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• W4387590006 abstract "Purpose/Objective(s) The use of diagnostic CT (dCT) scans in place of CT simulation (CTsim) scans can increase departmental efficiency and reduce patient burden. The goal of the DART trial was to assess the impact of dCT-based planning on patient experience, plan deliverability, adequacy of target coverage, and staff workflows. Materials/Methods In this medical radiation therapist (MRT)-led trial, we enrolled patients undergoing same-day CTsim and treatment for palliative radiotherapy (PRT) to thoracic, abdominal, pelvic, or proximal limb targets. A recent dCT (within 28 days) in a reproducible position was required. After stratifying by target type (bone/soft tissue vs. visceral), patients were randomized in a 1:2 ratio between standard CTsim-based planning (control arm) vs. dCT-based planning (dCT arm). The primary endpoint was time in center (TIC), defined as the total time spent in the cancer center on the day of treatment, from first appointment to treatment delivery completion. Secondary endpoints included plan deliverability, adequacy of target coverage (scored by blinded physicians), and stakeholder acceptability (based on surveys of patients, MRTs, medical physicists and ROs). Results Accrualbegan in June 2022 and target accrual was reached in April 2023: 33 patients were enrolled with a total of 42 treatment sites. Median age was 72 (interquartile range [IQR]: 67-78), 73% were male, and the most common primary cancers were lung (33%), prostate (24%), and breast (12%). Treatment target volumes were bone/soft tissue metastasis for group 1 (n=25, 76%), and visceral (primary or metastatic) lesions for group 2 (n=8, 24%). The most commonly prescribed doses were 8 Gy in 1 fraction and 20 Gy in 5 fractions (50% and 43% of plans, respectively), and 91% of plans used parallel-opposed paired beams. Median time from dCT to enrollment date was 13 days (IQR: 8-22). The primary endpoint, TIC, was 4.8 ± 1.1 hours (mean ± SD) in the control arm vs. 0.4 ± 0.1 hours in the dCT arm (p<0.001). All plans were deliverable in the dCT arm. There were no differences in dose distribution acceptability rates, with all plans in both arms rated as “acceptable” (80% in control; 81% in dCT) or “acceptable with minor deviation” (20% in control; 19% in dCT). Patient perception of acceptability was similar in both arms with the exception of time burden, rated as “acceptable” by 50% in the control arm vs. 90% in the dCT arm (p=0.025). On a 5-point scale ranging from unacceptable (1) to acceptable (5), with 3 being neutral, the dCT workflow was rated as a 4 or higher by 90% of clinical stakeholders, including all ROs and medical physicists. Conclusion dCT-based radiation planning substantially reduced TIC without detriment in plan deliverability or quality and also reduced patient-reported time burden. dCT-based planning is a viable workflow and should be considered for patients with a recent diagnostic CT scan who are undergoing PRT. The use of diagnostic CT (dCT) scans in place of CT simulation (CTsim) scans can increase departmental efficiency and reduce patient burden. The goal of the DART trial was to assess the impact of dCT-based planning on patient experience, plan deliverability, adequacy of target coverage, and staff workflows. In this medical radiation therapist (MRT)-led trial, we enrolled patients undergoing same-day CTsim and treatment for palliative radiotherapy (PRT) to thoracic, abdominal, pelvic, or proximal limb targets. A recent dCT (within 28 days) in a reproducible position was required. After stratifying by target type (bone/soft tissue vs. visceral), patients were randomized in a 1:2 ratio between standard CTsim-based planning (control arm) vs. dCT-based planning (dCT arm). The primary endpoint was time in center (TIC), defined as the total time spent in the cancer center on the day of treatment, from first appointment to treatment delivery completion. Secondary endpoints included plan deliverability, adequacy of target coverage (scored by blinded physicians), and stakeholder acceptability (based on surveys of patients, MRTs, medical physicists and ROs). Accrualbegan in June 2022 and target accrual was reached in April 2023: 33 patients were enrolled with a total of 42 treatment sites. Median age was 72 (interquartile range [IQR]: 67-78), 73% were male, and the most common primary cancers were lung (33%), prostate (24%), and breast (12%). Treatment target volumes were bone/soft tissue metastasis for group 1 (n=25, 76%), and visceral (primary or metastatic) lesions for group 2 (n=8, 24%). The most commonly prescribed doses were 8 Gy in 1 fraction and 20 Gy in 5 fractions (50% and 43% of plans, respectively), and 91% of plans used parallel-opposed paired beams. Median time from dCT to enrollment date was 13 days (IQR: 8-22). The primary endpoint, TIC, was 4.8 ± 1.1 hours (mean ± SD) in the control arm vs. 0.4 ± 0.1 hours in the dCT arm (p<0.001). All plans were deliverable in the dCT arm. There were no differences in dose distribution acceptability rates, with all plans in both arms rated as “acceptable” (80% in control; 81% in dCT) or “acceptable with minor deviation” (20% in control; 19% in dCT). Patient perception of acceptability was similar in both arms with the exception of time burden, rated as “acceptable” by 50% in the control arm vs. 90% in the dCT arm (p=0.025). On a 5-point scale ranging from unacceptable (1) to acceptable (5), with 3 being neutral, the dCT workflow was rated as a 4 or higher by 90% of clinical stakeholders, including all ROs and medical physicists. dCT-based radiation planning substantially reduced TIC without detriment in plan deliverability or quality and also reduced patient-reported time burden. dCT-based planning is a viable workflow and should be considered for patients with a recent diagnostic CT scan who are undergoing PRT." @default.
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• W4387590006 title "Diagnostic CT-Enabled Radiation Therapy (DART): Results of a Randomized Trial for Palliative Radiation Therapy" @default.
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