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Yinan Wang
Research Methods in Medical Dosimetry I
February 29, 2016
Article Comparison: Trade Publication Article vs. Peer Reviewed Article
Part I: Trade Publication
Trade publications, which are usually written by staff or contract writers or journalists, target a
wide audience in a specific industry.1 The articles in trade publications are most about news, new
products or technologies, job openings in that profession, written in simple language that can be
understood by general audience. Trade publications are published by commercial publishers and
usually contain advertising content in specific areas. In this paper, I will review an article entitled
In-Room Imaging Brings New Style to Radiation Therapy, which was written by Pamela Kropf
and published by Radiology Today, a trade publication. The article will be summarized, and
the accuracy, strengths and the weaknesses of the information in this article will be discussed.
The article introduced how in-room and onboard imaging as a new technique improves the
accuracy of the treatment dose delivery to patients.2 Since the tumor and surrounding tissue may
undergo changes in size, position due to tumor shrinkage, weight loss, internal organ movement,
or patient movement throughout the treatment sessions, initial simulation CT images will not
provide accurate information of tumor location for the whole treatment course. In-room and
onboard imaging such as cone beam CT and MV CT images taken just before each treatment
session will provide precise tumor location information, which also confirm the dose is delivered
to the intended target. The article also mentioned the disadvantages of "in-room" and "onboard"
imaging including that the images qualities are not as good as planning CT images, and that they
are more expensive and require more quality assurance (QA). Nevertheless, the author concluded
that "in-room" and "onboard" imaging have improved the accuracy of target location and setup
position, which allows the delivery of advanced treatment such as hypofractionated stereotactic
radiotherapy and intensity-modulated radiation therapy (IMRT).In addition, the recalculation of
the 3D dose distribution based on the "in-room" and "onboard" 3D images will enable radiation

oncology move from image-guided radiation therapy (IGRT) to dose-guided radiation therapy
(DGRT).
The Article has its strengths in the following aspects. First of all, this article provides general
information of in-room" and "onboard" imaging in a concise and understandable language to a
wide audience in the field of Radiation Oncology and related fields. Secondly, the article was
written from an objective point of view including both the advantages and disadvantages of inroom and onboard imaging. Thirdly, it quoted two prestigious medical physicists in the
department of radiation oncology as the evidence of the viewpoint of the article, which provide
credibility to this article. Last but not least, the article provides the readers the information
containing not only the background and current application of in-room" and "onboard" imaging,
but also the future development direction of this technique.
The weaknesses of the article lie in the following aspects. Firstly, the article only quoted two
medical physicists who work in the field by mentioned their names within the article, but did not
include a bibliography. Secondly, the article didnt provide much original and detailed
information such as how much margins can be reduced when creating PTV by using in-room
imaging system. The two aspects make this article less convictive than a peer reviewed journal
paper.
Overall, I feel that this article is helpful for both practicing medical dosimetrists and medical
dosimetry students. This article provides general and easy to understand information about "inroom" and "onboard" imaging to a wide audience from all levels in this field and audience may
not know much about the topic. "In-room" and "onboard" imaging taken right before each
treatment session can provide accurate information of patient position and tumor location, which
will improve the accuracy of the treatment delivery to patients. It's important for practicing
medical dosimetrists and medical dosimetry students to know and have a general idea of new
techniques and how the techniques will advance in the field in order to broaden our knowledge
and provide the best care possible to patients.

References
1. Lenards N, Weege M. Radiation Therapy and Medical Dosimetry Reading. [Powerpoint]. La
Crosse, WI: UW-L Medical Dosimetry Program; 2016.
2. Pamela K. (2008 May). Characterizing Refined Viewing In-Room Imaging Brings New
Style to Radiation Therapy. Radiology Today,(9)8,14. Retrieved from
http://www.radiologytoday.net/archive/rt04212008p14.shtml.

Part II: Peer Reviewed Journal Publication


Peer reviewed journal publications, written by professionals or researchers in a certain field,
present the authors' original research, methodologies, and theories in great detail.1 These articles
are written for experts in a specific profession using formal and technical language. Different
form trade publications, peer reviewed journal articles always contain a list of references from
other journals (a bibliography) at the end of the article. The authors of the article must submit the
article to the journal editor and have it reviewed by experts who are in the same academic field
and considered as the authors' peer. In this paper, I will review an article from the journal of
Medical Physics entitled Respiratory correlated cone beam CT, which was written by Jan-Jakob
Sonke, Lambert Zijp, Peter Remeijer, and Marcel van Herk.
This paper tried to address the respiratory motion artifact in a cone beam CT (CBCT) scan using
onboard imager.2 Instead of using external surrogate, such as Philips bellows on the chest wall
or abdomen, to acquire the breathing curve used for 4D CBCT reconstruction, the authors
developed an alternative method that worked directly on the projection image space. The method
had shown promising results both on phantoms and human subjects.
In the introduction, the authors reviewed the existing methods for dealing this important issue in
CT scans.2 In the so-called respiratory-correct CT, the projection images are sorted
retrospectively using an external signal. However, as the CBCT was new at that time, no 4D
CBCT was available at that point. The authors developed a new method to implement the 4D
CBCT. The introduction shows the status of the technique at that time and the contents are
appropriate.
In the method section, the research design was clearly explained.2 The authors first described the
hardware components and specifications for the onboard imaging system. The respiratory signal
retraction from projections, using the diaphragms as surrogate, and respiratory correlated CBCT
reconstruction were described in detail: by sorting the projections according to the respiratory
signal into different phases, the 4D CBCT dataset can be created. To evaluate the reconstruction,
contrast to noise ratio (CNR) was defined. Both phantom and patients study were conducted. In
phantom study, a sphere with 5 cm diameter was driven in and out with a period of 3 or 5s, both

regularly and irregularly, and with an excursion of 2.5 cm in SI direction and 2.0 cm in AP
direction. Three patients with different breathing pattern were used in the patients study.
In the CNR study, the results matched the theoretical relationship between CNR and the number
of projections.2 In the phantom study, the sphere trajectory reconstructed from the 4D CBCT
matched well with the real one, although there was some phase shift occurred at several phases.
In both sagittal and transverse images, the reconstruction quality was best at the peak exhale
phase and worst at the peak inhale phase. It became even worse when the motion was irregular
with 3s period. In the patient study, the tumor motions in the LR, SI, and AP directions measured
form the 4D CBCT were (0.2, 1.2, 0.2) cm, (0.0, 1.9, 0.4) cm, (0.1, 1.7, 0.3) cm for patients I
(regular breathing), II (relative regular), and III (extreme irregular), respectively. The motion
artifacts were substantially reduced for patients I and II.
The authors implemented a respirator correlated CBCT reconstruction method that took full
advantage of the diaphragms in the projection images.2 Through the results from both phantom
and patient studies, the authors demonstrated the feasibility of this method and improvement to
conventional 3D CBCT reconstruction in motion artifacts reduction.
I think this paper is very impressive. The article was appropriately organized with all required
components for a research article including abstract, introduction, methods, results, discussion,
conclusion, and references. A literature review was provided in the introduction which gave the
readers sufficient background information on the research. The methods, results, discussion, and
conclusion were clearly and accurately explained in great detail. A wide range of references were
provided at the end of the article. Overall, I think this article is of high quality and has deep
influence in the field of Radiation Oncology.

References
1. Lenards N, Weege M. Radiation Therapy and Medical Dosimetry Reading. [Powerpoint]. La
Crosse, WI: UW-L Medical Dosimetry Program; 2016.
2. Sonke J-J, Zijp L, Remeijer P, van Herk M. Respiratory correlated cone beam CT. Med Phys.
2005;32(4):1176-1186.

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