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SAN DIEGO -- Using recent diagnostic CT scans instead of CT simulation scans to plan palliative radiation treatments can substantially reduce the time to treatment completion for cancer patients, the small randomized DART trial showed.

For patients who were prescribed simple palliative radiation treatment, the use of a diagnostic scan to produce clinically acceptable plans reduced the time in center by more than 4 hours, reported Melissa O'Neil, MRT(T), MSc, of the London Health Sciences Centre in London, Ontario, during the American Society for Radiation Oncology annual meeting.

"This has major implications for patient care," O'Neil said at a press briefing. "Reduced waiting time for urgent treatment improves the patient experience. It equates to fewer appointments, less travel, less waiting, and when the workflow allows someone to circumvent often busy CT simulation appointment schedules, it can equate to faster relief. This eases treatment burden and financial toxicity for both patients and caregivers."

O'Neil and her colleagues found that treatment completion -- defined as total time the patient spent in the cancer center on the day of treatment -- took an average of 4.7 hours with the CT simulation workflow compared with just 0.4 hours with the use of diagnostic CT scans.

All treatment plans were delivered successfully and the adequacy of target coverage, as rated by blinded physicians, was considered acceptable in 80% of cases, or acceptable with some variations in 20%.

Patient ratings on the acceptability of their experience were similar in both treatment arms, except for time burden, with 50% of patients in the CT simulation arm considering the amount of time spent receiving treatment acceptable compared with 90% of those who had diagnostic CT planning.

Radiation oncologists, medical physicists, and radiation therapists were also surveyed about their thoughts on the different workflows, and on a 5-point scale of acceptability, 90% rated the diagnostic CT workflow as a 4 or higher (mean score of 4.6).

CT simulation -- a procedure that generates three-dimensional images for custom radiation treatment planning -- is considered the standard of care for patients referred for palliative radiation.

However, O'Neil pointed out that many of these patients will also have had recent diagnostic CT scans performed as part of routine follow-up care and that prior research has shown these scans can be used instead of CT simulation scans to produce clinically acceptable palliative radiation treatment plans.

She suggested that this treatment planning approach can optimize health system resources by freeing up appointment slots, allowing staff redistribution, and enabling departments to see more patients and maintain throughput in the cases of workforce shortages.

"Diagnostic CT-based planning is a viable workflow and should be considered for patients with a recent diagnostic CT scan who are undergoing simple palliative radiation treatment," she concluded.

Commenting on the study, Neha Vapiwala, MD, of the University of Pennsylvania Perelman School of Medicine in Philadelphia, who moderated the press briefing, noted that the vast majority of patients with metastatic cancer will at some point need palliative radiation, or at least consider it.

"And to the extent that radiation has long been established as a very effective tool for palliation of symptoms, we need to think about how we minimize the time for the patient with all they are going through in their lives," she said, adding that this innovative work "should be readily applicable to pretty much any clinic that uses CT-based treatment planning and uses CT for palliation of patients."

Vapiwala also pointed out that the ability to take an existing resource in the form of a CT diagnostic scan not only produced a dramatic reduction in workflow time, "but also gave the providers the sense they were still delivering high-quality, safe care -- which is ultimately our top priority."

This is "a win-win, in every regard," she said.

For this study, patients were eligible if they had been prescribed palliative radiation treatment to a soft tissue or bony target in their chest, abdomen, or pelvis, and had a recent (within the last 28 days) and acceptable diagnostic CT scan. The 33 study participants were assigned to either on-site standard treatment planning using conventional CT simulation or had their treatment planned in advance using the recent diagnostic CT scan.

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