As cancer treatments and survival outcomes are improving, there is a greater focus on survivorship, prevention and management of late toxicity Among cancer survivors alive five years after diagnosis, cardiovascular disease related deaths are shown to exceed cancer related deaths, from 13 years after diagnosis Radiation therapy is an integral component of cancer treatment, but radiation dose to the heart is associated with late cardiac toxicity. Accelerated atherosclerosis is an important mechanism in the development of radiation induced cardiac disease. Future risk of cardiac disease...

This is an ongoing national prospective observational study Patients commencing radiotherapy, who will have a planning thoracic CT-scan as part of standard of care, are invited to participate Using an automated workflow, participant's heart contour is scanned for calcium densities In those patients with caclification detected, CAC is manually scored by a remote Cardiologist Those identified as high risk (CAC>0) are referred to a CardioOncology clinic Feasibility, determined by adherence to the recommended CardioOncology pathway, is being assessed after 3 months Health-related QoL and anxiety...

101 patients have been enrolled and are at various stages of the study 3 patients failed screening and have been removed from the dataset [Fig 3] [Fig 2] 100% of planning CT scans had CAC successfully scored 32%CAC score >0 96%attended CardioOncology appointment 28%have completed three month follow-up

Measuring CAC from routine radiotherapy planning CT scans appears feasible to incorporate into standard clinical practice The pathway has identified patients at increased cardiac risk, who may not have been detected otherwise Patients had excellent adherence to the recommended CardioOncology follow-up Following the completion of this trial, further studies are required to determine the effectiveness of this pathway on longer-term cardiovascular endpoints

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