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

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