# Effect of Same-Day Volumetric Modulated Arc Therapy on Resource Utilization in Rapid Access Palliative Radiotherapy Clinics Using a Radiation Oncologist-Initiated Automated Planning Script

## TL;DR

This study shows that using automated planning for same-day radiation therapy in palliative clinics doesn't reduce patient throughput and maintains resource efficiency.

## Contribution

The study introduces and evaluates the use of an automated planning script (NoPAUSE-TPAS) for same-day volumetric modulated arc therapy in palliative care.

## Key findings

- Same-day VMAT implementation did not impact patient throughput or resource utilization compared to historical data.
- 84.9% of VMAT treatments using NoPAUSE-TPAS were delivered on the same day as consultation.
- The median time for NoPAUSE-TPAS optimization was 12 minutes.

## Abstract

Purpose: Rapid access palliative (RAP) radiotherapy (RT) clinics enable patients to access urgent same-day consultation, simulation, and treatment. This study aimed to examine the effect of same-day volumetric modulated arc therapy (VMAT) implementation using the Northern Plan Automation Service Treatment Planning Automation Service (NoPAUSE-TPAS) on patient throughput in RAP-RT clinics at a regional cancer center.

Methods:This retrospective study included all patients seen in RAP-RT clinics between February and August 2024 following the introduction of NoPAUSE-TPAS, compared to a data set from January to July 2019, prior to the introduction of NoPAUSE-TPAS. Baseline characteristics were analyzed using descriptive statistics. Measures of resource utilization and quality pertaining to consultations, computed tomography simulation slots, and treatment delivery were assessed.

Results: RAP-RT clinics saw 202 patients in 2024 and 213 in 2019. In 2019, 195 (91.5%) patients received RT to 249 sites, compared to 189 (93.6%) patients who received RT to 246 sites in 2024. Most patients (n=148 (69.5%) in 2019; n=143 (70.8%) in 2024) received RT to one site. Bone was the most common site treated (n=176 (70.7%) in 2019; n=177 (71.9%) in 2024). The most common fractionation was 8 Gy/1 (n=128 (51.5%) in 2019; n=156 (63.4%) in 2024). Of the bone metastases, 117 (66.5%) were treated with a single fraction in 2019, compared to 144 (81.4%) in 2024. Most patients (n=185 (94.9%) in 2019; n=171 (90.5%) in 2024) started RT the same date as consultation. Within the 2024 cohort, 133 (54.1%) sites were treated with an unplanned technique and 113 (45.9%) with VMAT. Of the sites treated, 192 (78%) were eligible for NoPAUSE-TPAS. Of the eligible sites, 113 (58.9%) received treatment with VMAT, with 96 (84.9%) of these delivered on the same date as consultation. The median time for NoPAUSE-TPAS optimization was 12 minutes.

Conclusions:Same-day VMAT using NoPAUSE-TPAS was implemented in RAP-RT clinics with no scheduling changes impacting patient throughput and similar resource utilization compared to historical data. Utilizing automation technology to improve efficiency can enable same-day VMAT for palliative RT.