Simulation-Free Palliative Radiation Therapy: Implementing the Value-Based and Easier-Access Model of Care in a Rural Setting

Palliative radiation therapy (RT) is a vital treatment modality for managing symptoms from metastatic disease, but access barriers and workflow inefficiencies can delay or preclude care delivery. Simulation-free RT (SFRT) offers an effective, value-based solution by eliminating the traditional computed tomography (CT) simulation process and utilising existing diagnostic or staging CT scans for treatment planning. This process reduces patient burden and accelerates time to treatment, prioritising patient-centred care over traditional treatment pathways. Key technical considerations include managing dosimetric and geometric variations through appropriate patient selection and quality assurance processes. The successful implementation of SFRT requires a collaborative, multidisciplinary team approach, drawing on expertise from established centres to familiarise the team with the process. Access to diverse diagnostic imaging datasets and collaboration with various imaging providers is crucial. While careful patient selection is essential, our experience demonstrates that SFRT exemplifies value-based healthcare principles by optimising resource utilisation while prioritising patient-centred care, particularly valuable in rural settings where travel distances significantly impact treatment access. This paper aims to review the benefits and technical aspects, as well as provide key considerations for implementing SFRT in palliative RT settings.