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. http://healthcareers.about.com/od/p/f/PACS.htm De Araujo Montagno, & E., Sabbatini, R. (1997). Radiosurgery. Retrieved October 15 th, 2010 from: http://www.cerebromente.org.br/n02/tecnologia/radioc irurg_i.htm. http://www.cerebromente.org.br/n02/tecnologia/radioc irurg_i.htm HL7 International. (2010). ANSI Approved Standards. Health Level Seven International. Retrieved October 25, 2010, from: http://www.hl7.org/implement/standards/ansiapprove d.cfm http://www.hl7.org/implement/standards/ansiapprove d.cfm International Radiosurgery Association. (2010). Stereotactic Radiosurgery Overview. International Radiosurgery Association. Retrieved on September 19, 2010, from: http://www.irsa.org/radiosurgery.html.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. 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/treatmentop tions/stereotacticradiosurgery.html#WhatDevicesAreUs ed. http://www.radonc.jhmi.edu/radiosurgery/treatmentop tions/stereotacticradiosurgery.html#WhatDevicesAreUs ed Kaminski, J. (2009). Nursing Informatics Competencies: Self-Assessment. Nursing- Informatics.com. Retrieved November 15, 2010, from: : http://www.nursing- informatics.com/niassess/index.html. 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.p hp http://www.medicalnewstoday.com/articles/122391.p hp Mongia, S. (2009). Gamma Knife Surgery. Retrieved on October 1, 2010, from gammaknifeonline: http://www.gammaknifeonline.in/. 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=stereotac tic. http://www.radiologyinfo.org/en/info.cfm?pg=stereotac tic 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. http://www.aapm.org/pubs/reports/rpt_54.pdf

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