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9?L diesel engine) in normal driving conditions, during a weekday and outside of peak times, and measured the actual distance travelled, time taken and fuel used. The estimates using Google maps were found to be an accurate reflection of such journeys (see online supplementary table S1). Therefore, for each patient with breast cancer treated with lumpectomy and TARGIT, we could estimate these values for travelling between their home and the radiotherapy centre using Google maps. We estimated the total travel distance assuming a standard 3-week course of radiation for the 22 patients who received TARGIT IORT mainly as part of training for participation in the TARGIT-B trial (http://www.nets.nihr.ac.uk/projects/hta/1010407, http://goo.gl/sgdcTr) in the past 15?months. Estimation of CO2 emission We estimated RVX-208 the carbon dioxide produced by private transport based on the following measurement and assumptions: the fuel economy of the car was 39.7 miles per gallon (mpg; 6.96l/100?km), public transport usage was Protein Tyrosine Kinase inhibitor negligible, and half of the cars used diesel as a fuel and half used petrol. The CO2 produced by a 40?mpg diesel car is 299?g/mile (186?g/km) and that produced by a 40?mpg petrol car is 272?g/mile (169?g/km).19 Statistical analysis The null hypothesis was no difference in travelling distance or time between the two randomised groups. For statistical analyses, given that the distances travelled were skewed (not normally distributed) for at least one of the randomisation arms (TARGIT), we used both the Student t test with unequal variance as well as the non-parametric Wilcoxon rank-sum (Mann-Whitney) test. We used Microsoft Excel and STATA V.14.0 for statistical analysis. Results TARGIT-A trial data Between 1999 and 2012, 714 patients were recruited to the UK centres for the TARGIT-A trial, and of these, 568 were in the prepathology stratum. Those patients randomised to receive TARGIT had their radiotherapy at the time of their primary surgery. Eighty-three patients (TARGIT 50, EBRT 33) were excluded from analysis due to insufficient (n=70) or inaccurate (n=6) home postcode details, or where the patient would have travelled to a closer radiotherapy centre to receive check details EBRT (n=7), leaving 485 (85.4%) for data analysis. Of these, 236 patients (48.7%) had been randomised to receive EBRT. In the 249 patients who had been randomised to receive TARGIT, 46 (18.5%) received additional EBRT. Travel distance Overall, these 485 UK patients would have travelled 114?273 miles (183?905?km; TARGIT 21?681 (34?892?km) versus EBRT 92?591 (149?011?km)) for planning, consent and receiving radiotherapy as part of the TARGIT-A trial, with those in the TARGIT arm travelling considerably less than those in the EBRT arm (mean distance driven in miles: TARGIT 87.1 (SE 19.1) versus EBRT 392.3 (SE 30.2), in kilometres: TARGIT 140.2 (SE 30.7) versus EBRT 631.4 (SE 48.6), p