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Research Organization Document

Phase I
In the lecture from this week, you learned about the first few essential steps to a successful research
project.
1. Select a philosophical foundation
2. Investigate a topic
a. Develop a research PROBLEM
3. Find a supporting problem/develop a theory base (literature review)
4. Develop scientific question/query and select a research design
This document will help you apply these essential steps to your capstone project.
1. What philosophical foundation are you pursuing? Why?

Logical Positivism.
Because our findings will be based on measurement and dose calculation to the
rectum and not based on the perception or experience of people.

2. What is your topic idea?

a. What is a problem that you can solve? Just because a topic is interesting doesn’t
mean that it is researchable. You MUST have a problem to solve. A good place to start is
to ask your clinical educators what are some problems they have encountered in their
clinics?
i.Is there routinely a dosimetric planning constraint that they can’t meet necessitating
the need to investigate a NEW way to plan that site?
ii.Does your clinic routinely have collision issues with the gantry/couch/patient?
Could you come up with a solution?
iii.Did your clinic recently implement a new technology (FFF capabilities, Vision RT,
bladder scanning etc.)? Is your clinical manager seeking feedback from staff on
how the process is going?
iv.Is there a step of the radiation oncology treatment process
(referral scheduling consult simulation treatment planning treatment) that
doesn’t transition easily? Or errors occur frequently? Could you solve this
problem?

A cumulative dose-comparison study between daily treatments and planned rectal

doses for prostate Stereotactic Body Radiation Therapy (SBRT) with
hydrogel spaceOAR (HS) implants.

3. Find a supporting 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
topic. What knowledge exists on your topic? Conduct a literature review on your topic. You’ve
identified a 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-
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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 articles that you intend to use to support your research in AMA formatting in this document.
Refer to this list often.

Supporting Problem:
The problem is that the estimated dose to the rectum made from a single planning
CT is not a complete representation of the dose received from daily treatments due to the
probable rectal filling variation.

Articles to support research:

1. Mariados N, Sylvester J, Shad D, et al. Hydrogel spacer prospective multicenter randomized

controlled pivotal trial: Dosimetric and clinical effects of perirectal spacer application in men
undergoing prostate image guided intensity modulated radiation therapy. Int J Radiat Oncol
Bio Phys.2015;972-977. http://dx.doi.org/10.1016/j.ijrobp.2015.04.030
2. Jones R, Hassan R, Desai N, et al. Dosimetric comparison of rectal-sparing capabilities of
rectal balloon vs injectable spacer gel in stereotactic body radiation therapy for prostate
cancer: lessons learned from prospective trials. Med Dosim J.2017;42(4):341-
347. http://dx.doi.org/10.1016/j.meddos.2017.07.002
3. Jackson W, Silva J, Hartman H, et al. Stereotactic body radiation therapy for localized
prostate cancer: a systematic review and meta-analysis of over 6000 patients treated on
prospective studies. Radiat Oncol Bio Phys.2019.104(4):778-
789. https://doi.org/10.1016/j.ijrobp.2019.03.051
4. Syed YA, Patel-Yadav AK, Rivers C, Singh AK. Stereotactic radiotherapy for prostate
cancer: a review and future directions. World J Clin Oncol.2017;8:389-97.
http://dx.doi.org/10.5306/wjco.v8.i5.389
5. Meier R. Dose-escalated robotic stereotactic radiotherapy for stage II prostate cancer. Front
Oncol. 2015;5:48. https://doi.org/10.3389/fonc.2015.00048
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6. King CR, Freeman D, Kaplan I, et al. Stereotactic body radiotherapy for localized prostate
cancer: pooled analysis from a multi-institutional consortium of prospective phase II
trials. Radiother Oncol. 2013;109:217-21. http://dx.doi.org/10.1016/j.radonc.2013.08.030
7. Madsen BL, His RA, Pham HT, Fowler JF, Esagui L, Corman J. Stereotactic
hypofractionated accurate radiotherapy of the prostate (SHARP), 33.5 Gy in 5 fractions for
localized disease: First clinical trial results. Int J Radiat Oncol Biol Phys.2007;67:1099-1105.
https://doi.org/10.1016/j.ijrobp.2006.10.050
8. Hannan R, Tumati V, Xie XJ et al. Stereotactic body radiation therapy for low and
intermediate risk prostate cancer-Results from a multi-institutional clinical trial. Europ J of
Cancer.2016;59:142-151. https://doi.org/10.1016/j.ejca.2016.02.014
9. Kim DW, Cho LC, Straka C et al. Predictors of rectal tolerance observed in a dose-escalated
phase 1-2 trial of stereotactic body radiation therapy for prostate cancer. Int J Radiat Oncol
Biol Phys.2014;89: 509-517. doi: 10.1016/j.ijrobp.2014.03.012
10. Bauman G, Chen J, Rodrigues G, Davidson M, Warner A, Loblaw A. Extreme
hypofractionation for high-risk prostate cancer: dosimetric correlations with rectal
bleeding. Pract Radiat Oncol. 2017;7(6):e457-e462.
https://dx.doi.org/10.1016/j.prro.2017.06.002
11. Fischer-Valuck B, Chundury A, Gay H. Bosch W, Michalski J. Hydrogel spacer distribution
within the perirectal space in patients undergoing radiotherapy for prostate cancer: Impact of
spacer symmetry on rectal wall. Practic Radiat Oncol. 2017;7:195-
https://doi.org/10.1016/j.prro.2016.10.004
12. Mok G, Benz E, Vallee JP, Miralbell R, Zilli T. Optimization of radiation therapy techniques
for prostate cancer with prostate-rectum spacers: a systematic review. Int J Radiat Oncol Biol
Phys. 2014;90(2):278–288. http://dx.doi.org/10.1016/j.ijrobp.2014.06.044
13. Lawrie TA, Green JT, Beresford M et al. Interventions to reduce acute and late adverse
gastrointestinal effects of pelvic radiotherapy for primary pelvic cancers. Cochrane Database
Sys Rev. 2018;1:CD012529. doi:10.1002/14651858.CD012529.pub2.
14. Hamstra D, Mariados N, Sylvester J, et al. Continued benefit to rectal separation for prostate
radiation therapy: final results of a phase III trial. Int J Radiat Oncol Bio Phys.2017;977-
985. http://dx.doi.org/10.1016/j.ijrobp.2016.12.024
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15. Potters L, Rana Z, Lee L, Cox B. Outcomes of a dose-escalated stereotactic body radiation
phase 1 trial for patients with low and intermediate-risk prostate cancer. Int J Radiat Oncol
Bio Phys.2019;104(2):334-342. http://dx.doi.org/10.1016/j.ijrobp.2019.01.092
16. Pinkawa M, Schubert C, Escobar-Corral N, Berneking V, Eble MJ. Optimization of prostate
cancer radiotherapy using a spacer gel, volumetric modulated arc therapy and single
biological organ at risk objective. Int J Radiat Res. 2018;16(2):169-
176. http://dx.doi.org/10.18869/acadpub.ijrr.16.2.169
17. Forero DF, Almeida ND, Dendukuri N. 2018 Report No. 82. P51. Hydrogel Spacer to reduce
rectal toxicity in prostate cancer radiotherapy: a health technology assessment: 2018.
Technology Assessment Unit of the McGill Univ Health Centre; 2020.
18. Paetkau O, Gagne IM, Pai HH, Lam J, Goulart J, Alexander A. Maximizing rectal dose
sparing with hydrogel: A retrospective planning study. J Appl Clin Med Phys. 2019;20(4):91-
98. http://dx.doi.org/10.1002/acm2.12566
19. Stavrev P, Ruggieri R, Stavreva N, Naccarato S, Alongi F. Applying radiobiological plan
ranking methodology to VMAT prostate SBRT. Phys Medica. 2016;32(4):536-
641. https://doi.org/10.1016/j.ejmp.2016.03.019
20. Chen Z, Yang Z, Wang J, Hu Weigang. Dosimetric impact of different bladder and rectum
filling during prostate cancer radiotherapy. Radiat Onc J.2016; 1-8. doi.10.1186/s13014-016-
0681-z
 
4. What are your supporting questions? Develop some key questions that your reader will
know the answer too after reading your research paper that support your research question.
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?

Is the volume of the rectum receiving 20 Gy (V20) higher in cumulative daily

plans compared to the initial treatment plan?

5. 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
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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 Research Design

Remember that the purpose of this document is to brainstorm ideas. You will post answers to
these questions in the private discussion forum for your group. The instructors and advisors will
then review your posts and give you direction on topics that you are seeking.