Predictors of Successful First-Attempt Prostate Cancer Computed Tomography Simulation: A Prospective Cohort Study

Successful computed tomography (CT) simulation in prostate cancer radiation therapy relies on consistent bowel and bladder preparation. This study aimed to determine the first-attempt CT simulation success rate and identify factors associated with a successful simulation.

This single-institution, prospective cohort study recruited patients with prostate cancer undergoing CT simulation for pelvic radiation. We abstracted the success of CT simulation on the first attempt, the number of scan attempts in a single visit, the reason for failed attempt(s), and the frequency of rescheduled appointments. Patients completed a survey regarding their preparation experiences, demographic data, and patient-reported outcomes. The primary outcome was a successful first-attempt CT scan. A generalized estimating equation model evaluated factors associated with successful first scan, including age, CT appointment time, American Urological Association urinary symptom scores, constipation, diarrhea, and instruction format. Additionally, qualitative analysis of open-text patient feedback explored barriers to effective preparation.

Among 247 patients, 31.2% had a successful first-attempt CT simulation, while 52.2% required multiple attempts on the same day, and 16.6% needed rescheduling. Bladder and bowel issues contributed to 30.8% and 22.7% of failed attempts, respectively. Patients who received both verbal and written instructions were significantly more likely to succeed (adjusted odds ratio 1.82, P = .01) compared to verbal instructions alone. Qualitative analysis of 118 patient comments revealed common barriers, including unclear preparation instructions (23.7%), difficulty timing bowel movements (10.2%), and confusion about expectations (14.4%).

Low CT simulation success rates emphasize the need for improved patient preparation strategies. Multimodal education significantly enhanced success rates. Addressing communication methods and, refining preparation protocols should reduce rescans, and optimize workflows.