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Ashley Walsh
DOS 711
March 25, 2015
Article Comparison: Trade Article vs. Peer Reviewed Article
Part I: Trade Publication
Trade publications are written to be informative, and entertaining and a little more of a
light read to the general public. Trade articles are published in a wide variety of magazines and
share one common journalistic and informal approach and usually pertain to broad human
interests.1 I will provide a critical review of the article produced by Radiology Today Magazine
entitled Proton Therapy and Cost written by Orenstein to determine the effectiveness and
communication in the article. While reading I will provide a summary and the reason has
usefulness to professionals in this area as well as the good and bad points.
The article was looking at the cost difference between traditional IMRT and Proton
therapy. It explored the difference in the overall construction and design of the two centers and
the individual reimbursement of treatments if you chose Protons vs. IMRT. In an era of
increasing cost scrutiny, investigators are studying the cost of proton treatments. What theyre
finding may not match many peoples perceptions.2 This article and topic is something that is
very interesting to me as a medical dosimetrist for looking into the future of which way treatment
planning is heading, but is beneficial to anyone in the Oncology department as this has the
potential to affect all of us. If the world of radiation therapy is changing to charged particles that
means the treatment planning we know will not be the same and we as dosimetrist would have to
figure out how to adapt to the evolving technologies. I think the accuracy of the author was true
at the time the article was written, however, reimbursement is something that is changing all the
time. And cost of the centers Im sure are reasonably close if not spot on. I think this article was
strong in giving exact numbers instead of just saying something is 30% more. That is fairly
useless when trying to compare two options.

References
1. Lenards N. Weege M. Radiation Therapy and Medical Dosimetry Reading [Powerpoint].
La Crosse,WI: UW-L Medical Dosimetry Program;2015.
2. Orenstein B.(2015 February).Proton Therapy and Cost. Radiology Today,
(16)2:22Retrieved from http://www.radiologytoday.net/archive/rt0215p22.shtml

Part II: Peer reviewed research article


Peer review articles are written to explain and give details of the authors research to a
narrow group of professionals who understand the topic. Peer review articles take a different
approach than trade articles, as these articles are written by professionals formally detailing the
basis of their hypotheses for research or debates for professional issues.1 A key aspect to these
articles is that they are carefully reviewed by peers in the same field before they are published.
This ensures if there are any inherent issues they will be challenged before published. I chose to
analyze an article from Medical Dosimetry entitled A planning comparison of 7 irradiation
options allowed in RTOG 1005 for early-stage breast cancer by Chen et al., I will provide a
critique of all aspects of the articles including a brief overview of the hypothesis, an analysis on
the background information the plan, results and conclusion.
The general research idea was to compare the 7 treatment plan options in achieving the
dose-volume criteria required by the Radiation Therapy Oncology Group (RTOG) 1005 protocol.
Dosimetry plans were generated for all 7 arms of the radiation portion of the protocol. Next a
variety of dose-volume parameters, including target dose conformity and uniformity as well as
normal tissue sparing were compared for these plans. The article was written to well explain the
useful ness of the study and relevant background information. The introduction explained the
current methods for treating breast cancer in different stages and outlined the reasons why
alternative approaches are continuously explored. The information provided was enough to
understand the subject and the experimental processes.
The research design was developed to test both arms of the protocol as well as each
combination of treatments. Arm I was for standard WBI comprising IMRT or 3DCRT with 2
Gy/fraction for 25 fractions with a boost of 12-14 Gy in 6-7 fractions. Arm II patients undergo
accelerated hypofractionated WBI comprising 3DCRT or IMRT with 2.67 Gy/fraction for 15
fractions with a concurrent boost to the lumpectomy site to reach 3.2 Gy/fraction. Overall, 7
treatment approaches are allowed: (1) 3DCRT WBI plus 3DCRT boost (3D+3D); (2) 3DCRT
WBI plus electron boost (3DCRT+e); (3) 3DCRT WBI plus IMRT boost (3D+IMRT); (4) IMRT
WBI plus 3DCRT boost (IMRT+3DCRT); (5) IMRT WBI plus electron boost (IMRT+e); (6)
IMRT WBI plus IMRT boost (IMRT+IMRT); and (7) simultaneous integrated boost (SIB) with
IMRT.2 Patients previously treated were re-planned and evaluated on a number of criteria looking
at both the planning target volume (PTV) coverage and Organs at risk (OR) sparring.

The researchers were able to achieve the required criteria on all 95 plans generated, with most
(89 out of 95) achieving the ideal criteria. The plans that failed to meet the idea criteria were both
failing on the PTV coverage, and one failing on OR constraints as well. The main reason pointed
to in this article was for patient specific anatomy. The researchers in this article are well versed
in protocol work, since sometimes it can be hard to start without understanding exactly what the
protocol is requiring, and experienced treatment planners since multiple modalities are used. The
results were that all 7 treatment options allowed in the RTOG 1005 protocol can meet the
required acceptable dose-volume criteria by the protocol, with most plans achieving the ideal
criteria for the patient cases studied.2 So if clinical trial sites fully understand the protocol and
understand what the objectives are they should be able to reach a treatment plan that is per
protocol and avoid any sort of deviations.
I think this article was well written and explained appropriately the subject matter, and
why it is the continued subject of research. Protocols can be frustrating and appear unobtainable
to new researchers, this helps break down each arm and show that the criteria can be met. And
showed if the ideal criteria cannot be met why, and show that is does happen but it is not a big
deal because patient specific anatomy can determine how much you will struggle when planning.
The article is a text book case of a peer reviewed article. The article outlined all of the critical
pieces including a hypothesis, explained the experimental design, results and a hypothesis. I have
a background in protocol work so it might be easier for me to follow than some, but I think all
the information was there.

References
1. Lenards N. Weege M. Radiation Therapy and Medical Dosimetry Reading [Powerpoint].
La Crosse, WI: UW-L Medical Dosimetry Program; 2015.
2. Chen G, et al, A planning comparison of 7 irradiation options allowed in RTOG 1005 for
early-stage breast cancer.Med Dosim.2015;40(16):21-25
http://dx.doi.org/10.1016/j.meddos.2014.06.007