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Ryan Clark
2/27/2016
Dos 711 Research Methods in Medical Dosimetry I

Article Comparison: Trade Publication Article vs. Peer Reviewed Article

Part 1: Trade Publication Article
Trade publication articles are often made to appeal to broader audiences and are written
in a more informal, journalistic format.1 These articles are often made for subscription magazines
and feature articles about certain products and services for a given field. The publishers are most
often times paid by a company that is being featured in the trade publication article. This in turn
can cause a trade articles integrity to be questioned by the reader. The trade publication article
that I will be reviewing comes from the online magazine Radiology Today. The title of the article
is Reducing PET Dose and is written by Beth W. Orenstein, a freelance medical writer.
This article was written to make readers aware that there are certain methods and
considerations that are being taken into account by the manufacturers of PET scanners to help
reduce the amount of dose a patient receives during a scan. There is new technology that has
been introduced by companies such as GE, Siemens, and Toshiba that can help lower the dose
that is required to produce high quality PET scans.2 Such improvements include higher
sensitivity of the cameras, so less FDG is needed, and variable table speeds, to better optimize
the overall scan time for each patient. The article claims that the main problem why there hasnt
been much stress on reducing the amount of radiation dose given during a pet scan is because the
FDA oversees radiation dose given from the CT portion of the scan while the Nuclear Regulatory
Commission oversees only the radiopharmaceuticals injected during a PET scan.2 A reason there
has not been a decrease in the amount of FDG delivered for each patients scan is that there is no
financial incentive for centers to use a lower dose. If a half of the dose was used in a scan it
would cost the same as a full dose and the exam would take longer. These new technologies in
the field will not only help reduce the radiation dose patient receive during PET/CT scans, but it
will also help improve the accuracy and clarity of PET scans that could potentially be used by
dosimetrists as well.

The field of medical dosimetry is heavily dependent on the constant advances of medical
technology that are currently being implemented in todays medical field. Advances in the
quality and safety of imaging devices greatly benefit 3D treatment plans. PET/CT scans are an
important part of the treatment planning process as they can be fused with simulation CT scans
to allow for better contouring and to easily define target volumes. This article shows that
manufacturers are working to improve the slice thickness and reduction of noise in future PET
scans. PET/CT scanners are being utilized more often in treatment clinics and may be utilized
even more if manufactures are able to further minimize the radiation exposure for each exam
while still improving the quality of the images.
When analyzing this article, there are several key points that I felt greatly benefited this
piece. The problem of why PET scans are having difficulties in reducing the dose of radiation
given to patients is clearly stated and is then followed by what the manufactures of the PET/CT
scanners are doing to help address the issue. The word choice used was appropriate and did not
use medical jargon. If there was a term or phrase that might confuse the average reader,
Orenstein would quickly follow up with a definition. The facts provided on how the industry was
improving were thought provoking and came from the leading manufactures in the industry such
as Siemens, GE, and Toshiba. The article guides readers through simple to more complex
solutions on solving the problem of helping reduce the patient dose of PET/CT scans. These
solutions are organized by explaining what each of these manufactures has done and will do to
help make reducing patient dose a top priority.
Despite these positive points, I feel that there are still a few flaws that can be found
within this trade publication article. Since this is a trade publication, it is not reviewed by any
peer editors and shows a biased view towards only the positive things the manufacturers are
providing. There is never a simple counter statement or differing view on PET/CT scans from
anyone outside of the industry that manufactures the scanners. There is only a small excerpt at
the end by Richard Morin where he is quoted that PET/CT scans should only be used for certain
clinical applications.2 Theoretically, the best way to reduce the radiation dose to a patient would
be to not have a PET/CT scan performed at all. Instead, I feel that this article could have better
highlighted ways in which standards could be created by those in the field of nuclear medicine to
determine when a patient truly would need a PET/CT scan. This article seems biased towards
only focusing on the benefits of what the scanners are going to be capable of in the future.

References:
1. Lenards N, Weege M. Readings in Radiation Therapy & Medical Dosimetry.
[Powerpoint]. La Crosse, WI: UW-L Medical Dosimetry Program; 2016.
2. Orenstein B. Reducing PET Dose. Radiology Today. January 2015; 17(1):22. Retrieved
from http://www.radiologytoday.net/archive/rt0115p22.shtml

Part II: Peer Reviewed Research Article

On the contrary to the trade article written by Orenstein, a peer review research article
titled, A practical method of modeling a treatment couch using cone-beam computed
tomography for intensity-modulated radiation therapy and RapidArc treatment delivery, written
by Aldosary G, Nobah A, Al-Zorkani F, et al. analyzed the effects in dose delivery that the
presence of the treatment room couch could have during radiation treatments. Unlike the trade
article, this study has a specific target audience for medical dosimetrists, has a scientific writing
style, comes from original research, and seeks to answer a hypothesis.1 This article has been
peer-reviewed and has had the data and methods of the study evaluated by other professionals in
the field. The article is a well written research paper that consists of sections such as an abstract,
introduction, methods and materials, results, discussion, conclusion, and references.
The problem and hypothesis that need answered were clearly stated in the introduction.
The author discusses how the increased use of IMRT plans has made the need for accounting for
the beam attenuation of the treatment room couch to be more pivotal than ever.2 When the
treatment room couch is neglected during the planning process, the dose distribution at the
location of treatment will deviate. The occurrence of treating through the table is much more
prevalent in IMRT and RapidARC techniques. The goal stated by the article is to offer a
comprehensive review of all dosimetric effects that treatment couches can cause while also
offering a practical and accurate method for facilities to easily model the correct density
parameters of their treatment couches.
The methods and materials section of the article was well written and easy to follow. The
tools and methods that were used to gather the Hounsfield unit values of the treatment room
tables were appropriate. For example, one of the studies used a Catphan 504 cylindrical phantom
that was scanned by a Phillips Brilliance CT scanner to acquire the electron densities used for the
treatment table comparison.2 The research design was clearly explained as it showed how
different densities of table material would affect the percent depth dose of an oncoming beam
that was read by MapCheck array. A total of three test were run using the same set of patient CT
data where one plan contained the default treatment couch, the second contained the modeled
couch, and the third plan did not include a couch.2
The results section accurately displayed all of the data that was acquired from the tests
that were conducted in the study. A series of tables were used to compare the acquired HU values

from the scans with the manufacturer reported HU values.2 The difference of PDD for when the
couch was present or not was illustrated in a table for both 4-MV and 10-MV. The data is
accurately shown for the PDDs acquired by using measurement square points and calculations
lines. The results are then related to different IMRT treatment plans in a table to show the 1, 2,
and 3 percent difference marks. These treatment plans include how the accuracy of the table
density can affect brain, pelvis, and abdomen treatment plans.2
The discussion takes the data and concisely answers the question that was asked in the
introduction portion of the article. The results show that there is a significant difference between
the HU units that are provided by the table manufacturer and by what is actually scanned by the
CT.2 Despite this, there was only a negligible 0.8% difference in dose given between the two
couch structures. The significant find of the study was that there is a large difference in the dose
delivered between if a table is included or not included within the treatment plan. It was found
that the dose delivered dose can be as large as 9.5% and 7.3% for 4-MV and 10-MV beams
respectively.2 The discussion does a great job evaluating how the results found in the study
confirm what other prior studies have found relating to couch structures and PDD. There is no
evidence of bias that could possibly hinder the data that was found from being accurate in this
article.
The conclusion accurately summarized the research process and highlighted the most
important findings from the tests that were performed. The authors stressed the importance that
future treatment plans should always include the couch structures for IMRT and RapidArc.2 A
wide variety of different articles and journals were used from reputable sources within the
reference section. Though, some of these references seem a little dated and go back to the late
1990s and early 2000s.
I felt that the peer-reviewed article did a much better job of walking the reader through
the scientific research process to answer the question at hand. It was clear that more extensive
research and thought was put into the work. The author seemed more unbiased and even came to
the conclusion that some of the research that was conducted did not have any significant result
for the field of medical dosimetry. Overall, I felt that the article was very well written and
presented the data that was found in an informative manner for the reader. I feel that this article
comes as an important reminder for current medical dosimetrists to always include the treatment
couch for IMRT and RapidArc plans.

References:
1. Lenards N, Weege M. Readings in Radiation Therapy & Medical Dosimetry.
[Powerpoint]. La Crosse, WI: UW-L Medical Dosimetry Program; 2016.
2. Aldosary G, Nobah A, Al-Zorkani F, et al. A practical method of modeling a treatment
couch using cone-beam computed tomography for intensity-modulated radiation therapy
and RapidArc treatment delivery. Medical Dosimetry. 2015; 40(4):304-313.
http://dx.doi.org/10.1016/j.meddos.2015.03.008. Published April 29 2015. Accessed
February 27, 2016.