Research Organization Document

Phase I
The Research Basics lecture identified the following steps in beginning the research
process:
1. Select a philosophical foundation
2. Determine group interest
3. Research your interests and develop a research problem
4. Find a supporting problem/develop a theory base (literature review)
5. Develop scientific question/query and select a research design
In the discussion forum, you should have narrowed down your interests into a single topic.
This document will help you apply these essential steps to your capstone project topic.
1. What philosophical foundation are you pursuing? Why?
 Group 3 will be pursuing Logical Positivism as our philosophical foundation.
Our research is an observable and measurable theory that can be verified
through a scientific method which mirrors the foundation of logical
positivism.
2. What is your group interest? (This would be the high-level idea that you
listed/discussed in the discussion forum).
Treatment Planning System/Techniques
 Brain treatments that specifically spare the hippocampus are treatment
plans that are difficult to design while meeting constraints. When discussing
how our clinics plan hippocampus sparing (HCS) brain treatments, it was
concluded that our sites plan very differently. Which method is superior in
delivering dose, keeping the hotspot down as much as possible, while
meeting OAR constraints and is time considerate? Is there a certain
technique that could become the standard for planning HCSP Brains?
 We will specifically be comparing VMAT HCS Whole Brain treatments
planned three different ways. Each treatment plan differs slightly with
different beam arrangements and table rotations.

3. Find a problem/develop a theory base. These concepts are combined because

b. What knowledge exists on your interests and the problems you’ve come
up with?
i. Conduct a literature review on your topics. If You’ve identified a
potential high-level 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-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 most pertinent articles that you intend
to use to support your research in AMA formatting in this document.
Refer to this list often. (Note: you will be providing summaries of
these articles in a later assignment so it’s a good idea to hold on to
notes about each article now).
 Prior research shows that there are many benefits in using VMAT techniques
to meet dose constraints to the hippocampus in comparison to 3D treatment
planning. There has not been much research to provide information on what
the best planning techniques using VMAT are to meet the hippocampus
constraint and provide optimal coverage.
References
1. Pokhrel D, Sood S, McClinton C, et al. Treatment planning strategy for whole-brain
radiotherapy with hippocampal sparing and simultaneous integrated boost for
multiple brain metastases using intensity-modulated arc therapy. Medical
Dosimetry. 2016; 41(4)315-322. https://doi.org/10.1016/j.meddos.2016.08.001
2. Krayenbuehl J, Di Martino M, Guckenberger M, et al. Improved plan quality with
automated radiotherapy planning for whole brain with hippocampus sparing: a
comparison to the RTOG 0933 trial. Radiation Oncology. 2017;12:161 DOI
10.1186/s13014-017-0896-7
3. Kazda T, Vrzal M, Prochazka T, et al. Left hippocampus sparing whole brain
radiotherapy (WBRT): A planning study. Biomed Pap Med Fac Univ Palacky Olomouc
Czech Repub. 2017 Dec; 161(4):397-402. https://doi.org/10.5507/bp.2017.031
4. Liu H, Clark R, Magliari A, et al. Rapidplan hippocampal sparing whole brain model
version 2 – how far can we reduce dose? Medical Dosimetry. 2022; 47:258-263.
https://doi.org/10.1016/j.meddos.2022.04.003
5. Sood S, Pokhrel D, McClinton C, et al. Volumetric-modulated arc therapy (VMAT) for
whole brain radiotherapy: not only for hippocampal sparing, but also for reduction
 of dose to organs at risk. Medical Dosimetry. 2017; 42:375-383.
https://doi.org/10.1016/j.meddos.2017.07.005
6. Sprowls CJ, Shah AP, Kelly P, et al. Whole brain radiotherapy with hippocampal
sparing using Varian HyperArc. Medical Dosimetry. 2021;46:264-268.
https://doi.org/10.1016/j.meddos.2021.02.007

4. What is the purpose of your study? This naturally falls in-line with the other
questions as you complete your literature review. What do you hope to find out
after you complete this research? What is the aim? These are all questions you
should ask yourselves.
 The purpose of this study is to compare VMAT HCS-WBRT techniques that
decrease the dose to the hippocampi and hot spot regions while maintaining
PTV coverage and NRG-CC001 OAR dose constraints.
 The goal of this research is to compare and determine which, if any, of the
three VMAT planning techniques will result in <1600 cGy dose to the
hippocampi as well as hot spots <110% while maintaining PTV coverage and
meeting NRG-CC001 dose constraints. Which could possibly lead to a VMAT
planning technique that can be used as a template for future planners for
HCS-WBRT that will save time, provide satisfactory target coverage, decrease
the hot spots, and reduce dose to the hippocampus and other OAR.

5. What are your supporting questions? Develop some key questions that your
reader will know the answer to after reading your research paper that support your
research problem. 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?

1. How many arcs are appropriate for HCSP brain treatments to achieve the best
coverage?
2. Why do we kick the couch to 90 for the last couple of arcs?
3. Do all clinics rotate the couch? Why or why not?
4. Will one of the three plans achieve less than 110% hot spot while maintaining
adequate PTV coverage?
5. Will one of the three plans keep the hippocampi dose to less than 1600cGy while
also meeting NRG-CC001 OAR dose constraints?
6. Comparison of planning techniques-which techniques provide the best tumor
coverage and lowest/least volume of hot spots?
 7. Comparison of planning techniques-which techniques meet planning goals with
less time needed for planning and for the patient to be on the table (couch kicks,
number of arcs)?
8. By comparing completed plans from three different facilities, one can determine
the best dosimetric plan that provides adequate and effective coverage while
keeping hot spots low and maintaining dose constraints.
9. Is there a difference between tumor coverage, dose constraints, or hot spots in
HCS-WBRT plans using FFF or FF beams?
10. Are plans with HDMLCs more effective at reducing OAR dose and/or hot spots?
11. Does split-x technique in VMAT planning help meet dose constraints and/or
decrease the hot spot(s)?
a. Split-x technique splitting brain superiorly/inferiorly
b. Split-x technique splitting brain left/right in sagittal arc
12. Does separating the brain into superior, middle, and inferior contours help meet
dose coverage and/or OAR constraints with VMAT optimization?
13. What couch angles are more effective at reducing OAR dose and/or hot spots?

6. 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 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.
 Quantitative: Experimental
Submit this document to the appropriate assignment area when instructed.