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Pham TT, Whelan B, Oborn BM, Delaney GP, Vinod S, Brighi C, Barton M, Keall P. Magnetic resonance imaging (MRI) guided proton therapy: A review of the clinical challenges, potential benefits and pathway to implementation. Radiother Oncol 2022; 170:37-47. [DOI: 10.1016/j.radonc.2022.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 02/09/2022] [Accepted: 02/25/2022] [Indexed: 10/18/2022]
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Duan YH, Gu HL, Yang XH, Chen H, Wang H, Shao Y, Li XY, Feng AH, Ying YC, Fu XL, Ma K, Zhou T, Xu ZY. Evaluation of IGRT-Induced Imaging Doses and Secondary Cancer Risk for SBRT Early Lung Cancer Patients In Silico Study. Technol Cancer Res Treat 2021; 20:15330338211016472. [PMID: 34184567 PMCID: PMC8251513 DOI: 10.1177/15330338211016472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objectives: This study performed dosimetry studies and secondary cancer risk assessments on using electronic portal imaging device (EPID) and cone beam computed tomography (CBCT) as image guided tools for the early lung cancer patients treated with SBRT. Methods: The imaging doses from MV-EPID and kV-CBCT of the Edge accelerator were retrospectively added to sixty-one SBRT treatment plans of early lung cancer patients. The MV-EPID imaging dose (6MV Photon beam) was calculated in Pinnacle TPS, and the kV-CBCT imaging dose was simulated and calculated by modeling of the kV energy beam in TPS using Pinnacle automatic modeling program. Three types of plans, namely PlanEPID, PlanCBCT and Planorigin, were generated with incorporating doses of EPID, CBCT and no imaging, respectively, for analysis. The effects of imaging doses on dose-volume-histogram (DVH) and plan quality were analyzed, and the excess absolute risk (EAR) of secondary cancer for ipsilateral lung was evaluated. Results: The regions that received less than 50 cGy were significantly impacted by the imaging doses, while the isodose lines greater than 1000 cGy were barely changed. The DVH values of ipsilateral lung increased the most in PlanEPID, followed by PlanCBCT. Compared to Planorigin on the average, the estimated EAR of ipsilateral lung in PlanEPID increased by 3.43%, while the corresponding EAR increase in PlanCBCT was much smaller (about 0.4%). Considering only the contribution of the imaging dose, the EAR values for the ipsilateral lung due to the MV-EPID dose in 5 years,10 years and 15 years were 1.49 cases, 2.09 cases and 2.88 cases per 104PY respectively, and those due to the kV-CBCT dose were about 9 times lower, correspondingly. Conclusions: The imaging doses produced by MV-EPID and kV-CBCT had little effects on the target dose coverage. The secondary cancer risk caused by MV-EPID dose is more than 8.5 times that of kV-CBCT.
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Affiliation(s)
- Yan-Hua Duan
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Heng-Le Gu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiao-Hui Yang
- Department of Engineering, Beijing Jingfang Technologies Co. Ltd, Beijing, China
| | - Hua Chen
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hao Wang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Shao
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiao-Yang Li
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ai-Hui Feng
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yan-Chen Ying
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiao-Long Fu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Kui Ma
- Clinical helpdesk, Varian Medical Systems, China
| | - Tao Zhou
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong, China
| | - Zhi-Yong Xu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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García-Hernández T, Romero-Expósito M, Sánchez-Nieto B. Low dose radiation therapy for COVID-19: Effective dose and estimation of cancer risk. Radiother Oncol 2020; 153:289-295. [PMID: 33065184 PMCID: PMC7553901 DOI: 10.1016/j.radonc.2020.09.051] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/16/2020] [Accepted: 09/27/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND PURPOSE The objective of this work is to evaluate the risk of carcinogenesis of low dose ionizing radiation therapy (LDRT), for treatment of immune-related pneumonia following COVID-19 infection, through the estimation of effective dose and the lifetime attributable risk of cancer (LAR). MATERIAL AND METHODS LDRT treatment was planned in male and female computational phantoms. Equivalent doses in organs were estimated using both treatment planning system calculations and a peripheral dose model (based on ionization chamber measurements). Skin dose was estimated using radiochromic films. Later, effective dose and LAR were calculated following radiation protection procedures. RESULTS Equivalent doses to organs per unit of prescription dose range from 10 mSv/cGy to 0.0051 mSv/cGy. Effective doses range from 204 mSv to 426 mSv, for prescription doses ranging from 50 cGy to 100 cGy. Total LAR for a prescription dose of 50 cGy ranges from 1.7 to 0.29% for male and from 4.9 to 0.54% for female, for ages ranging from 20 to 80 years old. CONCLUSIONS The organs that mainly contribute to risk are lung and breast. Risk for out-of-field organs is low, less than 0.06 cases per 10000. Female LAR is on average 2.2 times that of a male of the same age. Effective doses are of the same order of magnitude as the higher-dose interventional radiology techniques. For a 60 year-old male, LAR is 8 times that from a cardiac CT, when prescription dose is 50 cGy.
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Affiliation(s)
| | - Maite Romero-Expósito
- Área de Ciencias Básicas y Ambientales, Instituto Tecnológico de Santo Domingo (INTEC), P.O. Box 342-9/249-2, Santo Domingo, Dominican Republic
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Coffey M, Delaney G. The importance of quality and safety in radiotherapy delivery. Tech Innov Patient Support Radiat Oncol 2020; 14:30-31. [PMID: 32566766 PMCID: PMC7296426 DOI: 10.1016/j.tipsro.2020.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Sun W, Wang B, Qiu B, Liang J, Xie W, Deng X, Qi Z. Assessment of female breast dose for thoracic cone-beam CT using MOSFET dosimeters. Oncotarget 2017; 8:20179-20186. [PMID: 28423624 PMCID: PMC5386753 DOI: 10.18632/oncotarget.15555] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 01/23/2017] [Indexed: 11/25/2022] Open
Abstract
Objective: To assess the breast dose during a routine thoracic cone-beam CT (CBCT) check with the efforts to explore the possible dose reduction strategy. Materials and Methods: Metal oxide semiconductor field-effect transistor (MOSFET) dosimeters were used to measure breast surface doses during a thorax kV CBCT scan in an anthropomorphic phantom. Breast doses for different scanning protocols and breast sizes were compared. Dose reduction was attempted by using partial arc CBCT scan with bowtie filter. The impact of this dose reduction strategy on image registration accuracy was investigated. Results: The average breast surface doses were 20.02 mGy and 11.65 mGy for thoracic CBCT without filtration and with filtration, respectively. This indicates a dose reduction of 41.8% by use of bowtie filter. It was found 220° partial arc scanning significantly reduced the dose to contralateral breast (44.4% lower than ipsilateral breast), while the image registration accuracy was not compromised. Conclusions: Breast dose reduction can be achieved by using ipsilateral 220° partial arc scan with bowtie filter. This strategy also provides sufficient image quality for thorax image registration in daily patient positioning verification.
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Affiliation(s)
- Wenzhao Sun
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou 510060, China
| | - Bin Wang
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou 510060, China
| | - Bo Qiu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou 510060, China
| | - Jian Liang
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou 510060, China
| | - Weihao Xie
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou 510060, China
| | - Xiaowu Deng
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou 510060, China
| | - Zhenyu Qi
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou 510060, China
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Batumalai V, Phan P, Choong C, Holloway L, Delaney GP. Comparison of setup accuracy of three different image assessment methods for tangential breast radiotherapy. J Med Radiat Sci 2016; 63:224-231. [PMID: 27741383 PMCID: PMC5167282 DOI: 10.1002/jmrs.180] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 04/29/2016] [Indexed: 11/28/2022] Open
Abstract
Introduction To compare the differences in setup errors measured with electronic portal image (EPI) and cone‐beam computed tomography (CBCT) in patients undergoing tangential breast radiotherapy (RT). Relationship between setup errors, body mass index (BMI) and breast size was assessed. Methods Twenty‐five patients undergoing postoperative RT to the breast were consented for this study. Weekly CBCT scans were acquired and retrospectively registered to the planning CT in three dimensions, first using bony anatomy for bony registration (CBCT‐B) and again using breast tissue outline for soft tissue registration (CBCT‐S). Digitally reconstructed radiographs (DRR) generated from CBCT to simulate EPI were compared to the planning DRR using bony anatomy in the V (parallel to the cranio‐caudal axis) and U (perpendicular to V) planes. The systematic (Σ) and random (σ) errors were calculated and correlated with BMI and breast size. Results The systematic and random errors for EPI (ΣV = 3.7 mm, ΣU = 2.8 mm and σV = 2.9 mm, σU = 2.5) and CBCT‐B (ΣV = 3.5 mm, ΣU = 3.4 mm and σV = 2.8 mm, σU = 2.8) were of similar magnitude in the V and U planes. Similarly, the differences in setup errors for CBCT‐B and CBCT‐S in three dimensions were less than 1 mm. Only CBCT‐S setup error correlated with BMI and breast size. Conclusions CBCT and EPI show insignificant variation in their ability to detect setup error. These findings suggest no significant differences that would make one modality considered superior over the other and EPI should remain the standard of care for most patients. However, there is a correlation with breast size, BMI and setup error as detected by CBCT‐S, justifying the use of CBCT‐S for larger patients.
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Affiliation(s)
- Vikneswary Batumalai
- Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,South Western Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
| | - Penny Phan
- Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia
| | - Callie Choong
- Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia
| | - Lois Holloway
- Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,South Western Clinical School, University of New South Wales, Liverpool, New South Wales, Australia.,Centre for Medical Radiation Physics, University of Wollongong, Sydney, New South Wales, Australia.,School of Physics, University of Sydney, Liverpool, New South Wales, Australia
| | - Geoff P Delaney
- Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,South Western Clinical School, University of New South Wales, Liverpool, New South Wales, Australia.,School of Medicine, University of Western Sydney, New South Wales, Australia
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Niglas M, McCann C, Keller BM, Makhani N, Presutti J, Vesprini D, Rakovitch E, Elzibak A, Mashouf S, Lee J. A dosimetric study of cardiac dose sparing using the reverse semi-decubitus technique for left breast and internal mammary chain irradiation. Radiother Oncol 2016; 118:187-93. [DOI: 10.1016/j.radonc.2015.12.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 10/07/2015] [Accepted: 12/05/2015] [Indexed: 12/25/2022]
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Zhang Y, Wu H, Chen Z, Knisely JPS, Nath R, Feng Z, Bao S, Deng J. Concomitant Imaging Dose and Cancer Risk in Image Guided Thoracic Radiation Therapy. Int J Radiat Oncol Biol Phys 2015; 93:523-31. [PMID: 26460994 DOI: 10.1016/j.ijrobp.2015.06.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 05/27/2015] [Accepted: 06/23/2015] [Indexed: 12/25/2022]
Abstract
PURPOSE Kilovoltage cone beam computed tomography (CT) (kVCBCT) imaging guidance improves the accuracy of radiation therapy but imposes an extra radiation dose to cancer patients. This study aimed to investigate concomitant imaging dose and associated cancer risk in image guided thoracic radiation therapy. METHODS AND MATERIALS The planning CT images and structure sets of 72 patients were converted to CT phantoms whose chest circumferences (Cchest) were calculated retrospectively. A low-dose thorax protocol on a Varian kVCBCT scanner was simulated by a validated Monte Carlo code. Computed doses to organs and cardiac substructures (for 5 selected patients of various dimensions) were regressed as empirical functions of Cchest, and associated cancer risk was calculated using the published models. The exposures to nonthoracic organs in children were also investigated. RESULTS The structural mean doses decreased monotonically with increasing Cchest. For all 72 patients, the median doses to the heart, spinal cord, breasts, lungs, and involved chest were 1.68, 1.33, 1.64, 1.62, and 1.58 cGy/scan, respectively. Nonthoracic organs in children received 0.6 to 2.8 cGy/scan if they were directly irradiated. The mean doses to the descending aorta (1.43 ± 0.68 cGy), left atrium (1.55 ± 0.75 cGy), left ventricle (1.68 ± 0.81 cGy), and right ventricle (1.85 ± 0.84 cGy) were significantly different (P<.05) from the heart mean dose (1.73 ± 0.82 cGy). The blade shielding alleviated the exposure to nonthoracic organs in children by an order of magnitude. CONCLUSIONS As functions of patient size, a series of models for personalized estimation of kVCBCT doses to thoracic organs and cardiac substructures have been proposed. Pediatric patients received much higher doses than did the adults, and some nonthoracic organs could be irradiated unexpectedly by the default scanning protocol. Increased cancer risks and disease adverse events in the thorax were strongly related to higher imaging doses and smaller chest dimensions.
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Affiliation(s)
- Yibao Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiotherapy, Peking University Cancer Hospital & Institute, Beijing, China
| | - Hao Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiotherapy, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhe Chen
- Department of Therapeutic Radiology, Yale University, New Haven, Connecticut
| | - Jonathan P S Knisely
- Department of Radiation Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York
| | - Ravinder Nath
- Department of Therapeutic Radiology, Yale University, New Haven, Connecticut
| | - Zhongsu Feng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiotherapy, Peking University Cancer Hospital & Institute, Beijing, China
| | - Shanglian Bao
- Beijing Key Laboratory of Medical Physics and Engineering, Peking University, Beijing, China
| | - Jun Deng
- Department of Therapeutic Radiology, Yale University, New Haven, Connecticut.
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Batumalai V, Quinn A, Jameson M, Delaney G, Holloway L. Imaging dose in breast radiotherapy: does breast size affect the dose to the organs at risk and the risk of secondary cancer to the contralateral breast? J Med Radiat Sci 2015; 62:32-9. [PMID: 26229665 PMCID: PMC4364804 DOI: 10.1002/jmrs.91] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 11/24/2014] [Accepted: 11/27/2014] [Indexed: 12/25/2022] Open
Abstract
Introduction Correct target positioning is crucial for accurate dose delivery in breast radiotherapy resulting in utilisation of daily imaging. However, the radiation dose from daily imaging is associated with increased probability of secondary induced cancer. The aim of this study was to quantify doses associated with three imaging modalities and investigate the correlation of dose and varying breast size in breast radiotherapy. Methods Planning computed tomography (CT) data sets of 30 breast cancer patients were utilised to simulate the dose received by various organs from a megavoltage computed tomography (MV-CT), megavoltage electronic portal image (MV-EPI) and megavoltage cone-beam computed tomography (MV-CBCT). The mean dose to organs adjacent to the target volume (contralateral breast, lungs, spinal cord and heart) were analysed. Pearson correlation analysis was performed to determine the relationship between imaging dose and primary breast volume and the lifetime attributable risk (LAR) of induced secondary cancer was calculated for the contralateral breast. Results The highest contralateral breast mean dose was from the MV-CBCT (1.79 Gy), followed by MV-EPI (0.22 Gy) and MV-CT (0.11 Gy). A similar trend was found for all organs at risk (OAR) analysed. The primary breast volume inversely correlated with the contralateral breast dose for all three imaging modalities. As the primary breast volume increases, the likelihood of a patient developing a radiation-induced secondary cancer to the contralateral breast decreases. MV-CBCT showed a stronger relationship between breast size and LAR of developing a radiation-induced contralateral breast cancer in comparison with the MV-CT and MV-EPI. Conclusions For breast patients, imaging dose to OAR depends on imaging modality and treated breast size. When considering the use of imaging during breast radiotherapy, the patient's breast size and contralateral breast dose should be taken into account.
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Affiliation(s)
- Vikneswary Batumalai
- Liverpool Cancer Therapy Centre and Ingham Institute Liverpool, New South Wales, Australia ; South Western Clinical School, University of New South Wales Sydney, New South Wales, Australia
| | - Alexandra Quinn
- Liverpool Cancer Therapy Centre and Ingham Institute Liverpool, New South Wales, Australia ; Centre for Medical Radiation Physics, University of Wollongong Wollongong, New South Wales, Australia
| | - Michael Jameson
- Liverpool Cancer Therapy Centre and Ingham Institute Liverpool, New South Wales, Australia ; Centre for Medical Radiation Physics, University of Wollongong Wollongong, New South Wales, Australia
| | - Geoff Delaney
- Liverpool Cancer Therapy Centre and Ingham Institute Liverpool, New South Wales, Australia ; South Western Clinical School, University of New South Wales Sydney, New South Wales, Australia ; Collaboration for Cancer Outcomes Research and Evaluation, Liverpool Hospital Liverpool, New South Wales, Australia ; School of Medicine, University of Western Sydney New South Wales, Australia
| | - Lois Holloway
- Liverpool Cancer Therapy Centre and Ingham Institute Liverpool, New South Wales, Australia ; South Western Clinical School, University of New South Wales Sydney, New South Wales, Australia ; Centre for Medical Radiation Physics, University of Wollongong Wollongong, New South Wales, Australia ; School of Physics, University of Sydney Sydney, New South Wales, Australia
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Quinn A, Holloway L, Begg J, Nelson V, Metcalfe P. Kilovoltage cone-beam CT imaging dose during breast radiotherapy: A dose comparison between a left and right breast setup. Med Dosim 2014; 39:190-3. [PMID: 24630912 DOI: 10.1016/j.meddos.2013.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 10/22/2013] [Accepted: 12/31/2013] [Indexed: 11/18/2022]
Affiliation(s)
- Alexandra Quinn
- Northern Sydney Cancer Centre, Royal North Shore Hospital, NSW, Australia; Centre for Medical Radiation Physics, University of Wollongong, NSW, Australia; Liverpool and Macarthur Cancer Therapy Centres, NSW, Australia.
| | - Lois Holloway
- Centre for Medical Radiation Physics, University of Wollongong, NSW, Australia; Liverpool and Macarthur Cancer Therapy Centres, NSW, Australia; School of Physics, University of Sydney, NSW, Australia; Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia; South West Clinical School, School of Medicine, University of New South Wales, Australia
| | - Jarrad Begg
- Liverpool and Macarthur Cancer Therapy Centres, NSW, Australia
| | - Vinod Nelson
- Liverpool and Macarthur Cancer Therapy Centres, NSW, Australia
| | - Peter Metcalfe
- Centre for Medical Radiation Physics, University of Wollongong, NSW, Australia; Liverpool and Macarthur Cancer Therapy Centres, NSW, Australia; Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
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Lee WR. Editor's Note: The importance of understanding patient safety, international scope, and scientific misconduct. Pract Radiat Oncol 2013; 3:79. [DOI: 10.1016/j.prro.2013.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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