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Article Analysis Part 1: Trade Magazine

For the compare and contrast article assignment I chose two articles written about prone
versus supine positioning for the treatment of breast cancer. One of these articles came from a
trade magazine and the other a professional journal. While I found both articles to be interesting,
there were many differences between the two.
The trade magazine article I read came from the website Everyday Health and was titled
“How Body Position Can Make Breast Cancer Radiation Safer” and was written by Julia White,
MD. This article discusses the benefits that treatment in the prone position can offer. These
benefits include, lower dose to heart and lung tissues and better overall cosmesis of the breast
after radiation is completed.1 These lower doses are achievable using the prone board because
the position allows breast tissue to fall away from the chest wall so that radiation can target the
necessary breast tissue while sparing nearby healthy organs; additionally, this position provides a
more uniform dispersal of tissue resulting in more uniform dose coverage and improved long-
term cosmesis.1
I found this article to be interesting because it caused me to think more about the
cosmetic effects radiation can cause our patients following treatment. However, I’m not sure it
truly offers any new information that practicing medical dosimetrists will find useful. The
author of this article, Dr. Julia White, is the director of breast radiation oncology at the Ohio
State University Wexner Medical Center and is very qualified to speak on this topic; however, I
believe the article was written more for a general audience, and in many ways is biased toward
the university that the author works for. For example, White1 makes statements such as “we’ve
developed a modified treatment board” and “when patients come to the Ohio State University’s
James Cancer Hospital and Solove Research Institute for treatment…” which give the impression
that this treatment technique cannot be found elsewhere.
This article describes another alternative to standard supine treatment for breast radiation
and could be very useful to women newly diagnosed with breast cancer who are researching all
of their options. I do not believe this article offers a lot to medical professionals other than
reinforcing the fact that prone positioning can be a better alternative for some women; however,
it is a good source for those looking to understand what benefits prone positioning can provide.
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Reference List

1. White J. How body position can make breast cancer radiation safer. Everyday Health
Web site. https://www.everydayhealth.com/columns/health-answers/how-body-position-
can-make-breast-cancer-radiation-safer/. Retrieved January 25, 2018. Updated October
17, 2014.
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Article Analysis Part 2: Professional Journal

The second article I chose to review came from the professional journal Radiation
Therapist and is titled “Comparing Critical Structure Dose: Prone vs Supine Breast Treatments”
and was written by Richard C McKinnies, Med, R.T.(R)(T) and Kevin S Collins, Med,
R.T.(R)(T),CMD. This article had a much more professional appearance compared to the trade
article because it was free of advertisements, was organized in a logical manner and the intended
purpose, method, results, and conclusion were easily identified.
The purpose of this study was to evaluate the V20 (volume of total lung that receives
20Gy), global max hot spot, and breast bridge distance in patients treated prone vs supine. The
question being researched is does treating a patient in the prone position vs supine help to
decrease these variables and produce an overall better plan? The literature provided in this
article gave an excellent background as to why these factors are clinically important and should
be researched. For example, according to Graham, Purdy, Emami, et al. (as cited in McKinnies
& Collins),1 the V20 can be an independent predictor of radiation pneumonitis, which is why
limiting it is so important. Additionally, it was explained that the larger a patient’s breast bridge
(separation between lateral and medial border), the larger the hot spot or maximum dose point
will be in the plan, which is important because decreasing the hot spots in a plan can have a
positive impact on the cosmesis a patient experiences after receiving radiation.1
To carry out this research, 25 patients were treated for right sided breast cancer, 11 were
treated supine and 14 were treated prone. A mean breast bridge measurement was recorded for
patients in the supine and prone positions as well as the mean V20 and global max hot spot. The
prone vs supine results were then compared. Results showed that the mean breast bridge of the
prone patients was significantly smaller than that of the supine patients, 17.78 cm compared to
24.87 cm, which resulted in a lower hot spot for the prone patients, 107.57% compared to
115.14% in supine patients. The V20 results were especially interesting, with the prone patients
having an average of 1.49% lung volume receiving 20Gy compared to 10.92% in supine patients.
My overall impression of this research is that it is a very worthwhile topic and can offer
many benefits to patients. However, I do feel the research could have been improved if carried
out in a different way. For example, each patient could have been planned in the prone and
supine position to more accurately represent the improvements in the factors being studied.
Since the study was only conducted on 25 patients, the results could also be skewed, especially if
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the patients studied had largely varying body types. Although I feel there could have been
improvements made on how this study was conducted, I do believe the research demonstrates the
reduction in lung volume and global max dose that can be achieved by having a patient lay in a
prone position. This research topic is definitely one of interest to the radiation oncology
community and prone treatment for breast cancer should be strongly considered for those who
are candidates.
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Reference List

1. McKinnies R, Collins K. Comparing critical structure dose: prone vs supine breast

treatments. Radiation Therapist. Fall 2011; 20(2):103-107. http://web.a.ebscohost.com.
libweb.uwlax.edu/ehost/pdfviewer/pdfviewer?vid=4&sid=01d4c16c-1fae-4083-8abc-
a16f729514bc%40sessionmgr4006. Accessed January 24, 2018.