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Article Comparison: Trade Publication Article vs. Peer Reviewed Article

Megan Sullivan
Part I: Trade Publication
Trade journals are magazines that house articles designed to be a relatively easy read and
appeal to a broad audience.1 In between articles, one can easily find advertisements and
photographs while flipping through the weekly edition. The simple language used for these
publications do a great job summarizing a topic for a population that is not employed in the field
of study in which the subject focuses on. This is on par with the author frequently being a person
that is a staff or contract writer. This informal style of relaying information succeeds in
entertaining, but is not necessarily a great reference for current research methods. With this in
mind, I chose to review an article I found in Radiology Today Magazine entitled, MRI-Guided
Radiation Therapy by Kathy Hardy. My intentions with this review is to summarize and present
its application to the field of medical dosimetry.
This article discusses the use of magnetic resonance imaging (MRI) as an aid for image
guidance in the delivery of radiation treatments. This form of imaging would not only serve as a
pre-treatment guidance, but as guidance in real-time as well. The MRIdian system can be
compared to the operations of tomotherapy, but instead of using computed tomography (CT)
imaging, MRI would be the imaging modality.2 The article illustrates the benefits of this type of
imaging through the excellent soft-tissue definition and the ability to gain a greater
understanding of the physiological movements during treatment that effect the position of the
tumor. The article states that the MRIdian system allows the user to adapt to the changes of the
tumor over the course of the treatment. This means the dose could be calibrated on the spot based
the patients current anatomy. According to the article, this is an advancement to the current way
of treating patients from a scan done in the past and assuming everything about the patient has
remained the same. In order to couple this imaging modality with radiation treatment, a solution
was needed for the effects of the radiofrequency (RF) energy given off from the treatment beam
and creating noise that interferes with the MR signals. To overcome this, the solution of
treating with a cobalt source was the direction the developers decided to go due to the lack of RF
emission. This is a treatment modality that will no doubt have an effect on treatment planning in
the future.

There are a lot of different layers to this treatment system that have an impact on
dosimetrists and current dosimetry students. The idea of having MRI quality for treatment
guidance has the potential to change the standard definitions of contoured volumes and contours
of normal structures. This type of resource has the potential to minimize margins which would
lead to more sparing of normal tissue. Adapting the dose based on a regular basis based on
physiologic movements and using cobalt as a radioactive source would affect current treatment
planning practices for the dosimetrist and student, alike. Taking all of this into consideration, it is
to the benefit of the practicing dosimetrist and student to stay up to date to technological changes
such as this one.
Overall I think this article did a good job summarizing a complicated topic in a simplistic
way. The key points were highlighted without getting too caught up in medical jargon of the
field of radiation oncology. This style of writing successfully relayed the information for a broad
audience and supplied enough knowledge to create discussion among patients and medical
professionals. Articles such as these are important because news in the medical fields affect both
patients and medical professionals. Having a resource that can speak to a general population
helps to bridge this gap. The credibility of this article is lacking seeing as there are no citations
listed at the end and the author is a free-lance writer, not a professional in the field of radiation
oncology. The author does, however, quote two radiation oncologists. The third person quoted in
this article is the senior director of marketing for the company that developed MRIdian.
Although this source is informative, he is slightly biased towards the benefits of this product.
Which brings me to my next point of discussion, this article failed to touch upon any downside to
this treatment system. My experience in this field led me to a few questions of my own, none of
which were answered in this article. Any hint of addressing an area of concern with this system
was simply brushed over and redirected towards a positive aspect instead.
This article gives a great introduction to the use of MRI guided radiation therapy in realtime to advance treatment techniques. Dosimetrists, dosimetry students, and other radiation
oncology professionals would gain a lot from reading this article as in opens the doors to
possible advancements in the field. The writing style allows the general population to benefit
from this article as well. The validity of the information can be questioned as there are not any
sources cited, but the testimony of two radiation oncologists and input from the marketing

director of the company shed some light to the potential role of MRIdian. Generally speaking, I
enjoyed this article and would recommend it to colleagues.

References
1.

Lenards N, Weege M. Reading and Writing in Radiation Therapy and Medical

Dosimetry. [Softchalk]. LaCrosse, WI: UW-L Medical Dosimetry Program; 2016.

2. Hardy K. MRI-guided radiation therapy. Radiology Today Magazine. 2014;15(9):20.

http://www.radiologytoday.net/archive/rt0914p20.shtml. Published September 2014.
Accessed March 2, 2016.

Part II: Peer Reviewed Research Article

Peer-reviewed journals are scholarly publications containing articles written by a
professional in the field that target a specific audience in the same field on an academic level.1
The articles found in these journals go through a process called peer review in order to validate
the content of the article and ensure a high level of quality prior to the information being
published. Because the target audience are those in the same field, peer-reviewed articles assume
the reader has a knowledge base of the topic or research being presented. This assumption leads
to formal writing techniques and jargon that may not be fully understood by the general public.
The authors of these articles are driven by seeking answers to hypotheses or adding tried and
tested academic knowledge to a growing subject. With this in mind, I evaluated a peer-reviewed
article from the Medical Dosimetry Journal entitled Dosimetric Comparison of Metastatic Spinal
Photon Treatment Techniques by Ewing MM, Carnes SM, Henderson MA, and Das IJ. My
evaluation of this article will contain a summary of the question that was tested, the literature
review presented, the design of the research, results and conclusions drawn, and lastly my overall
impression of the research.
The goal of this study was to dosimetrically compare the standard treatment techniques
for palliative spine radiotherapy with using intensity-modulated radiation therapy (IMRT).
Anticipating the results of this research to show IMRT to produce the superior plan, the authors
sought out to compare optimal coverage versus optimal sparing for different conventional
techniques from each other as well. The conventional techniques included single-field, wedgedpair fields, and parallel opposed beam arrangements. One reason for this is due to the insurance
obstacle IMRT plans frequently run into for cases such as palliative spine metastasis.2
The literature review in the introduction of this paper covered the relevance of this topic
sufficiently. References were made to other journal articles regarding the prevalence of spine
metastasis and how nearly 50% of all metastatic disease is found in the spine.2 Additionally,
advancement in treatment techniques are allowing patients to live longer and therefore
retreatments are not uncommon. This recurrence is cause for seeking ways to more optimally
spare normal tissue, specifically the proximal spinal cord, in order to prevent long-term
neurologic complications. This background information validated the usefulness of this research
and gave the reader sufficient understanding and reference of related research.

The research design was well thought out, and had a lot of foresight. Because the authors
anticipated the IMRT plans to surpass the conventional plans, they made a point to identify the
advantages and disadvantages of the conventional treatment options. Additionally, the authors
addressed the fact that spine metastasis is found in the cervical, thoracic, and lumbar spine and
noted how anatomically different these levels are from one another.2 Considering these anatomic
variables, the authors started out with 55 patient datasets and strategically narrowed down to a
total of 9 datasets. These 9 were selected by measuring the separation from anterior to posterior
at C5, T6, and L3 in order to have three size categories for each level of the spine: small,
medium, and large. Upon taking the mean at each level for each size, one dataset was selected
that best represented the average of each category thus 9 total datasets were nominated. For each
of the 9 datasets, the gross tumor volume (GTV) was contoured by a single radiation oncologist
to maintain consistency. Organs at risk (ORs) were contoured for each dataset and the remaining
volume at risk was defined in order to measure the dose to the entire body minus the ORs. Plans
were generated for each of the 9 datasets to compare maximum doses in the GTV target, the
volume covered by the 100%, 95%, and 90% isodose lines, as well as the sparing of ORs,
especially the spinal cord. With this design, the researchers were able to compare the all of the
plans created for each of the datasets and determine the best technique for each level of the spine.
As expected, the authors proved the IMRT technique to produce the best plans for all
three levels of the spine.2 To look beyond this result, the authors reported the advantages and
disadvantages of the conventional plans for the cervical, thoracic, and lumbar spine, as well. For
the cervical spine it was noted that none of the conventional techniques provided optimal
coverage of the 100% isodose line, however, majority provided the desired coverage with the
95% line.2 Overall for the conventional techniques, the anterior wedge pair gave the best plan
based on its target coverage and minimal dose to ORs. For the thoracic spine, the results were
similar as the cervical spine in terms of the lack of 100% isodose line coverage and the only
technique that did not offer the adequate coverage of the 95% isodose line was the single
posterior field. The overall best technique for this level of the spine was the posterior wedge pair.
For the lumbar spine, the results were the same as the thoracic spine. Sufficient coverage with
the 95% isodose line with all of the conventional plans except for the single posterior field.

This is a peer-review article I appreciated greatly because of the preparedness and

relevancy it has to the field of Medical Dosimetry. There were many sources this paper
referenced to help validate the background information. The research itself was conducted in a
controlled manner by selecting 9 average datasets to represent anatomical differences, having a
single radiation oncologist contour the target volumes, and working on the same treatment
planning system to model and calculate every plan. This controlled environment allowed the
researchers to compare a mass scale of variables to a reasonable level. As a student in the field, I
believe this article combines a great concept of applying advanced treatment techniques to
otherwise elementary ones. Metastatic spine lesions are cases that come through virtually every
department and it is easy to adhere to traditional standards for the treatment planning process
regardless of it being the best technique. Initially reading through this article I found myself
asking questions such as, how practical is it to do an IMRT treatment on an emergency sim and
treat patient? or how much margin would there need to be on an IMRT plan to compensate for
possible movement with a patient in pain? or how easy would it be to match an IMRT plan in
the future if there is a recurrence nearby? For this reason, I enjoyed the article because it forced
me to think outside the box. I do not actually know the answers to these questions, and perhaps
the idea is not as farfetched as I had initially thought it to be. Maybe an IMRT plan can be
justified more often than we think. The authors acknowledge some clinical obstacles of using an
IMRT plan for such a case, but ultimately they are challenging the professionals in this field to
strive for the best option rather than the adequate one.

References
1. Lenards N, Weege M. Reading and Writing in Radiation Therapy and Medical
Dosimetry. [Softchalk]. LaCrosse, WI: UW-L Medical Dosimetry Program; 2016.
2. Ewing MM, Carnes SM, Henderson MA, Das IJ. Dosimetric comparison of metastatic
spinal photon treatment techniques. Medical Dosimetry. 2012;37(4):369-373.
doi:10.1016/j.meddos.2012.02.002. Accessed February 29, 2016.