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Wang L, Ding Y, Bruno TL, Stafford RJ, Lin E, Bathala TK, Sanders JW, Ning MS, Ma J, Klopp AH, Venkatesan A, Wang J, Martirosyan KS, Frank SJ. A Novel Positive-Contrast Magnetic Resonance Imaging Line Marker for High-Dose-Rate (HDR) MRI-Assisted Radiosurgery (MARS). Cancers (Basel) 2024; 16:1922. [PMID: 38792000 PMCID: PMC11119838 DOI: 10.3390/cancers16101922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/15/2024] [Accepted: 05/17/2024] [Indexed: 05/26/2024] Open
Abstract
Magnetic resonance imaging (MRI) can facilitate accurate organ delineation and optimal dose distributions in high-dose-rate (HDR) MRI-Assisted Radiosurgery (MARS). Its use for this purpose has been limited by the lack of positive-contrast MRI markers that can clearly delineate the lumen of the HDR applicator and precisely show the path of the HDR source on T1- and T2-weighted MRI sequences. We investigated a novel MRI positive-contrast HDR brachytherapy or interventional radiotherapy line marker, C4:S, consisting of C4 (visible on T1-weighted images) complexed with saline. Longitudinal relaxation time (T1) and transverse relaxation time (T2) for C4:S were measured on a 1.5 T MRI scanner. High-density polyethylene (HDPE) tubing filled with C4:S as an HDR brachytherapy line marker was tested for visibility on T1- and T2-weighted MRI sequences in a tissue-equivalent female ultrasound training pelvis phantom. Relaxivity measurements indicated that C4:S solution had good T1-weighted contrast (relative to oil [fat] signal intensity) and good T2-weighted contrast (relative to water signal intensity) at both room temperature (relaxivity ratio > 1; r2/r1 = 1.43) and body temperature (relaxivity ratio > 1; r2/r1 = 1.38). These measurements were verified by the positive visualization of the C4:S (C4/saline 50:50) HDPE tube HDR brachytherapy line marker on both T1- and T2-weighted MRI sequences. Orientation did not affect the relaxivity of the C4:S contrast solution. C4:S encapsulated in HDPE tubing can be visualized as a positive line marker on both T1- and T2-weighted MRI sequences. MRI-guided HDR planning may be possible with these novel line markers for HDR MARS for several types of cancer.
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Affiliation(s)
- Li Wang
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (L.W.); (E.L.)
| | - Yao Ding
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Y.D.); (J.W.)
| | - Teresa L. Bruno
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (T.L.B.); (M.S.N.); (A.H.K.)
| | - R. Jason Stafford
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (R.J.S.); (J.M.)
| | - Eric Lin
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (L.W.); (E.L.)
| | - Tharakeswara K. Bathala
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (T.K.B.); (A.V.)
| | | | - Matthew S. Ning
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (T.L.B.); (M.S.N.); (A.H.K.)
| | - Jingfei Ma
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (R.J.S.); (J.M.)
| | - Ann H. Klopp
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (T.L.B.); (M.S.N.); (A.H.K.)
| | - Aradhana Venkatesan
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (T.K.B.); (A.V.)
| | - Jihong Wang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Y.D.); (J.W.)
| | - Karen S. Martirosyan
- Department of Physics, The University of Texas Rio Grande Valley, Brownsville, TX 78500, USA;
| | - Steven J. Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (T.L.B.); (M.S.N.); (A.H.K.)
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Otal A, Celada F, Chimeno J, Vijande J, Pellejero S, Perez-Calatayud MJ, Villafranca E, Fuentemilla N, Blazquez F, Rodriguez S, Perez-Calatayud J. Review on Treatment Planning Systems for Cervix Brachytherapy (Interventional Radiotherapy): Some Desirable and Convenient Practical Aspects to Be Implemented from Radiation Oncologist and Medical Physics Perspectives. Cancers (Basel) 2022; 14:cancers14143467. [PMID: 35884528 PMCID: PMC9318845 DOI: 10.3390/cancers14143467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/10/2022] [Accepted: 07/14/2022] [Indexed: 11/16/2022] Open
Abstract
Intracavitary brachytherapy (BT, Interventional Radiotherapy, IRT), plays an essential role in the curative intent of locally advanced cervical cancer, for which the conventional approach involves external beam radiotherapy with concurrent chemotherapy followed by BT. This work aims to review the different methodologies used by commercially available treatment planning systems (TPSs) in exclusive magnetic resonance imaging-based (MRI) cervix BT with interstitial component treatments. Practical aspects and improvements to be implemented into the TPSs are discussed. This review is based on the clinical expertise of a group of radiation oncologists and medical physicists and on interactive demos provided by the software manufacturers. The TPS versions considered include all the new tools currently in development for future commercial releases. The specialists from the supplier companies were asked to propose solutions to some of the challenges often encountered in a clinical environment through a questionnaire. The results include not only such answers but also comments by the authors that, in their opinion, could help solve the challenges covered in these questions. This study summarizes the possibilities offered nowadays by commercial TPSs, highlighting the absence of some useful tools that would notably improve the planning of MR-based interstitial component cervix brachytherapy.
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Affiliation(s)
- Antonio Otal
- Medical Physics Department, Hospital Universitari Arnau de Vilanova, 25198 Lleida, Spain
- Unidad Mixta de Investigación en Radiofísica e Instrumentación Nuclear en Medicina (IRIMED), Instituto de Investigación Sanitaria La Fe (IIS-La Fe), Universitat de Valencia (UV), 46010 Valencia, Spain; (J.V.); (J.P.-C.)
- Correspondence: ; Tel.: +34-973248100
| | - Francisco Celada
- Radiotherapy Department, La Fe Hospital, 46026 Valencia, Spain; (F.C.); (M.-J.P.-C.)
| | - Jose Chimeno
- Medical Physics Department, Hospital San Juan, 03550 Alicante, Spain;
| | - Javier Vijande
- Unidad Mixta de Investigación en Radiofísica e Instrumentación Nuclear en Medicina (IRIMED), Instituto de Investigación Sanitaria La Fe (IIS-La Fe), Universitat de Valencia (UV), 46010 Valencia, Spain; (J.V.); (J.P.-C.)
- Department of Atomic, Molecular and Nuclear Physics, University of Valencia, 46010 Valencia, Spain
- Instituto de Física Corpuscular, IFIC (UV-CSIC), 46010 Valencia, Spain
| | - Santiago Pellejero
- Radiation Oncology Department, Hospital Universitario de Navarra, 31008 Navarre, Spain; (S.P.); (E.V.); (N.F.)
| | | | - Elena Villafranca
- Radiation Oncology Department, Hospital Universitario de Navarra, 31008 Navarre, Spain; (S.P.); (E.V.); (N.F.)
| | - Naiara Fuentemilla
- Radiation Oncology Department, Hospital Universitario de Navarra, 31008 Navarre, Spain; (S.P.); (E.V.); (N.F.)
| | - Francisco Blazquez
- Radiotherapy Department, Hospital Clínica Benidorm, 03501 Alicante, Spain; (F.B.); (S.R.)
| | - Silvia Rodriguez
- Radiotherapy Department, Hospital Clínica Benidorm, 03501 Alicante, Spain; (F.B.); (S.R.)
| | - Jose Perez-Calatayud
- Unidad Mixta de Investigación en Radiofísica e Instrumentación Nuclear en Medicina (IRIMED), Instituto de Investigación Sanitaria La Fe (IIS-La Fe), Universitat de Valencia (UV), 46010 Valencia, Spain; (J.V.); (J.P.-C.)
- Radiotherapy Department, La Fe Hospital, 46026 Valencia, Spain; (F.C.); (M.-J.P.-C.)
- Radiotherapy Department, Hospital Clínica Benidorm, 03501 Alicante, Spain; (F.B.); (S.R.)
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Hanlon MD, Smith RL, Franich RD. MaxiCalc: A tool for online dosimetric evaluation of source-tracking based treatment verification in HDR brachytherapy. Phys Med 2022; 94:58-64. [PMID: 34998133 DOI: 10.1016/j.ejmp.2021.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/09/2021] [Accepted: 12/16/2021] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Source tracking is becoming a more widely used approach in HDR brachytherapy treatment verification. While it provides a sensitive method to detect deviations from the treatment plan during delivery, it does not show the clinical significance of any detected changes. By incorporating a tool that calculates volumetric doses and DVH indices from measurements, source tracking systems can be expanded to assess dosimetric significance of any deviations from the plan. METHODS The source tracking dose calculation tool, MaxiCalc, was developed in MATLAB. Validation was performed by comparing doses and DVH indices calculated in MaxiCalc to those calculated by the clinical TPS, for several test plans and 10 clinical plans. Clinical implementation was demonstrated by calculating volumetric doses from a clinical source tracking event. RESULTS MaxiCalc showed excellent agreement with the clinical TPS for point and volumetric doses (mean difference < 0.01% and 0.1% respectively). MaxiCalc calculates dosimetrically equivalent plans to the TPS with agreement < 0.3% for all DVH indices except PTV V200%. Small differences seen for the clinical source tracking event were consistent with the known tracking uncertainties enabling them to be quantified for clinical decision making. Calculations are fast, enabling real-time use. CONCLUSIONS MaxiCalc is an independent tool that calculates doses and DVH indices from dwells measured with any clinical HDR brachytherapy source tracking system. This extends the capabilities of source tracking systems from determining discrepancies in positions or times during delivery to assessing the dosimetric impact of any detected deviations, allowing for more comprehensive treatment verification and evaluation.
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Affiliation(s)
- Maximilian D Hanlon
- School of Science, RMIT University, Melbourne, Australia; Alfred Health Radiation Oncology, The Alfred, Melbourne, Australia.
| | - Ryan L Smith
- School of Science, RMIT University, Melbourne, Australia; Alfred Health Radiation Oncology, The Alfred, Melbourne, Australia
| | - Rick D Franich
- School of Science, RMIT University, Melbourne, Australia
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Tambasco M, Pang G, Fuller L, Brescia EL, Mardirossian G. Impact of a 1.5 T magnetic field on DNA damage in MRI-guided HDR brachytherapy. Phys Med 2020; 76:85-91. [PMID: 32623225 DOI: 10.1016/j.ejmp.2020.06.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/16/2020] [Accepted: 06/23/2020] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Some studies have suggested that the presence of a static magnetic field (SMF) during irradiation alters biological damage. Since MRI-guided radiotherapy is becoming increasingly common, we constructed a DNA-based detector to assess the effect of a 1.5 T SMF on DNA damage during high dose rate (HDR) brachytherapy irradiation. METHODS Block phantoms containing a small cavity for the placement of plasmid DNA (pBR322) samples were 3-D printed with biocompatible tissue equivalent material. The phantom was CT scanned and an HDR brachytherapy treatment plan was designed to deliver 20 Gy and 30 Gy doses to the DNA samples in the presence and absence of a 1.5 T SMF. Relative yields of single- and double-strand breaks (SSBs and DSBs, respectively) were computed from gel electrophoresis images of the DNA band intensities and averaged over sample sizes ranging from 12 to 30. Radiation dose was also measured in the presence and absence of the 1.5 T SMF using GafChromic™ EBT3 film placed in the coronal, sagittal, and axial planes. RESULTS The average yield of DNA with SSBs and DSBs in the presence and absence of the SMF showed no statistically significant differences (all p ≥ 0.17). Differences in the net optical densities of the EBT3 films for each plane were within experimental uncertainty, suggesting no dose difference in the presence and absence of the SMF. CONCLUSIONS HDR irradiation in the presence of the 1.5 T SMF did not alter dose deposition to the DNA cavity nor change SSB and DSB DNA damage.
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Affiliation(s)
- Mauro Tambasco
- Department of Physics, San Diego State University, San Diego, CA, USA.
| | - Geordi Pang
- Odette Cancer Centre, Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Loni Fuller
- Department of Physics, San Diego State University, San Diego, CA, USA
| | - Erika L Brescia
- Department of Physics, San Diego State University, San Diego, CA, USA; Department of Medical Physics, Genesis Healthcare Partners, San Diego, CA, USA
| | - George Mardirossian
- Department of Medical Physics, Genesis Healthcare Partners, San Diego, CA, USA
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Ning MS, Venkatesan AM, Stafford RJ, Bui TP, Carlson R, Bailard NS, Vedam S, Davis R, Olivieri ND, Guzman AB, Incalcaterra JR, McKelvey FA, Thaker NG, Rauch GM, Tang C, Frank SJ, Joyner MM, Lin LL, Jhingran A, Eifel PJ, Klopp AH. Developing an intraoperative 3T MRI-guided brachytherapy program within a diagnostic imaging suite: Methods, process workflow, and value-based analysis. Brachytherapy 2020; 19:427-437. [DOI: 10.1016/j.brachy.2019.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/11/2019] [Accepted: 09/21/2019] [Indexed: 12/22/2022]
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Clinical utility and value contribution of an MRI-positive line marker for image-guided brachytherapy in gynecologic malignancies. Brachytherapy 2020; 19:305-315. [DOI: 10.1016/j.brachy.2019.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/29/2019] [Accepted: 12/30/2019] [Indexed: 01/19/2023]
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Kallis K, Abu-Hossin N, Kreppner S, Lotter M, Strnad V, Fietkau R, Bert C. Estimation of inter-fractional variations in interstitial multi-catheter breast brachytherapy using a hybrid treatment delivery system. Radiother Oncol 2019; 141:312-320. [PMID: 31495517 DOI: 10.1016/j.radonc.2019.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Irradiation of the tumor bed using interstitial multi-catheter brachytherapy is one of the treatment options for breast cancer patients. In order to ensure the planned dose delivery an advanced quality intervention method using an electromagnetic tracking (EMT) system is presented. The system is used to assess inter-fractional variations within the framework of a patient study. METHODS AND MATERIALS Until now 41 patients were included in the study for the evaluation and overall 355 EMT measurements were performed. The catheter traces are measured automatically and sequentially using an afterloader prototype (Flexitron, Elekta, Veenendaal, The Netherlands) equipped with an EMT sensor. The implant geometry is tracked directly after implantation, after CT imaging and after each irradiation fraction. The acquired data is rigidly registered to the catheter traces defined in the treatment plan and the dwell positions (DP) are reconstructed. DPs defined in treatment planning serve as reference. Breathing motion was corrected and recorded using three reference 6DoF sensors placed on the patients' skin. The Euclidean distance between the planned and reconstructed DPs provides information about possible inter-fractional deviations. Further, the influence of various factors on the occurrence of large deviations was investigated, like the patients' age, the length of the catheter, the breast volume, etc. RESULTS: Over all patient measurements a median Euclidean distance of 2.19 mm was determined between the reconstructed DPs and the reference DPs. The median deviation combining all datasets was minimal (1.67 mm) at the measurement directly after CT imaging. The deviations between the different fractions have a median distance of 2.31 mm which could be improved to 2.05 mm by adapting the treatment plan according to the follow-up CT. No correlation between the distance to the skin, ribs, mammilla or the breast volume and the occurrences of large deviations was found. The largest deviations were determined in the upper inner quadrant of the breast. CONCLUSION The afterloader prototype could be well integrated into the clinical routine and is beneficial for ensuring the quality of the brachytherapy. Overall, a small median DP deviation, lower than the used step size of 2.5 mm, was detected.
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Affiliation(s)
- Karoline Kallis
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Nadin Abu-Hossin
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Stephan Kreppner
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Michael Lotter
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Vratislav Strnad
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Christoph Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
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Beld E, Moerland MA, van der Voort van Zyp JRN, Viergever MA, Lagendijk JJW, Seevinck PR. MRI artifact simulation for clinically relevant MRI sequences for guidance of prostate HDR brachytherapy. Phys Med Biol 2019; 64:095006. [PMID: 30947159 DOI: 10.1088/1361-6560/ab15ed] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
For the purpose of magnetic resonance imaging (MRI) guidance of prostate high-dose-rate (HDR) brachytherapy, this paper presents a study on the potential of clinically relevant MRI sequences to facilitate tracking or localization of brachytherapy devices (HDR source/titanium needle), and which could simultaneously be used to visualize the anatomy. The tracking or localization involves simulation of the MRI artifact in combination with a template matching algorithm. Simulations of the MRI artifacts induced by an HDR brachytherapy source and a titanium needle were implemented for four types of sequences: spoiled gradient echo, spin echo, balanced steady-state free precession (bSSFP) and bSSFP with spectral attenuated inversion recovery (SPAIR) fat suppression. A phantom study was conducted in which mentioned sequences (in 2D) as well as the volumetric MRI sequences of the current clinical scan protocol were applied to obtain the induced MRI artifacts for an HDR source and a titanium needle. Localization of the objects was performed by a phase correlation based template matching algorithm. The simulated images demonstrated high correspondences with the acquired MR images, and allowed localization of the objects. A comparison between the object positions obtained for all applied MRI sequences showed deviations (from the average position) of 0.2-0.3 mm, proving that all MRI sequences were suitable for localization of the objects, irrespective of their 2D or volumetric nature. This study demonstrated that the MRI artifact induced by an HDR source or a titanium needle could be simulated for the four investigated types of MRI sequences (spoiled gradient echo, spin echo, bSSFP and bSSFP-SPAIR), valuable for real-time object localization in clinical practice. This leads to more flexibility in the choice of MRI sequences for guidance of HDR brachytherapy, as they are suitable for both object localization and anatomy visualization.
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Affiliation(s)
- Ellis Beld
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. Author to whom correspondence may be addressed
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Alnaghy S, Cutajar DL, Safavi-Naeini M, George S, Howie A, Bece A, Bucci JA, Jakubek J, Pospisil S, Lerch MLF, Petasecca M, Rosenfeld AB. BrachyView: initial preclinical results for a real-time in-body HDR PBT source tracking system with simultaneous TRUS image fusion. Phys Med Biol 2019; 64:085002. [DOI: 10.1088/1361-6560/ab0a7e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Beld E, Seevinck PR, Schuurman J, Viergever MA, Lagendijk JJ, Moerland MA. Development and Testing of a Magnetic Resonance (MR) Conditional Afterloader for Source Tracking in Magnetic Resonance Imaging-Guided High-Dose-Rate (HDR) Brachytherapy. Int J Radiat Oncol Biol Phys 2018; 102:960-968. [DOI: 10.1016/j.ijrobp.2018.04.066] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 03/13/2018] [Accepted: 04/24/2018] [Indexed: 01/18/2023]
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