Intracranial Radiosurgery: A Disruptive Innovation In Medicine

Ajay Niranjan, MCh1, Ravi Madhavan2, L Dade Lunsford2, Peter C. Gerszten2

1Department of Neurological Surgery, University of Pittsburgh 2UPMC, Pittsburgh, USA

Keywords: technique, image guidance, gamma knife, brain tumor, arteriovenous malformation

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     Physicians are guided by the teachings of their chosen field, standards of accepted practice, peer pressure, prior training, and other sources of bias. When potential bias begins to impact recommendations for care in the field of tumor management, physicians may fail to realize the importance of emerging medical innovations. Some of these ultimately turn out to be “disruptive innovations.” These innovations are more often than not both low risk and cost effective. The leaders in the field often initially ignore these newer technologies in favor of more mature existing technologies. However, over time these technologies gradually improve and become mainstream management practices.
      Intracranial radiosurgery is one such innovation which was not embraced by the neurosurgical community in the beginning.
     In the early 1980s, L. Dade Lunsford initiated a strategy to install the first 201 Cobalt source Gamma Knife in North America. The project echoed responses ranging from skepticism to outright resistance from colleagues in his own as well as other fields.. One radiation oncologist wrote to the hospital chief executive in 1983: “I don’t know what the Gamma Knife is, but I am against it.” Introduction of this technology took more than four years of continuous negotiation with the hospital leadership, state agencies, and federal agencies. The first patient to undergo radiosurgery at the University of Pittsburgh (August 14, 1987) had an acoustic neuroma of moderate size. By April of 2009, 9,627 patients had undergone radiosurgery using the Gamma Knife at the University of Pittsburgh. A wide variety of disorders are now treated with radiosurgery.
     We analyzed the trends in the management of acoustic tumors at our center by comparing number of patients selecting Gamma Knife radiosurgery versus microsurgery for their management. Similarly we plotted the trend in management of brain metastases over the years.
     The number of acoustic neuroma patients selecting Gamma Knife over conventional microsurgery has steadily increased over the years. At our center, 120 acoustic neuroma patients underwent radiosurgery and only 18 selected microsurgery in year 2007. This trend is accurate example of the impact of disruptive innovation. Brain metastasis is another example of a rapidly growing indication of intracranial radiosurgery. Brain metastases now comprise about 45% of radiosurgery cases at our center.
     This is a retrospective study.
     Radiosurgery is an example of disruptive innovation in neurosurgery. Such disruptive innovations are changing the landscape of health care. At first, established institutions and clinicians initially resist these innovations only to become late adopters.
     The history of disruptive innovations tells us that such institutions will be replaced by those with business models that adopt new technologies early. Instead of working to preserve the existing systems, physicians, hospitals, regulators, and insurance companies must focus on enabling and embracing more disruptive innovations in medicine. Disruption will ultimately lead to providing better health care treatments associated with both higher quality and lower cost.


Project Roles:

A. Niranjan (), R. Madhavan (), L. Lunsford (), P. Gerszten ()