DART: Diagnostic-CT-Enabled Planning: A Randomized Trial in Palliative Radiation Therapy

The objective of this trial is to assess the efficacy, acceptability, and scalability of diagnostic-CT-enabled planning, compared to conventional CT simulation planning.

Inclusion Criteria: * Age 18 years or older * Able to provide informed consent * Patient has consented to PRT to bone/soft tissue metastases or primary targets in the thorax, abdomen, or pelvis and RO will use simple planning techniques (i.e. parallel-opposed pair or direct field beam arrangement) * Patient will be scheduled for same-day simulation and treatment (if randomized to Arm 1) * Patient has a pre-existing and recent (i.e. within 4 weeks of time of enrollment) diagnostic CT or CT-fused scan with full visualization of the region-of-interest which has been acquired from an approved diagnostic scanner * Patient positioning scan is deemed acceptable and reproducible (e.g., patient is lying supine and relatively flat, there is no/minimal motion blur, ect.) * Intravenous (IV)/oral contrast in the region-of-interest is permitted as long as it does not create artifact which obscured the target volume (density override calculations may be required) Exclusion Criteria: * Any contraindication to receiving radiation * Oncologic emergencies and/or on-call cases * Pregnant or lactating women * Cases requiring composite dosimetric planning to account for previous radiotherapy or extended distance set-up