Impact of Audiovisual-Assisted Therapeutic Ambience in Radiation Therapy (AVATAR) on Anesthesia Use, Payer Charges, and Treatment Time in Pediatric Patients

dc.contributor.authorBalazy, Katy E.
dc.contributor.authorGutkin, Paulina M.
dc.contributor.authorSkinner, Lawrie
dc.contributor.authorvon Eyben, Rie
dc.contributor.authorFowler, Tyler
dc.contributor.authorPinkham, Daniel W.
dc.contributor.authorRodriguez, Samuel
dc.contributor.authorMaxim, Peter G.
dc.contributor.authorDonaldson, Sarah S.
dc.contributor.authorLoo, Billy W., Jr.
dc.contributor.authorBush, Karl
dc.contributor.authorHiniker, Susan M.
dc.contributor.departmentRadiation Oncology, School of Medicineen_US
dc.date.accessioned2020-04-23T18:29:30Z
dc.date.available2020-04-23T18:29:30Z
dc.date.issued2020
dc.description.abstractPurpose 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.en_US
dc.eprint.versionAuthor's manuscripten_US
dc.identifier.citationBalazy, K. E., Gutkin, P. M., Skinner, L., von Eyben, R., Fowler, T., Pinkham, D. W., ... & Bush, K. (2020). Impact of Audio-Visual Assisted Therapeutic Ambience in Radiotherapy (AVATAR) on Anesthesia Use, Payer Charges, and Treatment Time in Pediatric Patients. Practical Radiation Oncology. https://doi.org/10.1016/j.prro.2019.12.009en_US
dc.identifier.urihttps://hdl.handle.net/1805/22616
dc.language.isoenen_US
dc.publisherElsevieren_US
dc.relation.isversionof10.1016/j.prro.2019.12.009en_US
dc.relation.journalPractical Radiation Oncologyen_US
dc.rightsPublisher Policyen_US
dc.sourcePublisheren_US
dc.subjectpediatric radiation therapyen_US
dc.subjectaudiovisual-assisted therapeutic ambience in RTen_US
dc.subjectanesthesiaen_US
dc.titleImpact of Audiovisual-Assisted Therapeutic Ambience in Radiation Therapy (AVATAR) on Anesthesia Use, Payer Charges, and Treatment Time in Pediatric Patientsen_US
dc.typeArticleen_US
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