Brendan Gallagher

Research Methodology
Compare/Contrast Activity
February 24, 2016
Part I: Trade Publication Article
Trade articles are journalistic articles and are meant to inform a specific group of
readers. Trade articles are free and offered online or in subscriptions such as Radiology
Today which this article is from. Trade articles are free because because advertisers pay
for them1. Trade publication offer news and information about products or services in a
particular area1. Staff and contact writers write these publications. They do not have the
credibility that peer reviewed journals have, but are still very educational for the group of
readers that are in that field.
The article I read was called Reducing PET Dose and I thought it would be
interesting to read since we do a lot of fusions in clinicals and it wasnt very old or out of
date like the others. The article was written in January 2015 in the Radiology Today
magazine. The article was written by Beth Orenstein who is a medical writer and is
commonly featured in Radiology Today. Since our job is to provide correct doses to the
patients, it was nice reading how nuclear medicine technologists deal with this as well.
Being able to reduce the dosages for scans is a huge benefit for the patient. This article
explored how the industry, software, and differences from CT affects the dose with PET
scans.
Dose reductions for PET scans do not get as much attention that CT does. PET
scans and PET/CT scans expose the patient to more radiation than CT does on its own2.
The major problem for dosages wit PET scans is that there are two different industries
that provide the cameras and radiopharmaceuticals. In CT, all of the equipment is usually
for the same manufacturer. Regulations for CTs and PETs are also from two different
agencies. The FDA oversees CTs whereas the Nuclear Regulatory Commission oversees
PET scans. This means that the protocols are very different and PET scans require a lot
more coordination from different parties. Another issue is that it is impossible to predict
a patients metabolism when theyre injected with FDG. If you inject less to reduce the
patients dose, it would take much longer to do the scans and severely affect the

departments efficiency2. In CT it is a little more predictable since it can be calculated

depending on what anatomical part is being imaged and the patients body habitus2. In
recent years, technology has been introduced to lower the dosages from PET scans. This
would require more sensitive cameras. Toshiba, Siemens, and GE have all created
equipment to lower the dosages, but their approaches are different. The last issue
addressed was the regulation agencies like I mentioned earlier. So much attention has
been given to CT so they have the technology to produce scans with the lowest possible
doses2. This has resulted in nuclear medicine being the diagnostic modality that produces
the most dose2. As you can see, there are many issues that have recently been given
attention in order to reduce the dosages to patients with PET scans.
In my opinion, this article is very important for a medical dosimetrist or medical
dosimetry student to read. I found this article very helpful since medical dosimetrists
encounter PET scans or CT/Pet scans on a daily basis. The dose to patients is even
greater when they have a CT/PET scan which is very often. Since dosimetrists encounter
MRI, CT, and PET images very frequently I think they should have a fair amount of
knowledge about all 3 modalities. Reducing the amount of radiation for our patients is
crucial. It is important to know these kinds of issues that modalities face in your
department.
This article presented many strengths and weaknesses. A strength of this article
was the sources that they used. They gathered a lot of information from various vendors,
a radiology professor, and a biophysicist. I think it helped give the article credibility.
These individuals are experts on this topic so it was nice to read what their opinion was
on the subject. Another strength was that the article provided a lot of valid issues on why
PET scans have trouble reducing doses. The one that stood out to me the most is that the
patients metabolism isnt predictable and you cant sacrifice all of that time and the
departments efficiency to give less radiopharmaceuticals. A weakness that I found in
this article was that there was too much comparison to CT. In the title it says nothing
about CT and I feel like they spent half the article comparing the two modalities. It made
me feel as if the author had a grudge against the advancements of CT technology. Maybe
it is because the newer technology in nuclear medicine from the vendors hasnt been
issued as much. Like the article stated, there has been a lot of recent advancement in the

past couple of years, but is it being utilized yet? Also, if they get more sensitive cameras
in the near future will that impact the image quality when theyre fused? Overall, this
article was very informative and had more strengths than weaknesses in my opinion.
I think this article was very helpful to me and could be very educational for
individuals in other diagnostic departments and even the general public. A lot of the
general public have had or will have PET scans eventually and a lot of patients do
research on what they will be doing in the hospital. When they come across the
information that nuclear medicine has the highest dosages compared to other modalities
they might get a little worried. It would help them to know why the dose is higher and
how the benefits outweigh the risks.

References
1. Lenards N, Weege M. Reading & Writing Radiation Therapy & Medical
Dosimetry. [Powerpoint]. La Crosse, WI: UW-L Medical Dosimetry Program.
2016.
2. Orenstein B. Reducing PET Dose. Radiology Today.
http://www.radiologytoday.net/archive/rt0115p22.shtml. Published January 2015.
Accessed February 24, 2016.

Part II: Peer Reviewed Journal Article

Peer reviewed articles are professionally written articles that focus on a specific
research study or debate. They usually aim to seek an answer originating from a
hypothesis. Professionals in the same field review them and ok them before the articles
are published. These articles are meant for professionals, academics, and researchers. A
peer reviewed article usually contains an abstract, introduction, methodology, results,
discussion, and references. The article I viewed was titled Whole-brain hippocampal
sparing radiation therapy: Volume-modulated arc therapy vs. intensity-modulated
radiation therapy case study. Lee et al1 wrote this article going through our program and

compared the two types of treatments for hippocampal sparing. I evaluated this article
and found it to be very interesting and fun to read.
The author provided all of the elements that are apart of a peer reviewed journal.
Each section was in the correct order. I found this article to be interesting because it was
nice reading an article from an alumni of ours in the AAMD journal. Also, we just had a
hippocampal sparing in clinicals this week so when I came across the article I was eager
to read it. Three patients were randomly selected for this study. They all had brain mets
and were all receiving a 30 Gy (3000 cGy) palliative dose. Three IMRT plans and 3
VMAT plans were used. I think this is a good article for dosimetry students or recently
certified dosimetrists to read. I think seasoned dosimetrists might not benefit as much
from this article since the author was a student and dosimetrists should know the
difference between those treatments for a whole brain. I mention this just because some
of the information in the conclusion could have been stronger and more definitive by
focusing on answering what the title asks. I enjoyed reading how each patient was
treated and looking at the tables of beam angles and couch rotations. I noticed that on a
patient her facility used a sliding windows or step and shoot IMRT which we dont do at
my clinical facility. The author gave great details of the plans and how some issues were
overcome so this was a very informative and beneficial article.
I felt like I found a few strengths and weaknesses in this article. I thought a
strength was that the author provided details about each patients plan and also discussed
the similarities and differences between IMRT and VMAT planning. For each patient, the
doses, gantry angles, couch position, and collimator rotations were included. The
margins for the plans were also explained as well. A weakness I found in the article was
the conclusion. I think it could have been better. For example, in the conclusion the
author discussed how important setting up the patient is for reproducibility. That topic
wasnt really a crucial aspect of the article so it didnt need to be included in the
conclusion in my opinion. Prophylactic irradiation was also put in the conclusion and
that topic was only mentioned once in the introduction. I just thought that the conclusion
needed to conclude what the purpose of this paper was examining. Another weakness
was that the amount of fractions werent included. Usually for hippocampal sparing I
think 10-12 fractions are used. Did one patient receive 10 and the other two receive 12
fractions? In the overall scheme of the paper that might not be a big deal, but so much

detail about the plans was given that I thought it should be included. Overall, it was a
terrific article to read and caught my attention.
This article would be very beneficial for people that have careers in dosimetry,
especially students like myself. Hippocampal sparing, IMRT, and VMAT planning are all
things we will encounter frequently. This article provided great similarities and
differences between IMRT and VMAT planning for the hippocampus. I learned a lot
from reading this and Im sure others would too.

References
1. Lee, K. & Lenards, N. & Holson, J. (2015). Whole-brain hippocampal sparing
radiation therapy: Volume-modulated arc therapy vs. intensity-modulated
radiation therapy case study. Medical Dosimetry, 41, 15-21.
doi: 10.1016/j.meddos.2015.06.003
2. Lenards N, Weege M. Reading & Writing Radiation Therapy & Medical
Dosimetry. [Powerpoint]. La Crosse, WI: UW-L Medical Dosimetry Program.
2016.