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Jessica Ezelle

Comparative Article Analysis Part I: Trade Journal

While reading the article Managing Dose by Beth Orenstein from the magazine
Radiology Today, the very first thing that becomes apparent is that the biggest difference from
this trade journal to a professional journal is there is no abstract for a quick read to make a
decision if this is the right article for the job or not. This article peaked my interest because of its
striking, bold, colorful title page and the subject matter. This article is much more informal than
a professional journal using a very casual writing form, focused on human interest, and even
included an advertisement at the bottom of the article.1 This article also had e very broad interest
it didnt just focus on managing dose in radiation therapy or CT, it combined and intertwined the
two.

This article begins with a very alarming concern for high radiation doses particularly in
CT scanners and radiation therapy to grab the readers attention. It even references a New York
Times article where two patients died from their course of radiation treatment to prove its point
about how dangerous radiation dose can be.2 It goes on it discuss how the Medical Imaging and
Technology Alliance (MITA) is working with various vendors of CT machines and radiation
therapy machines to help seek improvements to the technology to reduce dose.2 Firstly the article
talks about CT machines and how they have been adapted to alert technologists when a dose is
higher than normal for a patient. Then based on the patients size the technologist can decide to if
the dose is appropriate or not. Secondly the article talks about the importance of quality
assurance checks especially on radiation therapy plans to ensure their accuracy and also the
accuracy of patient set-ups. Thirdly the article emphasizes the importance of hands on training as
well as in house training for the equipment being used, to ensure its proper use. Lastly it details
the importance of continuing education and keeping up with the current medical standards.
Either by replacing machines or going to educational seminars.

For a non-medical professional reading this article, the way Orenstein takes a negative
such as radiation induced death and turns it around and explains how things are changing for the
better is one of her strengths. It adds some relief to the reader that things have advanced and
these serious situations should not happen anymore. However, as a medical professional, I know
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there are still chances of a medical event occurring and it is not as simplistic as Orenstein
portrays it to be.

She must have put in a fair amount of research into writing this article, as she does
reference several associations, such as MITA, Tomotherapy and Varian to name a few. She if
nothing else comes across as very knowledgeable and confident in what she is writing. If this
were written as a scholarly journal it could be very useful information regarding how radiologic
departments have implemented new safeguards to limit the dose to their patients. The only
problem is there are no references listed for these statistics or facts for one to follow up with and
further research.

As a medical dosimetrist, it is important to know about managing dose. As this article


mentions limiting dose to a patient is very important and as a medical dosimetrist it is crucial that
critical structures be avoided or dose to those structures be limited so that there is not a case such
as the mentioned radiation induced death.

Although seemingly useful knowledge about dose limitation in radiation therapy and CT
scanners was presented in this article, when it comes to using this information for a research
paper or a source for a scholarly journal it tends to fall short of some of the key ingredients such
as a professional writing it, a very narrow interest, scientific writing or a professional audience.1
However interesting as the article was it would not serve much purpose for a medical
dosimetrist.
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References

1. Lenards N, Weege M. Reading & Writing in Radiation Therapy & Medical Dosimetry.
[SoftChalk]. La Crosse, WI: UW-L Medical Dosimetry and Radiation Therapy Program;
2016
2. Orenstein BW. Managing Dose. Radiology Today. 2010;11(10):18-21.
http://viewer.zmags.com/publication/a0b5deab#/a0b5deab/1. Accessed January 28, 2017.
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Comparative Article Analysis Part II: Peer- Reviewed Journal

In the peer-reviewed journal Radiation Therapist, I found an article particularly


interesting by Amara Miescke called Bolus in Radiation Therapy: The Versatility of Water.
Miescke detailed two types of bolus, Superflab and water, but showed how water was found to
be very versatile option for bolus in three unique cases.1

Miescke explains bolus and its use in radiation therapy to bring the dose to the skin
surface or to fill in surface irregularities in a patients skin surface. Bolus is the same density as
tissue (1.0 g/cm3) therefore the radiation beam build-up occurs in the bolus before reaching the
skin or cavity giving the tumor a more homogenous dose. She explains the difference between
water as a bolus and Superflab as a bolus along with the pros and cons of both. Then she goes
into her three case studies.

The first case study was a hand in a bucket of water lined with Superflab (to prevent
back scatter) making sure the water line was at 100cm SSD every day. This patient was treated
for T-cell Lymphoma of the hand with 6MV photons to a total dose of 20Gy.1

The second case study is an ear with basal cell carcinoma of the triangular fossa of the
left ear. This was treated with 6MeV electrons to a total dose of 51Gy with a combination of
water and Aquaphor as bolus. The water went in the ear canal and the Aquaphor filled the pinna
of the ear till it was leveled.1

Case study number three was a woman with biliary adenocarcinoma of extrahepatic
origin. Her umbilical region was treated with water in the umbilicus and a sheet of Superflab
over so that there were no air gaps in the bolus with 6MV photons to a total dose of 30Gy.1

Miescke noted that all of these cases saw noticeable shrinkage or decreased pain by their
first follow-up visit. She described the down fall to each case study. Case 1 being cumbersome
and messy. Case 2 becoming unable to handle the water bolus in the ear canal as treatment
progressed and had to revisit the patients treatment set up.

Miescke concluded with radiation therapists need to familiarize themselves with all types
of bolus but remember water is a great source. Each situation is different and requires different
types of boluses to be used to achieve the greatest effect.
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This article was very easy to follow and understand and was presented very well.
Miescke gave 3 very good examples of how bolus can be used in very odd circumstances where
you have to think outside the box. To be honest water is not a bolus material that usually comes
to mind when I think of fabricating bolus, Superflab is usually my go to bolus. This article
defiantly opened my mind up to new possibilities. All of her information pertained to her original
thought and flowed in a matter that made sense. She gave just enough information to pull it all
together without overloading the reader with information.

Overall I find this article quite positive and informative. I feel it would be a good
refresher for every radiation therapist to read. This article had all of the components I would
expect to find in a peer reviewed journal, an abstract, introduction, methodology, results,
discussion, conclusion and references.2
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References

1. Miescke A. Bolus in Radiation Therapy: The Versatility of Water. Radiation Therapist


[serial online]. Spring2016 2016;25(1):22-27. Available from: CINAHL Plus with Full
Text, Ipswich, MA. Accessed January 29, 2017.
2. Lenards N, Weege M. Reading & Writing in Radiation Therapy & Medical Dosimetry.
[SoftChalk]. La Crosse, WI: UW-L Medical Dosimetry and Radiation Therapy Program;
2016
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