title: Initial clinical outcomes of audiovisual-assisted therapeutic ambience in radiation therapy (AVATAR).
abstract: OBJECTIVE
  Radiation therapy is an important component of treatment for many childhood cancers. Depending upon the age and maturity of the child, pediatric radiation therapy often requires general anesthesia for immobilization, position reproducibility, and daily treatment delivery. We designed and clinically implemented a radiation therapy-compatible audiovisual system that allows children to watch streaming video during treatment, with the goal of reducing the need for daily anesthesia through immersion in video.
  
  
  METHODS
  We designed an audiovisual-assisted therapeutic ambience in radiation therapy (AVATAR) system using a digital media player with wireless streaming and pico projector, and a radiolucent display screen positioned within the child's field of view to him or her with sufficient entertainment and distraction for the duration of serial treatments without the need for daily anesthesia. We piloted this system in 25 pediatric patients between the ages of 3 and 12 years. We calculated the number of fractions of radiation for which this system was used successfully and anesthesia avoided and compared it with the anesthesia rates reported in the literature for children of this age.
  
  
  RESULTS
  Twenty-three of 25 patients (92%) were able to complete the prescribed course of radiation therapy without anesthesia using the AVATAR system, with a total of 441 fractions of treatment administered when using AVATAR. The median age of patients successfully treated with this approach was 6 years. Seven of the 23 patients were initially treated with daily anesthesia and were successfully transitioned to use of the AVATAR system. Patients and families reported an improved treatment experience with the use of the AVATAR system compared with anesthesia.
  
  
  CONCLUSIONS
  The AVATAR system enables a high proportion of children to undergo radiation therapy without anesthesia compared with reported anesthesia rates, justifying continued development and clinical investigation of this technique.
authors.affiliation: Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California. Electronic address: shiniker@stanford.edu.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Hiniker
authors.affiliation: Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California.
authors.forename: Karl
authors.initials: K
authors.lastname: Bush
authors.affiliation: Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California.
authors.forename: Tyler
authors.initials: T
authors.lastname: Fowler
authors.affiliation: Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California.
authors.forename: Evan C
authors.initials: EC
authors.lastname: White
authors.affiliation: Department of Pediatric Anesthesia, Lucile Packard Children's Hospital, Stanford, California.
authors.forename: Samuel
authors.initials: S
authors.lastname: Rodriguez
authors.affiliation: Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Maxim
authors.affiliation: Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California.
authors.forename: Sarah S
authors.initials: SS
authors.lastname: Donaldson
authors.affiliation: Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California.
authors.forename: Billy W
authors.initials: BW
authors.lastname: Loo
mesh_terms: D000367:Age Factors; D000758:Anesthesia / Q000009:adverse effects*; D001296:Audiovisual Aids; D002648:Child; D002675:Child, Preschool; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D007223:Infant; D020407:Internet; D008297:Male; D009369:Neoplasms / Q000532:radiotherapy*; D056888:Patient Positioning / Q000009:adverse effects; D010865:Pilot Projects; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D059015:Wireless Technology