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I: Trade Article Review

As development in the technology world increases many of our daily tasks will be changing as
well while working in a radiation oncology department. As weve learned with dosimetry,
treatment planning is not like it used to be when dosimetry first became a field. Minimizing
Errors in Radiation Therapy, written by Beth W. Orenstein, discussed the publicized deaths of
two patients who were receiving radiation treatment and continued on by discussing the
responses by both the American Society for Radiation Oncology (ASTRO) and the American
Association of Physicists in Medicine (AAPM).1 The article then continued to explore the
importance of the rapid development in the field, educating the patients as well as the idea of
recording near misses. Each area explored the root of the problem and offered a solution to help
with regards to patient safety.
I feel as though the article was very credible and non-biased. It was very clear that the
author believed that there were flaws in the system. He went into detail about the deaths being
publicized by the New York Times (NYT) as well as patients showing concern about being
treated with radiation therapy. However, the author also showed how ASTRO and the AAPM
were taking control of the situation and the responses that the two organizations had about
patient safety. The two organizations didnt shun away from the articles but rather used them to
make the effort to change how the system is set up and to reassure patients that their safety takes
priority when being treated.1
The author was very strong in the sense that he didnt dehumanize the incidents of the
two deaths but also did a great job going into detail about the reactions and efforts from the
ASTRO and the AAPM. Having the strength from both sides does a great job at reassuring the
everyday person that radiation treatment is still a reputable and viable treatment option as well as
stressing the importance of the everyday tasks that are performed by a radiation oncology team.
The author did a great job with whom he was sourcing as well. The NYT, AAPM and ASTRO
are all very reputable sources regarding with whom they are representing. I do feel as though the
author could have done a better job at representing the NYT more throughout the article. Having
more information and some responses from them regarding the changes that ASTRO and the
AAPM presented would have made the article stronger.

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I found this article helpful in the current development of my education as well as for
practicing dosimetrists. As a student Ive learned many key details in creating a treatment plan
that will make the treatment process easier for the radiation therapist. Organizing the plan so that
the beams are treating the patient with as little movement between fields will help reduce any
errors that could come with double checking the angle changes and couch shifts. For example, a
patient being treated with craniospinal irradiation will have many couch shifts as well as
collimator and gantry angle changes. Organizing these shifts while creating the treatment plan
can make the radiation therapists job a lot easier, in turn reducing the chance for human error.
Along with that, following up on the quality assurance for this same treatment plan reassured the
dosimetrist and myself that the treatment plan was doing what its intended purpose was. As a
practicing dosimetrist, it would be important to keep all the ideas that were presented in the
article in mind. Safety for the patients should be the number one priority and should always be
kept in mind when treating patients. As the article discussed, the field is continuously evolving
and its important for all team members to be aware of these changes while working in the field.

References
1 Beth W. Orenstein. Minimizing Errors in Radiation Therapy. Radiology Today Magazine.
http://www.radiologytoday.net/archive/rt0111p30.shtml. 2011. Accessed March 22nd 2015.

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II: Peer Reviewed Article
As technology is developing many different aspects of diagnostic imaging should be explored to
further increase their capabilities and safety towards patients. For my peer reviewed article, I
chose to analyze and critically evaluate the article CT Image Quality Over Time: Comparison of
Image Quality for Six Different CT Scanners Over a Six-Year Period. This article was published
in the Journal of Applied Clinical Medical Physics and was written and researched by Ana Maria
A, Hilde K, Anne T, et al.1 Its crucial that a research paper be organized in a systemic way as to
make it easy for the reader to follow.2 Its also important that research be logical, understandable,
confirmable and useful in order to be credible. This article was organized and written in a clear
manner in order to showcase the materials and methods, analysis of results as well as a
discussion and conclusion.
The aim of this study was to analyze the developments in computed tomography (CT)
scanners by measuring image quality parameters and variability so that it may help reduce the
stochastic effects of radiation dose to those receiving CT scans.1 The article starts out by
introducing the developments in CT scanners and how this may be affecting patients that are
receiving CT scans. The article mentions that 13.4 million more CT scans were performed in
2011 as compared to 2009 and that it has become a much more utilized diagnostic tool. However,
the problem lies in how much radiation dose patients will receive and how to reduce this dose.
The article then goes on to discuss, in great detail, the materials and methods used. The
study examined six different Catphan phantoms, of different makes and models, that are used to
take CT scans and tested their slice thickness, spatial resolution, uniformity and noise, linearity
and CT numbers. I believe that given the amount of CT scanners that are used in the world, that
they should have tested more and that their sample was too small. The article then goes into
detail discussing the parameters and techniques for each area that was tested and compared. After
quality tests were taken, the images were then burned on to CDs as DICOM files. These images
were then thoroughly analyzed to determine if comparison of the images was appropriate. This
left the study with a 95% level of significance.1
The results were then discussed and analyzed pertaining to each area that was
experimented on. It was determined that the uniformity between all the scanners was relatively
large but considered acceptable. Two problems occurred during the study for unknown reasons.
The uniformity showed improvement throughout the study and showed smaller variations in the

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images that were taken using the helical protocol as opposed to the head and body protocols. The
study determined that the noise that was measured from all the scanners needed to be normalized
with regards to slice thickness in order to be comparable. This is due to the fact that there were
differences in acquisition protocols. A graph of error bars was presented in order to indicate the
range of measurements with regards to the noise that was measured. As for linearity, the results
were presented with average values and their corresponding standard deviations with regards to
body, head and helical protocols. These results were considered consistent and satisfied the
requirements for their test. The CT numbers were also presented and were said to be more
consistent with past CT numbers and that there wasnt much difference throughout the six years.
Spatial resolution was recorded for three of the CT scanners. The other three CT scanners were
tested using the same methods as the three CT scanners that produced reliable data, but produced
significant differences in their frequencies and their data wasnt considered credible. Slice
thickness presented results that were large in variability for the Phillips scanners and relatively
small for the GE and Toshiba scanners.1
Minor changes in all aspects that were experimented on was what was concluded from
this research.1 Although it could be true that minor changes in CT developments have been made,
I think that the issue that the study has was the fact that they were only following 6 CT scanners.
Like mentioned in the critique, many of the areas that were studied had issues with regards to
protocols or errors that were encountered leaving a good majority of the data unusable. I believe
that the importance of the testing was very viable and if there is a way to perform CT scans while
also reducing the amount of dose that will be given to a patient, then it should be studied.
However, I feel as though this study in particular wasnt a strong study with regards to what it
was trying to prove and solve. Although the article was very well structured and organized, the
content wasnt very helpful or beneficial as to what it set out to do.

References

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1 Ana Maria A, Hilde K, Anne T, et al. CT image quality over time: comparison of image quality
for six different CT scanners over a six year period. 2015;16(2).
http://www.jacmp.org/index.php/jacmp/article/view/4972/html_263#author. Published 2015.
Accessed on March 22nd, 2015.
2 The Research Process. [Powerpoint]. La Crosse, WI: UW-L Medical Dosimetry Program.