Speaker: Melissa O'Neil, Advanced Practice Radiation Therapist
Melissa O'Neil: Hi everyone, I'm Melissa O'Neil, I'm an Advanced Practice Radiation Therapist at the London Health Sciences Centre in Ontario, Canada. I'd like to thank the Red Journal for accepting our article for publication and for the opportunity to present to you. now, the "Diagnostic CT-Enabled Radiation Therapy (DART) Trial: The Results of a Randomized Study for Palliative RT." CT [simulation] is considered the gold standard in radiation treatment planning. Yet, for as long as this has been true, there has been interest in exploring so-called "sim-free" workflows. Previous investigations have studied both cone-beam CT as well as diagnostic CT-based pathways and have demonstrated dosimetric viability as well as clinical feasibility. Recent work has also demonstrated similar pain response rates when comparing these planning pathways as well as a potential gain in expediting the consult to treatment time for symptomatic patients when employing diagnostic CT planning. The DART trial aimed to assess the impact of diagnostic CT planning on the patient experience, plan deliverability, adequacy of target coverage and staff workflows. Patients were considered eligible if they had consented to simple palliative RT for bone or soft tissue disease or mets, were planning to undergo same- day CT sim and treatment, and had a recent diagnostic CT. And we defined "recent" as 28 days old or less at the time of enrollment and this was simply to minimize the risk of any significant interval radiographic change. Participants were randomized in a 1: 2 ratio between CT sim and diagnostic CT-based simple palliative RT planning. Our primary endpoint was time in center, defined as the total time spent in the cancer center on the first day of treatment. This endpoint was selected specifically to enable evaluation of the workflows in the context of both patient and system benefit. Secondary endpoints included efficacy, defined as planned deliverability and adequacy of target coverage, as well as stakeholder acceptability and scalability. Between June 2022 and April 2023, we enrolled 33 patients with a total of 42 treatment sites. Baseline characteristics were well- balanced between arms. The mean time in center was 4.7 +/- 1.1 hours in the CT sim arm versus 0.41 +/- 0.14 in the diagnostic CT arm, and this was statistically significant. but moreover, we believe it to be clinically significant. This reduced the TIC, time in center, from just under five hours to just over half an hour. All dCT plans were deliverable and all plans in both arms and groups were rated as acceptable, about 80% in each arm, or acceptable with minor deviation. Patient acceptability was similar across study arms, though there was one notable and statistically significant exception and this was in the domain of time burden. 50% of CT sim versus 90% of diagnostic CT patients rated the time spent at the cancer center to receive treatment as acceptable. 90% of clinicians rated the diagnostic CT workflow as a 4 or higher on a 5-point scale of acceptability, and lastly, a scalability assessment was completed with input from our MDT stakeholders and this was reviewed by program leadership as well as for various quality improvement committees. Ultimately, the workflow was determined to merit scale up. In conclusion, diagnostic CT- based planning is a viable workflow and should be considered for patients with
Melissa O'Neil: a recent diagnostic CT undergoing simple palliative RT. Patient care impacts include reduced waiting time for urgent treatment, fewer appointments and less travel, and potentially decreased financial toxicity. Health system benefits include resource optimization, as well as the opportunity to open up space in the CT simulator or redistribute staff. And this can enable departments to see more patients and/or maintain their throughput through times of workforce or resource shortage. Thank you so much for your time. I really encourage you to check out the full manuscript and to reach out to us if you have any questions. Thank you.
