Problem that needs to be solved

surrounded by or abut tissues of low density such as lung parenchyma. Appropriate FFF MLC
margins needs to be studied to result in optimal PTV coverage in dome liver lesions when
calculated with Acuros algorithm.

Key questions that need to be answered

What are the optimal MLC margins in SBRT of dome liver lesions calculated with AAA
algorithm?

What are the differences in metrics such as D90, D95, HI, CI, GI, Liver V20 Gy, and mean
liver dose between AAA and Acuros algorithms after calculations?

How much additional superior MLC margins are needed in SBRT of dome liver lesions
calculated with Acuros algorithm to overcome inadequate PTV coverage?

What are the effects of various additional superior MLC margins on metrics such as HI,
CI, GI, Liver V20Gy, and mean liver dose using Acuros algorithm?

What is the correlation (if any) of between PTV volume and superior MLC margins?

What are the limitations of the study?

Evidence of gap in literature

Cakir3 studied dosimetric plan results with 10MV flattening filter free (FFF) beams using
Anisotropic Analytical Algorithm (AAA) and Acuros XB (Varian; Palo Alto, CA) calculation
algorithm in the treatment of liver lesions and the effect of calculation grid size; however, the
Lee P, Sioshani S. Outcomes of SBRT for HCC in patients with child-pugh B and C
cirrhosis. Int J Radiat Oncol Biol Phys. 2018;102(3);S136.
https://doi.org/10.1016/j.ijrobp.2018.06.334
Yan C, Combine AG, Bednarz G, et al. Clinical implementation and evaluation of the
Acuros dose calculation algorithm. J Appl Clin Med Phys. 2017;18(5):195-209.
http://dx.doi.org/10.1002/acm2.12149
Cakir A. Dosimetric comparison of anisotropic analytical algorithm and Acuros XB in
stereotactic body radiotherapy and effect of calculation grid size. Turk J Oncol.
2017:32(3):100-105. http://dx.doi.org/10.5505/tjo.2017.1619
Ogata T, Nishimura H, Mayahara H, Uehara K, Okayama T. Identification of the
suitable leaf margin for liver stereotactic body radiotherapy with flattening filter-free
beams. Med Dosim. 2017;42(4):268-272.
http://dx.doi.org/10.1016/j.meddos.2017.06.002
Wakai N, Sumida I, Otani Y, et al. Optimization of leaf margins for lung stereotactic
body radiotherapy using a flattening filter-free beam. Med. Phys. 2015;42(5):2125-2131.
http://dx.doi.org/10.1118/1.4916683
Padmanaban S, Warren S, Walsh A, Partridge M, Hawkins MA. Comparisons of Acuros
(AXB) and Anisotropic Analytical Algorithm (AAA) for dose calculation in treatment of
esophageal cancer: effects on modelling tumour control probability. Radiat Oncol.
2014;9:286. http://dx.doi.org/10.1186/s13014-014-0286-3
Yan Y, Yadav P, Bassetti M, et al. Dosimetric differences in flattened and flattening
filter-free beam treatment plans. J Med Phys. 2016;41(2):92-99.
http://dx.doi.org/10.4103/0971-6203.181636
Sharma SD. Unflattened photon beams from the standard flattening filter free
accelerators for radiotherapy: Advantages, limitations and challenges. J Med Phys.
2011;36(3):123-125. http://dx.doi.org/10.4103/0971-6203.83464
Vieillevigne L, Bessieres S, Ouali M, Lanaspeze, C. Dosimetric comparison of flattened
and unflattened beams for stereotactic body radiation therapy: Impact of the size of the
PTV on dynamic conformal arc and volumetric modulated arc therapy. Physica Medica.
2016;32(11):1405-1414. http://dx.doi.org/10.1016/j.ejmp.2016.10.007T
Pollom EL, Chin AL, Diehn M, Loo BW, Chang DT. Normal tissue constraints for
abdominal and thoracic stereotactic body radiotherapy. Semin Radiat Oncol.
2017;27(3):197-208. http://dx.doi.org/10.1016/j.semradonc.2017.02.001
Finalized Research Topic

SBRT of superior liver lesions using Acuros XB calculation algorithm and 10 MV FFF beams: a
search of optimal (MLC) margins.

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.

Basic Study Components

1. Do any group members need to obtain IRB approval? (To determine if you need IRB
approval from your clinical site to conduct research, ask your clinical preceptor. The preceptor
should be aware of the protocol for your site or will be able to direct you to the correct resource.
If you DO need IRB approval you will most likely need to prepare a formal research proposal
and submit to the IRB.)

IRB approval most likely needed.

2. Will your study by prospective or retrospective?

Retrospective study.

3. Number of patients for data collection

10 patients.

4. Type of study (Ex: Comparison of planning techniques, comparison of OAR etc.)

Comparison of PTV MLC margins using AAA and Acuros algorithms.

Amy

Data Collector(s) (someone who will be doing the data collection and data reporting in excel;
maintaining journal entries)

Amy and Nathan

Data analysis (someone who will be responsible for analyzing the raw data, running any
statistical tests and providing conclusive data for the writer)

Amy

Writer (someone who is responsible for writing the outline (later in the course) and the paper;
usually the best writer of the group takes this role)

Neil

Editor (someone who is responsible for checking each draft for errors and providing feedback
and corrections to writer)

Amy Nishele and Ashley

**The roles must be assigned in such a way that all of the work is divided equally.
For example, if 2 of 3 group members are data collectors, the 3rd group member should be the
writer. Only 1 group member can write the paper so that the tone of paper is consistent.
Because the writing is such a large part of the research paper, the writer should have a smaller
part in the other aspects of the research paper.

Data Collection Details

1. How many clinical sites will you be collecting data from?

1 clinical site

2. What information are you interested in (if a planning study, list structures for
CI

3. What is your inclusion criteria? Exclusion criteria?

tissue.

4. How will you limit the number of variables in your study? (For example, if you are doing
a planning study, only 1 person should be doing the planning to eliminate the variables.)

1 planner, 1 writer.

5. Read through Chapter 20 in your textbook. Are you interested in completing a statistical
analysis on this data? If so, what parameters will you be analyzing? (pvalue, mean, t-test
ect.). (Keep in mind that anything beyond the test listed might be required for your paper.
The UWL stats center is an excellent resource for students need a more complex statistical
-depth analysis, reach out to the stats
center and they will be able to provide you with insight. It is also important to note that
statistical analysis of any kind will add robustness and validity to your research study!)
Why do you think that those metrics will be best for your topic?

Mann-Whitney U test:

-Small sample size

-Assumption that distributions of dependent variables will be similar

p-value

6. Where will you house your data? (Excel etc., this will all be housed in OneDrive).

Excel spreadsheets and Word documents on OneDrive

7. How will you anonymize your patients? (It is often necessary to transfer data sets or
patient information between group members. It is VERY IMPORTANT that you respect
HIPPA protocols! If you need to transfer data sets between facilities, we can assist you
Clinical support from physicists as needed.

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

NRG BR001/BR002 protocols

Pollom EL, Chin AL, Diehn M, Loo BW, Chang DT. Normal tissue constraints for abdominal
and thoracic stereotactic body radiotherapy. Semin Radiat Oncol. 2017;27(3):197-208.
http://dx.doi.org/10.1016/j.semradonc.2017.02.001

10. List a loose weekly deadline for your data collection. (If you want to add writing
deadlines as well, feel free. However, paper due dates will be assigned in Research II and
Research III). It is very easy to be overwhelmed with this project, therefore, it is
ESSENTIAL that you set yourselves up for success and set deadlines within your group to
stay on track. We cannot set the deadlines for you because every project develops at a
different rate and with differing complexities. Based on your deadlines, we will setup
conference calls with each group to check-in. Remember that this project will continue

essential to lay the foundation for success with this project.

Summer 2019 Semester

Weeks 1-2: Patient selection and data sorting.

Weeks 3-6: Data collection and analysis.

Weeks 7-10: Draft 1 and editing

Weeks 11-12: Draft 2

This document will serve as your research organizer and research guide. Refer to it often so that
you stay on track with project development. This document may change as your study progresses