RadFlix: A welcome distraction from radiation treatments

Radiation oncology treatments can be an intimidating experience. Patients at the University of Colorado Cancer Center get through theirs by watching their favorite videos via the RadFlix system..
Nov. 2, 2020
Casey Betancur, center, with his five children, all of whom have supported him during his battle with solitary plasmacytoma.
Casey Betancur, center, with his five children, all of whom have supported him during his battle with solitary plasmacytoma. Photo courtesy: Casey Betancur.

Twenty-three times last December and January, Casey Betancur settled down in Aurora to watch segments of the long-running TV series “NCIS.”

Nothing unusual about that. It’s his favorite show, and he enjoys soaking up the tales of the special agents who never fail to crack their case.

patient watches RadFlix system during radiation oncology treatments.
The RadFlix system allows patients to watch videos during radiation oncology treatments. Photo courtesy of University of Colorado Cancer Center.

What was unusual was the setting for Betancur’s viewing. He was flat on his back in a room at the University of Colorado Cancer Center on the Anschutz Medical Campus, lying still while a machine delivering a focused radiation beam to cancerous cells in his neck periodically moved above him. The table tipped and rotated to afford the radiation the most effective angle of attack. To ensure that he remained perfectly positioned while he was treated with the cancer-killing radiation, Betancur wore a tight-fitting plastic mask across his face and chest.

If it seems like the setup might make it hard to concentrate on a TV show, think again. While the machine trained radiation on his cancer cells, Betancur focused on the show’s action, which danced on an iPad-size screen in front of his face. The 12- to 15-minute treatment session went by in a flash.

Dr. Douglas Holt, chief resident in Radiation Oncology at CU, worked with Dr. Brian Miller to design, test and implement the RadFlix system. Photo courtesy of Douglas Holt.
Dr. Douglas Holt, chief resident in Radiation Oncology at CU, worked with Dr. Brian Miller to design, test and implement the RadFlix system. Photo courtesy of Douglas Holt.

“The time went by quickly once I could watch ‘NCIS,’” Betancur said.

Sinking into the screen via RadFlix

The key to his stress-free treatments was RadFlix, a “video distraction therapy system” for patients receiving external beam radiation therapy. It was designed and developed for the CU Cancer Center by Dr. Douglas Holt, chief resident in the Department of Radiation Oncology at CU, and Dr. Brian Miller, a medical physicist and assistant professor in the same department.

The goal for the system is simple: help patients pass their treatment time less stressfully in a tight, confined environment. Betancur, now 44, is one of a small number of adult patients who have used RadFlix, but it has proved beneficial for a much larger group of pediatric patients suffering from brain tumors, sarcomas, lymphomas and other cancers, said Dr. Sarah Milgrom, assistant professor of Radiation Oncology at CU.

“Kids love it. They don’t want their radiation treatments to be over,” Milgrom said. “The treatments can be emotionally difficult for many reasons. At the time of treatment, they are alone, surrounded by medical equipment, with a big machine rotating around them. They are separated from their parents. Having an engaging distraction for them to focus on is very helpful.”

Shrinking the image

The concept is straightforward, but the implementation of RadFlix took some doing. Miller said he first encountered the video-distraction idea during a conference presentation by Stanford University Medical Center.

Unlike the Stanford system, Holt and Miller designed a custom optic lens for projectors mounted much farther back from the patient. The lenses also shrunk the video image to the size of a small screen that remains directly in front of the patient even as the table rotates to accommodate the various angles of the radiation beam.

Cancer Center radiation oncologist Dr. Sarah Milgrom.
Cancer Center radiation oncologist Dr. Sarah Milgrom says RadFlix has vastly improved the experience of children receiving radiation treatments. Photo by UCHealth.

Holt said it took four to five months to develop a working prototype after many design Iterations. Over the next year and a half, he and Miller solicited feedback from the CU Cancer Center’s radiation therapists to design a system that would not get in the way of delivering lifesaving care to patients.

“It had to be completely wireless and reliable, with no hazards or interference with workflow,” Holt said. For example, there could be no wires hanging from the ceiling or under the radiation table, he added.

Positive reviews and practical benefits

From her perspective, Milgrom said they accomplished the mission.

“It’s a technology that anyone can benefit from,” she said. “This system works for any radiation treatment, and for any patient treated in our department. We’ve gotten great feedback from patients.”

The positive response has extended beyond the walls of the CU Cancer Center. The design team presented their work on RadFlix at the July 2019 meeting of the American Association of Physicists in Medicine and applied for a patent for the system that should be official in November, Holt said. In addition, the team is assembling a RadFlix consortium that will operate as a non-profit. Holt said Ohio State University, the University of Pittsburgh and the New York Proton Center have started the process for acquiring the RadFlix system for their own patients.

“It’s very scalable and can go to other centers to use with minimal effort,” he said.

The team is also interested in quantifying other benefits RadFlix might offer, such as reducing post-traumatic stress in patients and their families and decreasing the amount of anesthesia required for treatment. Both of these factors increase recovery times and add to the challenges of treatment.

“Decreasing the need for anesthesia would benefit pediatric patients and their families, not to mention reduce the costs for the health care system,” Milgrom added.

Adult viewing

Casey Betancur is a kid no longer, but he can relate to the stress a serious illness imposes and the benefits RadFlix provided him during treatment.

Dr. Brian Miller, a medical physicist who specializes in optics, developed a lens that is critical to the success of the RadFlix system.
Dr. Brian Miller, a medical physicist who specializes in optics, developed a lens that is critical to the success of the RadFlix system. Photo courtesy of Brian Miller.

With many years working in construction, framing and landscaping, Betancur wasn’t surprised last year when he felt painful twinges in his back. He was mystified, however, when the right side of his face went numb. He told his primary care physician about it at his annual checkup and got a CT scan that showed degenerative disk disease in his lower back. But that didn’t explain the facial numbness. Betancur got a referral to a neurosurgeon who did an MRI of his neck and head to try to figure out the reason for that.

The culprit turned out to be a solitary plasmacytoma – a single mass of cancerous plasma cells – lodged in the tissue of his neck at the second level of his cervical spine. With the input and support of his five children, he sought a second opinion for his treatment, which brought him to the CU Cancer Center. He agreed to five weeks of treatment, five days a week, under the care of Dr. Rachel Rabinovitch, professor of Radiation Oncology at CU. The goal was to kill the cancerous plasma cells and prevent them from recurring and spreading to other parts of Betancur’s body.

Confinement concerns

When he went in to get fitted for the stabilizing mask, however, Betancur ran into a big problem. He found he would be pinned to the bed in a small room, surrounded by medical equipment, and he didn’t want any part of it. The problem wasn’t claustrophobia but rather a feeling that he wasn’t in control of the situation. He’d struggled with the same feelings during MRI sessions.

“Being in a locked room, locked in a bed, something goes wrong and they can’t get to me, the door is locked, all those things I can’t be in control of started going through my head,” Betancur said. “It started to freak me out.” Medication to relax him didn’t help, he added.

When a nurse suggested that he try watching using RadFlix to help him concentrate on something else, Betancur agreed and requested “NCIS.” That turned the trick.

“I was able to get lost in the show,” Betancur said. “It helped me out a lot.”

He learned one other anxiety-reducing trick. As the external beam machine moved to a new position, he closed his eyes for several seconds so as not to see the reflection of himself in a mask.

Successful conclusion

With the help of RadFlix, Betancur completed his treatments – 23 in all – without any further trouble and is now waiting to see the results. The numbness and soreness in his neck are gone and he’s working steadily for a floor rental company, picking up and delivering equipment.

Milgrom said radiation treatments for solitary plasmacytomas have a good chance of controlling the tumor at the initial site. For his part, Betancur is focused on recovering while awaiting his next checkup.

“I’m still getting on with my life,” he said. “I won’t let it get me down.”

RadFlix played a big role in helping him to get on that path, Betancur said. He had just one piece of advice for other patients who need the radiation and the distraction from it: Choose something to watch that they love as much as he does “NCIS.”

“It has to be something you like a lot or you’re not going to get into it,” he said.

About the author

Tyler Smith has been a health care writer, with a focus on hospitals, since 1996. He served as a writer and editor for the Marketing and Communications team at University of Colorado Hospital and UCHealth from 2007 to 2017. More recently, he has reported for and contributed stories to the University of Colorado School of Medicine, the Colorado School of Public Health and the Colorado Bioscience Association.