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Wael Mekhael
Research Methods in Medical Dosimetry I
March 25, 2015
Article Comparison: Trade Publication Article vs. Peer Reviewed Article
Part 1: Trade Publication
Trade Publications are magazines that are particularly designed for some selected audience
and their writing style is casual, moreover, the supporters or the contributors of trade
publications are paid for their work. 1 Here is basic concept that should be kept in mind when
talking or understanding about trade publications, trade publications are not needed to be
assessed or evaluated by extensive process that is usually done by various peer-reviewers.
For trade article I decided to evaluate MRI-Guided Radiation Therapy, The article has been
written by Kathy Hardy for Radiology Today. 2 I will analyze this trade article for its worth
and significance of its reported data by keeping in view the applications or benefits for the
dosimetrists and other professionals.
This article is from 2014 issue and provides information about the MRI Guided Radiation
Therapy, this system is actually made up of two subunits; one is the Precise Adaptive
Radiation Therapy and second one is real time MRI Imaging. Benefits of these tools are
explained in this article. One of the interesting things that I found was this system got
510(k) clearance in 2012 and now successfully installed at various sites. According to this
article the very first MRI Guided Radiation system were installed at Siteman Cancer Center
at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis and
the first patient received radiation therapy from this system during January of 2014. The
article also tells that this system became very popular among healthcare professionals and
the physicians have positive perception of this system. The article also claims that the real
time imaging technology along with radiation helped physicians in measuring the size of the
tumor and observing the real situation of the body. Perspectives of physicians and patients
undergoing therapy were also enlisted. According to this article radiation is being used as a
treatment method with approximately two-thirds of all cancer patients. This article raised a
point that before radiation therapy there was no proper mechanism of identification of site

or size of internal tumors. That was a good point for support of their product because their
system offers radiation as well as imaging both simultaneously. Using MRI-guided
treatments also reduced additional radiation exposure from CT scans or other methods. One
more interesting feature of the system was it targets only specific locations and does not
harm any other part of the body. In addition, it was compared with various other products
that are available in the market.
The article entails the possible use of MRI guidance in the treatment of cancers. There is no
doubt to the fact that radiation therapy is itself very damaging to the normal body cells in
addition to being damaging to the cancer cells. So as clinicians need to make every possible
attempt to reduce the harmful effects of radiotherapy to the normal body cells. MRIdian
system is a turn towards these horizons and has shown to be quite promising in terms of its
projections to radiation treatments.
Accurate Tomotherapy system uses the same technique. With the help of this technique,
using CT guided imaging; we can visualize the tumor areas and apply the appropriate
dosage to the desired place. MRI guided therapy has the added benefit of not only providing
better resolution and definition; it also saves the patient from all that unnecessary radiation
that a CT scan delivers to the patient.
It helps provide a real time image of what actually is happening with the tumor. With this
system, it gets easier to adjust the dosages to be delivered to the patient and avoid that
excessive radiation to the patients healthy cells. It also lets the physician know if the tumor
has regressed or gone into remission with radiation treatment or not. In short, we are not
working on a wild guess; rather the imaging lets us know if our radiation therapy has any
advantage to the patient.
With the advent of a more personalized way of dealing with cancer patients rather than a
more standardized care system that is similar for all patients, it has now become necessary
to deeply look into the patients tumor in real time. MRI guided radiation therapy lets the
oncologists know all that to a great extent.
The MRIdian system is great in terms of imaging the soft tissues and it helps a great deal in
individualizing the treatment and adjusting the individual patient dosages. After all it is the
satisfaction and treatment of the patient that matters a lot.

The MRI guided radiation therapy lets us combat the dynamic motion of the tumors. It gives
us an idea of the variability of motion during the treatment. With the knowledge of this
variability in motion, a physician can better modify the treatment plan. Often some tumors,
for instance head and neck tumors adapt to certain sensitive structures in the vicinity. The
head and neck tumors are not that mobile, their fixity and closeness to sensitive nerves can
make the treatment risky. With MRI guidance, the visualization of those structures and
prevention of unnecessary dosage for them has become possible.
One thing to understand is the purpose of the MRI guidance in radiation therapy. It is not
used as a diagnostic tool here; rather it is used as a treatment modality so the magnet
strength would need to match the radiation source as well. Using cobalt as the radiation
source and a weaker magnetic field, we can achieve the significant noise reduction and
viable results.
The MRI guided therapy is also good for the patients as the real time visualization of the
damage to the tumor cells, reassures him that he is being treated.
Despite the several positives of this therapy, the modality is still a novice. Clinicians are still
figuring out the exact clinical potential of this therapy and it is yet to be seen as beneficial
by the population at large.
The article is very helpful in the sense that it has provided us with hope in radiation induced
damage to the healthy body cells. An oncologists prime concern is the limitation of the
damage caused to the patient by the radiation and also the treatment of the cancer that is
primary. Having a view of all these factors and adjusting the dosages accordingly to limit
patient morbidity is a great help. So yes, professionally this article is very helpful and
productive for clinically practicing dosimetrists.
The information provided above has cited various practicing oncologists and they belong to
respectable clinical institutes. So the question about the accuracy of the information
provided is answered here in terms of the credibility of the clinicians mentioned here. The
information is accurate, valid and very much up to speed with the latest advancements in the
field of radiation therapy.
The article is very well written. It involves the basics of the problem and moves to the
solutions of the problem with the described modality. The information is accurate and
trustworthy and based on clinical observations by practicing doctors.

Various physiological benefits were explained in detail in the article; however, nothing was
explained about the cost of the system. Throughout the article there was nothing discussed
that explained the limitations of the system because in this world no one can make any
device that is 100% perfect. There are chances of error and in the cases of human e.g.
patients Special attention shall be paid toward identification of harms besides measuring
only benefits, There are a few red flags about the language in this article as a common man
might not be fully able to understand all the terminologies and intricacies in the article.
Apart from this, the article is very interesting and in flow with whats required.

Reference:
1- Lenards N, Weege M. Radiation Therapy and Medical Dosimetry Reading. [Powerpoint].
2- LaCrosse, WI: UW-L Medical Dosimetry Program; 2015.
3- Hardy K. (2014, September 30). MRI-Guided radiation therapy. Radiology Today, (15)9,
20. Retrieved from http://www.radiologytoday.net/archive/rt0914p20.shtml

Part II: Peer Reviewed Article


Peer reviewed articles varies from trade type of publication in that they are not implied for
the overall population. They are highly specific and complex type of articles that are target
oriented and specially designed for targeting specific audience of experts in the same
field.1These articles are expected to expand upon the expert collection of information,
convey truths, and give history of the field. This type of articles is composed by experts of
the same field and is reviewed by an expert peers in that same field before distribution.
Articles in this class are viewed as more regarded and must give a bigger number of
certainties and foundation data than trade publications.
Moreover, a peer review article is an article meant to be read by academics and
professionals. It is a formal article and is penned down by a professional in that particular
field or a researcher. The objective of this article is to answer or validate a formal question
or a hypothesis. It also has a formal structure containing: an abstract, an introduction, the
methodology used, results, discussion and references. Peer reviewed articles are usually a
reliable source of information for trade magazine articles or case studies. Their main
subjects are related to technical topics or professional issues. There is no classified
advertising in them, and they are reviewed by other professionals in the same field prior to
publication.
Im going to write a review of a research conducted by the Journal of Clinical Oncology on
the topic Heart Failure Risk Prediction in Childhood Cancer Survivors: Where Is Our
Crystal Ball? this article that I choose is an editorial type of scholarly article that was
written by Elizabeth C Bluhm. 2 Im going to analyze and look into each aspect of this
research and I will afterwards finalize a critique of this article.
The article was introduced in a very efficient and useful way and it provided good insight
into the problem. The research design was quite clearly explained and the sample
attainments were also described with their time frame and the patient treatment modalities.
The research helps predict the risk of heart failure in the survivors of the cancer prior to the
age of 21 years. The research material looks into various systems devised to predict the risk
of cardiovascular diseases in childhood survivors of cancer. The study data included more
than 14000 cancer survivors who had cancer before the age of 21 years in the time frame of

1970 to 1986. People who survived 5 years or more post treatment were considered the
survivors and were on long term follow up after the treatment. All the treatment data from
the patients was acquired and it included all the treatment modalities like chemo and
radiotherapy.
Questionnaires were mailed to the patients and cardiovascular results were assessed on the
basis of the responses obtained. The heart disease severity was scaled by the CTCAE and
different grades were assigned to different heart manifestations including severe, life
threatening and death. The points are assigned on the basis of three standard models. The
standard model, the simple model and the third model that takes into account, cardiac
dosimetry.
On the basis of the results obtained, there was found to be an association between the risk of
heart disease and cancer treatments. However, there are a lot of factors and individual facts
that have to be determined.
This article discussed that longitudinal studies are more powerful than other studies and
those can help in understanding the situation that will help in taking proper preventive
measures. Moreover, the editor also discussed the possible interactions between the drug
therapy and their adverse outcomes that focused on the antilipiemic drugs and some of the
antineoplastic drugs as well. Moreover the authors also highlighted that besides
advancements and huge data, still an exact model was not available. The authors said that
CCSS-CHF prediction tool may allow clinicians to predict symptomatic CHF, but it does not
increase our understanding of whether and when in the life of a young cancer survivor an
intervention might prevent adverse outcomes or death. The model can help physicians in
diagnosing these diseases properly and controlling the situation from being worse. The
authors also tried to pay attention on the validation of tools because only development of
tool does not solve the problem. To become a proper tool validation studies are needed to
confirm the use ability of that tool in different sample population.
The research was further modified and refined to include the cancer risk factors and
outcomes in the patients up to the age of 45 years rather than 40 years. This increased more
person years with the prevalent risk factors. This enables us to reach a hypothesis that if
considering an age of before 30 years for a survivor, the risk of cancer treatments for heart
failure outweighs the prevalent and classical risk factors of heart disease. After the age of 30

years the prevalent risk factors for cardiac disease play an increasingly greater role in
causing heart failure.
The new prediction system presented by Armstrong proves to be more clinically applicable
in general patient settings. For instance, for a young woman treated for mediastinal
lymphoma at the age of 15 years, treated with doxorubicin and chest radiation, the risk of
heart failure at 40 years would be 9.2%.
Many new prediction tools have been proposed for the assessment of the risk of heart
disease among the cancer patients. Accoding to McGin et al, there should be an impact
assessment of the tool to see if it alters the physical behavior and improves the patient
outcomes overtime.
The new CCSS-CHF tools provide the clinicians with a glimpse at the prediction of the
outcomes from childhood cancer survivors who suffer from heart failure. These do however
raise a few questions as to whether or not these new prediction tools can alter the course or
the risk of heart failure in young cancer survivors.
The result section is however a little lacking in terms of clear cut figures and facts. Although
it does confirm a relationship between the risk of heart failure and cancer treatment, the
research can be improved a little in this particular aspect.
This article lacked abstract, introduction, in detail methodology, results and discussion. All
of these heading were absent because according to journal requirements there is no need to
write all these headings. However a structured format and sequence is maintained and the
sources are also cited properly for meeting the requirements of the publishing journal.
Actually this sort of articles are prepared by the editors of the journal to highlight their topic
of interest or to highlight the recent or disturbing problems that are ignored and dont
receive proper attention from the experts of the field.
The authors utilized a wide range of references and quite a few of the references were
within the recent years. The data and the references were attained from different search
results and were versatile. Overall the research has helped greatly in assessing the risk of
heart disease in childhood cancer patients and the authors should be commended for their
efforts on the particular subject.
References:

1- Lenards N, Weege M. Radiation Therapy and Medical Dosimetry Reading.


[Powerpoint]. LaCrosse, WI: UW-L Medical Dosimetry Program; 2015.
2- Bluhm E. Heart failure risk prediction in childhood cancer survivors: Where is our
crystal ball? Am J Clin Oncol. 2015;33(5): 379-380.
http://dx.doi.org/10.1200/JCO.2014.58.8038.