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Introduction Radiation therapy is a standard treatment option for prostate cancer. With growing use of escalated doses and tighter margins, procedures to limit rectal size variation are needed to reduce prostate motion, increase treatment accuracy, and minimize rectal toxicity. This prospective study was done to determine whether the introduction of an antiflatulent medication would decrease rectal distention at computed tomography (CT) simulation and throughout a course of radiation therapy. Methods and materials Patients undergoing a radical course of radiation therapy to the prostate/prostate bed were eligible to participate. Participants were randomly assigned to the intervention arm (antiflatulent medication) or the control arm (no medication). For each participant, the number of CT simulation rescans was recorded. Rectal diameters were measured on CT simulation and treatment cone beam CT scans. Acute rectal toxicities were assessed at baseline and weekly using National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE), version 4.0. A χ2 analysis was used to compare the number of participants requiring a rescan in each study arm. Change in rectal diameter over time was assessed using repeated measures analysis of variance. Results A total of 78 patients participated, with equal numbers assigned to each study arm. There was no significant difference between arms in the number of participants requiring a CT simulation rescan (P = .5551). There was no significant variation in rectal diameter between arms (P = .8999); however, there was a significant effect of time (P = .0017) and a significant interaction effect between study arm and time on rectal diameter (P = .0141). No acute rectal toxicities above grade 2 were reported. Conclusions The addition of antiflatulent medication did not affect the frequency of CT simulation rescans. Both time and the interaction between study arm and time had a statistically significant effect on rectal diameter, although neither finding was clinically significant. Instead, standardized bowel preparation education developed for this study may have been sufficient to limit rectal size variation.

among team members. The same standard of care is also maintained for all patients, as determined by their specific disease presentation and treatment technique. The new workflow introduced major changes to the RT end-toend process. A great deal of effort was consequently invested in project planning. An extensive training schedule was also established to support each member of the team so that they can perform their tasks correctly and confidently. Conclusion/Impact/Outcomes: RO Care Plans have been successfully implemented and used clinically since March 2015. Process improvement is now facilitated by measuring different quality indicators within MosaiQ. For example, the time associated with the generation and completion of a QCL item is able to provide information regarding the duration of a specific activity in the process. These performance indicator reports can therefore facilitate measurement of process efficiency and guide subsequent investigations and corrective actions. The data can then guide the allocation of resources and ensure workflow efficiency. Thus, the new innovative RO Care Plans process provides the framework to continuously improve healthcare services. The multiple performance indicators obtained can ensure data-driven improvement and guide the future development of our services.