Katy E Balazy1, Paulina M Gutkin1, Lawrie Skinner1, Rie von Eyben1, Tyler Fowler1, Daniel W Pinkham1, Samuel Rodriguez2, Peter G Maxim3, Sarah S Donaldson4, Billy W Loo4, Karl Bush1, Susan M Hiniker5. 1. Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California. 2. Department of Anesthesia, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California. 3. Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana. 4. Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California. 5. Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California. Electronic address: shiniker@stanford.edu.
Abstract
PURPOSE: Pediatric radiation therapy (RT) requires optimal immobilization that often necessitates daily anesthesia. To decrease anesthesia use, we implemented a novel audiovisual-assisted therapeutic ambience in RT (AVATAR) system that projects video onto a radiolucent screen within the child's line of vision to provide attentional diversion. We investigated its reduction on anesthesia use, payer charges, and treatment time, in addition to its impact on radiation delivery. METHODS AND MATERIALS: A 6-year retrospective analysis was performed among children undergoing RT (n = 224) 3 years before and 3 years after the introduction of AVATAR. The frequency of anesthesia use before and after AVATAR implementation, in addition to RT treatment times, were compared. The number of spared anesthesia treatments allowed for a charge to payer analysis. To document the lack of surface dose perturbation by AVATAR, a phantom craniospinal treatment course was delivered both with and without AVATAR. Additionally, an ion chamber course was delivered to document changes to the dose at depth. RESULTS: More children were able to avoid anesthesia use entirely in the post-AVATAR cohort compared with the pre-AVATAR cohort (73.2% vs 63.4%; P = .03), and fewer required anesthesia for each treatment (18.8% vs 33%; P = .03). AVATAR introduction reduced anesthesia use for all ages studied. Treatment time per session was reduced by 38% using AVATAR compared with anesthesia. There were 326 fewer anesthesia sessions delivered over 3 years after AVATAR was introduced, with an estimated savings of >$500,000. Optically stimulated luminescent dosimeters revealed a small increase in dose of 0.8% to 9.5% with AVATAR, whereas the use of a thermomolded face mask increased skin dose by as much as 58%. CONCLUSIONS: AVATAR introduction decreased anesthesia use in children undergoing RT. More children avoided anesthesia entirely, and fewer needed anesthesia for every treatment, resulting in a reduction in treatment time and savings of nearly $550,000 in approximately 3 years, with minimal perturbation of RT dose delivery.
PURPOSE: Pediatric radiation therapy (RT) requires optimal immobilization that often necessitates daily anesthesia. To decrease anesthesia use, we implemented a novel audiovisual-assisted therapeutic ambience in RT (AVATAR) system that projects video onto a radiolucent screen within the child's line of vision to provide attentional diversion. We investigated its reduction on anesthesia use, payer charges, and treatment time, in addition to its impact on radiation delivery. METHODS AND MATERIALS: A 6-year retrospective analysis was performed among children undergoing RT (n = 224) 3 years before and 3 years after the introduction of AVATAR. The frequency of anesthesia use before and after AVATAR implementation, in addition to RT treatment times, were compared. The number of spared anesthesia treatments allowed for a charge to payer analysis. To document the lack of surface dose perturbation by AVATAR, a phantom craniospinal treatment course was delivered both with and without AVATAR. Additionally, an ion chamber course was delivered to document changes to the dose at depth. RESULTS: More children were able to avoid anesthesia use entirely in the post-AVATAR cohort compared with the pre-AVATAR cohort (73.2% vs 63.4%; P = .03), and fewer required anesthesia for each treatment (18.8% vs 33%; P = .03). AVATAR introduction reduced anesthesia use for all ages studied. Treatment time per session was reduced by 38% using AVATAR compared with anesthesia. There were 326 fewer anesthesia sessions delivered over 3 years after AVATAR was introduced, with an estimated savings of >$500,000. Optically stimulated luminescent dosimeters revealed a small increase in dose of 0.8% to 9.5% with AVATAR, whereas the use of a thermomolded face mask increased skin dose by as much as 58%. CONCLUSIONS: AVATAR introduction decreased anesthesia use in children undergoing RT. More children avoided anesthesia entirely, and fewer needed anesthesia for every treatment, resulting in a reduction in treatment time and savings of nearly $550,000 in approximately 3 years, with minimal perturbation of RT dose delivery.
Authors: Paulina M Gutkin; Sarah S Donaldson; Lawrie Skinner; Michelle Callejas; Jaclyn Cimino; Jacob Lore; Karl Bush; Susan M Hiniker Journal: Adv Radiat Oncol Date: 2020-12-10
Authors: Douglas E Holt; Susan M Hiniker; John A Kalapurakal; John C Breneman; Jay C Shiao; Nicole Boik; Benjamin T Cooper; Paige L Dorn; Matthew D Hall; Natalie Logie; John T Lucas; Iain J MacEwan; Adam C Olson; Joshua D Palmer; Samir Patel; Luke E Pater; Stephanie Surgener; Derek S Tsang; Jennifer H Vogel; Alyssa Wojcik; Cheng-Chia Wu; Sarah A Milgrom Journal: Int J Radiat Oncol Biol Phys Date: 2020-09-12 Impact factor: 8.013