Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah 84132, USA.
J Neurosurg. 2010 Jul;113(1):10-5. doi: 10.3171/2010.1.JNS09842.
Neurosurgeons, radiation oncologists, and, increasingly, other surgical specialists recognize that radiosurgery is an important tool for managing selected disorders throughout the body. The partnership between neurosurgeons and radiation oncologists has resulted in collaborative studies that have established the clinical benefits of radiosurgery. Today, however, a range of political and financial issues is straining this relationship and thereby undermining the practice of radiosurgery. Neurosurgeons and radiation oncologists recently restricted the definition of radiosurgery to include only cranial- and spine-focused radiation treatments. Meanwhile, organized radiation oncology decided unilaterally that radiosurgery administered to other parts of the body would be termed stereotactic body radiation therapy. Finally, neurosurgical and radiation oncology coding experts developed new Current Procedural Terminology codes for cranial vault and spine radiosurgery, which were approved for use by the Relative Value Scale Update Committee as of 2009. The authors suggest that the neurosurgery strategy-which included 1) reasserting that all of the tasks of a radiosurgery procedure remain bundled, and 2) agreeing to limit the definition of radiosurgery to cranial vault and spine-has failed neurosurgeons who perform radiosurgery, and it may jeopardize patient access to this procedure in the future. The authors propose that all of the involved medical specialties recognize that the application of image-guided, focused radiation therapy throughout the body requires a partnership between radiation and surgical disciplines. They also urge surgeons to reexamine their coding methods, and they maintain that Current Procedural Terminology codes should be consistent across all of the different specialties involved in these procedures. Finally, surgeons should consider appropriate training in medical physics and radiobiology to perform the tasks involved in these specific procedures; ultimately all parties should receive equivalent reimbursement for similar assigned tasks, whether performed individually or jointly.
神经外科医生、放射肿瘤学家，以及越来越多的其他外科专家都认识到，放射外科是治疗全身特定疾病的重要工具。神经外科医生和放射肿瘤学家之间的合作关系促成了协作研究，这些研究确立了放射外科的临床益处。然而，如今一系列政治和财务问题正在削弱这种关系，从而破坏了放射外科的实践。神经外科医生和放射肿瘤学家最近将放射外科的定义限制为仅包括颅和脊柱为焦点的放射治疗。与此同时，有组织的放射肿瘤学单方面决定，对身体其他部位进行的放射外科治疗将被称为立体定向体部放射治疗。最后，神经外科和放射肿瘤学编码专家为颅盖和脊柱放射外科开发了新的当前操作术语代码，这些代码自 2009 年起被相对价值更新委员会批准使用。作者建议，神经外科策略包括：1）重申放射外科手术的所有任务仍然捆绑在一起；2）同意将放射外科的定义限制在颅盖和脊柱。该策略未能惠及进行放射外科的神经外科医生，并且可能会危及未来患者获得该程序的机会。作者建议所有涉及的医学专业都认识到，全身应用图像引导的聚焦放射治疗需要放射和外科学科之间的合作。他们还敦促外科医生重新审视他们的编码方法，并坚持认为当前操作术语代码应该在涉及这些程序的所有不同专业中保持一致。最后，外科医生应该考虑在医学物理和放射生物学方面进行适当的培训，以执行这些特定程序中涉及的任务；最终，所有各方都应该为类似的指定任务获得同等的补偿，无论是单独完成还是联合完成。
