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Deep learning based MLC aperture and monitor unit prediction as a warm start for breast VMAT optimisation. Phys Med Biol 2023; 68:225013. [PMID: 37903442 DOI: 10.1088/1361-6560/ad07f6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/30/2023] [Indexed: 11/01/2023]
Abstract
Objective. Automated treatment planning today is focussed on non-exact, two-step procedures. Firstly, dose-volume histograms (DVHs) or 3D dose distributions are predicted from the patient anatomy. Secondly, these are converted in multi-leaf collimator (MLC) apertures and monitor units (MUs) using a generic optimisation to obtain the final treatment plan. In contrast, we present a method to predict volumetric modulated arc therapy (VMAT) MLC apertures and MUs directly from patient anatomy using deep learning. The predicted plan is then provided as initialisation to the optimiser for fine-tuning.Approach. 148 patients (training: 101; validation: 23; test: 24), treated for right breast cancer, are replanned to obtain a homogeneous database of 3-arc VMAT plans (PTVBreast: 45.57 Gy; PTVBoost: 55.86 Gy) according to the clinical protocol, using RapidPlanTMwith automatic optimisation and extended convergence mode (clinical workflow). Projections of the CT and contours are created along the beam's eye view of all control points and given as input to a U-net type convolutional neural networks (CNN). The output are the MLC aperture and MU for all control points, from which a DICOM RTplan is built. This is imported and further optimised in the treatment planning system using automatic optimisation without convergence mode, with clinical PTV objectives and organs-at-risk (OAR) objectives based on the DVHs calculated from the imported plan (CNN workflow).Main results. Mean dose differences between the clinical and CNN workflow over the test set are 0.2 ± 0.5 Gy atD95%and 0.6 ± 0.4 Gy atD0.035ccof PTVBreastand -0.4 ± 0.3 Gy atD95%and 0.7 ± 0.3 Gy atD0.035ccof PTVBoost. For the OAR, they are -0.2 ± 0.2 Gy forDmean,heartand 0.04 ± 0.8 Gy forDmean,ipsilateral lung. The mean computation time is 60 and 25 min respectively.Significance. VMAT optimisation can be initialised by MLC apertures and MUs, directly predicted from patient anatomy using a CNN, reducing planning time with more than half while maintaining clinically acceptable plans. This procedure puts the planner in a supervising role over an AI-based treatment planning workflow.
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The NCS code of practice for the quality assurance of treatment planning systems (NCS-35). Phys Med Biol 2023; 68:205017. [PMID: 37748504 DOI: 10.1088/1361-6560/acfd06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/25/2023] [Indexed: 09/27/2023]
Abstract
A subcommittee of the Netherlands Commission on Radiation Dosimetry (NCS) was initiated in 2018 with the task to update and extend a previous publication (NCS-15) on the quality assurance of treatment planning systems (TPS) (Bruinviset al2005). The field of treatment planning has changed considerably since 2005. Whereas the focus of the previous report was more on the technical aspects of the TPS, the scope of this report is broader with a focus on a department wide implementation of the TPS. New sections about education, automated planning, information technology (IT) and updates are therefore added. Although the scope is photon therapy, large parts of this report will also apply to all other treatment modalities. This paper is a condensed version of these guidelines; the full version of the report in English is freely available from the NCS website (http://radiationdosimetry.org/ncs/publications). The paper starts with the scope of this report in relation to earlier reports on this subject. Next, general aspects of the commissioning process are addressed, like e.g. project management, education, and safety. It then focusses more on technical aspects such as beam commissioning and patient modeling, dose representation, dose calculation and (automated) plan optimisation. The final chapters deal with IT-related subjects and scripting, and the process of updating or upgrading the TPS.
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PO-1539 In-silico assessment of the out-of-field over-response of an optically stimulated luminescent film. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03503-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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PO-1406 Hematological toxicity in pN1 prostate cancer patients treated with extended field irradiation. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03370-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Clinical Evaluation of a Deep Learning Model for Segmentation of Target Volumes in Breast Cancer Radiotherapy. Radiother Oncol 2022; 171:84-90. [PMID: 35447286 DOI: 10.1016/j.radonc.2022.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE/OBJECTIVE(S) Precise segmentation of clinical target volumes (CTV) in breast cancer is indispensable for state-of-the art radiotherapy. Despite international guidelines, significant intra- and interobserver variability exists, negatively impacting treatment outcomes. The aim of this study is to evaluate the performance and efficiency of segmentation of CTVs in planning CT images of breast cancer patients using a 3D convolutional neural network (CNN) compared to the manual process. MATERIALS/METHODS An expert radiation oncologist (RO) segmented all CTVs separately according to international guidelines in 150 breast cancer patients. This data was used to create, train and validate a 3D CNN. The network's performance was additionally evaluated in a test set of 20 patients. Primary endpoints are quantitative and qualitative analysis of the segmentation data generated by the CNN for each level specifically as well as for the total PTV to be irradiated. The secondary endpoint is the evaluation of time efficiency. RESULTS In the test set, segmentation performance was best for the contralateral breast and the breast CTV and worst for Rotter's space and the internal mammary nodal (IMN) level. Analysis of impact on PTV resulted in non-significant over-segmentation of the primary PTV and significant under-segmentation of the nodal PTV, resulting in slight variations of overlap with OARs. Guideline consistency improved from 77.14% to 90.71% in favor of CNN segmentation while saving on average 24 minutes per patient with a median time of 35 minutes for pure manual segmentation. CONCLUSION 3D CNN based delineation for breast cancer radiotherapy is feasible and performant, as scored by quantitative and qualitative metrics.
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Promises of film dosimetry based on radiophotoluminescence imaging in radiotherapy including charged particle beams. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00030-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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PD-0819 Dose mimicking by deep learning based fluence prediction: one model for different class solutions. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07098-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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PH-0547 Quality assurance of Treatment Planning Systems: upgrading the NCS report 15. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07357-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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OC-0021 End-to-end verification of 3D printed applicators for HDR skin brachytherapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06274-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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P49.01 Treatment Planning QA of Hippocampal Avoidance Prophylactic Cranial Irradiation in the Multicenter Randomized Phase III Trial (NCT01780675). J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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PO-1591: Dosimetric accuracy of beam gating, MLC tracking and couch tracking to manage prostate rotation. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01609-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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OC-0704: Six degrees of freedom dynamic motion-including dose reconstruction in a treatment planning system. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00726-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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OC-0342: Experimental validation of real-time rotation-including dose reconstruction during tumor tracking. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00366-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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OC-0514: VMAT treatment planning for head-and-neck cancer with the novel fast-rotating linac halcyon. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30824-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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EP-1590: Can bolus range shifting improve plan quality in the IMPT of head and neck cancer? Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)32025-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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SU-F-T-299: An Experimental 2D Computed Radiography (CR) Dosimeter for IMRT. Are In-Field Measurements Affected by the Low Energy Photon Overresponse? Med Phys 2016. [DOI: 10.1118/1.4956484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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EP-1516: Evaluating a versatile new-generation anthropomorphic phantom for SBRT and thoracic IMRT/VMAT. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32766-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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A spectroscopic study of the chromatic properties of GafChromic™EBT3 films. Med Phys 2016; 43:1156-66. [DOI: 10.1118/1.4941312] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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SU-E-T-497: Initial Characterization of a Novel 2D Computed Radiography (CR) Dosimeter for SBRT. Med Phys 2015. [DOI: 10.1118/1.4924859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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SU-E-T-44: A Micro-Raman Spectroscopy Study of the Dose-Dependence of EBT3 GafChromicTM Films for Quantifying the Degree of Molecular Polymerization. Med Phys 2015. [DOI: 10.1118/1.4924405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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PD-0462: Towards dosimetric tracking with adaptive VMAT? Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40458-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Ct Characteristics Allow the Identification of Patient-Specific and Regional Susceptibility for Radiation-Induced Lung Damage. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv045.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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OC-0253: CT characteristics allow to identify individual and regional susceptibility for radiation-induced lung damage. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40251-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Comparison of measured and estimated maximum skin doses during CT fluoroscopy lung biopsies. Med Phys 2015; 41:073901. [PMID: 24989420 DOI: 10.1118/1.4884231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To measure patient-specific maximum skin dose (MSD) associated with CT fluoroscopy (CTF) lung biopsies and to compare measured MSD with the MSD estimated from phantom measurements, as well as with the CTDIvol of patient examinations. METHODS Data from 50 patients with lung lesions who underwent a CT fluoroscopy-guided biopsy were collected. The CT protocol consisted of a low-kilovoltage (80 kV) protocol used in combination with an algorithm for dose reduction to the radiology staff during the interventional procedure, HandCare (HC). MSD was assessed during each intervention using EBT2 gafchromic films positioned on patient skin. Lesion size, position, total fluoroscopy time, and patient-effective diameter were registered for each patient. Dose rates were also estimated at the surface of a normal-size anthropomorphic thorax phantom using a 10 cm pencil ionization chamber placed at every 30°, for a full rotation, with and without HC. Measured MSD was compared with MSD values estimated from the phantom measurements and with the cumulative CTDIvol of the procedure. RESULTS The median measured MSD was 141 mGy (range 38-410 mGy) while the median cumulative CTDIvol was 72 mGy (range 24-262 mGy). The ratio between the MSD estimated from phantom measurements and the measured MSD was 0.87 (range 0.12-4.1) on average. In 72% of cases the estimated MSD underestimated the measured MSD, while in 28% of the cases it overestimated it. The same trend was observed for the ratio of cumulative CTDIvol and measured MSD. No trend was observed as a function of patient size. CONCLUSIONS On average, estimated MSD from dose rate measurements on phantom as well as from CTDIvol of patient examinations underestimates the measured value of MSD. This can be attributed to deviations of the patient's body habitus from the standard phantom size and to patient positioning in the gantry during the procedure.
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OC-0168: Impact of CT-MR registration imprecision on treatment planning for prostate cancer. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30273-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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PO-0879: Dosimetric fluence correction in non-rigid IMRT adaptation: preserving the penumbra margin. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30997-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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PO-0909: CT density changes in the lungs after SBRT are dependent on the baseline HU of the irradiated lung. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)31027-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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PD-0277: Verification of Acuros XB and analytical anisotropic algorithm (AAA) in heterogeneous media. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)32583-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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PO-0673: Accelerated Helical Tomotherapy versus RapidArc in a head and neck cancer treatment planning study. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)32979-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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PO-0847: A strategy for non-MU preserving adaptive radiotherapy. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)33153-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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SU-E-J-138: Fast 2-D Fiducial Marker Detection on Sequential MV Projections in Arc Therapy. Med Phys 2012; 39:3684. [DOI: 10.1118/1.4734974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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TH-E-BRB-03: Incorporating a Lateral Scan Effect Correction in a EBT3 Calibration Protocol. Med Phys 2012. [DOI: 10.1118/1.4736353] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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PO-0842 ANALYSIS OF PERIPHERAL DOSES FOR TRUEBEAM STX. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71175-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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PO-0892 TARGET SURFACE BASED FLUENCE DEFORMATION, FOR ADAPTIVE INTENSITY MODULATED RADIOTHERAPY. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71225-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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SU-E-T-519: Reduction of Matching Errors Due to Variations of Breathing Patterns in Gated Breast Treatments. Med Phys 2011. [DOI: 10.1118/1.3612472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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SU-GG-T-251: Evaluating Dose Measurements of Rotational Treatment Techniques. Med Phys 2010. [DOI: 10.1118/1.3468643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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SU-FF-T-133: RapidArcTM: Commissioning and Dose Escalation Possibilities. Med Phys 2009. [DOI: 10.1118/1.3181607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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SU-GG-T-214: On Technical Aspects of the Implementation of a New Respiratory Gating System with the Option of Three-Dimensional Tracking of a Surrogate's Motion Via a Wall-Mounted Camera. Med Phys 2008. [DOI: 10.1118/1.2961966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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