S2940
RTT- RTT operational practice and workflow innovations
ESTRO 2026
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 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.
evacuation time exists, guidance recommends immediate transfer (2), and simulations showed two radiographers could move a patient to a safe resuscitation area in under two minutes. All resuscitation team members were onsite, pacemaker assessments were uploaded successfully, and the radiographer-led safety framework ensured efficient workflow. Conclusion: Radiographer-led planning and safety protocols enabled the safe delivery of hypofractionated MRL radiotherapy for VA patients with ICDs. Multidisciplinary coordination and resuscitation drills enhanced efficiency and response times. This radiographer-led framework shows that complex cardiac cases can be safely managed on MRL systems through simulation training and coordinated emergency planning. 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. Keywords: ICD, MRL Safety, Stellate ganglia 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 Digital Poster Highlight 3877
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
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