including adherence to department protocols and studies. Behavior and performance scoring was presented and ranked by RO during a subsequent C-AWF meeting, with comprehensive discussion of each case among peers, incorporating individualized, enabling and educational feedback. b) SR-AWF: The fortnightly SR-AWF meeting rapidly evaluated patient management for all patients simulated during the prior week, via review of treatment charts, simulation/verification films and plans. Performance items alone were scored and recorded during the meeting, and educational/enabling feedback given. c) QI reminders (attached to “advice to simulator” sheets and treatment cards) targeting RO behavior and protocol/study adherence were mandated for completion prior to every TCI patient commencing radiotherapy. d) CME talks were targeted weekly based on self- and program-identified learning needs. 2. Evaluation RO behavior, performance and protocol/study adherence were evaluated by comparing the prospectively recorded audit results of patients reviewed in C-AWF and SR-AWF meetings during the first and second 6 months of the program. Actions generated from the AWF were also prospectively recorded and evaluated. Results: 36 and 39 charts were evaluated during the first and second 6 months of the C-AWF, and 99 and 79 for the SR-AWF. Of patients audited, 29% had breast, 21% lung, 8% nasopharyngeal and 5% colorectal cancer. 58% were treated radically. Mean behavior significantly increased (12.7 to 13.6 out of 14, p = 0.0005). In addition, RO performance also improved over the same period (7.6 to 7.9 out of 8, p = 0.018). Protocol/study adherence significantly improved from 90.3% to 96.6% (p = 0.005). A total of 50 actions were generated in the form of targeted CME talks for knowledge or skills identified as deficient (14 actions), requirement for protocol refinement (11), systematic changes to RO practice (10), and remediation of deficient management of individual patients reviewed at the meetings (7, representing 3.0% of all patients reviewed). Conclusions: An integrated CME/QI program combining C-AWF, SR-AWF, QI reminders and targeted CME tutorials effectively improved targeted RO behavior and performance over a 12 month period. There was a corresponding increase in departmental protocol and study adherence. The program had additional benefits including the identification of learning needs to direct CME tutorials, the systematic change of suboptimal RO practice, and the alteration of deficient management of 3% of patients audited during the program. 2370 Preliminary Report of the Six-Minute Walk Test (6MWT) as a Predictor of Radiation-Induced Pulmonary Toxicity K. L. Miller, 1 D. Kahn, 1 Z. Kocak, 1 S. Zhou, 1 A. Baydush, 1 A. Tisch, 1 T. Shafman, 1 R. Clough, 1 X. Yu, 1 R. Folz, 1 K. Light, 1 L. Marks 1 1 Duke University, Durham, NC Purpose/Objective: Accurately predicting the risk of radiation therapy-induced lung injury (RTLI) is difficult. Dosimetric parameters (such as the mean lung dose-- MLD) and patient-specific parameters (such as pulmonary function tests--PFTs) are sub-optimal. 6MWT is a validated functional capacity study used in preoperative risk assessment, lung transplantation evaluation and pulmonary rehabilitation. We herein report our preliminary results using the 6MWT for the evaluation of RT effects. Materials/Methods: Since 1992, patients receiving thoracic RT have been enrolled in a prospective study to relate RT-induced changes in lung function with dosimetric and functional metrics. The 6MWT was added in 2002. It is administered on a flat, pre-measured course; results include distance walked, heart rate and oxygen saturation. 41 patients with pre-RT 6MWT evaluations were analyzed. We used receiver operating curve (ROC) techniques to determine whether the 6MWT provides additional information beyond traditional PFTs and to compare the predictive capacity for RTLI of the pre-RT 6MWT with the forced expiratory volume in 1 second (FEV1) and diffusing capacity for carbon monoxide (DLCO). To evaluate the 6MWT, alone or in combination with MLD in predicting RTLI, the rates of RTLI in patients subgroups defined by the 6MWT were compared using the Fisher exact test. The prognostic utility of combining the 6MWT with either pre-RT PFTs and the MLD were also assessed using ROC techniques. Results: 31 patients have had 3-month minimum follow-up. The median baseline 6MWT result was 1400 ft. (range = 150 –2000 ft.). 7/31 developed grade  2 RTLI. Figure 1 shows the incidence of RTLI relative to MLD and 6MWT distance. 5/14 with an MLD 18 Gy (the median level) developed RTLI vs. 2/15 with MLD  18(p = 0.2). For those  18 Gy, the RTLI rates were 0/8 and 2/7 for 6MWT  or 1400 ft., (the median value), p = 0.2. The ROC area under the curve for individual metrics was: FEV1 0.65, MLD 0.68, DLCO 0.61, and 6MWT 0.53. Combining FEV1 with 6MWT increased the ROC to 0.72. 12 patients had f/u 6MWTs between 3 and 12 months: 5 had declines in 6MWT (range = 150 –300 ft.) and 2 developed symptomatic RTLI; 4 had increases in 6MWT (by 110 –305 ft.), 1 developed symptomatic RTLI; in 3 with unchanged 6MWT, one had symptomatic RTLI. Conclusions: The 6MWT, a dynamic functional metric, appears to provide additional prognostic information beyond PFTs and dosimetric parameters. Patients with good functional capacity (measured by 6MWT) relative to their PFTs appear to have a reduced risk of RTLI. Increased MLD is known to increase toxicity risk. However, among patients receiving a modest dose of thoracic RT, those with a better 6MWT result appear to have a lower risk of RTLI. While no correlation has been seen between change in 6MWT after treatment and symptomatic toxicity, we continue to enroll patients and await further maturation of the data. We are hopeful that this validated functional metric will prove helpful in the pre-treatment assessment and post-treatment monitoring of irradiated patients. Supported in part by NIH Grant: CA69579 S556 I. J. Radiation Oncology ● Biology ● Physics Volume 60, Number 1, Supplement, 2004