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Amber Mehr
April 15, 2018
Future Research in Medical Dosimetry
Article 1: In an article by Olson el al¹, researchers discussed how immobilization devices,
though good for replication and preventing movement, attenuate radiation beams. This study
looked specifically at head/neck devices.¹ The goal was to determine how these devices effected
planning target volume (PTV) coverage.¹ They performed one measurement and calculation
incorporating the immobilization devices and one without within Eclipse and compared the
plans.¹

The article provided possibilities for future research. One way to add to this research
would be using a new treatment planning system to see how it incorporates the attenuation of the
head and neck devices into the plan.¹ The article also suggested seeing how the attenuation by
the head and neck devices effected the dose to critical organs and not just the PTV.¹ Finally
another way to expand the research would be using a new dose algorithm for calculations and
seeing the difference with and without the attenuating immobilization devices.¹

Article 2: In the study by Wright et al², researchers assessed volumetric-modulated arc therapy
(VMAT) when completing treatment planning for prostates within Pinnacle using a dose of
7800cGy in 200cGy fractions. The goal of the study was to determine measurements and
guidelines that could be used to regulate the quality of the prostate plan and use them for plan
evaluation.² The data gathered was used to make a new protocol for VMAT of the prostate with
contouring procedures and critical organ goals.²

Future research suggested by this study, would be taking the new protocol created in this
article and applying it in future plans and reporting the results.² Another place for future research
could be creating objectives using a new treatment planning system like Eclipse. Researchers
could also test these objectives within a treatment planning system other than Pinnacle. Finally,
researchers could continue this research looking at different fractionation regimes and different
doses and coming up with objectives of their own.

Article 3: The article by Nawa et al³, looked at the accuracy of an automatic treatment planning
program for prostates within the Pinnacle planning system. Patients who were previously treated
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were planned again with the Auto-Planning module and then compared.³ No changes were made
to the Auto-Planning program’s plan.³

Reading this article presented many possibilities for future research. One possibility for
future research would be looking at the accuracy of other Auto-Planning programs for prostates
and comparing them with previously planned treatments. Researchers could look at thorax or
abdomen cancers and see how automatic treatment planning works for these cases. They could
also try prostate Auto-Planning programs within different treatment planning systems besides
Pinnacle and see how well they do when compared to the Pinnacle Auto-Planning or the
previously planned cases within the same system.

Article 4: In the study presented by Liao et al⁴, researchers aimed to protect the small bowel
while performing brachytherapy for cervix cancer. They wanted to limit the dose to the small
bowel but still provide satisfactory coverage of the PTV.⁴ All of the patients had previous
treatments of 4500cGy in 180cGy fractions of external beam radiation and then they were treated
with a high-dose-rate of 2800cGy in 700cGy fractions using a brachytherapy ring applicator.⁴
They kept the dose received by 2cm³ of the small bowel under 500cGy while still following the
additional organ at risk objectives.⁴ The plans then looked at how these changes effected PTV
coverage.⁴

Possibilities for future research provided by this article would be looking into future
disorders that occur due to the dose of 2cm³ of the small bowel.⁴ Other possibilities for future
research could be seeing how brachytherapy treatments alone effect dose to the small bowel
when treating cancer of the cervix. Completing a similar study but not using patients with
previous external beam treatments. Researchers could also test a different fractionation regime to
see if it will maintain coverage of PTV but also reduce small bowel dose.

Article 5: In an article by Ward et al⁵, the researchers look at different ways to treat the
beginning stages of glottic carcinoma. The traditional treatment is a parallel-opposed beam
technique and the researchers wanted to test intensity-modulated radiotherapy (IMRT) and
VMAT in a special set of patients.⁵ The researchers want to see if these methods can help protect
certain organs at risk better than the traditional treatment method.⁵
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Through reading this article, one possibility for future research is figuring out the percent
occurrence of a geographical miss when using IMRT to treat glottic carcinoma.⁵ Reading this
article also sparks the question if IMRT can be used for other cancers that use 3D treatments.
Researchers could look at other treatments that typically use 3D and see if IMRT treatment
protects critical organs without a high chance of PTV geographical miss.
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References
1. Olson A, Phillips K, Eng T, et al. Assessing dose variance from immobilization devices
in VMAT head and neck treatment planning: A retrospective case study analysis. Med
Dosim. 2018;43(1):39-43.
https://doi.org/10.1016/j.meddos.2017.08.001
2. Wright K, Ferrari-Anderson J, Barry T, et al. Improving plan quality for prostate
volumetric-modulated arc therapy. Med Dosim. 2017;42(4):348-356.
https://doi.org/10.1016/j.meddos.2017.07.001
3. Nawa K, Haga A, Nomoto A, et al. Evaluation of a commercial automatic treatment
planning system for prostate cancers. Med Dosim. 2017;42(3):203-209.
https://doi.org/10.1016/j.meddos.2017.03.004
4. Liao Y, Dandekar V, Chu JCH, et al. Reporting small bowel dose in cervix cancer high-
dose-rate brachytherapy. Med Dosim. 2016;41(1):28-33.
https://doi.org/10.1016/j.meddos.2015.06.005
5. Ward MC, Pham YD, Kotecha R, et al. Clinical and dosimetric implications of intensity-
modulated radiotherapy for early-stage glottic carcinoma. Med Dosim. 2016;41(1):64-69.
https://doi.org/10.1016/j.meddos.2015.08.004