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Ikushima H, Ii N, Noda SE, Masui K, Murakami N, Yoshida K, Watanabe M, Kawamura S, Kojima T, Nomoto Y, Toita T, Ohno T, Sakurai H, Onishi H. Patterns of care for brachytherapy in Japan. JOURNAL OF RADIATION RESEARCH 2024; 65:168-176. [PMID: 38151923 PMCID: PMC10959427 DOI: 10.1093/jrr/rrad099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/16/2023] [Indexed: 12/29/2023]
Abstract
This study aimed to assess the current state of brachytherapy (BT) resources, practices and resident education in Japan. A nationwide survey was undertaken encompassing 177 establishments facilitating BT in 2022. Questionnaires were disseminated to each BT center, and feedback through online channels or postal correspondence was obtained. The questionnaire response rate was 90% (159/177), and every prefecture had a response in at least one center. The number of centers in each prefecture ranged from 0.6 to 3.6 (median: 1.3) per million population. The annual number of patients in each center ranged from 0 to 272 (median: 31). While most prefectures provided intracavitary (IC) BT for gynecological cancers and interstitial (IS) BT for prostate cancer, only one-third of the prefectures provided IS BT for cancer sites other than the prostate. The institutional image-guided BT implementation rate was 71%. IC and IS BT was performed for 15.4% of IC BT cases of gynecological cancer. Only 47% of the BT training centers answered that they could provide adequate training in BT for residents. The most common reason for this finding was the insufficient number of patients in each center. The results show that, although BT has achieved uniformity in terms of facility penetration, new technologies are not yet widespread enough. Furthermore, IS BT, which requires advanced skills, is limited to a few BT centers, and considerable number of BT training centers do not have sufficient caseloads to provide the necessary experience for their residents.
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Affiliation(s)
- Hitoshi Ikushima
- Department of Therapeutic Radiology, Tokushima University Graduate School, Japan, 3-18-15, Kuramoto-cho, Tokushima-shi, Tokushima 770-8503, Japan
| | - Noriko Ii
- Department of Radiation Oncology, Ise Red Cross Hospital, Japan, 1-471-2, Funae, Ise-shi, Mie 516-8512, Japan
| | - Shin-ei Noda
- Department of Radiation Oncology, Saitama Medical University, International Medical Center, Japan, 1397-1, Yamane, Hidaka-shi, Saitama 350-1298, Japan
| | - Koji Masui
- Department of Radiology, Kyoto Prefectural University of Medicine, Japan, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Naoya Murakami
- Department of Radiation Oncology, Juntendo University Graduate School of Medicine, Japan, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Ken Yoshida
- Department of Radiology, Kansai Medical University Medical Center, Japan 2-5-1, Shin-machi, Hirakata-shi, Osaka 573-1010, Japan
| | - Miho Watanabe
- Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Japan, 1-8-1, Inohara, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan
| | - Shinnji Kawamura
- Department of Radiological Technology, Teikyo University Graduate School of Medicine, Japan, 6-22, Misakimachi, Omuta-shi, Fukuoka 836-8505, Japan
| | - Toru Kojima
- Department of Radiation Oncology, Saitama Prefectural Cancer Center, Japan, 1696, Itai, Kumagaya-shi, Saitama 360-0197, Japan
| | - Yoshihito Nomoto
- Department of Radiology, Mie University Graduate School of Medicine, Japan, 2-174, Edobashi, Tsu-shi, Mie 5148-507, Japan
| | - Takafumi Toita
- Radiation Therapy Center, Okinawa Chubu Hospital, Japan, 281, Miyasato, Uruma-shi, Okinawa 904-2293, Japan
| | - Tatsuya Ohno
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Japan, 3-39-22, Showa-machi, Maebashi-shi, Gunma 371-8511, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, University of Tsukuba, Japan, 1-1-1, Tennoudai, Tsukuba-shi, Ibaraki 305-8575, Japan
| | - Hiroshi Onishi
- Department of Radiology, Faculty of Medicine, University of Yamanashi, Japan, 4-4-37, Takeda, Kofu-shi, Yamanashi 400-8510, Japan
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A national survey of AIRO (Italian Association of Radiation Oncology) brachytherapy (Interventional Radiotherapy) study group. J Contemp Brachytherapy 2018; 10:254-259. [PMID: 30038646 PMCID: PMC6052379 DOI: 10.5114/jcb.2018.76981] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 06/12/2018] [Indexed: 12/02/2022] Open
Abstract
Purpose To review brachytherapy resources and to explore current practice patterns in Italy. Material and methods In 2016, on behalf of the Italian Association of Radiation Oncology (AIRO), the Brachytherapy Study Group proposed conducting a survey in order to identify brachytherapy practice patterns. An electronic questionnaire was sent to all radiotherapy centres in Italy, asking for: 1. General information on the Radiation Oncology Centre (affiliation, whether brachytherapy was delivered or not); 2. Brachytherapy equipment and human resources; 3. Brachytherapy procedures; 4. Brachytherapy assessment (number of patients treated annually, treated sites, and different modalities of treatments). Results A total of 66 questionnaires were returned (33.5% of all brachytherapy centers in Italy), out of which 48 (74%) from non-academic hospitals, 6 (10%) from academic hospitals, and 12 (16%) from private institutions. Most centers (84%) had only one brachytherapy machine; 44% did not deliver brachytherapy treatments or delivered less than demanded because of the lack of staff or expertise, need of modernization, or other reasons. The majority of treatments were administered to outpatients for gynecological tumors. Conclusions This survey illustrates the current status of brachytherapy in Italy and should encourage collaboration to develop, implement, and monitor its use when appropriate.
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Tanderup K, Ménard C, Polgar C, Lindegaard JC, Kirisits C, Pötter R. Advancements in brachytherapy. Adv Drug Deliv Rev 2017; 109:15-25. [PMID: 27637454 DOI: 10.1016/j.addr.2016.09.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 06/14/2016] [Accepted: 09/05/2016] [Indexed: 11/17/2022]
Abstract
Brachytherapy is a radiotherapy modality associated with a highly focal dose distribution. Brachytherapy treats the cancer tissue from the inside, and the radiation does not travel through healthy tissue to reach the target as with external beam radiotherapy techniques. The nature of brachytherapy makes it attractive for boosting limited size target volumes to very high doses while sparing normal tissues. Significant developments over the last decades have increased the use of 3D image guided procedures with the utilization of CT, MRI, US and PET. This has taken brachytherapy to a new level in terms of controlling dose and demonstrating excellent clinical outcome. Interests in focal, hypofractionated and adaptive treatments are increasing, and brachytherapy has significant potential to develop further in these directions with current and new treatment indications.
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Affiliation(s)
- Kari Tanderup
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.
| | - Cynthia Ménard
- Centre Hospitalier de l'Université de Montréal, Montréal and Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Csaba Polgar
- Center of Radiotherapy, National Institute of Oncology, Budapest, Hungary
| | | | - Christian Kirisits
- Department of Radiotherapy, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Richard Pötter
- Department of Radiotherapy, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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Phan T, Mula-Hussain L, Pavamani S, Pearce A, D'Souza D, Patil NG, Traptow L, Doll CM. The changing landscape of brachytherapy for cervical cancer: a Canadian practice survey. ACTA ACUST UNITED AC 2015; 22:356-60. [PMID: 26628868 DOI: 10.3747/co.22.2562] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND We documented changes in practice from 2009 to 2012 for cervical cancer brachytherapy in Canada. METHODS Centres with gynecologic brachytherapy services were sent an e-mail questionnaire querying their 2012 practice. Responses are reported and compared with practice patterns identified in a similar survey for 2009. RESULTS The response rate was 77% (24 of 31 centres). Almost all use high-dose-rate brachytherapy (92%); low-dose-rate brachytherapy has been completely phased out. Most continue to move patients from the site of applicator insertion to the radiation treatment simulation suite (75%) or to a diagnostic imaging department (29%), or both. In 2012, the imaging modalities used for dose specification were computed tomography [ct (75%)], magnetic resonance imaging [mri (38%)], plain radiography (21%), and cone-beam ct (8%). The number of institutions using mri guidance has markedly increased during the period of interest (9 vs. 1). Most respondents (58% vs. 14%) prescribed using guidelines from the Groupe Européen de Curiethérapie and the European Society for Therapeutic Radiology and Oncology, but they also used point A as a reference. Commonly used high-dose radiation regimens included 30 Gy in 5 fractions and 24 Gy in 3 fractions. CONCLUSIONS In Canada, image-guided brachytherapy for cervical cancer continues to evolve. Although ct-based imaging remains the most commonly used modality, many centres have adopted mri for at least 1 brachytherapy treatment. More centres are using fewer fractions and a slightly lower biologically effective dose, but are still achieving EQD2 (2-Gy equivalent) doses of 80-90 Gy in combination with external-beam radiation therapy.
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Affiliation(s)
- T Phan
- Department of Oncology, Tom Baker Cancer Centre, Calgary, AB
| | - L Mula-Hussain
- Department of Oncology, Tom Baker Cancer Centre, Calgary, AB
| | - S Pavamani
- Department of Radiation Oncology, Christian Medical College, Vellore, South India
| | - A Pearce
- Department of Radiation Oncology, Northeast Cancer Centre, Sudbury, ON
| | - D D'Souza
- Department of Radiation Oncology, London Regional Cancer Program, London, ON
| | - N G Patil
- Department of Radiation Oncology, Nova Scotia Cancer Centre, Halifax, NS
| | - L Traptow
- Department of Oncology, Tom Baker Cancer Centre, Calgary, AB
| | - C M Doll
- Department of Oncology, Tom Baker Cancer Centre, Calgary, AB
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Yamada Y, Rogers L, Demanes DJ, Morton G, Prestidge BR, Pouliot J, Cohen GN, Zaider M, Ghilezan M, Hsu IC. American Brachytherapy Society consensus guidelines for high-dose-rate prostate brachytherapy. Brachytherapy 2012; 11:20-32. [PMID: 22265435 DOI: 10.1016/j.brachy.2011.09.008] [Citation(s) in RCA: 230] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 09/23/2011] [Accepted: 09/23/2011] [Indexed: 01/26/2023]
Abstract
PURPOSE A well-established body of literature supports the use of high-dose-rate (HDR) brachytherapy as definitive treatment for localized prostate cancer. Most of the articles describe HDR as a boost with adjuvant external beam radiation, but there is a growing experience with HDR monotherapy. METHODS AND MATERIALS The American Brachytherapy Society has convened a group of expert practitioners and physicists to develop guidelines for the use of HDR in the management of prostate cancer. This involved an extensive literature review and input from an expert panel. RESULTS Despite a wide variation in doses and fractionation reported, HDR brachytherapy provides biochemical control rates of 85-100%, 81-100%, and 43-93% for low-, intermediate-, and high-risk prostate cancers, respectively. Severe toxicity is rare, with most authors reporting less than 5% Grade 3 or higher toxicity. Careful attention to patient evaluation for appropriate patient selection, meticulous technique, treatment planning, and delivery are essential for successful treatment. CONCLUSION The clinical outcomes for HDR are excellent, with high rates of biochemical control, even for high-risk disease, with low morbidity. HDR monotherapy, both for primary treatment and salvage, are promising treatment modalities.
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Affiliation(s)
- Yoshiya Yamada
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
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Guedea F, López Torrecilla J, Londres B, Ventura M, Bilbao P, Borràs JM. Patterns of care for brachytherapy in Europe: updated results for Spain. Clin Transl Oncol 2012; 14:36-42. [DOI: 10.1007/s12094-012-0759-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Herruzo I, Romero J, Palacios A, Mañas A, Samper P, Bayo E, Guedea F. The white book of radiation oncology in Spain. Clin Transl Oncol 2011; 13:385-95. [PMID: 21680299 DOI: 10.1007/s12094-011-0672-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The White Book of Radiation Oncology provides a comprehensive overview of the current state of the speciality of radiation oncology in Spain and is intended to be used as a reference for physicians, health care administrators and hospital managers. The present paper summarises the most relevant aspects of the book's 13 chapters in order to bring the message to a wider audience. Among the topics discussed are the epidemiology of cancer in Spain, the role of the radiation oncologist in cancer care, human and material resource needs, new technologies, training of specialists, clinical and cost management, clinical practice, quality control, radiological protection, ethics, relevant legislation, research & development, the history of radiation oncology in Spain and the origins of the Spanish Society of Radiation Oncology (SEOR).
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Pavamani S, D'Souza DP, Portelance L, Craighead PS, Pearce AG, Traptow LL, Doll CM. Image-guided brachytherapy for cervical cancer: a Canadian Brachytherapy Group survey. Brachytherapy 2011; 10:345-51. [PMID: 21345744 DOI: 10.1016/j.brachy.2010.12.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Revised: 12/08/2010] [Accepted: 12/14/2010] [Indexed: 12/19/2022]
Abstract
PURPOSE To survey the current use and future plans for image-guided brachytherapy (BT) for cervical cancer by radiation oncologists in Canada. METHODS AND MATERIALS Canadian radiation oncologists treating gynecologic malignancies were identified in January 2009. A 29-item questionnaire (English and French) querying the current practice in the use of imaging in BT planning, and plans for transition to three-dimensional (3D) image guidance for BT for cervical cancer (curative intent, intact cervix), was electronically circulated. Questionnaire responses were tabulated and analyzed by respondent and by center. RESULTS Response rate was 62% (36 of 58 radiation oncologists), representing 71% (22 of 31) of Canadian radiation oncology centers with a gynecologic BT facility. Most of the centers were using high-dose-rate BT (68%), followed by low-dose-rate BT (23%) and pulsed dose-rate BT (10%). Main imaging used for treatment planning by center was plain X-ray (50%), computerized tomography (CT) (45%), and magnetic resonance imaging (MRI) (5%). For respondents using CT or MRI for planning, point A was the most common dose prescription point (50%), followed by gross tumor volume/clinical target volume as per Groupe Européen de Curiethérapie and the European Society for Therapeutic Radiology and Oncology guidelines (44%). For centers using plain X-rays for planning, 73% planned to transition to a 3D image-based approach, with the majority to adopt CT imaging. Eighty percent of respondents agreed that 3D image-guided BT should become standard of care for treatment of cervical cancer in Canada, and additionally support the development of national guidelines. CONCLUSIONS Most of the Canadian radiation oncologists surveyed and Canadian cancer centers are either using 3D imaging and planning or transitioning to a 3D image-based approach within the next year. Point A remained a commonly documented prescription point. Access to MRI was very low. These results may lead to national treatment guidelines.
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Affiliation(s)
- Simon Pavamani
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
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Guedea F, Ventura M, Londres B, Pinillos L, Poitevin A, Ospino R, Cordova A, Camacho R, Britton R, Sarria G, Sempere P, Delgado RL, Bulnes R, Ventura NC, Limbergen EV, Haie-Meder C, Kovacs G. Overview of brachytherapy resources in Latin America: a patterns-of-care survey. Brachytherapy 2011; 10:363-8. [PMID: 21296032 DOI: 10.1016/j.brachy.2010.12.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 11/30/2010] [Accepted: 12/06/2010] [Indexed: 11/16/2022]
Abstract
PURPOSE Relatively little is known about available resources and patterns of practice for brachytherapy (BT) in Latin America. To rectify this situation, we performed a patterns-of-care survey whose aim was to assess the human and material resources available for BT in Latin America and document current clinical practices. METHODS AND MATERIALS A total of 392 radiotherapy (RT) centers located in 17 Latin American countries were asked to complete an online survey that included detailed questions about BT practices, facilities, and staffing. The study was coordinated through central offices located in Spain and Peru. National coordinators were appointed to manage the survey in each individual country. RESULTS Overall, 77 of the 392 institutions (20%) completed the questionnaire. Of the 14 countries with at least one response, the participation rate was 35% (77 of 223 RT centers). The average number of patients (RT+BT) per center was 917. The mean number of BT patients per center increased by 46% (from 105 to 153 patients) from 2002 to 2007. Gynecologic localizations (endometrium, cervix, and vagina) accounted for 95% of treatments, and the uterine cervix was the most common tumor site (75% of all treatments). CONCLUSIONS In Latin America, BT is most commonly used to treat gynecologic tumors, particularly of the cervix. Relatively few interventions were performed for breast and prostate. This was the first study of its kind in this region and should be repeated periodically.
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Affiliation(s)
- Ferran Guedea
- Department of Radiation Oncology, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain.
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Patterns of care study for brachytherapy: results of the questionnaire for the years 2002 and 2007 in The Netherlands. J Contemp Brachytherapy 2011; 2:145-152. [PMID: 27853475 PMCID: PMC5104817 DOI: 10.5114/jcb.2010.19493] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Accepted: 12/28/2010] [Indexed: 11/24/2022] Open
Abstract
Purpose The goal of the ESTRO Patterns of Care study for Brachytherapy in Europe (PCBE) 2002 was to develop an aid to analyse brachytherapy practices. A 2nd version of the PCB questionnaire was created for 2007. Data over 2007 were collected at the radiotherapy institutions in The Netherlands and compared with those from 2002. The aim of this study is to describe national brachytherapy practices, to demonstrate trends, and to provide data for rational health care planning. Material and methods Data were collected using a web-based questionnaire. For each centre, a local coordinator, responsible for coordinating the questionnaires and support of the further analysis was assigned. Data from the national cancer incidence registry was used for comparison with the data from the 21 Dutch departments. Results There was a decrease in low-dose rate equipment in parallel to an increase in both pulsed-dose rate and high-dose rate equipment. The use of 3D CT and MR based imaging techniques showed a slow rise. The most common clinical procedures were for prostate, gynaecological, and oesophageal tumours. A large increase (146%) in permanent implant prostate applications using 125I seeds was observed. The numbers of oesophageal and gynaecological treatments remained stable. There is concern on the low numbers of cases treated in some institutions for a few complex treatment sites. For head and neck, anal canal, paediatrics, bladder and eye interventions it ranged from 3-20 patients per year per institution. Conclusions The increase in number of patient treated with brachytherapy is in accordance with the increases in cancer incidence. The percentage of all radiotherapy patients treated with brachytherapy (approximately 5%) remained stable. The survey identified certain trends in resources and techniques, as well as areas of expected improvement and possible gain in clinical outcome. Data reported from this survey can be used for further planning of resources, facilities and concentration of a low-volume specialised and complex treatments.
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Guedea F, Venselaar J, Hoskin P, Hellebust TP, Peiffert D, Londres B, Ventura M, Mazeron JJ, Limbergen EV, Pötter R, Kovacs G. Patterns of care for brachytherapy in Europe: Updated results. Radiother Oncol 2010; 97:514-20. [PMID: 20950878 DOI: 10.1016/j.radonc.2010.09.009] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Accepted: 09/06/2010] [Indexed: 10/19/2022]
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External beam radiotherapy plus high-dose-rate brachytherapy for treatment of locally advanced prostate cancer: The initial experience of the Catalan Institute of Oncology. Brachytherapy 2010; 9:15-22. [DOI: 10.1016/j.brachy.2009.05.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2008] [Revised: 01/08/2009] [Accepted: 05/07/2009] [Indexed: 11/21/2022]
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Andersen CE, Nielsen SK, Lindegaard JC, Tanderup K. Time-resolved in vivo
luminescence dosimetry for online error detection in pulsed dose-rate brachytherapy. Med Phys 2009; 36:5033-43. [DOI: 10.1118/1.3238102] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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