Jonathan Gonzales

DOS 711 Research Methods in Medical Dosimetry I

March 25, 2015
Article Comparison: Trade Publication Article vs. Peer Reviewed Article
Part I: Trade Publication Article
Trade articles are written publications, usually magazines, which are geared to people
who work within that specific field. Trade publications cover a specific industry and are typically
written by professionals who specialize or work within that particular industry. Trade
publications share a common journalistic and informal approach1 and are designed to cater to the
consumers of that field and usually are not meant to be read by the general public. The trade
publication that I chose to investigate is an article by Beth W. Orenstein, entitled Lean
Management Wisconsins ThedaCare Improves Its Radiation Oncology Care Process. This
article is something I can relate to because we use that same management system at the
University of Michigan.
This article discusses the devlopment of a lean management system in the radiation
oncology department at ThedaCare Hospital in Wisconsin. ThedaCares goal was to lower their
normal 26-day process, time from when a patient was told they needed radiation therapy to their
first day of treatment. ThedaCare hired a third party company, Simpler Healthcare, to aide in
creating a lean management system in hopes to lower the patient wait time. By the end of the
process, ThedaCare was able to develop a lean management system that changed the patient flow
from a 26-day process to a seven-day process.2 This article briefly discusses the 4 steps in
developing a lean management system. The first step would be to analyze the patient flow within
your department and map out how the patients flow throughout the system and identify where
potential improvement opportunities would exist.2 Secondly, develop an action plan to fix the
problem that has been identified in the first step. Thirdly would be to implement the plan. The
final step would be to continue improvements on a daily basis. The article ends with ways to help
lower patient wait time after the lean management system is in place.
This article I found to be very interesting because I had never heard of lean management
until my clinical dosimetry rotation at the University of Michigan (UM). At UM, a majority of
their lean cases are palliative treatments. As a student, I have currently been planning a majority

of these cases. This article helped me better understand the team effort and work that went into
developing the lean management at the UM. I feel that this article would be a great thing to not
only share with other dosimestrists but also other radiation oncology departments that are
looking at ways of decreasing patient waiting time.
Overall, this article was very good at demonstrating how lean management could cut your
patient wait time and the author clearly outlined the basic steps in developing this system, but at
the same time these steps also lacked detail. Steps 1 4 were quickly mentioned but further in
depth explanations or examples were nowhere to be found. This article also touched upon how
the ThedaCare group was able to shave days from their patient wait time. After reading this
portion of the article, I found it to be the most important aspect on how to drastically reduce
patient waiting times but the author could only touch upon the methods vaguely. The author
described the shaving days process as the first time through we learned to dance, and the
second one, we were doing some pretty advanced steps.2 I felt that this could be seen as the
most important part of how to decrease days, but there seems to be a lot of statements left for
interpretation.
This article had a very positive message for those looking for a system to help lower
patient waiting times. I feel the author touched upon many of the positive aspects of lean
management and I feel that this article could be very beneficial for a radiation oncology
departments seeking aide in reducing waiting times.

References
1. Lenards N, Weege M. Radiation Therapy and Medical Dosimetry Reading. [Powerpoint].
LaCrosse, WI: UW-L Medical Dosimetry Program; 2015.
2. Orenstein BW. Lean Management - Wisconsins ThedaCare Improves Its Radiation
Oncology Care Process. Radiology Today, 2009: 10(12). Retrieved from
http://www.radiologytoday.net/archive/rt061509p14.shtml

Part II: Peer Reviewed Research Article

A peer reviewed publication is an article that goes through an approval process before
being published. These articles are written by professionals with the aims of answering their
hypotheses and to debate professional issues.1 Peer reviewed articles must be submitted for
publication in a scholarly journal, but before the article can be deemed appropriate, it must go
through a specific process of evaluations before professionals within that field. These articles
must maintain an identity of profession and are considered more prestigious for publication.1 The
peer reviewed article that I have chosen to review is written by Rachel McDonald et al and is
entitled Quality of life after palliative radiotherapy in bone metastases: A literature review. I will
review and present information summarizing this publication.
This publication clearly outlines all the subsections required for a research article. The
abstract was very concise and identified all the aspects that would be covered in the research:
Objective, Methods, Results, and Conclusion.
The objective of this article is to investigate the quality of life following palliative
radiotherapy for painful bone metastases. Within the introduction portion of this article, the
author gives a background of the prevalence of bone metastases in advanced cancer to be about
50-75% in patients with pain being the most common symptom.2 The author makes it clear that a
course of radiation therapy has been proven to relieve pain, but there is still not an indication that
the patients quality of life has been improved. The author then begins to go further in depth on
what pertains to an individuals quality of life. This article aims to answer the question, if quality
of life is really increased for patients receiving radiation therapy for painful bone metastases.
The methods section of this article outlined how the study was performed. This article
analyzed past literature from three separate databases. The author identified the data that would
be used and how the study would only be investigate data that pertained to a patients quality of
life post radiation therapy. Although this method did not indicate the type of cases that would be
gathered, I feel that it would be safe to assume that all cases were experiencing painful
symptoms prior to treatment. The author does place a disclaimer at the end of the methods stating
that articles were then retrieved and examined further for relevancy.2 Eighteen articles were
selected in this study. Using these sources, the research then analyzed the results of three
different reported methods of assessing quality of life: Brief Pain Inventory, Edmonton Symptom

Assessment Scale, and the European Organized for Research and treatment of Cancer
measurements.2 The use of these measuring instruments are seen as a reliable source for
evaluation because they have been implemented as standard practice for evaluating bone pain,
but the author does bring up the point that quality of life can be a very tricky subject to define
because there are so many different aspects involved. The author touches upon these
complexities in the discussion portion of the article.
The introduction and selected literature in review was very pertinent to the article. I feel
that the author indicated to his audience the importance of analyzing a patients quality of life for
bone metastases treatments because of the high occurrence seen in pretty much every radiation
oncology department. The use of the selected data was very well identified and was made
evident to the reader that they are just focusing on a certain population of patients that pertain to
their study.
The results of this research indicated that patients did report an increase in quality of life
post responsive radiation therapy treatments. There was, however, an inconsistency in reports for
patients that did not respond to the therapy. The statistical evidence to support these results were
very logical and well displayed. The author organized each dataset into categories based on the
measuring tool used. At the end of each grouping, the author displayed the quality of life
reported during the patients follow up visit.
Prior to concluding the research, the author presents a discussion and limitation to the
study. In the discussion, the author identifies difficulty in determining which aspects of quality
of life improve is due to the wide range of questionnaires used.2 This difficulty is due to the lack
of a standardized assessment tool for evaluating a patients quality of life. The subtle variations
in measuring tools can lead to inconsistency in the results. The author was very clear in
explaining the difficulties of the study and believes that a universal measuring tool could result
more accurate results. In the limitations portion of the article, the author states that the study did
not exclude patients who are on other cancer treatments, including hormone therapy and
chemotherapy.2 The side effects associated with those treatments could in fact impact the
reported quality of life.2 Another limitation was the inconsistency in the timing of the scheduled
follow up visit. The variations in visit could also impact the reported quality of life. The author
suggests that having a more consistent scheduled follow up visit could result in more accurate

results. I believe that the author made great points in both the discussion and limitation. I feel
that the suggestions for better results are quite accurate and do pertain to the research.
The conclusion of this research was that quality of life does improve for patients who
respond to palliative radiotherapy for painful bone metastases. This section of the article was
well stated and adequately summarized the entire article. The author again mentioned the use for
standardized measuring tools for future studies and how the results could be beneficial for aiding
in informed decision making by patient and physician.
The author of this article did have 25 different references with a majority dating within
the past 7 years. All the sources used were referenced from other published journals and all
appeared to be very appropriate for this peer reviewed article.
My overall impression of this research article was positive. I found this publication to be
very well formatted and informative. The format of the article followed the abstract and even
went further by adding a discussion and limitation section. I found the addition of the two
sections to be very beneficial to the article because it allowed the reader to better understand how
to develop more accurate future studies. I felt that the authors choice in words and sentence
structure was very easy to follow and it made for an easy read. I do not have any negative
feedback for this article.

References
1. Lenards N, Weege M. Radiation Therapy and Medical Dosimetry Reading. [Powerpoint].
LaCrosse, WI: UW-L Medical Dosimetry Program; 2015.
2. McDonald R, Chow E, Rowbottom L, et al. Quality of life after palliative radiotherapy in
bone metastases: A literature review. J Bone Oncol, 2014.
doi:10.1016/j.jbo.2014.11.001