Research Organization Document

Phase I
In the lecture from this week, you learned about the first few essential steps to a successful
research project.
1. Select a philosophical foundation
2. Investigate a topic
a. Develop a research PROBLEM
3. Find a supporting problem/develop a theory base (literature review)
4. Develop scientific question/query and select a research design
This document will help you apply these essential steps to your capstone project.
1. What philosophical foundation are you pursuing? Why?
This project will require us to use an experimental systematic strategy to develop a
hypothesis and derive and formally test the hypothesis through deductive
reasoning. This is because we will need to form an idea how manipulating the
isocenter location may alleviate the collision issue.
On the other hand, our problem is also naturalistic in nature since collisions or near
collisions can be alarming to patients and may affect treatment plans. This is a
motivating factor to complete this project and find a solution for isocenter
placement. However, due to the nature of our project, we will prioritize the
experimental foundation.
2. What is your topic idea?

a. What is a problem that you can solve? Just because a topic is interesting doesn’t
mean that it is researchable. You MUST have a problem to solve. A good place to
start is to ask your clinical educators what are some problems they have
encountered in their clinics?
i. Is there routinely a dosimetric planning constraint that they can’t meet
necessitating the need to investigate a NEW way to plan that site?
ii. Does your clinic routinely have collision issues with the
gantry/couch/patient? Could you come up with a solution?
iii. Did your clinic recently implement a new technology (FFF capabilities,
Vision RT, bladder scanning etc.)? Is your clinical manager seeking
feedback from staff on how the process is going?
iv. Is there a step of the radiation oncology treatment process
(referral→scheduling→consult→simulation→treatment
planning→treatment) that doesn’t transition easily? Or errors occur
frequently? Could you solve this problem?
 Our topic idea is clearance issues of the gantry head with immobilization device
with prone breast patients. I have spoken with therapists and dosimetrists and
there currently is no standard for preventing collisions. Prone breast treatments are
relatively new here and there is not always clear communication between the
therapists and dosimetrists regarding problems related to clearance.
We aim to find a general position to place the isocenter in order to consistently
avoid collisions for prone breast set ups. The research will help us avoid collisions
from prone breast set ups which interrupt treatment and can cause distress to
patients.
3. Find a supporting problem/develop a theory base. These concepts are combined
because both concepts support the idea that you need to determine what’s out there
on your particular topic. What knowledge exists on your topic? Conduct a literature
review on your topic. You’ve identified a problem to solve but how do you know
that someone else hasn’t already researched this problem? This is the purpose of a
literature review. You need to find peer-reviewed scholarly articles that support
the need for your proposed research. The pertinent articles that you find will be
used to confirm or refute the results of your study so the research must be current
(5 years old at the most). The only circumstance in which older articles should be
used is in the case of task group reports, QUANTEC or similar monumental articles.
List the articles that you intend to use to support your research in AMA formatting
in this document. Refer to this list often.
The problem is that prone breast set ups occasionally result in collisions of the
gantry head with the immobilization device depending on the isocenter which can
negatively impact treatment and patient experience.
From what I've seen, there isn't a lot of research published on prone breast set up
collisions and a 'magic number' that may help with clearance issues. There are some
articles that discuss the benefits and challenges related to prone breast treatments. I
found articles comparing the benefits of prone versus supine treatment in order to
reduce the dose to the heart, lungs and skin. 1 One article mentions that inadequate
coverage and set up reproduction are challenges, but I haven't seen much directly
related to collisions.2
I have found peer review articles that propose solutions by adding in extra cameras
in the treatment rooms, and one that discusses the position of isocenter for VMAT
lung cancers, but I have not found anything relating to prone breast treatments.
Links to papers are posted below.3
4. What are your supporting questions? Develop some key questions that your reader
will know the answer too after reading your research paper that support your
research question. These questions should require elaboration (a simply stated
yes/no answer question is not permitted). For example:
 a. Research Question: Where should our next coffee shop location be?
b. Supporting Questions: What customer base are we seeking?

Can an isocenter location be used that ensures patient safety from collisions in all
directions?
Will this isocenter location still allow for the creation of a quality treatment plan?
Is there anything that could be done differently in simulation to help with collisions?
5. What type of research design are you interested in pursuing with this topic? Some
very basic information on each type (experimental/quantitative or
naturalistic/qualitative) was provided at the end of this week’s lecture. You will get
more into the research design in the coming weeks but you should determine which
design you are going to pursue now.
Regarding philosophical foundations, I believe our research idea will require us to
be methodical and utilize a logical positivism and naturalistic approach. This is
because the metrics we will observe will be measurable and observable, but also
very dependent on the site, patient, set up and numerous other factors. We will have
to be aware that the quantitative data we measure are true to our case (machines,
tables, set up procedures, etc.) and may not be universal.
I think we should be able to find somewhat of a ‘magic number’ or guideline that
other sites can use as an indicator for prone breast treatments. The primary focus
will be on the isocenter location which is quantitative.
 References
1. Huppert N, Jozsef G, Dewyngaert K, Formenti SC. The role of a prone setup in breast
radiation therapy. Front Oncol. 2011;1:1-8. https://dx.doi.org/10.3389/fonc.2011.00031.
2. Fahimian B, Yu V, Horst K, Xing L, Hristov D. Trajectory modulated prone breast
irradiation: A LINAC-based technique combining intensity modulated delivery and
motion of the couch. Radiother Oncol. 2013;109(3):475–481.
https://dx.doi.org/10.1016/j.radonc.2013.10.031
3. Boyer A, Biggs P, Galvin J, et al. AAPM report 72: basic applications of multileaf
collimators. Madison, WI: Medical Physics Publishing, American Association of
Physicists in Medicine; 2001.
4. Nguyen SM, Chlebik AA, Olch AJ, Wong KK. Collision risk mitigation of varian
TrueBeam linear accelerator with supplemental live-view cameras. Prac Radiat Oncol.
2019;9(1):e103-e109. https://dx.doi.org/10.1016/j.prro.2018.07.001.
5. Yao S, Zhang Y, Nie K, et al. Setup uncertainties and the optimal imaging schedule in the
prone position whole breast radiotherapy. Radiat Oncol. 2019;14(1).
https://dx.doi.org/10.1186/s13014-019-1282-4.