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?
Logical positivism – The problem we are researching will define a specific hypothesis that
identifies one issue. The outcome will result in measurable data being obtained.
2. What is your group interest? (This would be the high-level idea that you
listed/discussed in the discussion forum).
Treating patients with prostate and lymph node fields with a dual isocenter treatment
technique with Magnetic resonance guided radiotherapy (MRgRT) on an MR Linac (MRL)
MRgRT has the capability to improve radiation treatments by effectively adapting and
optimizing plans to account for intra-fraction motion. However, it can be restricted from
adequately treating all patients or anatomical sites due to its longitudinal field size
limitations. Currently, patients with nodal volumes are unable to receive treatment on the
Froedtert Clinical Cancer Center’s MRL. RayStation TPS may have a solution by allowing for
treatment planning with dual isocenters on the Elekta Unity MRL.
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 research problem? Your working problem statements below.
Currently, the MRL at Froedtert Clinical Cancer center, as well as MRL’s across the world,
cannot treat any pelvic patients with involved lymph nodes. With the introduction of a dual
isocenter approach combined with the Raystation TPS, will the treatment of prostate
patients with involved lymph nodes be feasible in the clinic?
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).
The field of Radiation Oncology is continuously pursuing more accurate and precise
treatment practices by utilizing new technologies that will eliminate areas of treatment
uncertainty or error. The combination of Magnetic Resonance Imaging and a Linear
Accelerator (MRL) now offers MR guided Radiation Therapy (MRgRT). This provides
greater soft tissue contrast, compared with other image guidance methods, and allows for
adaptive treatment planning to correct for inter- and intra-fraction changes. However, it
does come with its own limitations, such as the superior/inferior field size restrictions.
Many treatment areas, especially with nodal involvement, require large field sizes not
compatible with MRLs, which eliminates patients from receiving such therapy. The
treatment of prostate cancer has been shown to benefit from the MRL capabilities but may
not always be within field size tolerance when lymph nodes are involved. Prostate cancer is
one of the most prevalent cancers in men worldwide, and with the field size limitations,
there are patients currently ineligible for MRL treatments. An emerging approach to combat
this issue is the use of dual isocenter irradiation. With the evidence that MRgRT provides
more optimal image guidance and treatment plans, further research of this technique is
necessary to ensure a greater proportion of patients can be provided with this treatment
option.
References
1. Placidi L, Nardini M, Cusumano D, et al. Dosimetric accuracy of dual isocenter
irradiation in low magnetic field resonance guided radiotherapy system for extended
abdominal tumours. Phys Med. 2021; 84:149-158.
https://doi.org/10.1016/j.ejmp.2021.03.037

2. Snyder JE, St-Aubin J, Yaddanapudi S, et al. Commissioning of a 1.5T elekta unity MR-
linac: a single institution experience. J Appl Clin Med Phys. 2020: 21(7):160-172.
https://doi.org/10.1002/acm2.12902
3. Ng-Cheng-Hin B, Nutting C, Newbold K, et al. The impact of restricted length of
treatment field and anthropometric factors on selection of head and neck cancer
patients for treatment on the MR-Linac. Br J Radiol. 2020; 93(1111).
https://doi.org/10.1259/bjr.20200023

4. Rippke C, Renkamp CK, Stahl-Arnsberger C, et al. A body mass index-based method for
“MR-only” abdominal MR-guided adaptive radiotherapy. Z Med Phys. 2022; 34(1).
https://doi.org/10.1016/j.zemedi.2022.12.001

5. Chuter RW, Brewster F, Retout L, et al. Feasibility of using a dual isocentre technique for
treating cervical cancer on the 1.5 T MR-Linac. Phys Med Biol. 2023; 68(2)025017.
https://doi.org/10.1088/1361-6560/acae18

6. Sritharan K, Tree A. MR-guided radiotherapy for prostate cancer: state of the art and
future perspectives. Br J Radiol. 2022; 95(1131).
https://doi.org/10.1259/bjr.20210800

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 study is to better understand the extent of the MRL in combination
with the RayStation TPS. This study will aim to treat patients with disease of the prostate
combined with nodal volumes through a dual isocenter approach when deemed
appropriate, similar in the way it can be done on a conventional linac. We hope that this
study will show that the MRL combined with RayStation TPS can produce an acceptable
and highly adaptable, dual isocenter treatment plan for prostate patients with involved
lymph nodes.
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?
A. Is there an increase in the time it takes to deliver a treatment on an MR linac when using
a dual isocenter approach?
B. If there is an increase in treatment time, is this time significant enough to make an
impact on the clinical teams’ workload?
C. Would this new approach increase the time it takes to plan a treatment on an MRL?
D. Could other pelvic diseases with involved nodes be treated in a similar manner?
E. Can this dual iso approach be used to treat nodal fields in other sites throughout the
body as well?
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

Submit this document to the appropriate assignment area when instructed.