Background/Aim: External Beam Radiotherapy (EBRT) is an effective, well tolerated, inexpensive treatment for painful bone metastases with response rates of 60–80%. 25% of patients report complete resolution of pain. 1 2 Results are similar with an 8Gy single fraction (#) vs 20Gy in 5#. Single treatments are quicker, less expensive and minimise patient travel.This audit describes Royal Marsden (RM) prescribing practice, and documentation of performance status (PS) and pain response.Standard: Audit standards are RCR guidelines.3 Patients with an uncomplicated painful bone metastasis receive a single 8Gy fraction, good prognosis patients with MSCC (malignant spinal cord compression) receive 20Gy/5# or 30Gy/10# of EBRT4 and all patients should have documented PS and treatment response.Methodology: Retrospective audit using electronic patient records to collect data for April and May 2012.Results: 114 patients (125 sites) were treated at RM. The commonest tumour site was prostate, commonest fractionation schedules were 8Gy/1# (46%) and 20Gy/5# (43%) and commonest site of treatment was spine(63%). 68% patients with uncomplicated bone metastasis received 8Gy/1#. All good prognosis patients with MSCC received 20Gy/5# or 30Gy/10#. Pain responses were documented in 55% of patients, the response rate being 76% of those with documentation. PS was documented in 54% of cases. Using 8Gy /1# appropriately could free one linear accelerator for one day a month.Action Plan: We aimed to improve education through discussion at the Clinical Oncology Consultants Meeting and departmental audit meeting. Particular points for discussion included appropriate use of an 8Gy single fraction and the most appropriate follow-up after EBRT.Results of Re-audit: In April and May 2013, 147 patients received 163 treatments. 70% patients received 8Gy /1# (previously 68%). 98% patients with MSCC received 20Gy/5 or 30Gy/10 #. Pain response was documented in 48%. Documented pain response was 90%. PS documentation significantly improved to 77%.Key references[1] Wu et al. Meta-analysis of dose-fractionation radiotherapy trials for the palliation of painful bone metastases. Int J Radiat Oncol Biol Phys 2003, 55(3)594–605.[2] Chow et al. Update on the systematic review of palliative radiotherapy trials for bone metastases. Clin Oncol, 24(2012)112–124[3] Royal College Radiologists Guidelines on treatment of bone metastases with radiotherapy, July 2006, http://www.rcr.ac.uk/docs/oncology/pdf/DoseFract_415_Bone.pdf[4] NICE, 2010, CG75 Metastatic spinal cord compression, http://guidance.nice.org.uk/CG75/NICEGuidance/pdf/English Background/Aim: External Beam Radiotherapy (EBRT) is an effective, well tolerated, inexpensive treatment for painful bone metastases with response rates of 60–80%. 25% of patients report complete resolution of pain. 1 2 Results are similar with an 8Gy single fraction (#) vs 20Gy in 5#. Single treatments are quicker, less expensive and minimise patient travel. This audit describes Royal Marsden (RM) prescribing practice, and documentation of performance status (PS) and pain response. Standard: Audit standards are RCR guidelines.3 Patients with an uncomplicated painful bone metastasis receive a single 8Gy fraction, good prognosis patients with MSCC (malignant spinal cord compression) receive 20Gy/5# or 30Gy/10# of EBRT4 and all patients should have documented PS and treatment response. Methodology: Retrospective audit using electronic patient records to collect data for April and May 2012. Results: 114 patients (125 sites) were treated at RM. The commonest tumour site was prostate, commonest fractionation schedules were 8Gy/1# (46%) and 20Gy/5# (43%) and commonest site of treatment was spine(63%). 68% patients with uncomplicated bone metastasis received 8Gy/1#. All good prognosis patients with MSCC received 20Gy/5# or 30Gy/10#. Pain responses were documented in 55% of patients, the response rate being 76% of those with documentation. PS was documented in 54% of cases. Using 8Gy /1# appropriately could free one linear accelerator for one day a month. Action Plan: We aimed to improve education through discussion at the Clinical Oncology Consultants Meeting and departmental audit meeting. Particular points for discussion included appropriate use of an 8Gy single fraction and the most appropriate follow-up after EBRT. Results of Re-audit: In April and May 2013, 147 patients received 163 treatments. 70% patients received 8Gy /1# (previously 68%). 98% patients with MSCC received 20Gy/5 or 30Gy/10 #. Pain response was documented in 48%. Documented pain response was 90%. PS documentation significantly improved to 77%. Key references [1] Wu et al. Meta-analysis of dose-fractionation radiotherapy trials for the palliation of painful bone metastases. Int J Radiat Oncol Biol Phys 2003, 55(3)594–605. [2] Chow et al. Update on the systematic review of palliative radiotherapy trials for bone metastases. Clin Oncol, 24(2012)112–124 [3] Royal College Radiologists Guidelines on treatment of bone metastases with radiotherapy, July 2006, http://www.rcr.ac.uk/docs/oncology/pdf/DoseFract_415_Bone.pdf [4] NICE, 2010, CG75 Metastatic spinal cord compression, http://guidance.nice.org.uk/CG75/NICEGuidance/pdf/English