Name of the Procedure:

Image-guided robotic linear accelerator-based stereotactic radiosurgery (SRS), delivery including collimator changes and custom plugging, fractionated treatment, all lesions, per session, second through fifth sessions, maximum five sessions per course of treatment (HCPCS Code: G0340).

Summary

Image-guided robotic linear accelerator-based stereotactic radiosurgery is a highly precise form of radiation therapy used to target and treat tumors or other abnormalities in the brain and body. The combination of image guidance and robotic technology allows for precise targeting of lesions while minimizing exposure to healthy tissue.

Purpose

This procedure is used to treat various conditions, such as cancerous and non-cancerous tumors, brain metastases, and certain neurological disorders. The primary goal is to destroy abnormal cells and control tumor growth while preserving the surrounding healthy tissue.

Indications

• Presence of brain or spinal tumors (both primary and metastatic)
• Certain types of arteriovenous malformations (AVMs)
• Inoperable or surgically complex tumors
• Patients who cannot undergo traditional surgery due to medical reasons

Preparation

• Patients may need to fast for a few hours prior to the procedure.
• Complete a series of imaging tests (e.g., MRI, CT scans) for precise lesion mapping.
• Adjust medications as advised by the healthcare provider.
• Avoid wearing any metallic objects on the day of the procedure.

Procedure Description

1. The patient is positioned on a specially designed table, and immobilization devices are often used to keep the patient still.
2. Advanced imaging technology is used to locate the lesion with high precision.
3. Detailed treatment planning is conducted using sophisticated software to determine the exact radiation dose and target areas.
4. The robotic linear accelerator delivers highly focused beams of radiation from multiple angles to converge on the lesion.
5. Adjustments may be made to the collimator and custom plugging during the session to further refine the treatment.
6. The process is repeated over multiple fractionated sessions, typically up to five, to achieve optimal outcomes and minimize side effects.

Duration

Each session usually lasts between 30 to 90 minutes, depending on the complexity and location of the lesions.

Setting

This procedure is typically performed in a hospital's radiotherapy department, but it can also be done in specialized outpatient radiotherapy centers.

Personnel

• Radiation oncologist
• Medical physicist
• Radiologic technologist
• Radiotherapy nurse
• Sometimes a neurosurgeon or other specialists depending on the case

Risks and Complications

• Fatigue
• Skin irritation at the treatment site
• Headaches or nausea
• Rare risks: radiation necrosis, neurological deficits, secondary cancers Management involves symptomatic treatment, occasional surgical intervention, or medications as needed.

Benefits

• Highly precise treatment with minimal damage to healthy tissue.
• Non-invasive and typically has a shorter recovery time compared to traditional surgery.
• Effective for treating otherwise inoperable tumors. Benefits can be realized within a few weeks to months, depending on the condition being treated.

Recovery

• Patients can usually return to normal activities within a day or two.
• Follow-up appointments are necessary to monitor progress.
• Continue to follow any specific post-treatment care instructions provided by the healthcare team.

Alternatives

• Conventional surgery
• Whole-brain radiation therapy or standard radiotherapy
• Chemotherapy
• Watchful waiting or palliative care Each alternative has its own pros and cons related to invasiveness, recovery time, and suitability for the patient's condition.

Patient Experience

During the procedure, patients might feel slight discomfort from immobilization devices. Post-procedure, some may experience mild fatigue or headaches, which can be managed with over-the-counter pain medication. Emotional support and information about the procedure can significantly enhance the patient's comfort and overall experience.