Research Organization Document

Phase I
The Research Basics lecture identified the following steps in beginning the research
process:
1. Select a philosophical foundation
2. Determine group interest
3. Research your interests and develop a research problem
4. Find a supporting problem/develop a theory base (literature review)
5. Develop scientific question/query and select a research design
In the discussion forum, you should have narrowed down your interests into a single topic.
This document will help you apply these essential steps to your capstone project topic.
1. What philosophical foundation are you pursuing? Why?
Our philosophical foundation is logical positivism. Our research is going to be
experimental, therefore we will be collecting and analyzing data to prove/disprove
hypotheses. Through logical positivism we will be able to obtain objective and
quantitative results, in order to make realistic predictions about phenomenon.

2. What is your group interest? (This would be the high-level idea that you
listed/discussed in the discussion forum).
We will be comparing 3D conformal arc therapy vs. VMAT/IMRT for liver lesions.
The applicability of VMAT and IMRT in clinic is widely accepted to spare OAR and
maintain conformity but is limited by stringent insurance requirements. This
research will attempt to evaluate the applicability of 3D methods for this region of
treatment.

3. Find a 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 interest/topic.
a. What is the problem related to your interest? List your working problem
statements below.
Commonly found difficulties with insurance clearance for liver VMAT/IMRT
poses a dosimetric challenge to maintain adequate coverage while sparing
 sensitive organs like the kidneys, bowels, and normal liver tissue.
Conventional 3D and multi-field plans produce a significant dose to OARs in
comparison to VMAT/IMRT, but 3DCAT uses the concept similar to arc
therapy that may help spare normal tissue.

b. What knowledge exists on your interests and the problems you’ve come
up with?
i. Conduct a literature review on your topics. If You’ve identified a
potential high-level 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 most pertinent articles that you intend
to use to support your research in AMA formatting in this document.
Refer to this list often. (Note: you will be providing summaries of
these articles in a later assignment so it’s a good idea to hold on to
notes about each article now).
Prior research shows that insurance authorization for VMAT to treat palliative liver
tumors is complex and challenging. The lack of accessibility to many prominent
insurance policies and discrepancies between them make VMAT authorization time
consuming and may delay treatment time. Increased VMAT use has caused a rise in
the cost of inverse planning compared to 3D planning methods. The role of DCA in
comparison to VMAT has been explored for lung cancer patients, but not much
research has been done to see how DCA can be used for liver tumors.
References

1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70(1):7-30.
http://doi.org/10.3322/caac.21590.
2. Verma V, Ludmir EB, Mesko SM, et al. Commercial insurance coverage of advanced
radiation therapy techniques compared with American society for radiation oncology model
policies. Pract Radiat Oncol. 2020;10(5):324-329. http://doi.org/10.1016/j.prro.2019.08.005.
3. Guo J, Kim H, Kalchman I, Dan TD, Zhan T, Werner-Wasik M. The influence of health
insurance policy on radiation oncology physician SBRT/SABR use practices: a north
american survey. Int J Radiat Oncol Biol Phys. 2017;99(3):524-529.
http://doi.org/10.1016/j.ijrobp.2017.06.2447.
4. Roach MC, Thomas TO, Paravati AJ, Mahajan A. Differences in United States insurance
payer policies and American society for radiation oncology's (ASTRO) model policy on
stereotactic body radiation therapy (SBRT). Int J Radiat Oncol Biol Phys. 2019;104(4):740-
744. http://doi.org/10.1016/j.ijrobp.2019.01.005.
5. Piana R. Rising costs in radiation oncology linked to medicare coverage. The ASCO Post
website: https://ascopost.com/issues/march-15-2012/rising-costs-in-radiation-oncology-
linked-to-medicare-coverage/. March 12, 2020. Accessed April 1, 2021.
6. Yong JH, McGowan T, Redmond-Misner R, et al. Estimating the costs of intensity-
modulated and 3-dimensional conformal radiotherapy in Ontario. Curr Oncol.
2016;23(3):e228-e238. http://doi.org/10.3747/co.23.2998.
7. Kale MS, Mhango G, Bonomi M, et al. Cost of intensity-modulated radiation therapy for
older patients with stage III lung cancer. Ann Am Thorac Soc. 2016;13(9):1593-1599.
http://doi.org/10.1513/AnnalsATS.201603-156OC.
8. Pokhrel D, Visak J, Sanford L. A novel and clinically useful dynamic conformal arc (DCA)‐
based VMAT planning technique for lung SBRT. American Association of Physicists in
Medicine (AAPM) website: https://aapm.onlinelibrary.wiley.com/doi/10.1002/acm2.12878.
Published April 19, 2020. Accessed April 10, 2021.

4. What is the purpose of your study? This naturally falls in-line with the other
questions as you complete your literature review. What do you hope to find out
after you complete this research? What is the aim? These are all questions you
should ask yourselves.
The purpose of this research is to test dose metrics to the target and organs at risk
using DCA and VMAT. Both plans will be analyzed for conformity, dose fall off,
integral dose, and reasonably deliverable dose. Through this research we will show
that DCAT is either an applicable alternative method or not an adequate treatment
for liver patients if VMAT is denied by insurance companies.
 5. What are your supporting questions? Develop some key questions that your
reader will know the answer to after reading your research paper that support your
research problem. 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?
i. Why would an insurance company be more likely to approve a
conventional plan over a DCA/SBRT plan?
ii. Are certain OAR spared more or just as well with DCA compared to
VMAT?
iii. Do small changes in tumor size and/or location effect the outcome of a
DCA and VMAT plan?
iv. Can DCA be used to meet hard objectives such as dose to normal liver
and lung?
v. Can DCA provide adequate coverage to the target like VMAT?
vi. What are some planning challenges with DCA and VMAT?
vii. What are the realistic pros and cons (regarding patient setup,
deliverability, treatment times, etc.) with DCA vs VMAT?

6. 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.
Experimental/quantitative is the research design we will be pursuing. This research
design allows us to test a hypothesis. In addition, we will have multiple control
factors for our research. Some control factors we are considering include , only
studying patients with an early-stage liver cancer and a metastatic tumor limited to
a specific size in specific lobes of the liver and having one person doing the planning.

Submit this document to the appropriate assignment area when instructed.