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The PROMISE of a Better Pediatric Radiation Experience

Treating the pediatric radiation oncology population has historically been difficult. Because it is imperative to have patients stay still during radiation treatment, general anesthesia is commonly used to facilitate radiation treatments in children, with most children age 7 and under receiving general anesthesia. This can cause many complications, difficulties, and detriments to the quality of life for patients because the regular course of radiation typically involves four to six weeks of daily treatment. Some of these setbacks include not being able to eat before treatments, a substantial increase in treatment time and recovery, potential health effects such as neurocognitive impairments from repeated doses of anesthesia, allergic reactions, more pronounced anxiety and fear, vascular access device complications, and a significant rise in financial burden. The stress that these patients and their families endure is tremendous and is amplified by the daily anesthesia – school schedules are severely disrupted, moods worsen because they cannot eat, and medical costs are high.

Vision RT motion monitoring system

Vision RT motion monitoring system

The use of anesthesia in the pediatric population puts stress on the hospital system logistically and financially as well. Prolonging treatment time for children from 30-45 minutes to three or four hours because of the need for anesthesia, which requires increased staff, decreases clinical efficiency significantly. To combat these issues, using pictures or videos to assist in relaxing pediatric patients is a technique in the field that has been successful but not to the extent of its integration with other systems to provide enhanced safety and behavioral training for children. 

Kiran Kumar, M.D., M.B.A., Assistant Professor of Radiation Oncology and Chief of Lymphoma and Pediatric Radiation Oncology Services, along with physicists Steve Jiang, Ph.D., and Tsuicheng David Chiu, Ph.D., in the Department of Radiation Oncology, have pioneered an exciting new technology; as a result of initial early success, they launched a clinical trial in February 2022 called PROMISE (Pediatric Radiation Oncology with Movie Induced Sedation Effect).

In this new model, an interactive incentive-based movie system is integrated with Vision RT, a commercial video surveillance gating module to be used in lieu of sedation. Patients being treated on the PROMISE protocol choose a movie to watch for the duration of their radiation treatment. Once radiation starts, the video will play and the system will provide real-time motion monitoring of the patient, automatically shutting off the radiation beam and movie if there is excessive movement. Once the patient is back in the correct position, the movie and the radiation beam will continue. Consequently, this system provides a one-of-a-kind, built-in safety mechanism as well as real-time behavioral training that uses mostly positive reinforcement for pediatric patients.

This method has minimal risk and is targeted for children ages 3 to 11 with the goal of decreasing the percentage of patients who require general anesthesia in the 3 to 7 age group from 70% to 30%. Dr. Kumar and his team have great hopes for the outcomes of this trial.

“Our vision as a team is to reach a point where the large majority of kids ages 3 or older are able to get radiation treatment without needing anesthesia every day,” Dr. Kumar says. “This will significantly improve their quality of life and their happiness, especially when they’re already going through cancer and coming in every day for radiation treatment. If there is any small thing we can do to improve their quality of life, we think it’s a pretty big deal. We believe that PROMISE is something that could be done across the world and could be a game changer for all kids who need radiation.”

UTSouthwestern Doctors