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Akcay K, Kibar A, Sahin OE, Demirbilek M, Beydagi G, Asa S, Aghazada F, Toklu T, Selcuk NA, Onal B, Kabasakal L. Prediction of clinically significant prostate cancer by [ 68 Ga]Ga-PSMA-11 PET/CT: a potential tool for selecting patients for active surveillance. Eur J Nucl Med Mol Imaging 2024; 51:1467-1475. [PMID: 38112777 DOI: 10.1007/s00259-023-06556-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 11/30/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE In our study, our aim was to investigate the role of [68 Ga]Ga-PSMA-11 PET /CT imaging in the diagnosis of clinically significant prostate cancer (csPCa) (ISUP GG 2 and higher) in patients initially diagnosed with ISUP GG 1 and 2 after prostate biopsy. MATERIALS AND METHODS We retrospectively reviewed 147 patient records in whom [68 Ga]Ga-PSMA-11 PET/CT imaging was performed preoperatively. All patients were initially diagnosed with ISUP GG 1 and 2 PCa by biopsy. Final pathology reports were obtained after radical prostatectomy. The [68 Ga]Ga-PSMA-11 PET/CT images were evaluated to determine the PRIMARY score. Patients' mpMRI-PIRADS scores were also recorded when available and analyzed in correlation with the pathology results. RESULTS For the 114 patients scored using PRIMARY, 19 out of 37 patients with scores of 1 and 2 (51%) were diagnosed with csPCa. Of the 77 patients with PRIMARY scores between 3 and 5, 64 (83%) had csPCa. Notably, every patient with a PRIMARY score of 5 had csPCa. PRIMARY scoring had a sensitivity of 77% and specificity of 58%, with a positive predictive value of 83%. A moderate correlation was observed between PRIMARY scores and ISUP GG (Rho = 0.54, p < 0.001). In contrast, the PIRADS score displayed a sensitivity and specificity of 86% and 25% respectively, with a positive predictive value of 68%. No substantial correlation was found between PIRADS and ISUP GG. Statistical analysis revealed a significant correlation between PRIMARY and ISUP GG (p < 0.001), but not between PIRADS and ISUP GG (p = 0.281). Comparatively, PRIMARY scoring was significantly more reliable than PIRADS scoring in identifying csPCa. CONCLUSION [68 Ga]Ga-PSMA-11 PET/CT imaging is promising for distinguishing high-risk prostate cancer patients from those apt for active surveillance, potentially aiding in the identification of csPCa.
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Affiliation(s)
- Kaan Akcay
- Department of Nuclear Medicine, Yeditepe University Medical Faculty, Koşuyolu Mah. Koşuyolu Cad. No: 168, 34718, Kadıköy/Istanbul, Turkey
| | - Ali Kibar
- Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Fatih, Istanbul, 34098, Turkey
| | - Onur Erdem Sahin
- Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Fatih, Istanbul, 34098, Turkey
| | - Muhammet Demirbilek
- Department of Urology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Fatih, Istanbul, 34098, Turkey
| | - Gamze Beydagi
- Department of Nuclear Medicine, Yeditepe University Medical Faculty, Koşuyolu Mah. Koşuyolu Cad. No: 168, 34718, Kadıköy/Istanbul, Turkey
| | - Sertac Asa
- Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Fatih, Istanbul, 34098, Turkey
| | - Fuad Aghazada
- Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Fatih, Istanbul, 34098, Turkey
| | - Turkay Toklu
- Department of Nuclear Medicine, Yeditepe University Medical Faculty, Koşuyolu Mah. Koşuyolu Cad. No: 168, 34718, Kadıköy/Istanbul, Turkey
| | - Nalan Alan Selcuk
- Department of Nuclear Medicine, Yeditepe University Medical Faculty, Koşuyolu Mah. Koşuyolu Cad. No: 168, 34718, Kadıköy/Istanbul, Turkey
| | - Bulent Onal
- Department of Urology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Fatih, Istanbul, 34098, Turkey
| | - Levent Kabasakal
- Department of Nuclear Medicine, Yeditepe University Medical Faculty, Koşuyolu Mah. Koşuyolu Cad. No: 168, 34718, Kadıköy/Istanbul, Turkey.
- Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Fatih, Istanbul, 34098, Turkey.
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Uygur E, Sezgin C, Parlak Y, Karatay KB, Arikbasi B, Avcibasi U, Toklu T, Barutca S, Harmansah C, Sozen TS, Maus S, Scher H, Aras O, Gumuser FG, Muftuler FZB. The Radiolabeling of [161Tb]-PSMA-617 by a Novel Radiolabeling Method and Preclinical Evaluation by In Vitro/In Vivo Methods. Res Sq 2023:rs.3.rs-3415703. [PMID: 37961521 PMCID: PMC10635383 DOI: 10.21203/rs.3.rs-3415703/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Background Prostate cancer (PC) is the most common type of cancer in elderly men, with a positive correlation with age. As resistance to treatment has developed, particularly in the progressive stage of the disease and in the presence of microfocal multiple bone metastases, new generation radionuclide therapies have emerged. Recently, [161Tb], a radiolanthanide introduced for treating micrometastatic foci, has shown great promise for treating prostate cancer. Results In this study, Terbium-161 [161Tb]Tb was radiolabeled with prostate-specific membrane antigen (PSMA)-617 ([161Tb]-PSMA-617) and the therapeutic efficacy of the radiolabeled compound investigated in vitro and in vivo. [161Tb]-PSMA-617 was found to have a radiochemical yield of 97.99 ± 2.01% and was hydrophilic. [161Tb]-PSMA-617 was also shown to have good stability, with a radiochemical yield of over 95% up to 72 hours. In vitro, [161Tb]-PSMA-617 showed a cytotoxic effect on LNCaP cells but not on PC-3 cells. In vivo, scintigraphy imaging visualized the accumulation of [161Tb]-PSMA-617 in the prostate, kidneys, and bladder. Conclusions The results suggest that [161Tb]-PSMA-617 can be an effective radiolabeled agent for the treatment of PSMA positive foci in prostate cancer.
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Affiliation(s)
- Emre Uygur
- Manisa Celal Bayar University: Manisa Celal Bayar Universitesi
| | | | - Yasemin Parlak
- Manisa Celal Bayar University: Manisa Celal Bayar Universitesi
| | - Kadriye Busra Karatay
- Ege University Institute of Nuclear Sciences: Ege Universitesi Nukleer Bilimler Enstitusu
| | | | - Ugur Avcibasi
- Manisa Celal Bayar Üniversitesi: Manisa Celal Bayar Universitesi
| | | | - Sabri Barutca
- Adnan Menderes Üniversitesi Tıp Fakültesi: Adnan Menderes Universitesi Tip Fakultesi
| | | | | | - Stephan Maus
- Saarland University Hospital and Saarland University Faculty of Medicine: Universitatsklinikum des Saarlandes und Medizinische Fakultat der Universitat des Saarlandes
| | - Howard Scher
- Memorial Sloan-Kettering Cancer Center Inpatient Hospital and Main Campus: Memorial Sloan Kettering Cancer Center
| | - Omer Aras
- Memorial Sloan-Kettering Cancer Center Inpatient Hospital and Main Campus: Memorial Sloan Kettering Cancer Center
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Alan-Selcuk N, Beydagi G, Demirci E, Ocak M, Celik S, Oven BB, Toklu T, Karaaslan I, Akcay K, Sonmez O, Kabasakal L. Clinical Experience with [ 225Ac]Ac-PSMA Treatment in Patients with [ 177Lu]Lu-PSMA-Refractory Metastatic Castration-Resistant Prostate Cancer. J Nucl Med 2023; 64:1574-1580. [PMID: 37620050 DOI: 10.2967/jnumed.123.265546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/13/2023] [Indexed: 08/26/2023] Open
Abstract
For patients with advanced-stage metastatic castration-resistant prostate cancer (mCRPC) who do not respond to [177Lu]Lu-PSMA therapy, there are limited treatment options. Clinical results obtained with [225Ac]Ac-PSMA are promising. We retrospectively analyzed the outcomes of patients treated with [225Ac]Ac-PSMA between December 2018 and October 2022. Methods: We evaluated the treatment results of 23 patients (mean age, 70.3 ± 8.8 y) with mCRPC who were refractory to treatment with [177Lu]Lu-PSMA (2-9 cycles). The safety profile was assessed according to Common Technology Criteria for Adverse Events version 5.0. Treatment efficacy was assessed using prostate-specific membrane antigen PET progression criteria and prostate-specific antigen (PSA) response according to Prostate Cancer Working Group 2 criteria after the first cycle of [225Ac]Ac-PSMA treatment. Results: All patients received androgen-deprivation therapy, whereas 22 (96%) and 19 (83%) patients received chemotherapy and second-generation antiandrogen therapy, respectively. One patient received 4 cycles, 2 received 3 cycles, 8 received 2 cycles, and 12 received 1 cycle of [225Ac]Ac-PSMA. The median interval between cycles was 13 wk (range, 8-28 wk). [225Ac]Ac-PSMA was administered with a mean activity of 7.6 MBq (range, 6.2-10.0 MBq) in each cycle. Patients were at an advanced stage of disease, and tumor burden was very high. Although the best PSA response was observed in 5 patients (26%) after [225Ac]Ac-PSMA treatment, there was at least some level of decline in PSA observed in 11 patients (58%; n = 19). Treatment response was assessed in patients who underwent [68Ga]Ga-PSMA PET/CT imaging. After the first cycle of treatment (n = 18), 50% of patients (n = 9) showed disease progression according to prostate-specific membrane antigen PET progression criteria, and the disease control rate was calculated to be 50%. Median progression-free survival was 3.1 mo, and median overall survival was 7.7 mo. Grade 3 hematologic toxicity occurred in 1 patient, and grade 3 nephrotoxicity was observed in another patient. Parotid SUVmax decreased by 33%, although all patients complained of dry mouth before treatment. Conclusion: We observed that [225Ac]Ac-PSMA therapy was safe and showed potential even in cases with advanced-stage mCRPC in which all other treatment options were completed.
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Affiliation(s)
- Nalan Alan-Selcuk
- Department of Nuclear Medicine, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
| | - Gamze Beydagi
- Department of Nuclear Medicine, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
| | - Emre Demirci
- Department of Nuclear Medicine, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
- Department of Radiology, University of Missouri, Columbia, Missouri
| | - Meltem Ocak
- Molecular Imaging and Theranostics Center, University of Missouri, Columbia, Missouri
| | - Serkan Celik
- Department of Medical Oncology, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
| | - Bala B Oven
- Department of Medical Oncology, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
| | - Turkay Toklu
- Department of Nuclear Medicine, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
| | - Ipek Karaaslan
- Department of Physics, Yeditepe University, Istanbul, Turkey; and
| | - Kaan Akcay
- Department of Nuclear Medicine, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
| | - Omer Sonmez
- Department of Nuclear Medicine, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
| | - Levent Kabasakal
- Department of Nuclear Medicine, Faculty of Medicine, Yeditepe University, Istanbul, Turkey;
- Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
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Akyol O, Olgar T, Toklu T, Eren H, Dirican B. Dose distrubution evaluation of different dental implants on a real human dry-skull model for head and neck cancer radiotherapy. Radiat Phys Chem Oxf Engl 1993 2021. [DOI: 10.1016/j.radphyschem.2021.109751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Topcuoglu OM, Alan Selcuk N, Sarikaya B, Toklu T. Safety of transarterial radioembolization with Yttrium-90 glass microspheres without cystic artery occlusion. Radiol Med 2019; 124:575-580. [DOI: 10.1007/s11547-018-00984-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 12/20/2018] [Indexed: 11/29/2022]
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Akyol O, Dirican B, Toklu T, Eren H, Olgar T. Investigating the effect of dental implant materials with different densities on radiotherapy dose distribution using Monte-Carlo simulation and pencil beam convolution algorithm. Dentomaxillofac Radiol 2019; 48:20180267. [PMID: 30663343 DOI: 10.1259/dmfr.20180267] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate the effect of dental implant materials with different physical densities on dose distribution for head and neck cancer radiotherapy planning. METHODS Titanium (Ti), Titanium alloy (Ti-6Al-4V), Zirconia (Y-TZP), Zirconium oxide (ZrO2), Alumina (Al2O3) and polyetheretherketone (PEEK) dental implant materials were used for determination of implant material effect on dose distribution. Dental implant effect was investigated by using pencil beam convolution (PBC) algorithm of Eclipse treatment planning systems (TPS) and Monte Carlo (MC) simulation technique. 6 MV photon beam of the Varian 2300 C/D linear accelerator was simulated by EGSnrc-based BEAMnrc MC code system. RESULTS Reasonable consistency was determined for percentage depth dose (PDD) curves between MC simulation and water phantom measurements at 6.4 MeV initial electron energy. The consistency between modelled linear accelerator PDD curve calculations and water-phantom PDD measurements were compatible within 1 % range. The dose increase in front of the dental implant calculated by MC simulation is in the range of 0.4-20.2%. We found by MC and PBC calculations that the differences in dose increase in front of the dental implant materials is in the range of 0.1-17.2% and is dependent on the physical density of the dental implant. CONCLUSIONS Dose increase for Zirconia was noted to be maximum while PEEK implant dose increase was minimum among the whole dental implant materials studied. This study revealed that the Eclipse TPS PBC algorithm could not accurately estimate the backscatter radiation from dental implant materials.
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Affiliation(s)
- Oya Akyol
- 1 Department Radiation Oncology, Faculty of Medicine, Gazi University , Ankara , Turkey
| | - Bahar Dirican
- 2 Radiation Oncology Department, Gülhane Faculty of Medicine, Health Sciences University , Ankara , Turkey
| | - Turkay Toklu
- 3 Department of Nuclear Medicine, Faculty of Medicine, Yeditepe University , Istanbul , Turkey
| | - Hakan Eren
- 4 Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University , Ankara , Turkey
| | - Turan Olgar
- 5 Faculty of Engineering, Department of Physics Engineering, Ankara University , Ankara , Turkey
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Alan Selcuk N, Toklu T, Beykan S, Karaaslan SI. Evaluation of the dosimetry approaches in ablation treatment of thyroid cancer. J Appl Clin Med Phys 2018; 19:134-140. [PMID: 29858536 PMCID: PMC6036368 DOI: 10.1002/acm2.12350] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 01/05/2018] [Accepted: 04/10/2018] [Indexed: 11/09/2022] Open
Abstract
In this study, we aimed to evaluate dosimetric approaches in ablation treatment of Differentiated Thyroid Carcinoma (DTC) without interrupting the clinical routine. Prior to therapy, 10.7 MBq 131I in average was orally given to 24 patients suffering from DTC. MIRD formalism was used for dosimetric calculations. For blood and bone marrow dosimetry, blood samples and whole‐body counts were collected at 2, 24, 72, and 120 h after I‐131 administration. For remnant tissue dosimetry, uptake measurements were performed at the same time intervals. To estimate the remnant volume, anterior and lateral planar gamma camera images were acquired with a reference source within the field of view at 24 h after I‐131 administration. Ultrasound imaging was also performed. Treatment activities determined with the fixed activity method were administered to the patients. Secondary cancer risk relative to applied therapy was evaluated for dosimetric approaches. The average dose to blood and bone marrow were determined as 0.15 ± 0.04 and 0.11 ± 0.04 Gy/GBq, respectively. The average remnant tissue dose was 0.58 ± 0.52 Gy/MBq and the corresponding required activity to ablate the remnant was approximately 1.3 GBq of 131I. A strong correlation between 24th‐hour uptake and time‐integrated activity coefficient values was obtained. Compared to fixed activity method, approximately five times higher secondary cancer risk was determined in bone marrow dosimetry, while the risk was about three times lower in lesion‐based dosimetry.
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Affiliation(s)
- Nalan Alan Selcuk
- Department of Nuclear Medicine, Yeditepe University Hospital, Istanbul, Turkey
| | - Turkay Toklu
- Department of Nuclear Medicine, Yeditepe University Hospital, Istanbul, Turkey
| | - Seval Beykan
- Department of Physics, Yeditepe University, Istanbul, Turkey.,Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
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Ordu C, Selcuk NA, Akosman C, Eren OO, Altunok EC, Toklu T, Oyan B. Comparison of metabolic and anatomic response to chemotherapy based on PERCIST and RECIST in patients with advanced stage non-small cell lung cancer. Asian Pac J Cancer Prev 2015; 16:321-6. [PMID: 25640373 DOI: 10.7314/apjcp.2015.16.1.321] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to explore the prognostic role of metabolic response to chemotherapy, determined by FDG-PET, in patients with metastatic non-small-cell lung cancer (NSCLC). MATERIALS AND METHODS Thirty patients with metastatic NSCLC were analyzed for prognostic factors related to overall survival (OS) and progression free survival (PFS). Disease evaluation was conducted with FDG-PET/CT and contrast-enhanced CT prior to and at the end of first-line chemotherapy. Response evaluation of 19 of 30 patients was also performed after 2-3 cycles of chemotherapy. Morphological and metabolic responses were assessed according to RECIST and PERCIST, respectively. RESULTS The median OS and PFS were 11 months and 6.2 months, respectively. At the end of first-line chemotherapy, 10 patients achieved metabolic and anatomic responses. Of the 19 patients who had an interim response analysis after 2-3 cycles of chemotherapy, 3 achieved an anatomic response, while 9 achieved a metabolic response. In univariate analyses, favorable prognostic factors for OS were number of cycles of first-line chemotherapy, and achieving a response to chemotherapy at completion of therapy according to the PERCIST and RECIST. The OS of patients with a metabolic response after 2-3 cycles of chemotherapy was also significantly extended. Anatomic response at interim analysis did not predict OS, probably due to few patients with anatomic response. In multivariate analyses, metabolic response after completion of therapy was an independent prognostic factor for OS. CONCLUSIONS Metabolic response is at least as effective as anatomic response in predicting survival. Metabolic response may be an earlier predictive factor for treatment response and OS in NSCLC patients.
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Affiliation(s)
- Cetin Ordu
- Department of Internal Medicine, Faculty of Medicine, Bilim University, Istanbul, Turkey E-mail :
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Kucuk BB, Oral K, Selcuk NA, Toklu T, Civi OG. The anti-inflammatory effect of low-level laser therapy on experimentally induced inflammation of rabbit temporomandibular joint retrodiscal tissues. J Orofac Pain 2010; 24:293-297. [PMID: 20664831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
AIMS To investigate the effect of low-level laser therapy (LLLT) on experimentally induced inflammation in retrodiscal tissues of the rabbit temporo?mandibular joint (TMJ) using scintigraphic imaging. METHODS Eleven male New Zealand rabbits were included in this study. Six randomly selected rabbits were imaged to provide normal joint images (normal group) before the initiation of the experiment. A 5% formalin solution was locally injected into both right and left TMJs of all rabbits. Subsequently, Ga-Al-As laser (wavelength: 815 nm; energy density: 12 J/cm2; output power: 250 mW) was applied for 48 seconds. The treatment was performed six times for 2 weeks to the left TMJ of all rabbits. The right TMJs of the rabbits were used as the control (nontreated) TMJ group, while left TMJs were used as the treated TMJ group. Static images of TMJ were taken at 24 hours, 7 days, and 14 days after the beginning of the treatment. The images of all TMJs were taken in the posteroanterior direction with the rabbit under sedation and its mouth open. The Mann-Whitney U test was used to compare group differences, and intragroup differences were determined by the Friedman test and Wilcoxon sign test. RESULTS Significant differences were found between normal and both the control and treated TMJ groups. A reduction of inflammation in both treated and control TMJ groups was obtained, but there was no statistically significant difference between the groups. CONCLUSION Under the conditions used in this study, quantitative scintigraphic measurements of TMJ inflammation of the treated TMJ group decreased but did not differ significantly from those of the control TMJ group.
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Affiliation(s)
- Barcu Bal Kucuk
- Department of Prosthodontics, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey.
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Bor D, Olgar T, Onal E, Caglan A, Toklu T. Assessment of radiation doses to cardiologists during interventional examinations. Med Phys 2009; 36:3730-6. [DOI: 10.1118/1.3168971] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Bor D, Onal E, Olgar T, Caglan A, Toklu T. TU-E-330D-04: Estimation of Cardiologists Radiation Doses Received During Interventional Examinations. Med Phys 2006. [DOI: 10.1118/1.2241615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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