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Article Analysis Part 1: Trade Magazine

Upon comparing two separate articles originating from a trade publication and a peer

reviewed journal several factors displaying their differences were noted. The trade article

gleaned from Radiology Today’s was surrounded by a multitude of web advertisements that

although appeared to have stemmed from the radiology field, were relatively distracting. The

article was drowned out by links to outside sources that were not in parallel with the articles

content. In contrast, the peer reviewed article selected from Medical Dosimetry stood alone

with no additional content but that related to the scope of the research conducted.1 This initial

observation gave insight to the difference in quality and focus to be found in each article. To

follow in the first section of this comparative analysis will be a summary of Radiology Today’s

trade article “Closer to the Heart – Proton Therapy for Left-Sided Breast Cancer” written by

Larisa Brass. Included with this summary will be the topic’s relevance in clinical practice, the

reliability of the information provided, and the strengths and weaknesses of the article.

Brass’s article focuses on the use of proton radiation therapy in treating breast cancer,

with an emphasis on the benefits for treating left-sided disease. She offers several examples as

to the advantages of using proton therapy such as a significant decrease in size of the radiation

field, decreased exposure to the heart, lungs and vital organs, superior dose distribution for

patients with unique anatomy and preservation of the cosmetic appearance of the breast. She

further demonstrates the benefits of proton therapy by referencing a study performed by Loma

Linda University of California. This study demonstrated the 5 year in-breast recurrence-free

survival rate of 97% in a sample size of 100 persons treated for breast cancer with proton

therapy.2
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Having encountered the difficulties in treating challenging breast cancer cases, this article

resonated with me as a Dosimetrist. Having no previous hands-on experience with proton

therapy planning, the benefits of proton radiation to the planner and more importantly the patient

piqued my interest. In difficult cases involving patient anatomy which abuts the heart to the

chest wall and subsequent treatment volumes, the technical properties of proton radiation would

prove a significant benefit. With this in mind, the article did not provide any technical

information regarding the planning aspect of proton therapy and instead served as a general

overview of the modality’s benefits. At the University of Rochester, physicians often display an

interest in implementing proton radiation in the clinic which is the basis for which this article

proved possible relevance to my career.

Brass’s article included a plethora of information supporting the use of proton therapy.

This information came in the form of quotations from patients, physicians and a research study

which advocated the benefits of treatment using protons which was not referenced. The article

contained two separate sections devoted to displaying the potential benefits of the modality as

well as the availability of centers nationwide. While the benefits of proton therapy are

undeniable, the article made no mention of the potential disadvantages such as the high cost and

low insurance reimbursement of this therapy or the escalated dose uncertainty inherited when

irradiating targets in motion.3 The author is a career journalist and freelance writer with a

Master’s degree in public health; pairing this with the unilateral presentation begged the question

of the authors intent for this article. After brief research of the author it was noted that she serves

as a social media and content coordinator for Provision Health in Knoxville, TN which

specializes in proton radiation therapy. The author has also written separate articles advocating

the use of proton therapy for treatment sites in addition to left sided breast cancer.
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Lastly, Brass’s article displayed strengths in it’s ability to provide an overall picture of

the benefits of proton therapy to those seeking treatment. It was well written and easily

decipherable which would appeal to those without technical knowledge of radiation therapy.

However, these qualities were overshadowed by the lack of technical data and reliance on

individual’s supporting testimonies. There was no data on the dosimetric advantage of protons

in relation to the sparing of the heart and lungs as well as other organs at risk.

As a whole, this trade article was interesting on the basis of learning the benefits of

proton therapy when treating left-sided breast cancers. The lack of detail and potential biased of

the information presented was limiting when considering its usefulness in clinical practice.
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Sources

1. Lenards N, Weege M. Reading and Writing in Radiation Therapy & Medical Dosimetry.

[SoftChalk]. La Crosse, WI: UW-L Medical Dosimetry Program; 2019.

2. Brass, L. Closer to the Heart – Proton Therapy for Left-Sided Breast Cancer. Radiology

Today, (19)4,5. Retrieved from http://www.radiologytoday.net/archive/rt0418p5.shtml.

3. Chang JY, et al. Clinical Implementation of Intensity Modulated Proton Therapy for

Thoracic Malignancies. Medical International Journal of Radiation

Oncology*Biology*Physics. DOI 10.1016/j.ijrobp.2014.07.045.

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Article Analysis Part 2: Professional Journal

In the second part of this article source analysis I will present the contrasting style of a

peer reviewed journal to that of the trade article discussed in Part 1. I selected an article from the

Medical Dosimetry journal that discusses treatment techniques of left-sided breast cancer. As

opposed to a trade article, the format of this article followed scientific method in reporting an

unbiased, measured observation.1 The focus was finite and the information that was generated

was clearly intended to supply information to professionals in the field of radiation oncology. In

this section of the analysis I will provide a summary of the research, the methods and materials

used, as well results of the study and conclusions that were drawn.

The article titled “Effects of multiple breath hold reproducibility on treatment localization

and dosimetric accuracy in radiotherapy of left-sided breast cancer with voluntary deep

inspiration breath hold technique” by Kapanen et al focused on examining the interfractional and

intrafractional error observed in left-sided breast treatments using a breath hold technique. These

dosimetric errors were correlated to positioning variances between treatments as well as the

errors resulting from the number of breath holds during the treatment delivery.2 In the abstract

and introduction portions of the article, the authors provided details explaining the importance of

accuracy and reproducibility when executing voluntary breath hold and the direct relation to

successfully sparing organs at risk.

The methods and materials section of the article offered thorough detail of the approach

taken to acquire the data for this study as well as the equipment used for collecting and recording

the information. A flowchart was provided that showed a step-by-step approach that was used to
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collect imaging data to be used to evaluate the intra- and interfractional errors, which showed the

research method to be well organized and systematic. The study consisted of two groups;

patients were separated into those who had received whole breast radiotherapy and those who

were simultaneously treated to the whole breast and supraclavicular lymph nodes. The sample

sizes were 20 and 27 patients respectively, which for the scope of this study I feel was adequate

to obtain reliable data as well as differentiate the results by the planning technique used. The

research was carried out using Varian Real-time Position Management (RPM) to monitor the

patient’s breath hold accuracy during treatment while both portal imaging and kV image

guidance were used during treatment to retrospectively assess positional error through Varian

Offline Review software. The authors acknowledged the potential error in assessing

intrafraction motion due to the inability of the RPM software to reflect patient anatomy during

treatment and further advocate for the use of surface guided imaging not available for use in this

study.2

Lastly, the results segment of this journal was well organized and broken down into

sections that illustrated the data analysis of the study. The study determined that there was a

linear relation to the mean intrafractional positional error and the number of breath holds taken

during treatment.2 The research further correlated this positional error to a dosimetric

uncertainty of approximately 8-10% for certain circumstances.2 This data was illustrated in a

plot-point style graph which was very easy to read and clearly demonstrated the authors findings.

My impression of this article and its findings is that it offers a quantitative analysis on the

issue of dosimetric accuracy when executing deep inspiration breath hold technique on patients

with left sided breast cancer. I felt the information to be very useful and applicable for use

personally in clinical practice. Alternately, I was concerned that the magnitude of the dosimetric
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error may have not been correctly modeled since the data was collected using the AAA

algorithm for planning. The authors consulted several sources for their research which all

centered around the use of deep inspiration breath hold techniques. I found the sources to be

relevant and recent and supportive to this article’s findings.

The differences in quality and purpose between the trade publication and the peer

reviewed journal are obvious. While the trade publication written by Larisa Brass was

informative as to the benefits of proton therapy for treating left-sided breast cancer, it served

more to promote the treatment modality in general. Overall, the article appeared to be generally

bias and lacked the detail necessary to make it useful for professionals in the field. The

professional journal by Kapanen et al displayed a finite scope that was intended to evaluate a

problem faced when treating left-sided breast cancer with a breath hold technique. The article’s

focus paired with its research-based information made it reliable and useful for practicing

professionals.
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Sources

1. Lenards N, Weege M. Reading and Writing in Radiation Therapy & Medical Dosimetry.

[SoftChalk]. La Crosse, WI: UW-L Medical Dosimetry Program; 2019.

2. Kapanen, M.; Laaksomaa, M.; Pehkonen, J.; et al. Effects of multiple breath hold

reproducibility on treatment localization and dosimetric accuracy in radiotherapy of left-

sided breast cancer with voluntary deep inspiration breath hold technique. Medical

Dosimetry. 2017; 42(3):177-84