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Chiutsao S.,Quality MediPhys LLC | Massillonjl G.,Institute Fisica | Domingomunoz I.,Institute Fisica | Chan M.,Memorial SloanKettering Cancer Center
Medical Physics | Year: 2012

Purpose: To study and compare the dose response curves of the new GafChromic EBT3 film for megavoltage and kilovoltage x‐ray beams, with different spatial resolution. Methods: Two sets of EBT3 films (lot#A101711‐02) were exposed to each x‐ray beam (6MV, 15MV and 50kV) at 8 dose values (50–3200cGy). The megavoltage beams were calibrated per AAPM TG‐51 protocol while the kilovoltage beam was calibrated following the TG‐61 using an ionization chamber calibrated at NIST. Each film piece was scanned three consecutive times in the center of Epson 10000XL flatbed scanner in transmission mode, landscape orientation, 48‐bit color at two separate spatial resolutions of 75 and 300 dpi. The data were analyzed using ImageJ and, for each scanned image, a region of interest (ROI) of 2×2cm2 at the field center was selected to obtain the mean pixel value with its standard deviation in the ROI. For each energy, dose value and spatial resolution, the average netOD and its associated uncertainty were determined. The Student's t‐test was performed to evaluate the statistical differences between the netOD/dose values of the three energy modalities, with different color channels and spatial resolutions. Results: The dose response curves for the three energy modalities were compared in three color channels with 75 and 300dpi. Weak energy dependence was found. For doses above 100cGy, no statistical differences were observed between 6 and 15MV beams, regardless of spatial resolution. However, statistical differences were observed between 50kV and the megavoltage beams. The degree of energy dependence (from MV to 50kV) was found to be function of color channel, dose level and spatial resolution. Conclusions: The dose response curves for GafChromic EBT3 films were found to be weakly dependent on the energy of the photon beams from 6MV to 50kV. The degree of energy dependence varies with color channel, dose and spatial resolution. GafChromic EBT3 films were supplied by Ashland Corp. This work was partially supported by DGAPA‐UNAM grant IN102610 and Conacyt Mexico grant 127409. © 2012, American Association of Physicists in Medicine. All rights reserved.


Purpose: To study the heterogeneity effect on dose distributions in eye phantom for COMS eye plaques with 125I seeds using radiochromic EBT film dosimetry. Methods: COMS eye plaques (14,16,18 and 20mm in size) uniformly loaded with 125I seeds (model I25.S16) were studied. EBT film (lot #36076‐003AL) was positioned in a polystyrene eye phantom above the eye plaque, in two configurations: (1) in the plaque's central plane, (2) perpendicular to the central axis at depth=5 or 12mm (from inner sclera) in the eye phantom. With the seed air‐kerma‐strengths of 2.4–4U, the exposure times (3.5–8.7h) were adjusted to deliver ∼400cGy at 5mm depth. Calibration films were irradiated by a single 125I seed at ∼5mm distance, one at a time, for doses up to 1200cGy. All films were scanned using Epson 10000XL scanner and data were analyzed using Mephysto FilmCal Mc2 software. With the established calibration curve, dose conversion was performed. Central axis depth doses and off‐axis profiles were determined. Results: The film dose data were compared with the calculated doses using Plaque Simulator v5.3.9 with homogeneous assumption (Homo) and heterogeneity correction (Hetero). The dose ratio (film/Homo) and (film/Hetero) values were obtained. The dose ratio (film/Homo) values are substantially lower than unity (mostly between 0.8 and 0.9) for all plaque sizes studied, indicating dose reduction by COMS plaque compared with homogeneous assumption. The film dose data agree with the Hetero values within the uncertainty of measurement data. Conclusions: We found significant heterogeneity effect on the 125I (model I25.S16) dose distributions in an eye for COMS plaques using radiochromic EBT film dosimetry. The film data agree with the calculated doses using Plaque Simulator with heterogeneity correction. The dose reduction effect for COMS plaques uniformly loaded with 125I seed (model I25.S16) found in this study is similar to that for other 125I seed models. © 2011, American Association of Physicists in Medicine. All rights reserved.


Acar H.,Istanbul University | Chiu-Tsao S.-T.,Quality MediPhys LLC | Ozbay I.,Istanbul University | Kemikler G.,Istanbul University | Tuncer S.,Istanbul University
Medical Physics | Year: 2013

Purpose: (1) To measure absolute dose distributions in eye phantom for COMS eye plaques with 125I seeds (model I25.S16) using radiochromic EBT film dosimetry. (2) To determine the dose correction function for calculations involving the TG-43 formalism to account for the presence of the COMS eye plaque using Monte Carlo (MC) method specific to this seed model. (3) To test the heterogeneous dose calculation accuracy of the new version of Plaque Simulator (v5.3.9) against the EBT film data for this seed model. Methods: Using EBT film, absolute doses were measured for 125I seeds (model I25.S16) in COMS eye plaques (1) along the plaque's central axis for (a) uniformly loaded plaques (14-20 mm in diameter) and (b) a 20 mm plaque with single seed, and (2) in off-axis direction at depths of 5 and 12 mm for all four plaque sizes. The EBT film calibration was performed at 125I photon energy. MC calculations using MCNP5 code for a single seed at the center of a 20 mm plaque in homogeneous water and polystyrene medium were performed. The heterogeneity dose correction function was determined from the MC calculations. These function values at various depths were entered into PS software (v5.3.9) to calculate the heterogeneous dose distributions for the uniformly loaded plaques (of all four sizes). The dose distributions with homogeneous water assumptions were also calculated using PS for comparison. The EBT film measured absolute dose rate values (film) were compared with those calculated using PS with homogeneous assumption (PS Homo) and heterogeneity correction (PS Hetero). The values of dose ratio (film/PS Homo) and (film/PS Hetero) were obtained. Results: The central axis depth dose rate values for a single seed in 20 mm plaque measured using EBT film and calculated with MCNP5 code (both in ploystyrene phantom) were compared, and agreement within 9% was found. The dose ratio (film/PS Homo) values were substantially lower than unity (mostly between 0.8 and 0.9) for all four plaque sizes, indicating dose reduction by COMS plaque compared with homogeneous assumption. The dose ratio (film/PS Hetero) values were close to unity, indicating the PS Hetero calculations agree with those from the film study. Conclusions: Substantial heterogeneity effect on the 125I dose distributions in an eye phantom for COMS plaques was verified using radiochromic EBT film dosimetry. The calculated doses for uniformly loaded plaques using PS with heterogeneity correction option enabled were corroborated by the EBT film measurement data. Radiochromic EBT film dosimetry is feasible in measuring absolute dose distributions in eye phantom for COMS eye plaques loaded with single or multiple 125I seeds. Plaque Simulator is a viable tool for the calculation of dose distributions if one understands its limitations and uses the proper heterogeneity correction feature. © 2013 American Association of Physicists in Medicine.


Chiu-Tsao S.-T.,Quality MediPhys LLC | Astrahan M.A.,University of Southern California | Finger P.T.,New York Eye Cancer Center | Followill D.S.,University of Texas M. D. Anderson Cancer Center | And 7 more authors.
Medical Physics | Year: 2012

Dosimetry of eye plaques for ocular tumors presents unique challenges in brachytherapy. The challenges in accurate dosimetry are in part related to the steep dose gradient in the tumor and critical structures that are within millimeters of radioactive sources. In most clinical applications, calculations of dose distributions around eye plaques assume a homogenous water medium and full scatter conditions. Recent Monte Carlo (MC)-based eye-plaque dosimetry simulations have demonstrated that the perturbation effects of heterogeneous materials in eye plaques, including the gold-alloy backing and Silastic insert, can be calculated with reasonable accuracy. Even additional levels of complexity introduced through the use of gold foil seed-guides and custom-designed plaques can be calculated accurately using modern MC techniques. Simulations accounting for the aforementioned complexities indicate dose discrepancies exceeding a factor of ten to selected critical structures compared to conventional dose calculations. Task Group 129 was formed to review the literature; re-examine the current dosimetry calculation formalism; and make recommendations for eye-plaque dosimetry, including evaluation of brachytherapy source dosimetry parameters and heterogeneity correction factors. A literature review identified modern assessments of dose calculations for Collaborative Ocular Melanoma Study (COMS) design plaques, including MC analyses and an intercomparison of treatment planning systems (TPS) detailing differences between homogeneous and heterogeneous plaque calculations using the American Association of Physicists in Medicine (AAPM) TG-43U1 brachytherapy dosimetry formalism and MC techniques. This review identified that a commonly used prescription dose of 85 Gy at 5 mm depth in homogeneous medium delivers about 75 Gy and 69 Gy at the same 5 mm depth for specific 125I and 103Pd sources, respectively, when accounting for COMS plaque heterogeneities. Thus, the adoption of heterogeneous dose calculation methods in clinical practice would result in dose differences >10 and warrant a careful evaluation of the corresponding changes in prescription doses. Doses to normal ocular structures vary with choice of radionuclide, plaque location, and prescription depth, such that further dosimetric evaluations of the adoption of MC-based dosimetry methods are needed. The AAPM and American Brachytherapy Society (ABS) recommend that clinical medical physicists should make concurrent estimates of heterogeneity-corrected delivered dose using the information in this reports tables to prepare for brachytherapy TPS that can account for material heterogeneities and for a transition to heterogeneity-corrected prescriptive goals. It is recommended that brachytherapy TPS vendors include material heterogeneity corrections in their systems and take steps to integrate planned plaque localization and image guidance. In the interim, before the availability of commercial MC-based brachytherapy TPS, it is recommended that clinical medical physicists use the line-source approximation in homogeneous water medium and the 2D AAPM TG-43U1 dosimetry formalism and brachytherapy source dosimetry parameter datasets for treatment planning calculations. Furthermore, this report includes quality management program recommendations for eye-plaque brachytherapy. © 2012 American Association of Physicists in Medicine.


Chan M.F.,Sloan Kettering Cancer Center | Chiu-Tsao S.-T.,Quality MediPhys LLC | Li J.,Sloan Kettering Cancer Center | Schupak K.,Sloan Kettering Cancer Center | And 2 more authors.
Technology in Cancer Research and Treatment | Year: 2012

In this study, we verified the treatment planning calculations of skin doses with the incorporation of the bolus effect due to the intervening alpha-cradle (AC) and carbon fiber couch (CFC) using radiochromic EBT2 films. A polystyrene phantom (25 × 25 × 15 cm3) with six EBT2 films separated by polystyrene slabs, at depths of 0, 0.1, 0.2, 0.5, 1, 1.4 cm, was positioned above an AC, which was ~ 1 cm thick. The phantom and AC assembly were CT scanned and the CT-images were transferred to the treatment planning system (TPS) for calculations in three scenarios: (A) ignoring AC and CFC, (B) accounting for AC only, (C) accounting for both AC and CFC. A single posterior 10 × 10 cm2 field, a pair of posterior-oblique 10 × 10 cm2 fields, and a posterior IMRT field (6 MV photons from a Varian Trilogy linac) were planned. For each radiation field configuration, the same MU were used in all three scenarios in the TPS. Each plan for scenario C was delivered to expose a stack of EBT2 films in the phantom through AC and CFC. In addition, in vivo EBT2 film measurement on a lung cancer patient immobilized with AC undergoing IMRT was also included in this study. Point doses and planar distributions generated from the TPS for the three scenarios were compared with the data from the EBT2 film measurements. For all the field arrangements, the EBT2 film data including the in vivo measurement agreed with the doses calculated for scenario (C), within the uncertainty of the EBT2 measurements (~4%). For the single posterior field (a pair of posterior-oblique fields), the TPS generated doses were lower than the EBT2 doses by 34%, 33%, 31%, 13% (34%, 31%, 31%, 11%) for scenario A and by 27%, 25%, 22%, 8% (25%, 21%, 21%, 6%) for scenario B at the depths of 0, 0.1, 0.2, 0.5 cm, respectively. For the IMRT field, the 2D dose distributions at each depth calculated in scenario C agree with those measured data. When comparing the central axis doses for the IMRT field, we found the TPS generated doses for scenario A (B) were lower than the EBT2 data by 35%, 34%, 31%, 16% (29%, 26%, 23%, 10%) at the depths of 0, 0.1, 0.2, 0.5 cm, respectively. There were no significant differences for the depths of 1.0 and 1.4 cm for all the radiation fields studied. TPS calculation of doses in the skin layers accounting for AC and CFC was verified by EBT2 film data. Ignoring the presence of AC and/or CFC in TPS calculation would significantly underestimate the doses in the skin layers. For the clinicians, as more hypofractionated regimens and stereotactic regimens are being used, this information will be useful to avoid potential serious skin toxicities, and also assist in clinical decisions and report these doses accurately to relevant clinical trials/cooperative groups, such as RTOG. © Adenine Press (2012).


Chiu-Tsao S.-T.,Quality MediPhys LLC | Napoli J.J.,John Theurer Cancer Center at Hackensack University Medical Center | Davis S.D.,McGill University | Hanley J.,Princeton Radiation Oncology Center | Rivard M.J.,Tufts University
Applied Radiation and Isotopes | Year: 2014

Purpose: To measure the 2D dose distributions with submillimeter resolution for 131Cs (model CS-1 Rev2) and 125I (model 6711) seeds in a Solid Water phantom using radiochromic EBT film for radial distances from 0.06cm to 5cm. To determine the TG-43 dosimetry parameters in water by applying Solid Water to liquid water correction factors generated from Monte Carlo simulations. Methods: Each film piece was positioned horizontally above and in close contact with a 131Cs or 125I seed oriented horizontally in a machined groove at the center of a Solid Water phantom, one film at a time. A total of 74 and 50 films were exposed to the 131Cs and 125I seeds, respectively. Different film sizes were utilized to gather data in different distance ranges. The exposure time varied according to the seed air-kerma strength and film size in order to deliver doses in the range covered by the film calibration curve. Small films were exposed for shorter times to assess the near field, while larger films were exposed for longer times in order to assess the far field. For calibration, films were exposed to either 40kV (M40) or 50kV (M50) x-rays in air at 100.0cm SSD with doses ranging from 0.2Gy to 40Gy. All experimental, calibration and background films were scanned at a 0.02cmpixel resolution using a CCD camera-based microdensitometer with a green light source. Data acquisition and scanner uniformity correction were achieved with Microd3 software. Data analysis was performed using ImageJ, FV, IDL and Excel software packages. 2D dose distributions were based on the calibration curve established for 50kV x-rays. The Solid Water to liquid water medium correction was calculated using the MCNP5 Monte Carlo code. Subsequently, the TG-43 dosimetry parameters in liquid water medium were determined. Results: Values for the dose-rate constants using EBT film were 1.069±0.036 and 0.923±0.031cGyU-1h-1 for 131Cs and 125I seed, respectively. The corresponding values determined using the Monte Carlo method were 1.053±0.014 and 0.924±0.016cGyU-1h-1 for 131Cs and 125I seed, respectively. The radial dose functions obtained with EBT film measurements and Monte Carlo simulations were plotted for radial distances up to 5cm, and agreed within the uncertainty of the two methods. The 2D anisotropy functions obtained with both methods also agreed within their uncertainties. Conclusion: EBT film dosimetry in a Solid Water phantom is a viable method for measuring 131Cs (model CS-1 Rev2) and 125I (model 6711) brachytherapy seed dose distributions with submillimeter resolution. With the Solid Water to liquid water correction factors generated from Monte Carlo simulations, the measured TG-43 dosimetry parameters in liquid water for these two seed models were found to be in good agreement with those in the literature. © 2014 Elsevier Ltd.


Chiu-Tsao S.-T.,Quality MediPhys LLC | Chan M.F.,Sloan Kettering Cancer Center
Medical Physics | Year: 2010

Purpose: In this study, the authors have quantified the two-dimensional (2D) perspective of skin dose increase using EBT film dosimetry in phantom in the presence of patient immobilization devices during conventional and IMRT treatments. Methods: For 6 MV conventional photon field, the authors evaluated and quantified the 2D bolus effect on skin doses for six different common patient immobilization/support devices, including carbon fiber grid with Mylar sheet, Orfit carbon fiber base plate, balsa wood board, Styrofoam, perforated AquaPlast™ sheet, and alpha-cradle. For 6 and 15 MV IMRT fields, a stack of two film layers positioned above a solid phantom was exposed at the air interface or in the presence of a patient alpha-cradle. All the films were scanned and the pixel values were converted to doses based on an established calibration curve. The authors determined the 2D skin dose distributions, isodose curves, and cross-sectional profiles at the surface layers with or without the immobilization/support device. The authors also generated and compared the dose area histograms (DAHs) and dose area products from the 2D skin dose distributions. Results: In contrast with 20% relative dose [(RD) dose relative to dmax on central axis] at 0.0153 cm in the film layer for 6 MV 10×10 cm2 open field, the average RDs at the same depth in the film layer were 71%, 69%, 55%, and 57% for Orfit, balsa wood, Styrofoam, and alpha-cradle, respectively. At the same depth, the RDs were 54% under a strut and 26% between neighboring struts of a carbon fiber grid with Mylar sheet, and between 34% and 56% for stretched perforated AquaPlast™ sheet. In the presence of the alpha-cradle for the 6 MV (15 MV) IMRT fields, the hot spot doses at the effective measurement depths of 0.0153 and 0.0459 cm were 140% and 150% (83% and 89%), respectively, of the isocenter dose. The enhancement factor was defined as the ratio of a given DAH parameter (minimum dose received in a given area) with and without the support device. For 6 MV conventional 10×10 cm2 field, the enhancement factor was the highest (3.4) for the Orfit carbon fiber plate. As for the IMRT field, the enhancement factors varied with the size of the area of interest and were as high as 3.8 (4.3) at the hot spot of 5 cm2 area in the top film layer (0.0153 cm) for 6 MV (15 MV) beams. Conclusions: Significant 2D bolus effect on skin dose in the presence of patient support and immobilization devices was confirmed and quantified with EBT film dosimetry. Furthermore, the EBT film has potential application for in vivo monitoring of the 2D skin dose distributions during patient treatments. © 2010 American Association of Physicists in Medicine.


Rivard M.J.,Tufts University | Chiu-Tsao S.-T.,Quality MediPhys LLC | Finger P.T.,New York Eye Cancer Center | Melhus C.S.,Tufts University | And 5 more authors.
Medical Physics | Year: 2011

Purpose: To investigate dosimetric differences among several clinical treatment planning systems (TPS) and Monte Carlo (MC) codes for brachytherapy of intraocular tumors using I 125 or P 103 d plaques, and to evaluate the impact on the prescription dose of the adoption of MC codes and certain versions of a TPS (Plaque Simulator with optional modules). Methods: Three clinical brachytherapy TPS capable of intraocular brachytherapy treatment planning and two MC codes were compared. The TPS investigated were Pinnacle v8.0dp1, BrachyVision v8.1, and Plaque Simulator v5.3.9, all of which use the AAPM TG-43 formalism in water. The Plaque Simulator software can also handle some correction factors from MC simulations. The MC codes used are MCNP5 v1.40 and BrachyDose/EGSnrc. Using these TPS and MC codes, three types of calculations were performed: homogeneous medium with point sources (for the TPS only, using the 1D TG-43 dose calculation formalism); homogeneous medium with line sources (TPS with 2D TG-43 dose calculation formalism and MC codes); and plaque heterogeneity-corrected line sources (Plaque Simulator with modified 2D TG-43 dose calculation formalism and MC codes). Comparisons were made of doses calculated at points-of-interest on the plaque central-axis and at off-axis points of clinical interest within a standardized model of the right eye. Results: For the homogeneous water medium case, agreement was within ∼2% for the point- and line-source models when comparing between TPS and between TPS and MC codes, respectively. For the heterogeneous medium case, dose differences (as calculated using the MC codes and Plaque Simulator) differ by up to 37% on the central-axis in comparison to the homogeneous water calculations. A prescription dose of 85 Gy at 5 mm depth based on calculations in a homogeneous medium delivers 76 Gy and 67 Gy for specific I 125 and P 103 d sources, respectively, when accounting for COMS-plaque heterogeneities. For off-axis points-of-interest, dose differences approached factors of 7 and 12 at some positions for I 125 and P 103 d, respectively. There was good agreement (∼3%) among MC codes and Plaque Simulator results when appropriate parameters calculated using MC codes were input into Plaque Simulator. Plaque Simulator and MC users are perhaps at risk of overdosing patients up to 20% if heterogeneity corrections are used and the prescribed dose is not modified appropriately. Conclusions: Agreement within 2% was observed among conventional brachytherapy TPS and MC codes for intraocular brachytherapy dose calculations in a homogeneous water environment. In general, the magnitude of dose errors incurred by ignoring the effect of the plaque backing and Silastic insert (i.e., by using the TG-43 approach) increased with distance from the plaque's central-axis. Considering the presence of material heterogeneities in a typical eye plaque, the best method in this study for dose calculations is a verified MC simulation. © 2011 American Association of Physicists in Medicine.


PubMed | Sloan Kettering Cancer Center and Quality MediPhys LLC
Type: Journal Article | Journal: Medical physics | Year: 2017

To study the effect of film scanning orientation for new EBT-XD film using Vidar and Epson scanners, compared with EBT3 films.The EBT-XD (lot#01081501) and EBT3 films (lot#11031501) were cut into 4cm7cm pieces and each film piece was uniformly exposed to a 6MV photon beam (1515cmDose response curves (netOD vs. dose) were established and compared with EBT-XD and EBT3 film in portrait or landscape orientation using these two scanners. The portrait to landscape (P/L) ratio for each film/scanner combination was determined. The EBT-XD film is about three times less sensitive than EBT3 film. The netOD is higher for portrait than landscape orientation for all the film/scanner combinations. For EBT-XD and EBT3, the average P/L ratios are 1.02 and 1.03 using Vidar scanner, and 1.03 and 1.05 using Epson scanner (red channel), respectively.The effect of film scanning orientation for new EBT-XD film using Vidar Advantage Red and Epson 10000XL scanners has been studied, in comparison with EBT3 film. The portrait/landscape ratios are the lowest for EBT-XD film using Vidar Advantage Red scanner among the four film/scanner combinations.


PubMed | Quality MediPhys LLC
Type: Journal Article | Journal: Medical physics | Year: 2012

Dosimetry of eye plaques for ocular tumors presents unique challenges in brachytherapy. The challenges in accurate dosimetry are in part related to the steep dose gradient in the tumor and critical structures that are within millimeters of radioactive sources. In most clinical applications, calculations of dose distributions around eye plaques assume a homogenous water medium and full scatter conditions. Recent Monte Carlo (MC)-based eye-plaque dosimetry simulations have demonstrated that the perturbation effects of heterogeneous materials in eye plaques, including the gold-alloy backing and Silastic insert, can be calculated with reasonable accuracy. Even additional levels of complexity introduced through the use of gold foil seed-guides and custom-designed plaques can be calculated accurately using modern MC techniques. Simulations accounting for the aforementioned complexities indicate dose discrepancies exceeding a factor of ten to selected critical structures compared to conventional dose calculations. Task Group 129 was formed to review the literature; re-examine the current dosimetry calculation formalism; and make recommendations for eye-plaque dosimetry, including evaluation of brachytherapy source dosimetry parameters and heterogeneity correction factors. A literature review identified modern assessments of dose calculations for Collaborative Ocular Melanoma Study (COMS) design plaques, including MC analyses and an intercomparison of treatment planning systems (TPS) detailing differences between homogeneous and heterogeneous plaque calculations using the American Association of Physicists in Medicine (AAPM) TG-43U1 brachytherapy dosimetry formalism and MC techniques. This review identified that a commonly used prescription dose of 85 Gy at 5 mm depth in homogeneous medium delivers about 75 Gy and 69 Gy at the same 5 mm depth for specific (125)I and (103)Pd sources, respectively, when accounting for COMS plaque heterogeneities. Thus, the adoption of heterogeneous dose calculation methods in clinical practice would result in dose differences >10% and warrant a careful evaluation of the corresponding changes in prescription doses. Doses to normal ocular structures vary with choice of radionuclide, plaque location, and prescription depth, such that further dosimetric evaluations of the adoption of MC-based dosimetry methods are needed. The AAPM and American Brachytherapy Society (ABS) recommend that clinical medical physicists should make concurrent estimates of heterogeneity-corrected delivered dose using the information in this reports tables to prepare for brachytherapy TPS that can account for material heterogeneities and for a transition to heterogeneity-corrected prescriptive goals. It is recommended that brachytherapy TPS vendors include material heterogeneity corrections in their systems and take steps to integrate planned plaque localization and image guidance. In the interim, before the availability of commercial MC-based brachytherapy TPS, it is recommended that clinical medical physicists use the line-source approximation in homogeneous water medium and the 2D AAPM TG-43U1 dosimetry formalism and brachytherapy source dosimetry parameter datasets for treatment planning calculations. Furthermore, this report includes quality management program recommendations for eye-plaque brachytherapy.

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