1. Goodwin, Peter M.

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VIENNA, Austria-Giving children with cancer movies to watch while they're being treated with radiotherapy helped them to stay still enough without having to use general anesthesia (GA), researchers noted in a study reported at the 2017 European Society for Radiotherapy and Oncology (ESTRO) Congress.

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Catia P. Aguas, RTT, a radiation therapy dosimetrist, at CHIREC Clinique Edith Cavell, Cliniques Universitaires Saint-Luc in Brussels, Belgium, said their study-called Video Launching Applied During Irradiation (VLADI)-was an alternative to anesthesia for children up to the age of 6 who found it difficult to stop moving when they were inside therapy machines such as tomotherapy devices which totally enclosed them.


"The child has to stay still during the treatment, [but] no one is there to tell [them] not to move. It is really hard to tell them to stay still and to make them understand," Aguas noted. "Radiotherapy can be very scary for children. It's a huge room full of machines and strange noises, and the worst part is that they're in the room alone during their treatment. Before their radiotherapy, they have already been through a series of tests and treatments-some of them painful-so they don't really feel very safe or confident."


Aguas said that because the tomotherapy device necessarily enclosed the patient-like an MRI machine-they put this to their advantage by converting the tunnel into the patient's personal movie theatre. "Since we already had a tunnel, we were able to place a small projector on top of the couch and angle it a little bit to project an image in front of the patient's eyes."


They then projected a movie-carefully chosen by or for each individual child. And the result? "They stay still! It's like they are hypnotized," Aguas stated.


The idea of showing children movies originally came from a patient's mother who didn't want her 2 year old to receive multiple courses of GA-one for each radiotherapy session.


Decreasing Anesthesia Use

The study assessed the impact of VLADI on the need for GA in patients between the ages of 1.5 and 6 years. Six children watched movies during their therapy and were matched with another six children treated before VLADI had been introduced.


"We decreased the use of anesthesia a lot in our department. From the study, 66 percent of the children benefited," explained Aguas, who added there were potential clinical and other benefits, too.


"It's a time-saver for the radiotherapy department [and] the anesthesiology department. It is less stressful for the patient and for the parents. Sometimes the child is so amused by the movie they don't even want to leave the room," she said, noting that avoiding an anesthetic side effects has been a big benefit.


"Since we implemented the VLADI project, we've diminished the use of GA from 83.3 percent to 33.3 percent, and we've reduced the number of anxiolytics. In total, 72.2 percent of the children benefited [from] this system instead of GA," Aguas noted.


She pointed out the system should work well with most children who need to have a radiotherapy technique requiring them to enter an enclosed device for treatment. And it could also be useful for adults. "I think it's going to work in adults. We are thinking about reducing stress medication for adult patients by projecting the movie and [also use it with] claustrophobic patients."


Aguas said the cost was low and VLADI saved time in the clinic. "It is actually quite simple. You just place the projector on top of the couch, and you put a movie on. Using video is saving money and resources by reducing the need for anesthesia," she said. "From what we've seen, we have awesome results and I think it's worth being tested everywhere in order to avoid anesthesia. In our department, VLADI has almost completely replaced anesthesia resulting in reduced treatment times and reduction of stress for the young patients and their families.


"Since we started using videos, children are a lot less anxious. Now they know that they're going to watch a movie of their choice, they're more relaxed. And once the movie starts, it's as though they travel to another world," she continued.


The research showed treatments that used to take 1 hour or more, now take around 15-20 minutes. This is partly because of the time saved by not having to prepare and administer anesthesia, but also because the children-who know they are going to watch videos-are more cooperative.


The President of ESTRO, Yolande Lievens MD, PhD, Head of the Department of Radiation Oncology at Ghent University Hospital, Belgium, said, "The success of this project is good news for young patients, their families, and their medical teams. Simply by installing a projector and showing videos, the team has reduced the need for anesthesia and reduced anxiety for these children. For parents, this means they no longer have to watch their child going under a general anesthetic and then in to the recovery room after treatment every day for weeks on end. In addition, the use of videos had a positive impact on the workflow in pediatric radiotherapy, which further increased the positive effect observed by the caregivers as well."


Peter M. Goodwin is a contributing writer.