Group 10 Research Organization Document

1. What philosophical foundation are you pursuing? Why?

a. Our group is pursuing the logical positivism philosophical foundation because the
result of our proposed topic is verifiable via quantitative data obtained from the
treatment planning system. It does not involve understanding individuals within
their environment.

2. What is your group interest?

a. Even though extensive data exists surrounding IMRT/VMAT treatment
techniques being superior, especially when it comes to OAR sparing, many
insurance companies still deny coverage in some situations. There is also
substantial data comparing hybrid planning techniques which consist of 3D
conformal treatment fields combined with IMRT. This leads us to question
whether there is a hybrid treatment planning technique using only 3D conformal
planning, that could provide patients with comparable conformal coverage and
OAR sparing.

3. Find a problem/develop a theory base.

a. What is the research problem?
i. There is a multitude of evidence that IMRT/VMAT treatment planning
techniques provide superior treatment outcomes. However, there is a
paucity of literature that a comparable option is accessible to patients in
the even that advanced techniques such as VMAT are not available. There
is a unique 3D conformal hybrid arc planning technique in which static 3D
conformal fields are combined with a 3D conformal arc, that shows
promising results when compared to VMAT. This 3D conformal hybrid
arc would be especially beneficial in cases that VMAT is denied by
insurance because of previously set industry standards.
b. What knowledge exists on your interests and the problems you’ve come up
with?
i. It has been widely researched that dynamic conformal arcs provide
comparable conformality to VMAT for certain sites, such as lung and
spine. However, conformal arcs alone are highly dependent on target
volume size, location, and patient contour. It has also been shown that 3D
conformal fields combined with IMRT fields offer improved outcomes
over 3D conformal fields alone.

References
1. Liu YC, Chang HM, Lin HH, Lu CC, Lai LH. Dosimetric comparison of intensity-modulated
radiotherapy, volumetric modulated arc therapy and hybrid three-dimensional conformal
radiotherapy/intensity-modulated radiotherapy techniques for right breast cancer. J Clin Med.
2020;9(12):3884.

doi:10.3390/jcm9123884

2. Basaran H, Inan G, Gul OV, Duzova M. Dosimetric comparison of three-dimensional

conformal radiotherapy, dynamic intensity modulated radiation therapy, and hybrid planning for
treatment of locally advanced lung cancer. Middle East Journal of Cancer. 2022;13(3):523-530.

10.30476/mejc.2021.90142.156

3. Makhtar I, Ghassaly ME, Abdouh E, El-Shahat K. Comparison study for IMRT, VMAT and
3D conformal in the treatment of gastric cancer patients. Oncology and Radiotherapy. 2022;16
(3):001-004.

4. Pokhrel D, Halfman M, Sanford L. A simple, yet novel hybrid-dynamic conformal arc therapy
planning via flattening filter-free beam for lung stereotactic body radiotherapy. J Appl Clin Med
Phys. 2020;21(6):83-92.

doi:10.1002/acm2.12868

5. Kendra C, Marsh L, Bogner E, Gielda B. Methods to optimize conformal dynamic arcs in

radiation therapy treatment planning. Med Dosim. 2021;46(2):143-151.
doi:10.1016/j.meddos.2020.10.003

6. Zhang X, Penagaricano J, Ganesh N, et al. Three-dimensional conformal planning using low-

segment multi-criteria optimization for hippocampal avoidance whole brain radiotherapy. J
Radiat Oncol. 2016;5(3):249-255. https://doi.org/10.1007/s13566-016-0263-6

7. Mancini A, Haddad C, Miranda F, et al. Hybrid 3D/VMAT technique for irradiation of

patients with breast cancer and unfavorable anatomy: preliminary dosimetric study. Oral
presentation presented at: International Conference on Advances in Radiation Oncology; June
21, 2017; Sao Paulo, Brazil. Accessed April 1, 2022.
https://conferences.iaea.org/event/108/contributions/2551/contribution.pdf

8. Guo B, Shah C, Xia P. Automated planning of whole breast irradiation using hybrid IMRT
improves efficiency and quality. J Appl Clin Med Phys. 2019;20(12):87-96.
doi:10.1002/acm2.12767

4. What is the purpose of your study?

 a. The purpose of this study is to compare 3D conformal hybrid arc to VMAT, by
comparing PTV coverage while maintaining OAR dose constraints for
mediastinal patients.

5. What are your supporting questions?

a. Research Question:
i. How would plan metrics of a 3D conformal hybrid arc compare to that of
a VMAT plan?
b. Supporting Questions:
i. Can a 3D conformal hybrid arc offer comparable conformality to a VMAT
plan? Are there tradeoffs?
ii. How does the DVH for OAR look compared to VMAT?
iii. How dose the dose distribution look/compare to the VMAT plan? Does
the hybrid plan provide equal coverage?
iv. Can the 3D conformal hybrid arc achieve a lower global maximum than
VMAT?
v. Could the 3D conformal hybrid arc be applied more widely? What type of
treatment sites could this be applied to?

6. What type of research design are you interested in pursuing with this topic?
a. Our group will pursue quantitative research design.