"Ionizing Radiation Is Not in My Toolbox": Ethical Collaboration for Emerging Psychiatric Indications in Radiosurgery

Recent advances in stereotactic radiosurgery have expanded consideration of non-malignant and functional indications, including emerging applications in psychiatric illness. In response to the review by Ehret et al. we offer a multidisciplinary perspective-co-authored by radiation oncology and psychiatry-on the ethical and educational implications of this evolving frontier. While psychiatric radiosurgery remains investigational, its irreversible neural effects and identity-relevant outcomes raise distinct considerations related to informed consent, decisional capacity, and long-term monitoring. We highlight the importance of early psychiatric involvement in trial design, strengthened and capacity-sensitive consent processes, independent interdisciplinary oversight, and longitudinal assessment of neurocognitive and behavioral outcomes. Additionally, we argue that expanding therapeutic indications into psychiatric domains carries implications for radiation oncology education, necessitating foundational literacy in psychiatric diagnosis, treatment paradigms, and the ethical complexities of caring for vulnerable populations. By pairing technical rigor with cross specialty collaboration, the field can ensure that innovation in radiosurgery proceeds within a framework that is both scientifically responsible and ethically sound.