Sheil

Patrick Sheil
Part I: Trade Journal

Trade journals are informal publications geared towards a broad audience. They

are written to appeal to the reader with colorful displays and brief length articles.1 These

articles are free to the public and written by freelance writers who are typically paid for

their services. I will analyze the article: Helical IMRT- New Treatments Taking Shape for

Multiple Myeloma by Thomas Rockwell Mackie in the trade publication Radiology

Today.2 Throughout my analysis, I will breakdown the relevance and accuracy of the

presented information, along with my personal opinions of its strengths and weaknesses.

This article discusses the benefits of treating patients with multiple myeloma

using TomoTherapy helical intensity modulated radiation therapy (IMRT) rather than

total body irradiation (TBI). The author discusses how multiple myeloma is the second

most prevalent blood cancer, affecting more 750,000 people worldwide. The author

advocates that helical IMRT is the superior treatment option due to its ability to reduce

radiation-related side effects and increase dosage while limiting exposure to healthy

tissue and organs.2 The author then goes on to include a personal statement from the first

multiple myeloma patient who was treated using the TomoTherapy treatment option in a

clinical trial, Carol Ramnarine. The article then discusses how her blood counts dropped

within a few days and that she has been in remission for nearly five years. The articles

concludes that early studies done at Far Eastern Memorial Hospital and the University of

Minnesota show dosimetric advantages and reduction of toxicity during treatments.

I found this article to be very engaging from start to finish. It gave a broad

synopsis of multiple myeloma and the treatment options of TBI and TomoTherapy in

which the common person could generally understand. Although it did grab my attention,
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I did not find the information to have substantial support backing its claim that

TomoTherapy is superior. The author incorporated a broad five-year survival rate for TBI

but did not include a comparison one for TomoTherapy. It lacked long term studies and

had contained no professionally reviewed studies with figures supporting its claim.

The author of the article cofounded TomoTherapy Inc, which makes me question

whether or not the article is written from an unbiased perspective. I find it hard to trust

that all information comparing TomoTherapy to TBI is on a fair playing field. In addition

to the bias, its core foundation of support relied on the opinion/case of one patient, who

was also the first patient treated during a clinical trial using TomoTherapy. One patients

account of his/her treatment is not a sufficient sample size and is more opinion based than

factual.

The article had some strong points but it was full of weak spots as well. The

biggest strength of this article was its short length and ease of understanding. For

someone who is not familiar with multiple myeloma or TBI/TomoTherapy, this article did

a good job of briefing him or her. The biggest weakness of this article is the bias of the

writer. The writer has a serious link to the treatment option that he is advocating is

superior to another. Another weakness is the lack of data or sample numbers. One

patients experience cannot exemplify the 750,000 people worldwide. A much larger

sample size would need to be seen for this article to have some traction.

Overall I found this trade article to be very intriguing. I am interested to see if a

more detailed study of TomoTherapy versus TBI for multiple myeloma patients comes

out in the future because I can definitely see how it could potentially be beneficial. The

helical aspect of TomoTherapy could in fact increase dosage to 16 Gy instead of

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traditional 10-12 Gy, while limiting exposure to healthy tissue and organs. Another aspect

that I found intriguing is how TomoTherapy would aid in day to day reproducibility in

patient setup over TBI where you are essentially eye-balling the field. I would not

recommend this article to a colleague/classmate due to the clear bias the author has

towards TomoTherapy. The bias and heavy use of opinions/quotations makes this article

lose credibility.
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References:

1. Lenards N, Weege M. Readings in Radiation Therapy & Medical Dosimetry.

[Powerpoint]. La Crosse, WI: UW-L Medical Dosimetry Program; 2017.

2. Mackie T. Helical IMRT- New Treatments Taking Shape for Multiple Myeloma.
Radiology Today. April 2010; 11(4):8. Retrieved from
http://www.radiologytoday.net/archive/rt0410p8.shtml
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Part II: Peer Review Publication

Peer-reviewed research articles are geared toward other researchers, professionals,

and individuals in the academic setting who work in a specialized field.1 These articles

are derived from detailed research, analysis, and data collection. They differ from trade

magazines by incorporating sections such as abstract, introduction, methods and

materials, results, discussion, and conclusion, which analyzes the sum result/findings of

the study. These articles undergo a vigorous process in which peers review them before

the research is accepted for publication.1 I chose an article from the peer-reviewed

journal, Medical Dosimetry. The article is titled, Whole-Breast Irradiation: A Subgroup

Analysis of Criteria to Stratify for Prone Position Treatment; conducted by Ramella S,

Trodella L, Ippolito E, et al.2 I will analyze all parts of this research article as well as

include my opinions regarding the research.

This question analyzed by Ramella and her peers was whether the benefit of using

prone-position technique outweighed the benefits versus supine-position technique for

various breast volume sizes. Ramella et al stated that the background of this research

relied on the observations and reports of radio-dermatitis, chronic fibrosis, lung toxicity,

and poorer cosmetic outcomes associated with patients treated in the supine position.

Whereas in the prone position, the breast hangs down away from the chest wall, which in

return improves target volume homogeneity, reduces infra-mammary and axillary folds

and decreases dose delivered to lung and heart.2 Previous research states that prone

treatment should solely be used for larger/pendulous breast, but Ramella et al wanted to

make a dosimetric comparison amongst subgroups of women having small (<400 mL),

medium (400700 mL), and large (>700 ml) breasts.

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The study included 38 women with early stage breast cancer. A CT plan was

derived in the supine and prone position for each woman. Of the 38 women, twelve had

small (<400 mL), 16 with medium (400700 mL), and 10 presented with large breast

volume (>700 mL). The lesions were located on the right breast in 23 cases and on the

left breast in the other 15 cases.2 Contours were drawn by the same physician for

consistency purposes and the prescribed dose was 50Gy to the isocenter in 25 fractions

within a 5 week span, followed by a 10Gy boost in 4 fractions to the tumor bed.

Following the methods section, Ramella et al provided the results of their study.

The summary of the findings was displayed in detailed tables and plotted graphs

comparing supine versus prone. The subgroup analysis according to breast volume

showed that non-target irradiated tissue in the supine was larger than in prone. It also

showed that the larger the breast volume, the bigger the non-target irradiated tissue there

was as well. Although the findings showed that the prone position showed a benefit

amongst all breast volumes, it wasnt significant in the medium and large groups. In the

small group however, it was evident that there was a 20% reduction in the mean value of

non-target irradiated tissue. The MUs delivered were also significantly decreased in each

subgroup. The authors concluded that the prone position is advantageous regardless of the

breast volume size.

Overall, I found this article to be very informative and could be useful for me

down the road as I enter the field as a dosimetrist. During my under-grad studies I did a

research paper on supine versus prone technique for breast patients so this article

especially intrigued me. I learned that prone is not only substantially beneficial for

large/pendulous breast but in this study, the small volume breast saw the most significant
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benefit. It is interesting to see as time goes on, how many institutions will choose prone

over supine as the primary position. Another factor not added to the discussion is whether

the patient can handle the prone position depending on their age, mobility, and comfort

level.

After reading both articles, it is clear to see the distinction in quality of the

information presented. Ramella et al break down why the study was done, the

background behind it, previous studies, materials and methods, and enhanced the results

section by implementing tables and figures so that the reader had a visual aid. Ramella et

al study showed figures and facts to support their claims whereas Mackie just provided

opinion. The professional journal is more useful for a medical professional who is

looking to learn and gain more insight and knowledge.

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References:

1. Lenards N, Weege M. Readings in Radiation Therapy & Medical Dosimetry.

[Powerpoint]. La Crosse, WI: UW-L Medical Dosimetry Program; 2017.

2. Ramella S, Trodella L, Ippolito E, et al. Whole-Breast Irradiation: A Subgroup
Analysis of Criteria to Stratify for Prone Position Treatment. Medical Dosimetry.
2010; Volume 37, Issue 2. Pg 186-191. Retrieved from:
http://www.meddos.org/article/S0958-3947(11)00149-X/pdf
doi:10.1016/j.meddos.2011.06.010