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Seravalli E, Bosman ME, Han C, Losert C, Pazos M, Engström PE, Engellau J, Fulcheri CPL, Zucchetti C, Saldi S, Ferrer C, Ocanto A, Hiniker SM, Clark CH, Hussein M, Misson-Yates S, Kobyzeva DA, Loginova AA, Hoeben BAW. Technical recommendations for implementation of Volumetric Modulated Arc Therapy and Helical Tomotherapy Total Body Irradiation. Radiother Oncol 2024; 197:110366. [PMID: 38830537 DOI: 10.1016/j.radonc.2024.110366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/10/2024] [Accepted: 05/27/2024] [Indexed: 06/05/2024]
Abstract
As a component of myeloablative conditioning before allogeneic hematopoietic stem cell transplantation (HSCT), Total Body Irradiation (TBI) is employed in radiotherapy centers all over the world. In recent and coming years, many centers are changing their technical setup from a conventional TBI technique to multi-isocenter conformal arc therapy techniques such as Volumetric Modulated Arc Therapy (VMAT) or Helical Tomotherapy (HT). These techniques allow better homogeneity and control of the target prescription dose, and provide more freedom for individualized organ-at-risk sparing. The technical design of multi-isocenter/multi-plan conformal TBI is complex and should be developed carefully. A group of early adopters with conformal TBI experience using different treatment machines and treatment planning systems came together to develop technical recommendations and share experiences, in order to assist departments wishing to implement conformal TBI, and to provide ideas for standardization of practices.
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Affiliation(s)
- Enrica Seravalli
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Mirjam E Bosman
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Chunhui Han
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Christoph Losert
- Department of Radiation Oncology, University Hospital, LMU Munich, Germany
| | - Montserrat Pazos
- Department of Radiation Oncology, University Hospital, LMU Munich, Germany
| | - Per E Engström
- Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Jacob Engellau
- Department of Radiation Oncology, Skåne University Hospital, Lund, Sweden
| | | | - Claudio Zucchetti
- Section of Medical Physics, Perugia General Hospital, Perugia, Italy
| | - Simonetta Saldi
- Section of Radiation Oncology, Perugia General Hospital, Perugia, Italy
| | - Carlos Ferrer
- Department of Medical Physics and Radiation Protection, La Paz University Hospital, Madrid, Spain
| | - Abrahams Ocanto
- Department of Radiation Oncology, San Francisco de Asís University Hospital, GenesisCare, Madrid, Spain
| | - Susan M Hiniker
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
| | - Catharine H Clark
- Radiotherapy Physics, National Radiotherapy Trials Quality Assurance Group (RTTQA), Mount Vernon Cancer Centre, Northwood, UK; Metrology for Medical Physics Centre, National Physical Laboratory, Teddington, UK; Radiotherapy Physics, University College London Hospitals NHS Foundation Trust, London, UK; Medical Physics and Bioengineering Department, University College London, London, UK
| | - Mohammad Hussein
- Metrology for Medical Physics Centre, National Physical Laboratory, Teddington, UK
| | - Sarah Misson-Yates
- Medical Physics Department, Guy's and St Thomas' Hospital, London, UK; UK School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; National Physical Laboratory, Metrology for Medical Physics Centre, London, UK
| | - Daria A Kobyzeva
- Deptartment of Radiation Oncology, Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Anna A Loginova
- Deptartment of Radiation Oncology, Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Bianca A W Hoeben
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
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Ritchie T, Awrey S, Maganti M, Chahin R, Velec M, Hodgson DC, Dama H, Ahmed S, Winter JD, Laperriere N, Tsang DS. Paediatric radiation therapy without anaesthesia - Are the children moving? Radiother Oncol 2024; 193:110120. [PMID: 38311029 DOI: 10.1016/j.radonc.2024.110120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/16/2024] [Accepted: 01/24/2024] [Indexed: 02/06/2024]
Abstract
PURPOSE Children who require radiation therapy (RT) should ideally be treated awake, without anaesthesia, if possible. Audiovisual distraction is a known method to facilitate awake treatment, but its effectiveness at keeping children from moving during treatment is not known. The aim of this study was to evaluate intrafraction movement of children receiving RT while awake. METHODS In this prospective study, we measured the intrafraction movement of children undergoing treatment with fractionated RT, using pre- and post-RT cone beam CT (CBCT) with image matching on bony anatomy. Study CBCTs were acquired at first fraction, weekly during RT, and at last fraction. The primary endpoint was the magnitude of vector change between the pre- and post-RT scans. Our hypothesis was that 90 % of CBCT acquisitions would have minimal movement, defined as <3 mm for head-and-neck (HN) treatments and <5 mm for non-HN treatments. RESULTS A total of 65 children were enrolled and had evaluable data across 302 treatments with CBCT acquisitions. Median age was 11 years (range, 2-18; 1st and 3rd quartiles 7 and 14 years, respectively). Minimal movement was observed in 99.4 % of HN treatments and 97.2 % of non-HN treatments. The study hypothesis of >90 % of evaluations having minimal movement was met. Children who were age >11 years moved less at initial evaluation but tended to move more as a course of radiation progressed, as compared to children who were younger. CONCLUSION Children receiving RT with audiovisual distraction while awake had small magnitudes of observed intrafraction movement, with minimal movement in >97 % of observed RT fractions. This study validates methods of anaesthesia avoidance using audiovisual distraction for selected children.
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Affiliation(s)
- Tatiana Ritchie
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - Susan Awrey
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - Manjula Maganti
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, 610, University Ave, Toronto, ON, M5G 2M9, Canada
| | - Rehab Chahin
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - Michael Velec
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - David C Hodgson
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - Hitesh Dama
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - Sameera Ahmed
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - Jeff D Winter
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - Normand Laperriere
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - Derek S Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, Toronto, ON, M5G 2M9, Canada.
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3
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Gutkin PM, Skinner L, Jiang A, Donaldson SS, Loo BW, Oh J, Wang YP, von Eyben R, Snyder J, Bredfeldt JS, Breneman JC, Constine LS, Faught AM, Haas-Kogan D, Holmes JA, Krasin M, Larkin C, Marcus KJ, Maxim PG, McClelland S, Murphy B, Palmer JD, Perkins SM, Shen CJ, Terezakis S, Bush K, Hiniker SM. Feasibility of the Audio-Visual Assisted Therapeutic Ambience in Radiotherapy (AVATAR) System for Anesthesia Avoidance in Pediatric Patients: A Multicenter Trial. Int J Radiat Oncol Biol Phys 2023; 117:96-104. [PMID: 37001762 DOI: 10.1016/j.ijrobp.2023.03.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/12/2023] [Accepted: 03/22/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE The Audio-Visual Assisted Therapeutic Ambience in Radiotherapy (AVATAR) system was the first published radiation therapy (RT)-compatible system to reduce the need for pediatric anesthesia through video-based distraction. We evaluated the feasibility of AVATAR implementation and effects on anesthesia use, quality of life, and anxiety in a multicenter pediatric trial. METHODS AND MATERIALS Pediatric patients 3 to 10 years of age preparing to undergo RT at 10 institutions were prospectively enrolled. Children able to undergo at least 1 fraction of RT using AVATAR without anesthesia were considered successful (S). Patients requiring anesthesia for their entire treatment course were nonsuccessful (NS). The PedsQL3.0 Cancer Module (PedsQL) survey assessed quality of life and was administered to the patient and guardian at RT simulation, midway through RT, and at final treatment. The modified Yale Preoperative Anxiety Scale (mYPAS) assessed anxiety and was performed at the same 3 time points. Success was evaluated using the χ2 test. PedsQL and mYPAS scores were assessed using mixed effects models with time points evaluated as fixed effects and a random intercept on the subject. RESULTS Eighty-one children were included; median age was 7 years. AVATAR was successful at all 10 institutions and with photon and proton RT. There were 63 (78%) S patients; anesthesia was avoided for a median of 20 fractions per patient. Success differed by age (P = .04) and private versus public insurance (P < .001). Both patient (P = .008) and parent (P = .006) PedsQL scores significantly improved over the course of RT for patients aged 5 to 7. Anxiety in the treatment room decreased for both S and NS patients over RT course (P < .001), by age (P < .001), and by S versus NS patients (P < .001). CONCLUSIONS In this 10-center prospective trial, anesthesia avoidance with AVATAR was 78% in children aged 3 to 10 years, higher than among age-matched historical controls (49%; P < .001). AVATAR implementation is feasible across multiple institutions and should be further studied and made available to patients who may benefit from video-based distraction.
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Affiliation(s)
- Paulina M Gutkin
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California; Medical College of Wisconsin, Wauwatosa, Wisconsin
| | - Lawrie Skinner
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Alice Jiang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Sarah S Donaldson
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Billy W Loo
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Justin Oh
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Yi Peng Wang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Rie von Eyben
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - John Snyder
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Jeremy S Bredfeldt
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - John C Breneman
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Louis S Constine
- Department of Radiation Oncology and Pediatrics, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Austin M Faught
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Daphne Haas-Kogan
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jordan A Holmes
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Matthew Krasin
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Charlene Larkin
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Karen J Marcus
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Peter G Maxim
- Department of Radiation Oncology, University of California, Irvine, California
| | - Shearwood McClelland
- Departments of Radiation Oncology and Neurologic Surgery, University Hospitals Seidman Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Blair Murphy
- Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon
| | - Joshua D Palmer
- Department of Radiation Oncology, Ohio State University School of Medicine, Columbus, Ohio
| | - Stephanie M Perkins
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Colette J Shen
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Stephanie Terezakis
- Department of Radiation Oncology, University of Minnesota School of Medicine, Minneapolis, Minnesota
| | - Karl Bush
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Susan M Hiniker
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California.
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Perkins SM, Prime S, Watts M, Huang J, Zhao T. Pediatric Experience and Outcomes from the First Single-Vault Compact Proton Therapy Center. Cancers (Basel) 2023; 15:4072. [PMID: 37627100 PMCID: PMC10452472 DOI: 10.3390/cancers15164072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
The first single-vault compact proton therapy center opened in 2013, utilizing a gantry-mounted synchrocylotron. The center was placed within a large academic radiation oncology department with a high priority for pediatric cancer care. Here we performed a retrospective study of pediatric (≤21 years) patients treated with proton therapy at our institution between 2013-2022. Patient, tumor, and treatment characteristics were obtained including race, socioeconomic status, insurance type, distance travelled, need for anesthesia, and outside referrals for proton therapy. In total, 250 pediatric patients were treated with proton therapy comprising 18% of our proton patient volume. Median follow-up was 3.1 years, 38.4% were female and 83% were white. The majority of cases were CNS (69.6%) and a large number of patients (80/250, 32%) required craniospinal irradiation. Anesthesia was required for 39.6% of patients. Average distance travelled for treatment was 111 miles and 23% of patients were referred from outside institutions for proton therapy. Insurance type was private/commercial for 61.2% followed by Medicaid for 32%. We found that 23% of patients lived in census tracts with >25% of people living below the national poverty line. Overall survival at 3 years was excellent at 83.7% with better outcomes for CNS patients compared to non-CNS patients. There were no cases of secondary malignancy at this early time point. As the world's first compact proton therapy center, we found that proton therapy increased our pediatric volume and provided proton therapy to a diverse group of children in our region. These data highlight some of the expected patient and tumor characteristics and necessary resources for providing pediatric proton beam therapy.
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Affiliation(s)
- Stephanie M. Perkins
- S. Lee Kling Proton Therapy Center, Washington University School of Medicine/Siteman Cancer Center, Saint Louis, MO 63110, USA
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Prasad RN, Baliga S, Banner J, Cadieux C, Centnar A, Degnan M, Depinet M, Ewing A, Hobbs N, Jiang AL, Manring I, Perlow HK, Rock A, Skinner LB, Tenney L, Walls V, Hiniker SM, Palmer JD. Radiation Therapy without Anesthesia for a 2-Year Old Child using Audio-Visual Assisted Therapeutic Ambience in Radiotherapy (AVATAR). Pract Radiat Oncol 2021; 12:e216-e220. [PMID: 34971793 DOI: 10.1016/j.prro.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/09/2021] [Accepted: 12/16/2021] [Indexed: 10/19/2022]
Abstract
Radiation therapy (RT) is essential to managing many pediatric malignancies, but can be anxiety, fear, and discomfort provoking for children due to prolonged treatment time, extended course, and restrictive immobilization. Patients under 10 years frequently require daily general anesthesia (GA), which is resource intensive, expensive, potentially toxic, and anxiety/fear provoking. The Audio-Visual Assisted Therapeutic Ambience in Radiotherapy (AVATAR), a video streaming device, has been proposed as an alternative to anesthesia in patients aged 3-10. A pilot study evaluating the efficacy of this novel innovation is accruing, but patients under 3 are ineligible. We simulated a 2-year-old with Stage IV Wilms tumor for bilateral whole lung and left flank irradiation without GA. Using the AVATAR, we attempted to deliver RT to this patient without sedation. Patient anxiety at the time of simulation and at the beginning, middle, and end of the treatment course was characterized using the validated Modified Yale Preoperative Anxiety Score (mYPAS) measurement tool. Although the patient tolerated CT simulation without GA or AVATAR use, his mYPAS of 14/18 indicated significant anxiety. Using the AVATAR, all treatments were delivered without GA; mYPAS scores were 5, 4 (lowest possible), and 4 at the first, mid-course and final treatments, indicating no significant anxiety and a decrease from pre-AVATAR baseline. Without GA, the package time to deliver RT decreased by 66% from 90 to 30 minutes. In summary, we describe an expanded, previously unreported indication for the AVATAR by demonstrating the feasibility of this anesthesia-reducing/omitting approach in appropriate younger patients currently excluded from ongoing trials. The financial and quality of life benefits (including decreased stress, anxiety, toxicity, cost, and appointment time) of AVATAR utilization may be extendable to a younger patient population than previously thought. In older children, prospective validation is ongoing, but additional study in patients under 3 is needed.
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Affiliation(s)
- Rahul N Prasad
- Department of Radiation Oncology at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Sujith Baliga
- Department of Radiation Oncology at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Julie Banner
- Department of Radiation Oncology at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Catherine Cadieux
- Department of Radiation Oncology at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Ashley Centnar
- Department of Radiation Oncology at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Michael Degnan
- Department of Radiation Oncology at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Megan Depinet
- Department of Radiation Oncology at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Ashlee Ewing
- Department of Radiation Oncology at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Nikki Hobbs
- Department of Radiation Oncology at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Alice L Jiang
- Department of Radiation Therapy, Stanford Cancer Institute
| | - Isabel Manring
- Department of Radiation Oncology at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Haley K Perlow
- Department of Radiation Oncology at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Ashley Rock
- Department of Radiation Oncology at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | | | - Lyndsie Tenney
- Department of Radiation Oncology at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Vanessa Walls
- Department of Radiation Oncology at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | | | - Joshua D Palmer
- Department of Radiation Oncology at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA.
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Sobey J, Tsai MH, Evans RE. An update on pediatric sedation techniques in nonoperating room locations. Curr Opin Anaesthesiol 2021; 34:449-454. [PMID: 34039846 DOI: 10.1097/aco.0000000000001018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To review advancements in care for pediatric patients in nonoperating room settings. RECENT FINDINGS Advances in patient monitoring technology, utilization of Child Life specialists, and alternative staffing models are helping anesthesia providers meet the rising demand for coverage of pediatric nonoperating room anesthesia (NORA) cases. The Wake Up Safe and Pediatric Sedation Research Consortium registries are exploring outcome measures regarding the safety of pediatric anesthesia in off-site locations and have reported an increased risk for severe respiratory and cardiac adverse events when compared to OR anesthesia sites. Additionally, malpractice claims for NORA have a higher proportion of claims for death than claims in operating rooms. SUMMARY Pediatric NORA requires thorough preparation, flexibility, and vigilance to provide safe anesthesia care to children in remote locations. Emerging techniques to reduce anesthetic exposure, improve monitoring, and alternative staffing models are expanding the boundaries of pediatric NORA to provide a safer, more satisfying experience for diagnostic and interventional procedures.
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Affiliation(s)
- Jenna Sobey
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Mitchell H Tsai
- Department of Anesthesiology, Orthopaedics and Rehabilitation (by courtesy), and Surgery (by courtesy), Larner College of Medicine, University of Vermont
| | - Rebecca E Evans
- Division of Pediatric Anesthesiology, Larner College of Medicine, University of Vermont Medical Center, Burlington, Vermont, USA
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Gutkin PM, Donaldson SS, Skinner L, Callejas M, Cimino J, Lore J, Bush K, Hiniker SM. Use of Audiovisual Assisted Therapeutic Ambience in Radiotherapy (AVATAR) for Anesthesia Avoidance in a Pediatric Patient With Down Syndrome. Adv Radiat Oncol 2021; 6:100637. [PMID: 33732961 PMCID: PMC7941013 DOI: 10.1016/j.adro.2020.100637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/16/2020] [Accepted: 11/19/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
| | - Sarah S Donaldson
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Lawrie Skinner
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Michelle Callejas
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Jaclyn Cimino
- Child Life Department, Lucile Packard Children's Hospital, Stanford, California
| | - Jacob Lore
- Child Life Department, Lucile Packard Children's Hospital, Stanford, California
| | - Karl Bush
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Susan M Hiniker
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
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8
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Holt DE, Hiniker SM, Kalapurakal JA, Breneman JC, Shiao JC, Boik N, Cooper BT, Dorn PL, Hall MD, Logie N, Lucas JT, MacEwan IJ, Olson AC, Palmer JD, Patel S, Pater LE, Surgener S, Tsang DS, Vogel JH, Wojcik A, Wu CC, Milgrom SA. Improving the Pediatric Patient Experience During Radiation Therapy-A Children's Oncology Group Study. Int J Radiat Oncol Biol Phys 2021; 109:505-514. [PMID: 32931864 PMCID: PMC9092316 DOI: 10.1016/j.ijrobp.2020.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/25/2020] [Accepted: 09/01/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Treatment with radiation therapy (RT) can cause anxiety and distress for pediatric patients and their families. Radiation oncology teams have developed strategies to reduce the negative psychological impact. This survey study aimed to characterize these methods. METHODS AND MATERIALS A 37-item questionnaire was sent to all radiation oncology members of the Children's Oncology Group to explore strategies to improve the pediatric patient experience. The Wilcoxon rank-sum test was used to assess factors associated with use of anesthesia for older children. RESULTS Surveys were completed by 106 individuals from 84/210 institutions (40%). Respondents included 89 radiation oncologists and 17 supportive staff. Sixty-one percent of centers treated ≤50 children per year. Respondents described heterogenous interventions. The median age at which most children no longer required anesthesia was 6 years (range: ≤3 years to ≥8 years). Routine anesthesia use at an older age was associated with physicians' lack of awareness of these strategies (P = .04) and <10 years of pediatric radiation oncology experience (P = .04). Fifty-two percent of respondents reported anesthesia use added >45 minutes in the radiation oncology department daily. Twenty-six percent of respondents planned to implement new strategies, with 65% focusing on video-based distraction therapy and/or augmented reality/virtual reality. CONCLUSIONS Many strategies are used to improve children's experience during RT. Lack of awareness of these interventions is a barrier to their implementation and is associated with increased anesthesia use. This study aims to disseminate these methods with the goal of raising awareness, facilitating implementation, and, ultimately, improving the experience of pediatric cancer patients and their caregivers.
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Affiliation(s)
- Douglas E Holt
- Department of Radiation Oncology, University of Colorado, Aurora, Colorado.
| | - Susan M Hiniker
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - John A Kalapurakal
- Department of Radiation Oncology, Northwestern University, Chicago, Illinois
| | - John C Breneman
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio
| | - Jay C Shiao
- Department of Radiation Oncology, University of Colorado, Aurora, Colorado
| | - Nicole Boik
- Department of Radiation Oncology, Miami Cancer Institute, Miami, Florida
| | - Benjamin T Cooper
- Department of Radiation Oncology, NYU Langone Health, New York City, New York
| | - Paige L Dorn
- Department of Radiation Oncology, Rocky Mountain Hospital for Children, Denver, Colorado
| | - Matthew D Hall
- Department of Radiation Oncology, Miami Cancer Institute, Miami, Florida
| | - Natalie Logie
- Department of Radiation Oncology, University of Calgary, Calgary, Alberta, Canada
| | - John T Lucas
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Iain J MacEwan
- Department of Radiation Oncology, University of California San Diego, La Jolla, California
| | - Adam C Olson
- Department of Radiation Oncology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Joshua D Palmer
- Department of Radiation Oncology, Ohio State University, Columbus, Ohio
| | - Samir Patel
- Division of Radiation Oncology, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Luke E Pater
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio
| | - Stephanie Surgener
- Department of Oncology, Children's Hospital of Colorado, Aurora, Colorado
| | - Derek S Tsang
- Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Jennifer H Vogel
- Department of Radiation Oncology Johns Hopkins University Medical Center, Baltimore, Maryland
| | - Alyssa Wojcik
- Department of Oncology, Children's Hospital of Colorado, Aurora, Colorado
| | - Cheng-Chia Wu
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York City, New York
| | - Sarah A Milgrom
- Department of Radiation Oncology, University of Colorado, Aurora, Colorado
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Capaldi DPI, Nano TF, Zhang H, Skinner LB, Xing L. Technical Note: Evaluation of audiovisual biofeedback smartphone application for respiratory monitoring in radiation oncology. Med Phys 2020; 47:5496-5504. [PMID: 32969075 PMCID: PMC7722016 DOI: 10.1002/mp.14484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/26/2020] [Accepted: 08/13/2020] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Radiation dose delivered to targets located near the upper abdomen or thorax are significantly affected by respiratory motion, necessitating large margins, limiting dose escalation. Surrogate motion management devices, such as the Real-time Position Management (RPM™) system (Varian Medical Systems, Palo Alto, CA), are commonly used to improve normal tissue sparing. Alternative to current solutions, we have developed and evaluated the feasibility of a real-time position management system that leverages the motion data from the onboard hardware of Apple iOS devices to provide patients with visual coaching with the potential to improve the reproducibility of breathing as well as improve patient compliance and reduce treatment delivery time. METHODS AND MATERIALS The iOS application, coined the Instant Respiratory Feedback (IRF) system, was developed in Swift (Apple Inc., Cupertino, CA) using the Core-Motion library and implemented on an Apple iPhone® devices. Operation requires an iPhone®, a three-dimensional printed arm, and a radiolucent projector screen system for feedback. Direct comparison between IRF, which leverages sensor fusion data from the iPhone®, and RPM™, an optical-based system, was performed on multiple respiratory motion phantoms and volunteers. The IRF system and RPM™ camera tracking marker were placed on the same location allowing for simultaneous data acquisition. The IRF surrogate measurement of displacement was compared to the signal trace acquired using RPM™ with univariate linear regressions and Bland-Altman analysis. RESULTS Periodic motion shows excellent agreement between both systems, and subject motion shows good agreement during regular and irregular breathing motion. Comparison of IRF and RPM™ show very similar signal traces that were significantly related across all phantoms, including those motion with different amplitude and frequency, and subjects' waveforms (all r > 0.9, P < 0.0001). We demonstrate the feasibility of performing four-dimensional cone beam computed tomography using IRF which provided similar image quality as RPM™ when reconstructing dynamic motion phantom images. CONCLUSIONS Feasibility of an iOS application to provide real-time respiratory motion is demonstrated. This system generated comparable signal traces to a commercially available system and offers an alternative method to monitor respiratory motion.
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Affiliation(s)
- Dante P I Capaldi
- Department of Radiation Oncology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Tomi F Nano
- San Francisco (UCSF) Comprehensive Cancer Centre, University of California, San Francisco, CA, USA
| | - Hao Zhang
- Department of Radiation Oncology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Lawrie B Skinner
- Department of Radiation Oncology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Lei Xing
- Department of Radiation Oncology, School of Medicine, Stanford University, Stanford, CA, USA
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