Research Organization Document

Section 1
The purpose of this document is to organize your ideas and keep in mind the key research
components as you begin working through your research. Please refer to this document often so
that you remember the key questions you are answering and to update the research components
as you research them.
First, you will outline the 3 key components to selecting a research topic: a problem that
needs to be solved, evidence of gap in the literature (a summary of different journal articles that
support a similar topic or a journal article that says further research should be conducted on the
topic you are interested in researching), an active “references” page that you update continuously
to keep track of your research information.
For the “problem that needs to be solved section,” you need to decide what the problem is
for your research. This includes addressing a set of 5-7 questions that you need to refer to often
in your research to make sure that you are staying on topic. Key questions should be your active
research questions. When you have finished writing your research paper, you reader should be
able to address and answer these questions easily.
For the “evidence of gap in the literature section,” you should include a paragraph written
in your own words with referenced superscripts to the references page so that the instructor can
look at the article you are using to support your research.
The “references to support your research section” should include all of the references you
have used for your research in AMA formatting. Use this as a place to keep track of your articles
and update this often as you get into your research. This shouldn’t necessarily include all of the
references that you sent to the instructor for the conference call. Since your topic was likely
tweaked during the conference call, only include the references that pertain directly to your topic.
This is important because there is a limit to the number of references you can have depending on
the type of paper you decide to write.
Finally, you will indicate the title of your official research topic. This may change as you
begin your research so it is important that you keep your topic updated so that the instructor
may track your progress through the research paper progression.
For most groups, this information was decided in the conference call with the instructor
so it should be easy to answer these questions.

Problem that needs to be solved:

There are multiple ways to plan whole breast tangents in radiation oncology today. Among the
options, electronic compensation and the field in field techniques are very popular. With modern
technology, dose conformity and maximum dose regions can be improved more today than ever
before. Do either of these techniques consistently provide better plans in whole breast treatments
with volumes of similar size?
Key Questions that need to be answered:
 Which technique is overall more effective at achieving clinical goals as addressed by the
RTOG guidelines for this patient population?
 Does electronic compensation or the field in field technique provide better dose
conformity for whole breast radiation planning?
 Which technique performs better at minimizing maximum dose regions in whole breast
radiation planning?
  If one technique is found more effective, is the difference significant enough to influence
the way oncology departments plan their patients?
 Do modern technology and treatment planning systems create plans consistent with
studies done in the recent past on the same topic?
 Does the most effective technique seem dependent on the size of the volume?
Evidence of a gap in the literature:
Following topic research from the four group members, a true study representing a comparison
of the two techniques with modern technology has not been found. Some studies make
comparisons but have too many variables to be considered reliable. A 2008 study compared the
two techniques but was filled with variables. Dosimetrists were restricted to 6MV beams on a
Varian 21 EX machine. Both left and right sided treatments were compared as well.1 A 2018
study with a patient population of 20 was done to compare techniques on multiple machines with
PTV volumes ranging from 417-2047ccs.2 Moreover, it was noted during the 2014 Combined
Science Meeting (CSM) that electronic compensation is not widely employed and literature
citations are limited.3
In Hideki’s article, a nice review of describing the comparison of two techniques for breast
tangential treatments: irregular surface compensation (ISC) and wedged tangent fields. The
comparison indicates that the ISC does a better job in reducing the hot spot to 105% when
compared to wedged fields.13 What the article does not do is compare ISC to field in field
treatment of tangential fields. Using this research will help in defining our project of comparing
ISC to field in field technique of treatment of tangent breast treatments.
References to support your research:
1. Lee JW, Hong S, Choi KS, et al. Performance evaluation of field-in-field technique for
tangential breast irradiation. Jpn J Clin Oncol. 2008;38(2):158-
163. https://dx.doi.org/10.1093/jjco/hym167
2. Koivumaki T, Fogliata A, Zeverino M, et al. Dosimetric evaluation of modern radiation
therapy techniques for left breast in deep-inspiration breath-
hold. Physica Medica. 2018;45:82-87. https://dx.doi.org/10.1016/j.ejmp.2017.12.009
3. Friend M. An overview of electronic tissue compensation (ECOMP) for breast
radiotherapy. Poster presented at: Combined Scientific Meeting; 2014; Melbourne,
AU. http://dx.doi.org/10.1594/ranzcr2014/R-0170. Accessed April 23, 2018.
4. Al-Hammadi N, Torfeh T, Sheim S, Petric P, Paloor S, Hammoud R. Indications for
intensity modulated radiation therapy using field-in-field and electronic compensator for the
treatment of large left breast volumes. Phy Med. 2016;32(3):322-
323.  https://dx.doi.org/10.1016/j.ejmp.2016.07.213 
5. Al-Rahbi ZS, Ravichandran R, Binukumar JP, Davis CA, Satyapal N, Al-Mandhari Z.
A dosimetric comparison of radiotherapy techniques in the treatment of carcinoma of
breast. J Cancer Ther. 2013;4:10-17. http://dx.doi.org/10.4236/jct.2013.411A002 
6. Lowe H, Hackett R, Salerno K, et al. Dosimetric Comparison of 3D-CRT, ECOMP, and
Hybrid IMRT Plans for Prone Whole Breast Irradiation. Lecture presented at: Roswell Park
Cancer Center; Buffalo, NY. 
7. Bellon JR, Wong JS, MacDonald SM, Ho, AY. Radiation Therapy Techniques and
Treatment Planning for Breast Cancer. Switzerland: Springer International
Publishing; 2016. http://dx.doi.org/10.1007/978-3-319-40392-2. Accessed April 23, 2018.
 8. Emmens DJ, James HV. Irregular surface compensation for radiotherapy of the breast:
correlating depth of the compensation surface with breast size and resultant dose
distribution. Br J Radiol. 2010;83(986):159–165. http://dx.doi.org/10.1259/bjr/65264916
9. Menon, G. Pudney, D. Smith, W. Dosimetric evaluation of breast radiotherapy in a
dynamic phantom. Phys Med Biol. 2011;56(23):7405–7418. http://dx.doi.org/10.1088/0031-
9155/56/23/005 
10. Caudell JJ, Jennifer F, Keene KS, et al. A dosimetric comparison of electronic
compensation, conventional intensity modulated radiotherapy, and tomotherapy in patients
with early-stage carcinoma of the left breast. Int J Radiat Oncol Biol Phys. 2007;68(5):1505-
1511. http://dx.doi.org/10.1016/j.ijrobp.2007.04.026
11. Flejmer AM, Josefsson D, Nilsson M, Stenmarker M, Dasu A. Clinical implications of the
ISC technique for breast cancer radiotherapy and comparison with clinical
recommendations. Anticancer Res. 2014;34(7):3563–3568.  http://dx.doi.org/10.1016/S0167-
8140(15)31349-9
12. Alghufaili AH, Shanmugarajah L, Kumaraswamy LK. Correlating the depth of
compensation to the 3-D shape of the breast to achieve homogeneous dose distribution using
the electronic tissue compensation treatment technique. Med Dosim. 2018 in press.
13. Hideki F, Nao K, Hiroyuki H, Hiroshi K, Haruyuki F. Improvement of dose distribution
with irregular surface compensator in whole breast radiotherapy. J Med Phys.
2013;38(3):115-119. http://dx.doi.org/10.4103/0971-6203.116361
14. Chang SX, Cullip TJ, Deschesne KM, Miller EP, Rosenman JG. Compensators: An
alternative IMRT delivery technique. J Appl Clin Med Phys. 2004;5(3):15-
36. http://dx.doi.org/10.1120/jacmp.v5i3.1965

New References:
1. Fragkandrea I, Kouloulias V, Mavridis P et al. Radiation induced pneumonitis following
whole breast radiotherapy treatment in early breast cancer patients treated with breast
conserving surgery: a single institution study. Hippokratia. 2013;17(3): 233-238.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3872459/

2. Radiation Therapy Oncology Group. NRG Oncology RTOG 1005. Updated

2014. http://www.rtog.org/ClinicalTrials/ProtocolTable/StudyDetails.aspx?action=openFile&
FileID=9366

3.
Research Topic:
A Dosimetric Comparison of Electronic Compensation vs. Field in Field Techniques in Whole
Breast Radiotherapy.
 Research approach
Section 2
The next section of your research organization document contains your research template to
follow as you begin your data collection. This section will change often but it will help you to
follow your goals closely as you progress and for the instructor to track your progress.
Study Details:
Retrospective vs. Prospective - Retrospective
Do any group members need to obtain additional IRB approval? No
Number of patients–10
Type of study – Case study
Roles of each group member (some members may have multiple roles)
Group Leader (someone who will keep the group on track, make sure
group members are adhering to deadlines, be the direct point of contact for the instructor with
overall questions, update the research organization document throughout the course of
research) - Ryan & Sean
Data Collector(s) (someone who will be doing the data collection and
data reporting in excel; maintaining journal entries) - Christina & Rodger
Data analysis (someone who will be responsible for analyzing the raw
data, running any statistical tests and providing conclusive data for the
writer)- Ryan & Sean
Writer (someone who is responsible for writing the outline (later in the
course) and the paper; usually the best writer of the group takes this role) - Ryan
Editor (someone who is responsible for checking each draft for errors
and providing feedback and corrections to writer) – Christina & Rodger
Data Collection Approach:
Indicate here what data you are looking to collect and your approach to collection:
Number of clinical sites for data collection: up to 4.
What information are you interested in (if a planning study, list structures for evaluation;
if a study survey, list your study questions): Breast dose conformity, OAR (lung,
heart, cont. breast dose), maximum dose region.
Are you interested in completing a statistical analysis on this data? If so, what parameters
will you be analyzing? (p-value, mean, t-test ect.). Yes – p-value, minimum dose,
maximum dose
What resources (in addition to the literature search) are available for you to use? Dr. Yu
Chen, site physicists.
 Previous research study that will be used for data analysis (ex: RTOG study
constraints): RTOG 1005
Description of your data collection approach (Please provide the instructor with the
details you intend to use in your research and use the example to be your guide). Example: We
will be analyzing how dose conformity changes comparing 3DCRT to IMRT. We will look at
pancreatic cases with tumor sizes between 200 and 500 cc to limit variability. All plan
comparisons will receive a total dose of 50 Gy in 25 fractions at 200cGy/day. We will analyze
dose coverage to the PTV, CTV and GTV structures including maximum dose, minimum dose
and the parameter of 100% of prescription dose covering 95% of the PTV, a constraint listed in
the RTOG 1234 trial. We will also analyze the following OR constraints: stomach: V10<70%;
V50<30%; small bowel: maximum dose of 50Gy, 0.03cc<47 Gy; total kidney: V20<40%,
V10<60%.
For data collection, our group plans to use anonymized CT datasets from any of our four clinical
locations. We are looking for patients with similarly sized breast and staging at time of
simulation. Our study will focus on only left or only right sided breast treatments.
All target volumes will be drawn by a single physician following a single protocol. (Dr. Yu Chen
using RTOG 1005 guidelines)
Patients will be planned for with both ISC and FIF methods by a respective student dosimetrist.
Whichever fractionation schedule we choose will be consistent for all patients. We will only be
focused on the primary treatment, although RTOG calls for a boost in some instances. We will
follow a 45-50Gy plan to the entire breast in 1.8-2Gy fractions.
Coverage will be analyzed to the PTV and GTV structures. Metrics of concern are maximum
dose location and percentage and overall dose conformity (100% of the volume is receiving X%
of dose).
OR constraints will also be analyzed. Ipsilateral and contralateral lungs, heart, and contralateral
breast doses will be studied. Which parameters we will use is not decided.
Additional details: