Research Organization Document

Section 1

For the problem that needs to be solved section, you need to decide what the problem is for your
research. This includes addressing a set of 5-7 questions that you need to refer to often in your research to
make sure that you are staying on topic. Key questions should be your active research questions. When
you have finished writing your research paper, you reader should be able to address and answer these
questions easily.

Problem that needs to be solved: Bladder and rectal filling can greatly affect the amount of
radiation being delivered to both these normal tissue structures, as well as adversely affect the
dose delivered to the target (prostate or prostate bed). Accounting for these daily changes has
always been a challenge. Typically, bladder and rectal filling are kept within a certain tolerance
based on the information from the cone-beam CT (CBCT) and the treatment plan. Margin is also
added to the target to account for this. The goal of our research is to develop a method to account
for the actual difference in the volumes from day to day, and to compare the predicted dose to
the actual dose delivered to the bladder, rectum, and targets. Accounting for this motion could
possibly allow for even tighter margins to be used for the target in the future.

Key Questions that need to be answered:

1. How efficient of a process can we develop to make the use of offline adaptive
therapy clinically manageable.
2. Is the daily change in volume clinically significant enough to warrant the extra
workload of daily CBCT evaluation?
3. Can we reduce the treatment margins with adaptive therapy to spare more
normal tissue?

For the evidence of gap in the literature section, you should include a paragraph written in your own
words with referenced superscripts to the references page so that the instructor can look at the article you
are using to support your research.

Evidence of a gap in the literature:

There are numerous studies done looking at variations of bladder and rectal volumes during the
treatment of prostate cancer. Rectal volume using CBCT for the entire treatment was measured
during one study. The results show significant volume changes, suggesting that adaptive
radiotherapy would potentially be beneficial for the treatment of prostate cancer.1 Another study
shows that there are significant changes in bladder and rectal volumes that may lead to
inaccurate radiation dose estimation during planning.2 This information suggests that there could
be improvements in the way we approach the treatment of prostate cancer.
The references to support your research section should include all of the references you have used for
your research in AMA formatting. Use this as a place to keep track of your articles and update this often
as you get into your research. This shouldnt necessarily include all of the references that you sent to the
instructor for the conference call. Since your topic was likely tweaked during the conference call, only
include the references that pertain directly to your topic. This is important because there is a limit to the
number of references you can have depending on the type of paper you decide to write.

References to support your research:

1. Prabhakar R, Oates R, Jones D, et al. A study on planning organ at risk volume

for the rectum using cone beam computed tomography in the treatment of prostate
cancer. Med Dos. 2014;39:38-43.

2. Huang TC, Chou KT, Yang SN, Chang CK, Liang JA, Zhang G. Fractionated
changes in prostate cancer radiotherapy using cone-beam computed tomography.
Med Dos. 2015;40:222-225.
3. Wu Q, Liu H. The Role of Offline adaptive planning in online image guided
radiation therapy of prostate cancer. Int J Radiat Oncol. 2011;81(2,
Supplement):S836. doi:10.1016/j.ijrobp.2011.06.1479.
4. Tonlaar NY, Marina O, Brabbins DS, et al. Use of weekly cone beam CT for
adaptive radiation therapy decreases toxicity for prostate cancer patients treated
with IMRT. Int J Radiat Oncol. 2013;87(2, Supplement):S176.
doi:10.1016/j.ijrobp.2013.06.454.
5. Zhang J, Ates O, Li A. Implementation of a machine learningbased automatic
contour quality assurance tool for online adaptive radiation therapy of prostate
cancer. Int J Radiat Oncol. 2016;96(2, Supplement):E668.
doi:10.1016/j.ijrobp.2016.06.2300.
6. Pirozzi S, Piper J, Nelson A, Shen Z, Gardner S. Evaluation of deformable
prostate cone beam computed tomography (CBCT) contouring methods for
adaptive radiation therapy. Int J Radiat Oncol. 2013;87(2, Supplement):S719.
doi:10.1016/j.ijrobp.2013.06.1904.
 7. Noel CE, Santanam L, Olsen JR, Baker KW, Parikh PJ. An automated method for
adaptive radiation therapy for prostate cancer patients using continuous fiducial-
based tracking. Phys Med Biol. 2010;55(1):65. doi:10.1088/0031-9155/55/1/005.

Research Topic: Offline adaptive radiation therapy in the

treatment of prostate cancer.
 Research approach
Section 2
The next section of your research organization document contains your research template to
follow as you begin your data collection. This section will change often but it will help you to
follow your goals closely as you progress and for the instructor to track your progress.

Study Details:
Prospective as well as retrospective study

Do any group members need to obtain additional IRB approval? No

Number of patients: 5-10

Type of study: Planning Study

Roles of each group member (some members may have multiple roles)

Group Leader Evgenia

Data Collector(s): Heath

Data analysis Heath

Writer Evgenia, Beverly

Editor Evgenia, Beverly

Data Collection Approach:

Indicate here what data you are looking to collect and your approach to collection:

Number of clinical sites for data collection: 1

What information are you interested in (if a planning study, list structures for evaluation;
if a study survey, list your study questions)

Projected and actual dose to:

Bladder
Rectum
Target (prostate or prostate bed)

Clinical time devoted to analysis, is it feasible? Attempt to automate as much as possible.

Are you interested in completing a statistical analysis on this data? If so, what parameters
will you be analyzing? (p-value, mean, t-test etc.).

As of right now, we dont think that well need the statistical analysis on the data. The
focus of our study is to assess the amount of time it will take to measure the volumetric
dose from the CBCT daily.

What resources (in addition to the literature search) are available for you to use?

MIM Software has offered to support the process of trying to automate the analysis as
much as possible. They will be giving us version 6.8 which hasnt been released yet, but
has better tools to automate this process.
We have a clinic database available for use (Aria/Eclipse) to use along with MIM for the
data collection/analysis.

Previous research study that will be used for data analysis (ex: RTOG study constraints):

Plans will be compared against both QUANTEC and RTOG/NRG constraints for the
prostate.

Description of your data collection approach (Please provide the instructor with the details
you intend to use in your research and use the example to be your guide).

Original simulation data for bladder and rectum filling will be compared to the daily
CBCT using MIM software. The isodose lines and the dose distribution to these organs,
as well as to the PTV, will be analyzed. Our goal is to track the daily changes, attempting
to make the process automated and to determine whether the changes are significant
enough to justify the extra work.