really, really hope and pray that, you know, I don't know, my grandma feels better or that I get into school or, you know, whatever it is. The reason that it's powerful is because it's infused with your own emotions. But here's the trick. Here's the tricky part. How many times do we infuse worries and fears with really strong negative emotions? Right? So meaning your worries are also prayers for things you don't want. If you're like, oh, I really, really, really, really hope I don't fail that test, you're like praying that you'll fail that test. It's not silly. So why not change the story and say, I really, really, really hope that I do really well on that test and I can't wait to take action towards it? And then go take action. Yeah. Is that making sense for you guys? If so, let's say the word gratitude. Gratitude. Yes, self-fulfilling prophecy. Apps of fricking Lutely. Yeah, is that making sense, you guys? Whoo. All right. And really quickly, you guys, on the topic of gratitude, take a moment right now, pick a random name, do the little ad sign so they can, you know, see it and say, I'm grateful for you. I'm grateful for you. Say, I'm grateful for you. Pick a name in the chat and say, I'm grateful for you. Maybe pick three names in the chat and say, I'm grateful for you. And just like, let's kind of infuse this energy of gratitude together and notice that in the pure energy of giving, just saying gratitude for somebody, it actually shifts to your energy, not somebody else's and potentially theirs too. But guess what? You don't have control over that. So don't dwell on that. But I love this. I'm grateful for you. Oh, you guys, do you feel this? This is so beautiful. Oh, because they're filling up my heart with so much love. And if you guys are watching this replay, take a random name that you see in the comments and say, I'm grateful for you or go comment under their name, make their day. Why not? Or take out your phone and text somebody, I'm grateful for you. Okay, now this is so fun. This is a party. All right, you guys. Okay, let's move on to the next, next tip here. This is actually, this is actually a really powerful exercise that I actually only typically share with my VIP clients. But today, I'm going to share with you guys. So pay attention, write this down. This is really powerful stuff. It's called turning the page process, turning the page process. So, and this is really powerful because, you know, when I'm talk about moving away from fear, moving away from anxiety, I'm not saying just ignore that it's there.  It's actually not at all what I'm saying. It's actually even more powerful if you can acknowledge how you feel first. So turning the page process, step number one is identify and acknowledge how you feel. So for example, are you feeling stressed? Are you feeling anxious? Are you feeling scared? Then number one, acknowledge how you feel and then write that down. I am feeling stressed. I am feeling scared. I am feeling whatever, whatever is true in your body right now, right now, write that down. And this is a powerful process or part of the process because yes, we want to move into that, but it's also really powerful to acknowledge that.  You're not happy right now. You're not, you know, grateful right now. Stop trying to force this. That's what your brain does. So by feeling, by acknowledge how you feel, you can start to move away from it. Okay. Now, step two, after that sentence that you wrote, so for example, if you said, I feel, you know, stress, write out this sentence or this phrase until now. I feel stressed until now. I feel ugly until now. I feel scared until now. Whatever you guys wrote down. I'm just reading off the chat. Write down the phrase until now. I'm feeling destroyed. Okay. Then say until now. This is like the same act of us like turning the page. We're saying, okay, I'm on page one, which is how I feel. But until now, it's acknowledging that it doesn't have to be that way forever. We can actually choose into something else. Do you notice that shift? Now, step three, choose, create how you want to feel. This is the problem with, this is a problem that arises when people get stuck in negative thinking loops or negative feeling loops. It's fine. It's actually powerful. It's actually healthy to acknowledge how you feel, but they don't stop to create the new possibility, how they really want to feel. Okay. That's cool. If you feel stressed until now, but what do you want to feel? How do you want to feel? Choose how you want to feel. So in the chat or wherever you're writing this down, write down, I choose to feel blank. I choose to feel love. I choose to feel inquisitive. I choose to feel powerful. I choose to feel confident. I choose to feel peace. I choose to feel happy. I choose to feel positive. I choose to choose to, I want pizza. I choose to feel joy. I choose, I choose, I choose, I choose to feel, look at all these beautiful affirmations that's coming through in the chat. So powerful, you guys. Do you see how this reminds us simply by changing our language pattern that this is a choice, that we get to choose how we feel. We don't have to be the victim of how we think we feel. Now, next step, turning the page process, verbalize all those parts together. So let's start from the beginning. Right now, check in with how you feel. I feel stressed until now and I choose to feel relaxed. I feel stressed until now and I choose to feel powerful. I feel sad until now and I choose to feel happy and grateful. Bring that power back and notice this power ignite within you in your stomach as you turn the page of how you choose to feel and putting that power within you as a creator that you are and choose to feel what you choose to feel. I feel anxious now and I choose to feel cute. That is amazing. I love that. Do you guys feel that shift in your energy as you verbalize this, as you write this down, as you choose to create how you want to feel? Yeah, it's powerful. I feel free. Prana, that's awesome. I feel free. Yeah, notice that shift in your body. Notice. Yeah, I choose to feel hot. I'd love it. Go for it. Go for it, babes. Choose to feel sexy, whatever. You guys deserve to feel how you want to feel. Amazing. Is this making sense for you guys? And if it is, let's say I choose love. If this is making sense, let's write down I choose love. I choose love. I choose love. And let's flood this chat with I choose love. Yes, I choose love. I choose freedom. Whatever you choose, write that out. I choose love. Ah, yes. This is so beautiful, you guys. I love this. I'm making a video of it because this is so cool. Thousands of people saying I choose love. Yes, I love it. Yeah, beautiful, you guys. So that is called turning the page process. Isn't that some powerful stuff? I told you from the start that I'm going to share some really, really powerful exercises today to literally get you out of feeling stressed and you know, whatever, fear based emotion into feeling good today right now as we go through this process together. This shift is happening right now in this moment. Do you guys feel that as you listen to this and as you hear this, as you walk through this exercise with me, as you verbalize what you feel, what you choose to feel and as you start to talk about choosing love, choose love for yourself and stop it. Drop these fears. Like you can drop this pen.  Okay, cool. Now, another thing, you feel the difference. That's beautiful. That's beautiful. Okay, you guys. So by the way, if you guys are just logging on, welcome, welcome. I just want to let you guys know really quickly. My name is Yuri Choi. I'm a performance coach for entrepreneurs and high achievers. You are right now in Psych2Go, the largest online mental health magazine and YouTube channel creating a movement to bring more people into healing, to happiness and joy and, you know, really stepping into whatever they get to be in the world. We are creating a movement to bring more awareness for mental health and to powerfully choose into healing together. So anyways, so all right, you guys. So let's go into the next one. That is like one of my favorite exercises that you guys got to experience today. So I'm so glad that we get to talk about this. We get to walk you guys through this today. The next one. This is something that is related to mindfulness, which is meditation. I'm going to walk you guys through a meditation today so that you can start to feel that difference in your energetic state. This is actually possible. And though I want to actually talk about the mechanics of why this works. So when we talk about fear and anxiety, by the way, like I said, our brain, our body is going into a state of, you know, survival mode. And that part of our brain that's fear base, which is flight or freeze, that's being activated. So on a physiological level, what's powerful about meditation is that it literally calms the body down to a normal state. Our normal state is supposed to be relaxed, joyful, playful. That's like what we're supposed to be, you guys. Like when you look at little kids like they're happy for the most part. And that's our normal natural state. That's our homeostasis. And what meditation allows us to do is tame our physical body so that we can come back to what's actually most natural to us starting and leading with the body. We think that we're going to remove stress and anxiety out of our mind by thinking more. That's not the case because our anxiety and stress comes from thinking too much. If you're like trying to think about how am I going to be, you know, less stressed and less fearful, that's going to just add another layer. So my invitation is come back to our body. Notice that we can relax our body. In fact, meditation in an eight-week study, it's actually changed the structure of our brain, the size of the plays in our brain that actually causes stress, that makes stress on a chemical level, a neurochemical level, it actually shrinks that part. So you actually have a smaller capacity to feel stress. So why the heck would we not meditate when we know it's that powerful? How cool is that? Did you guys know that about meditation?  But it's actually so powerful. It actually changes the physiological part of your brain that experiences stress. So let's try this on you guys. Let's take a moment here. And this is a real-time transformation that's happening right here, right now as I walk you guys through this powerful meditation. And if you've been feeling stressed and you have this resistance about meditation, please do stay for this. You're the one who need it the most.  This is so true. During the pandemic when it started, you guys, last year I was in California, and I knew that people were going to go into literally survival mode, like panic and stress and anxiety mode. So I was like, you know what? I know the power of meditation. I know how much it's helped me. So I'm going to amplify this meditation practice. So during the pandemic, I was meditating for like an hour or two a day. So while everyone was going into like stress mode and, you know, going into this panic mode, it was good. It was chill. And I was there to be able to serve the community. We did some really powerful fundraising for, um, the nurses and the front, like frontline workers. And, um, yeah, I got to do some really cool stuff during the pandemic. Even though I didn't leave home, you know, I was able to do a lot of stuff. I threw dance parties on zoom. Like it had so much fun. And that's because I chose a practical way to calm my body down where everyone else was feeling really stressful. So let's try to sign you guys. Are you guys ready? So excited. There's nothing that, um, fuels my heart more than, um, leading people from all over the world who are growth oriented, who choose love, who chooses growth, who, who realizes their power within as a creator to create the emotions that they want to feel in their body. And collectively, intentionally going into a state of meditation with the intention of not only elevating and growing ourselves, but elevating and growing the consciousness level of the universe. And you guys are doing that right now, right here. So let's do this. I know zoom dance party with Yuri. Okay, bring it on. Let's do it. Maybe we'll do a little bit today. We'll see. All right, you guys. So take a moment here.  If you're, um, lying down, that's okay too. Plant your feet on the floor like a tree.  Just imagine this for a second.  Feel really supported as if you have an energetic route that is going into the earth.  Fill up all the corners of your lungs and exhale everything out. Notice a relaxation. Notice the surrendering of your shoulders to gravity towards the earth. Another deep inhale through your nose. Hold at the top this time. Sip in a little bit more air. Maybe start to squeeze your body and exhale and let everything out and release. Let's do a few more like this. Another deep, deep inhale through your nose. Inhale even more. Fill up your lungs even more. Hold at the top. Squeeze your hand. Squeeze every part of your body. And exhale everything out. Do you guys feel that already? Feels good. Now from this place, with your eyes closed preferably, relax your shoulders away from your ears, surrendering them to gravity. Relax your jaws. We carry a lot of tension here. This is um we carry a pockets of tension here in stress. Relax your jaws, maybe move it around a little bit and let them surrender to the earth. Relax your tongue. We use our tongue a lot and oftentimes we carry a lot of attention in there that's unnecessary. Relax your tongue. Relax your eyes. Imagine that your eyeballs are just relaxing and falling to the earth.  Relax your stomach. They say our stomach is our second brain. We carry a lot of neurons and stress and you know all sorts of things going on there so maybe breathe into it a little bit and relax your stomach. Let it all just hang out. Relax. Relax your hips. Relax your legs. Relax your toes. And from this relax state take another deep inhale in and exhale everything out. Another deep deep inhale in as if you're sucking in all the blessings around you. And exhale all the gratitude out into the world with your eyes closed.  Notice that this is your safe place. Notice that in this giant bubble of protection in white light you are loved unconditionally. You are supported unconditionally.  Notice that your entire body feels light and powerful at the same time. Notice that this white light is your bubble of protection and now that you have created this energetic protection all around you anything that doesn't belong within this bubble will not enter. I know a lot of you guys are probably empaths like I am. We tend to soak in lots of energy that's not ours. Allow this white bubble of energy to be that protection. No, no more do you let any negative energy enter this white bubble of protection that is yours that is sacred. From the space know that this powerful energy that you have generated from within you today is powerful choosing into feeling good today, choosing into joy, choosing into power, choosing into connection, choosing into whatever you've chosen to feeling confident. That is yours now and no one else can take that from you. No one can enter into this bubble of love and protection only more love and more confidence, more feeling good or sources of can enter into this bubble.  Take a deep inhale in from the space and exhale everything out. Another deep inhale and exhale everything out and then another deep deep inhale and exhale everything out you guys. Whoa, how do you guys feel for those of you who entered into that beautiful space of meditation with me? How are you guys feeling? Did that feel amazing or what? Do you guys feel the spaciousness? You feel good. You feel relaxed. You feel good, right? Feel magical. Yes, Mary. I love that. Whoo, ethereal, amazing, wonderful, better, feels great, relaxed, and powerful. I love it. And look how quickly we were able to get here. Didn't take much. A few exercises, a few shifts in perspective. That's all available for you guys. You feel hot. Love it. Love it. All right, you guys. So share with me a little bit in the chat. What was the shift for you guys? Think about like an hour ago, if you guys are still here from an hour ago, or even just a few minutes ago of logging into this live stream, how you were feeling and then how you're feeling now. How are you guys feeling now? Are you guys feeling good? Do you feel the shift? If you're feeling the shift, type in I feel the shift. I feel the shift because I certainly feel the shift. And notice that that shift is available for you guys anytime. You might think that I caused this. The truth is I didn't. You are the one who chose to be here. You are the one who chose to go on to a site to go with an intention to heal and connect with other people.  You're the one who decided into meditation. You're the one who decided into feeling better. You created this feeling within yourself. So remember that knowing that you can always feel the shift at any time that you want. You are that powerful. This is sounds like a call. This is, you know, feeling good group. You know, if I can make, you know, everyone, if I can help everyone feel better about where they are, sure, you can call whatever you want. You feel reborn and how beautiful is that? These are amazing. All right, you guys. So really quickly, out of those things that we share today, you guys, there's some really powerful exercises that we share today and that we did together. We talked about what is fear and what is anxiety and what that means on a neurological and biological level so that you can really start to understand that you don't have to feel that way. You don't have to go into that survival zone. We talked about this mantra. I'm physically safe and all is good as a mantra to really powerfully remind ourselves that we don't need to be in a survival mode that we can actually start to feel like the creators that we are because we are safe. All these worries and fears that we have, it's not, sometimes it's not real simply. It's based on the stories that we create on our mind, not the actual reality of what's going on. We talked about how there's no, it makes no sense to worry about the things that you have control over because there's nothing you can do about them and that, and there's no reason to worry about the things that you do have control over and that you can do something about because then you can do something about them. We talked about how powerful gratitude is. We got to think ourselves. We got to think each other, make new friends around the world. We got to think just anything realizing that that is really the magnet for all the things that we want going into laws of attraction a little bit. We talked about the turning the page process which is a really powerful exercise with the phrase until now to really remind ourselves the power that we have to choose into the feeling that we want to create within our body and our mind. And we ended it with a really powerful meditation that allowed you to create a bubble of protection and bubble where you get to encircle yourself in the feeling that you want. So those are the things that we talked about. Which one was your favorite today? I'm curious. So share with me in the chat if you'd like. And let's do this one really quick. You know share with me what landed for you as well as um yeah please help me yeah I'm just reading the chat here. So everything helped all of them oh my gosh okay beautiful until now the bubble calls come on now you guys because you're funny okay meditation everything will I do it again yes I will be back here I believe May 15th I will come from the date and post it. Okay you guys so um I'm so honored to be here I'm so honored to have helped you guys I'm gonna end this with a little movement so let me actually um play a song here to end this and remember you guys you're here on psych2go the largest online mental health magazine and youtube channel in the world we're at 5.5 million subscribers and it's an honor to be a guest speaker here today my name is Yuri Choi I am a performance coach for entrepreneurs and high achievers um author and speaker and a youtuber myself so if you guys would like please take a moment to go to uh my channel subscribe um or you can search me on youtube my name is Yuri Choi please please meet me there I actually do live there as well um every week and that is on um I do live there on Monday California time 9 p.m. Pacific time which is Tuesday 1 p.m. korea time so if you guys are still here just really thanking you guys like this video share this video invite people into the movement of creating more awareness and mental health and shifting into the reality that we want by sharing my youtube channel as well as obviously psych2go youtube channel and the videos here I appreciate you guys so so much you guys are so freaking amazing and if you guys um and really quickly as I mentioned in the very beginning which you guys might have missed in the beginning um on behalf of psych2go we are so thankful for each and one of you guys we're making a huge impact around the world with over 5.5 million subscribers and every one of you guys are so appreciated we try to read all the comments but as you seen even today it's so hard to read them sometimes so there's an abundance of you and do know that we do take a moment to read all of them and all of your words matter so thank you for you know commenting continue to do so we try our best to get back to all of you guys if you guys ever have a topic suggestion feel free to comment your ideas and any of the videos below or email us we are recruiting for more innovators as you guys see we have beautiful animations that really help so if you do have any questions about that sign up for me in the description box other than that this gets to be a powerful reminder that bubble's cold but you guys are all so loved and powerful of Dr. Bubble Char you guys are hilarious I love you guys so much I love you guys so much thank you so much for being here please share in the comments below how this impacted you I'm going to take a moment after this live make sure to read all these you know chats and connect with as much of you guys as I can I possibly can try my best I love you guys so much so let's thank this and let's end this by saying thank you to somebody in the chat share with us how this impacted you and other than that I hope you guys have a beautiful beautiful rest of the week and I will probably see you guys here in about two weeks love you guys oh and then also feel free to follow me um on Instagram if you guys would like I love connecting with all my you know followers there that's Yuri1c on Instagram and then also follow psych2go instagram there's really powerful tips there that I think you guys would really enjoy and that's psych2go underscore tips so follow us there as well I'm going to type that in underscore tips and Yuri1c on Instagram see you guys there love you guys so much felt so good to serve you guys thank you for being here bubble cold oh my gosh you guys are so funny maybe that's something maybe that's the name maybe that's the name we'll see love you guys have a great day bubbles joy you guys and this is hilarious you guys are all amazing bye you guys


Hello and welcome to the session in which we would look at the taxability of social security benefits. There's a lot of confusion whether social security benefit is taxable or not. And the answer is it all depends. It depends on something called modified adjusted gross income or provisional adjusted gross income. So in this session, I will try to explain this concept. So let's take a look at the taxability of income. Well, the taxability of social security benefit depends on something we call the modified or provisional income. And of course, it depends on your filing status. Okay, the effect of the rules is to execute social security benefit for people who are in the lower individual tax brackets. Simply put, if you don't make a lot of money, okay, if you're in a low tax bracket, none of your social security benefit is taxable. If you are slightly a higher tax bracket up to 85%. So you could have zero social, none of it is taxable up to 85%. So this is what it could be zero to 85%. Now, before we proceed any further, I have a public announcement about my company, Farhat Lectures.com. Farhat Accounting Lectures is a supplemental educational tool that's gonna help you with your CPA exam preparation as well as your accounting courses. My CPA material is aligned with your CPA review course, such as Becker, Roger, Wiley, Gleam, Miles. My accounting courses are aligned with your accounting courses broken down by chapter and topics. My resources consist of lectures, multiple choice questions, true-false questions, as well as exercises. Go ahead, start your free trial today, no obligation, no credit card required. First, how do we compute this provisional modified income? That's the first thing you want to know. Well, we're gonna take your adjusted gross income before social security. So we're gonna look at, take out social security, compute your adjusted gross income. Then add any interest on US savings bonds that was executed for educational purposes. It means you received interest, it was not included in your income. Add most tax exempt interest. Add employer-provided adoption benefit. Add for an income, executed for an income. Add deducted interest on educational loans. Add deductions, tuition and fees. And then add, remember 50% of your social security. Why are they adding all of this? Because all of these, the risk is, somebody is getting social security, they will invest all their money in tax exempt interest. And by doing so, it will not be taxable. The interest on the tax exempt interest will not be taxable, and their social security is not taxable as well. So what they're saying, it's not fair. What we need to do is, if you have anything that's tax exempt, and usually on the CPA exam, usually they'll give you, they have tax exempt interest. And in the real world, usually it's people will have tax exempt interest that they have to add to their gross income. But that's what they have to do. They have to add certain items to arrive to something called provisional or modified income or modified adjusted gross income. That's the first thing we need to do, that after we compute this, then we have to follow this formula that's gonna show us how to determine whether the amount, whether the amount of social security is taxable or not. So here's how it works. First I'm gonna go over the formula for merit filing jointly and it works the same way for single head of a household qualifying widow or widower. First of all, if your provisional income is below 32,000, so it's below this amount, you're good, you don't have to worry about anything. It means zero of your social security is taxable. Then your provisional could be between 32 and 44. So you're in the middle, in between 32 and 44. The taxable portion of the benefit if the income is between those two limit is the lesser of 50% of your social security benefit or 50% of the access of provisional income over 32,000. Okay, so we're gonna look, what's the provisional income of our 42,000? We're gonna take 50% of it and compare that to 50% of your benefit and we're gonna take the lesser of those two numbers. If, if now if your provisional income is above 44,000, taxable income, taxable portion of benefit if provisional income is above the limit, we're gonna take the lesser of 85% of the benefit or 85% of the access of provisional income over 44,000 plus the lesser of either 6,000 may be filing jointly or 50% of your benefit. So you tag that to it. And if you are single, they have different figures. Remember, if you are single, they have different figures but the concept is the same. The best way to illustrate these concepts, guess what? Is to actually work an example. Okay, let's take a look at it. Robert and Cindy finally joined return. So we're looking here. So we're looking here. So we're looking here. Their AGI, before social security is 15,000 and receive 8,000 of benefit which is social security benefit. Okay, they had no items to add back. So first thing, computer provisional income. Well, we're gonna take their AGI plus 50% of their social security. Therefore, their provisional income is 19,000. Well, guess what? 19,000 is below 32. No social security benefit is taxable. Karen files a return as a qualifying widow which is, will bring us here to this table. She received 7,000 in social security benefit, 19,000 of interest income and 5,000 of non-taxable municipal bond interest. First, compute the provisional income. Be careful here what we're asking. Compute the provisional income. We're gonna take half of the social security plus 19,000 plus 5,000 which is provisional income is 27,500. This provisional income puts Karen in this right here in the middle. Now we have to look at the taxable portion will be 50% the lesser of 50% of the benefit which is 3,500 or 50% of the access amount 25 or for 25,000. So we have to find out what's the access amount over 25,000 which is 2,500. Okay, let's do that. So the taxable income will be the less equal to the lesser of 50% of social security which is 3,500 or the access that 50% of the access of the income over 25,000. Remember, we only have 2,500 times 50% is 1,250. Therefore the access is the taxable benefit is 1,250. That's the taxable benefits of the 7,000 of the 7,000 that she received 1,250 the remaining is tax free. The remaining is tax free. Let's take a look at this third example. CNM file a joint return, showing interest and dividend of 46,000 self-employment income for Carlson 31,000 and non-taxable money bond of 10,000. They executed 1,000 of interest on education alone in the received social security of 9,000. The first thing we do is we compute their provisional income. Okay, which is for their self-employment plus their dividend income plus the self-employment plus the 10,000 of mini bond plus the 1,000 of interest that they executed on deduction loans, we have to add it back plus 50% of their social security. Notice here, they are married filing jointly they are above 44. Therefore we're gonna be working with this section here. Well, they would report taxable income equal to the lesser of 85% of the social security benefit which is 7,650 that's one figure or 85% of the access of provisional income over 44,000 which is the amount is 41,000 225 plus the lesser of 6,000 which is given in the formula for 50% of social security benefit. 50% of social security benefit is 4,500. Okay, therefore their taxable income is 7,000 I'm sorry, their taxable benefit and their taxable income. Their taxable benefit is 7,650 because this number is gonna be lower than this number. Think about it, 41,225, 85% of that is way over 7650. Therefore they received 9,000, 7,650 is taxable and the remaining is tax free. So notice here, 85% of their social security benefit is taxable. So this is how we compute this social security tax benefit. Now on the CPA exam, they usually don't expect you to memorize the formula, these formulas but you have to know that you could have zero, none of it is taxable or if you are in between you could have up to 50% of your income is taxable. And if they gave you a large number, once the number is too large, just think of it 85% of their social security is taxable. So this is basically a shortcut.


Okay, I'm going to carry on from what I talked about in radiobiology this morning and now going to the next step. Can we apply some of those things we learned about radiobiology this morning into treatment planning and treatment evaluation? And a lot of what I'm going to say is based on this document which is AAPM Task Group 166. Does everybody know how to get AAPM Task Group reports on the internet free? No? Yes? Yes. Good. Just go AAPM.org, go into publications, Task Group reports, they're all free. So you can go and look at this one, it's a long report and it's got a lot of the kind of things that I'm going to be talking about today. So what is in this report? Well they start by looking at the quadratic model, I already did it so we won't have to do that again, to account for a fractionation in dose rate effects. And then they start defining newer terms that we didn't talk about yet this morning, things like the effective volume, the effective dose, the uniform dose, I mentioned equivalent uniform dose this morning, they talk about that in this report and how this can be used in treatment planning to account for volume effects, I'm going to talk about each of those, and then things like tumor control probability and normal tissue complication probability, and can we apply these in our treatment planning? I'll go into that, and then are any of these being used on treatment planning computers today? Yes they are, and I'll go over that. So let's start by looking about how do we compare two different treatment plans to decide which is the best plan? And the way we always used to do it in the old days was simply show the physician treatment plans and say pick the best one, and that was very highly subjective. What we really would like to do is give him some numbers. I mean ideally what he wants us to know to tell him is what's the probability I'm going to cure my tumor, and what's the probability I'm going to damage normal tissues, that would be ideal, and we'll talk about that. But this is very highly subjective just to look at two treatment plans. What we've been talking a lot about in this course is comparing those volume histograms, and looking at those volume histograms that decide which is the best. Well that's still pretty subjective, because you're still just looking at figures, and they're different, and trying to decide, and I'll look at that in a minute and show you how subjective it is. What we really want is a quantitative measure of the quality of a plan. And this can be done by using the dose volume histogram itself, and looking at all these different parameters, the maximum dose, the minimum dose, D90, D98 we've talked a bit about, and so on. Or we can go a little bit further and look at things like the effective volume, or particularly the effective dose, and the equivalent uniform dose. And ultimately, as I said, what the physician really wants is TCPs and NTCPs, which is the best plan. So let's start by looking at visual inspection of isodose curves. And here's some isodose curves, four different plans. There's a top left is a photon and electron plan. And then there's a five-field photon plan to the bottom left. And then top right, five-field IMRT and nine-field IMRT. And if you look at those dose distributions, yeah, they're a bit different. And probably the really complex plans like the nine-field IMRT is probably better. But I couldn't tell that just looking at the treatment plans. It's too difficult just looking at treatment plans. Very subjective, and physicians like to do it. But they would like us to give them some numbers. They would prefer us to give them those volume histograms, for instance. So let's look at those volume histograms. There's a comparison of a simple dose volume histogram here, which is a simple APPA plan, two-field plan. That's the red curve. And this is the dose volume histogram for this particular tumor. And this is all hypothetical. This is an imagined tumor. And then you've got the IMRT plan. And they're different. They cross each other. The median dose is the same, 63.7 grade. But there are hotspots and cold spots around there in this tumor. Okay, let's get some numbers. That's probably what we need to do. So from those curves, I've derived these numbers. And you can see the numbers are quite different. For instance, for the IMRT, it's the most uniform dose. It's the lowest standard deviation, only 2.5 grade. But it's got a higher V90, but a lower D100. And that can be a problem. You've actually got a cold spot in there, considerable cold spot in there. The range, if you look, goes from 30 gray up to 65 gray. So even though the standard deviation is smaller, the actual range is bigger. And you've got a cold spot there. That's bad news. But what about the simple APPA field? Oh, it's got a bigger standard deviation, but the range is smaller. And you've only got the lowest dose is 55 gray. And that's much better. But the highest dose is 73 gray, which is worse. It's got a shorter range, but it's got a much higher high dose. And you get all these other numbers. Okay, we can present these numbers to the physician and they can look at them. Well, that's only half the story. Which is the better plan? Well, you've got to now take into account the normal tissue deviations and the normal tissue deviation numbers. So it's getting more complicated now, rapidly. What we really want is good coverage of the target, low D max to normal tissues and low volume of normal tissues receiving doses close to tolerance. That's what we want. Well, can we come up with a single number or maybe two numbers to represent what's going on in the dose volume histogram so that we can compare them with single numbers? That would be ideal. And that's what we would like the treatment planning computer to be able to do and give us the best plan. This is what we want to do in optimization. Well, yes, can we do this? What we need is a volume effect model of dose response in normal tissues and tumors. And the volume effect model that is most commonly used in all of these computers that we use to do this is the power law model. Is it new? No, it's not new at all. We had a power law model first published in 1939 for skin doses and a power law model for volumes published in 1946. And we still use these today. This is the power law model we use today. So this is nothing new. It's just that now we have the computers capable of doing this. Up until 20 years ago, we really didn't have computers that were capable of applying the power law model, plotting deviations and analyzing deviations to get to use this model. So the model's been around a long time using it's been a problem, but now we can use it. And this is the power law model. Dv is the dose which if delivered to fractional volume v. So v is a fraction of the total volume. Let's say we're radiating the liver and we're radiating 10% of the liver to this dose. Then dv is the dose which if delivered it to 10% of the liver would reduce the same biological fact as the dose d1 to give them to the whole organ. So this is the volume effect model. And this is the basis of all the models are used in treatment planning computers today to calculate things like EUDs and TCPs and NTCPs. So it's a volume effect model and it's simple equation. So what does the exponent mean in the volume effect model? And I won't go over details of it, but if you sit and think about it, you'll realize that N is negative for tumors and N is positive for normal tissues. You'll realize that when you look at it and spend some time with that model. You realize that very quickly. N equals zero means that cold spots in tumors or hot spots in normal tissues are not tolerated. So when I show you some N values in a minute, you'll realize that a very low value of N, whether it's negative or positive, very low value of N means small hot spots and small cold spots are not tolerated. N equals one means that ISO effect doses change linearly with volume and N large means that cold spots in tumors and hot spots in normal tissues are very well tolerated. So let's look at a clinical example. This is the dose that will produce 50% damage in the spinal cord as a function of the partial volume. And notice that even though you go to very small volumes, as you decrease the volume, the dose that it will tolerate, the dose that will give you 50% damage is not changing much. There's not a big volume effect. And that's because N is small for spinal cord. At the other extreme, you've got something like the liver where N is large for the liver and there's an enormous volume effect. And you can go to extremely high doses to small volumes of the liver and liver function will not change significantly and the patient can go on without too much problem in the liver. So that gives you an idea of how important this value of N is for different tissues. Okay, what we would like to do now is use this volume effect power law model to convert dose volume histograms into single numbers. And this was published a long while ago. Here's the solid line represents a dose, a two step dose volume histogram for simplicity just to see this. It's a two step dose volume histogram. You can reduce it to a single number two different ways. You can reduce it to an effective volume and this is called the Kutcher and Berman model. And all you can reduce it to an effective dose which is called the Lyman and Wauberst model. And again, these were published probably 20 or 30 years ago. Couldn't use them because we didn't have to treat many computers capable of doing it. So this was published before we could use it. In fact, one of my graduate students published this in his thesis in the 1970s. We never could use it because we just didn't have the treatment of computers available in those days.  Well, here's the equation for the effective dose. Unfortunately, when those papers were first published this equation wasn't in there. So somebody had to go in and look for the equation and came out with the equation and this is your power law equation. This is the volume effect power law equation. So that was in the original paper that calculated the effective dose but they didn't give the equation. So VI is the sub volume irradiated to dose DI and then you sum it over all of the volume within the dose volume histogram. VT total is the total volume of the organ or tissue and N is the tissue equivalent volume effect parameter that we've been talking about. Mohan called this the effective uniform dose 1992, the effective uniform dose. He did not call it the EUD even though effective uniform dose could have been called EUD. It wasn't until 1999 that Namirco published his paper on EUD. He renamed the effective, the equivalent uniform dose, he hadn't really published anything different from what had been published before several years earlier but he got all the accolades for developing the EUD model even though the equation was published many years earlier. So here's his equation and you'll realize it's exactly the same equation as we just saw from Mohan and colleagues. The only difference here is that instead of N, we now have A as the exponent where A is simply one over N. So we just changed the equation and put the reciprocal of N and called it A. Exactly the same equation. So EUD was first published in its current format in 1999 but it actually had been published many years before. And this is just some values from Namirco on tumors, values of N for tumors and value of N for normal tissues. Note liver for normal tissues, the value of A is a small number.  So one over A, the old N, one over A is a very small number. Remember small number means for A means, for N means that the hot spots are not tolerated. We already knew that from observation in patients of course. So how can we apply, how can we calculate the EUD? How can computers do it? Or we could even do it manually. Well let's take a tumor and let's divide it into three parts. 90% of it gets the dose that will produce 50% cure, 50% local control. 5% of it gets half of that dose and 5% gets one and a half times that dose. What's the EUD? Okay, what we need to do is a cold spot and there's a hot spot. The cold spot we know in the tumor is bad news. Hot spot probably doesn't make a lot of difference. So what we need to do is add these up. The EUD is then the sum of the three parts with the power law, exponent A. And if you do that for breast, with an A of minus 7.2, remember A of negative is tumors. N of negative is tumors as well. And what you find is, look at the bottom line there, 8% tumor control probability. So instead of 50% tumor control probability, we've got 8% tumor control probability. So a cold spot made a big difference in breast. The A number is pretty big. That means a small value of N, cold spots aren't well tolerated. It's the same model. Okay, and how did we get tumor control probability out of this? Here's a typical sigmoid type curve for tumor control probability against EUD. And this is an equation that will fit it. There are multiple equations that will fit these sigmoid shaped curves. This one's called a logistic function. And it's simply a mathematical model. And that's what he used. This is from Nomeco's data I just showed. That's what he used to do those calculations of TCP and NTCP2. In fact, I've done the same thing for, oh, this is for a number of different types of cancers with his values of A shown. And you can see the higher the value of A, like Cordoma minus 13, the lower the tumor control probability, you get less tolerance for cold spots. And I've done the whole same thing for normal structures. I've taken a normal structure divided into three parts, just the way we did before, with a cold spot and the bad news for normal structures, a hot spot. And then I've looked at the probability of normal tissue complications and sure enough, liver can tolerate this very well.  I'm actually, with a non-uniform dose distribution with a hot spot and a cold spot in liver, I'm actually doing better. This is all mathematical. And it may be true, it may be true that I can do better because this cold spot might help even more with something like the liver. Whereas to go all the way to the bottom, spinal cord, instead of a 5% complication probability, I've got 55% probability of complication because the hot spot is really bad news in the spinal cord. So how do we do optimization? The objective is to develop the treatment plan which would deliver a dose distribution to ensure the highest TCP that meets the NTCP constraints. So tolerance constraints. This will usually be close to the peak of the probability of uncomplicated local control curve. So let's look at one of those. This is the probability of uncomplicated control curve for a 2D treatment plan and a 3D treatment plan. And you can see the way this is calculated. You take the TCP and multiply it by one minus the NTCP and you get the probability of uncomplicated control. And what you can see there is the 3D plan is better. You can get a higher probability of uncomplicated control. And by the way, at a higher prescribed dose too. So you can prescribe more dose because you've got a 3D plan that is more conformal. So how do we create a score function that could be used in optimizing treatment plans? How does the treatment planning computer do this? Well, it starts by DVH data. You've got all the data in a DVH. And then you can calculate the EUD for that particular tissue and then either the TCP or the NTCP depending on whether it's tumor or normal tissue. Do that for different plans. So you might run three plans. Do all that for three plans. And then get a score which is some function of the TCP throughout the tumor or tumors if there are multiple tumors. The TCP times one minus the NTCP for all the normal tissues that are in the beam. And you might want to use some kind of waiting factor for each of these depending on the type of tissue. So that's the way you can do some scores. So what does AAPM Task Group 166 tell us? What it tells us is, according to their report, that incorporating EUD based cost functions into inverse planning for the optimization of IRT plans may result in improved sparing of organs at risk without sacrificing target coverage. In other words, they believe from their studies that it's better than just using physics. You want to throw some biology in there in terms of the volume effect of the tissues. Now, do we have to go through EUDs to calculate things like TCPs or NTCPs? No, we don't. We could actually do it directly. The Pinnacle Treatment Planning System, for instance, uses the Kutcher and Burman DVH reduction method I mentioned before to calculate the effective volume. And these are the equations that it actually uses. And halfway down there, you'll see the volume effect snuck in there. There's a volume effect. And it's the power law volume effect. It's reducing the whole inhomogeneous dose distribution into a single number by using, and to convert that into NTCPs directly, using a probit type of dose response function for that particular tissue. So this is what is in the Pinnacle System for, and I'll go over some of the treatment planning systems later on that we have available to us. And all of them have these kinds of algorithms to calculate NTCPs and TCPs. It's all done by the volume effect model. Another way to calculate TCPs directly, and that's in some of the treatment planning systems, and you'll see a lot of this in the literature, is to use Poisson statistics, just like we did this morning to explain the shape of cell survival curves and the linear quadratic model. You can also use them in terms of designing treatments and calculating TCPs. If the number of patients with similar tumors are treated with a certain regimen, the probability of local control, i.e. the probability that no cancer cells will survive, that's local control, is given by exactly the same kind of equation as we saw this morning. In this case, NM is the mean number of cancer cells surviving in any one patient. So for instance, I've got 10 patients, and on average, I've got one cancer cell surviving in 10 patients. You put that in here, e to the minus one, and you finish with about 90%. You've got 90% of the patients cured, because on average, there's only one cancer cell in 10 patients. It's not quite 90% because some patients might have two cancer cells in them, and you might have 20 patients, and one patient has two cancer cells surviving. It's very close to 90% in that case, so this is another way that the treatment planning computer can do it. So if the average number of cancer cells in each patient's tumor, before treatment is N, it's zero, and the mean surviving fraction in all these patients is SM, then the number surviving is N zero times the fraction of surviving cells. So the equation for TCP becomes e to the minus N zero times the surviving fraction, okay? Which is better for optimization? EUD or TCP or NTCP or a combination of both? Well, AAPM Tasker report says, although both concepts can be used interchangeably for planned optimization, the EUD has the advantage of fewer model parameters, really just one A, as compared to TCP and NTCP models, which have to describe the shape of the dose response curve. So it allows more clinical flexibility. So that report prefers EUD for optimization over trying to calculate TCP and NTCP. A properly calibrated EUD model has the potential to provide a reliable ranking of rival treatment plans and it's most useful when a clinician needs to select the best plan from several alternates. So the physician says, well, try and get the best plan for me and you're showing three plans. And he'll say, give me the bottom line. You say, this one's better because it ranks better. He may or may not believe you. Can we take dose perfraction into account? I've mentioned dose perfraction. Well, of course we can. We can use the linear quadratic model in either calculating any of these terms that we've done before. I'm not gonna spend any time on doing that. The way it's being done most of the time is to convert every dose in every voxel within the particular organ or tissue weeks around the patient into the equivalent at two grade perfraction. Because the problem is that you're treating the liver. Parts of the liver are getting one grade perfraction. Other parts are getting three grade perfraction. It's very heterogeneous. Convert every single voxel to what it should be using the LQ model at two grade perfraction.  So that's how it's done. And simple was that. Very simple, you just use the basic LQ model. Now notice we haven't made any complications here like correction for repopulation, correction for overall treatment time. You can do that. I don't think any of the treatment planning systems have become that sophisticated but they could be that sophisticated if you wanted them to be. I think they just use this very simple plan. And most people would do that. Alternatively, you could use the LQ model directly in TCP calculations for instance. And it's very simple. Here's the equation we derived earlier. Using the LQ model, you now have an equation, the linear quadratic equation for cell survival and you just wrap that in to the TCP equation.  It's a double exponential. It's an exponential. And in the exponential is another exponential to calculate the effect of those perfraction using the linear quadratic model. You want more on the calculation of TCPs as a lot in the literature. Task group 166, for example. But there's a very good article, tumor control probability and radiation treatment, if you want to read that. And it's in medical physics by Zeta and Hanin published a couple of years, three years ago. So, this is a possibility if you want to read a bit more about it. Let me just look now then at biological models in treatment planning systems. The monocoe system, what does it have? I've looked on the internet to find out what's in there. I've actually contacted the manufacturers and asked them what's in their system. And it seems to me that to calculate tumor control probabilities, the way they do it, they use the Poisson statistic cell kid model that I just talked about, the last thing I talked about. For normal tissues, they use the UDs. The pinnacle system, they use the Poisson TCP model and the UDs for tumor, either one, both. And for normal tissues, they use the Lyman-Kutcher NTCP model and EUDs. Notice they're all using EUDs. Task Group 166 says that's the best way to do it. May or may not be. And then the EQUIP clip system uses the Poisson TCP model and EUDs. And for normal tissues, it uses the LQ-based Poisson NTC model. So they take into account the dose-perfraction as well. And probably the others can do that too, but it's not on the internet that they do it. I suspect all of them can convert everything to two-grade-perfraction equivalents throughout the tumor or normal tissue volume. So that's one of them. Now, do we know what parameters to use in all these models? And the answer isn't that easy. Kind of we do know, and we're getting to know better all the time, partly because of this Quantech initiative that the AAPM stimulated about six or seven years ago and they've started collecting lots and lots of data. You've heard this from other speakers. Lots of data is going in to this system, data on dose distributions, data on outcomes, did it work, fractionations and so on. And that's all being analyzed. I'm sure there are dozens of PhD students around the world that are going in to get that data and trying to analyze it, to find out the best parameters to use in different models. And maybe also designing new models. LQ model, as I said earlier, is really too simple. You need some more complicated models. Maybe somebody's gonna come up with a slightly more complicated model if it's better, we don't know. But they're all using this initiative, this Quantech initiative. Unfortunately, that's just normal tissues, but at the same time, tumor data's going in there and response data's going in there. So ultimately, we'll get a lot of analysis of the tumor control data as well as the normal tissue complication data. Very large databases are being created. They're accessible. You can get in there and look at them and you can evaluate models and analyze the data to get the best fitting parameters. So let me summarize, what have we learned? Biological models can be used for treatment planning, optimization, and evaluation. The power law volume effect models are used extensively. Let me, I didn't say anything about that. How can it be that simple? It can't be that simple. First of all, they were invented almost 100 years ago, about 80 years ago. How can we not have advanced? We really haven't. We're still using the power law volume effect model. Hopefully, studies like Quantech, they'll come up with better models than just a simple power law model. Biology doesn't work that simply. In homogeneous dose distribution, possibly corrected for the effective fractionation can be reduced to a single number but we've talked about EUDs, TCPs, NTCPs, or probability of uncomplicated local control. So let me stop, and you can look at that, your leisure, where we can stop and take any questions.