S2882
RTT - RTT education, training, and advanced practice
ESTRO 2026
Keywords: ICD, MRL Safety, Stellate ganglia References: 1. Mayinger M, Kovacs B, Tanadini-Lang S, Ehrbar S, Wilke L, Chamberlain M, et al. First magnetic resonance imaging-guided cardiac radioablation of sustained ventricular tachycardia. Radiother Oncol. 2020;152:203-207. 2. Doda Khera R, Hirsch JA, Buch K, Saini S. ED MRI: Safety, consent, and regulatory considerations. Magn Reson Imaging Clin N Am. 2022 Aug;30(3):553-563. 3. Hazwani TR, Abu-Hazrah M, Alhawsawi F, Al-Saeed O, Al-Ruwaili A. The impact of mock code simulation on the resuscitation team performance. J Clin Nurs. 2020;29(1–2):1–10. Reducing the burden of palliative radiation therapy for children with cancer through a simulation-free pathway: A feasibility study Katrina Woodford 1,2 , Alice Eriksen 1 , Laura Murphy 1 , Kirsty Wiltshire 1 , Jennifer Chard 1 , Greg Wheeler 1 , Elena Ungureanu 1 , Adam Yeo 1,2 , Jae H Choi 1 , Michelle P Li 1,2 1 Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia. 2 Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia Purpose/Objective: When a child requires palliative radiation therapy (RT), the time from referral to treatment can be delayed due to challenges in attending or accessing an urgent planning CT (pCT), for example in regional/interstate patients or younger patients requiring general anaesthesia (GA). Simulation-free RT (SF-RT) is an established workflow in the adult population that utilises a patient’s recent diagnostic CT (dCT) for palliative planning, as a surrogate for the traditional simulation CT1. Emerging evidence also suggests a diagnostic MRI (dMRI) can be converted into a synthetic CT for RT planning2,3. This study aims to explore the feasibility of SF-RT in the palliative paediatric context considering dCT and dMRI. Material/Methods: A retrospective clinical audit of a large Australian Digital Poster Highlight 3877 cancer centre that provides paediatric RT to the states of Victoria and Tasmania was conducted. Palliative treatment courses ( ≤ 20#) treated between August 2018 and July 2025 with megavoltage RT to a solid tumour in patients <18 years were collected from our database. Available diagnostic imaging suitable for SF- RT ( ≤ 30 days old, suitable field-of-view, scan length and patient position) at the time of referral was documented, along with demographics, treatment details and GA requirements. The number/proportion of courses eligible for SF-RT based on a suitable dCT or dMRI scan, as well as the number requiring GA were
quantified. Results:
Of 680 paediatric RT courses, 132 (19%) met the study criteria with an average patient age of 10 years (range: 0-17). A suitable dCT scan was available at the time of referral for 45/132 (34%) treatment courses, while 44/132 (33%) only had a suitable dMRI, (i.e. totalling 67% potentially eligible for SF-RT). GA for simulation could have been avoided on 17 occasions with SF-RT using a dCT and a further 13 occasions with SF-RT using a dMRI (i.e. 30 total occasions). The study workflow and summary of results, including the diagnostic scan type available, target sites treated, and RT technique used per dCT and dMRI subgroup is presented in Figure 1.
Conclusion: SF-RT using a dCT, could benefit a third of palliative paediatric patients by avoiding the need for a pCT and in some instances a GA. The ability to plan based on dMRI could increase the number of patients eligible for SF-RT up to 67%, with further work required in this area. Methods to safely treat more complex areas such as the brain and head and neck with SF-RT also need to be explored. Keywords: Simulation-free, paediatric, palliative References: 1 Schuler, T, Roderick, S, Wong, S, et al. (2025) Real- World Implementation of Simulation-Free Radiation Therapy (SFRT-1000): A Propensity Score-Matched Analysis of 1000 Consecutive Palliative Courses Delivered in Routine Care. IJROBP, 121(3), 585-595.2 Guerrero, F, Koivula, E, Seravalli, G, et al (2019) Feasibility of MRI-only photon and proton dose calculations for pediatric patients with abdominal tumors. Phys Med Biol, 64(5), 0550103 O’Connor, LM, Choi, JH, Dowling, A et al. (2022) Comparison of synthetic computed tomography generation methods, incorporating male and female anatomical differences, for magnetic resonance imaging-only definitive radiotherapy. Front Oncol, 12, 822687.
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