Stereotactic Radiosurgery

1. Stereotactic Radiosurgery By Angela Powers, RN

2. Objectives • Describe the trend of Stereotactic Radiosurgery. • Describe/evaluate hardware/software utilized. • Describe/evaluate information systems used. • Assess role of the nurse informaticist. • Examine legal and ethical issues involved. • Discuss advantages/disadvantages from nursing perspective.

3. Stereotactic Radiosurgery: • Treats brain disorders with a single, high dose of radiation. • Works the same as other radiation therapies. • Doesn't remove tumor, but distorts it's DNA. • Causes tumors to lose ability to reproduce. (International Radiosurgery Association, 2010)

4. Procedure: (Mongia, 2009)

5. Hardware • MRI • Linear Accelerator • Collimator • Patient Docking Device • Target Verification Device

6. LINAC • Short for Linear Accelerator. • Produces radiation needed in SRT procedures. • Operated by a Radiation Therapist. • Dosage calculated by a Radiation Oncologist. • Beam exits through the rotating Gantry. • Beams are shaped by the Collimator. (Montagno & Sabbatini, 1997)

7. Software • Three dimensional software for treatment planning. • Dose delivery software.

8. NovalisTX: (Jefferson Radiation Oncology, 2010)

9. Usability • Ease of Use • Ease of Learning • Satisfaction with Using • Efficiency of Use • Error Tolerance • Fit of System to the Task

10. Varian OncoView Picture Archiving and Communication System (PACS) • Collects, stores and distributes diagnostic images. • Digitalizes CT, MRI and X-ray results. • Enables ease of image sharing. • Enables collaborative approach to treatment. • Reduces data filing and retrieval times. • Saves time and money. • Reduces liability caused by errors and loss. (Varian Medical Systems, 2010)

11. Varian OncoView PACS System Review • Radiology Information System • Used by all members of team. • Enables digitalization of image results. • Generally part of Local Area Network. • HL7 and ANSI Data Standards. • Necessary for use of SRS.

12. Advantages of SRS • Simpler Process • Shorter surgery times • Shorter patient recovery times • Less invasive • Fewer side effects vs. brain surgery. • Ability to reach deeper brain tissue.

13. Disadvantages of SRS • High cost of purchase and use • Risk of neurological injury • Risk of mechanical inaccuracy • Potential necessity of multiple visits

14. Ethical/Legal Issues • Not available to everyone • Malpractice suits

15. Required Informatics Competencies and Role of Nurse Informaticist • Technical competencies - Modifier level • Utility competencies - Modifier level • Leadership competencies - User level

16. Functions and Responsibilities of Informatics Nurses in SRS • Technical capacities • Utility capacities • Leadership capacities (Kaminski, 2009)

17. In Summary: • Often outpatient procedure for brain surgery • High dose radiation distorts tumor DNA • Improved outcomes for many conditions • Reduced surgery and recovery time • Multidisciplinary team involved in planning, implementation.

18. References: • About.com. (nd). PACS – What is PACS? Retrieved October 25, 2010, from: http://healthcareers.about.com/od/p/f/PACS.htm. • De AraujoMontagno, & E., Sabbatini, R. (1997). Radiosurgery. Retrieved October 15th, 2010 from: http://www.cerebromente.org.br/n02/tecnologia/radiocirurg_i.htm. • HL7 International. (2010). ANSI Approved Standards. Health Level Seven International. Retrieved October 25, 2010, from: http://www.hl7.org/implement/standards/ansiapproved.cfm • International Radiosurgery Association. (2010). Stereotactic Radiosurgery Overview. International Radiosurgery Association.Retrieved on September 19, 2010, from: http://www.irsa.org/radiosurgery.html.

19. References, Continued • Jefferson Radiation Oncology. (2010). Novalis TX. Retrieved October 9, 2010, from: http://www.jeffradonc.com/page.php?pID=21. • Johns Hopkins Radiosurgery. (nd). Stereotactic Radiosurgery. Johns Hopkins Medicine. Retrieved October 9, 2010, from: http://www.radonc.jhmi.edu/radiosurgery/treatmentoptions/stereotacticradiosurgery.html#WhatDevicesAreUsed. • Kaminski, J. (2009). Nursing Informatics Competencies: Self-Assessment. Nursing-Informatics.com. Retrieved November 15, 2010, from: : http://www.nursing-informatics.com/niassess/index.html.

20. References, Continued • McGonigle, D. & Mastrian, K. (2009). Nursing Informatics and the Foundation of Knowledge. Sudbury, MA. Jones and Bartlett Publishers. • Medical News Today. (Sept, 2008). Non-Invasive Radiosurgery With Novalis TX platform Rolling Out Worldwide. Medical News Today. Retrieved on September 19, 2010, from: http://www.medicalnewstoday.com/articles/122391.php • Mongia, S. (2009). Gamma Knife Surgery. Retrieved on October 1, 2010, from gammaknifeonline: http://www.gammaknifeonline.in/.

21. References, Continued • Radiologyinfo.org. (2010). Stereotactic Radiosurgery and Stereotactic Body Radiotherapy (SBRT). Retrieved on October 1, 2010, from radiologyinfo.org: http://www.radiologyinfo.org/en/info.cfm?pg=stereotactic. • Schnell, M., Bova, F., Larson, D. A., Leavitt. D. D., Lutz, W. R., Podgorsak, E. B., Wu, A. (1995). Stereotactic Radiosurgery: Report of Task Group 42 Radiation Therapy Committee. College Park, MD. American Institute of Physics. Retrieved October 9, 2010, from : http://www.aapm.org/pubs/reports/rpt_54.pdf.

22. References, Continued. • Varian Medical Systems. (2010). TrueBeamSTx: Frequently Asked Questions. Retrieved October 9, 2010, from: http://www.variantruebeam.com/truebeamstx/faq.html