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effectively be treated with other therapies. However, neutron damage to nearby vulnerable areas such as the brain and sensory neurons can produce irreversible brain atrophy, blindness, etc. The risk of these side effects can be greatly mitigated by several techniques, but they cannot be eliminated. Moreover, some patients are more susceptible to such side effects than others and this cannot be predicted. The patient ultimately must decide whether the advantages of a possibly lasting cure outweigh the risks of this treatment when faced with an otherwise incurable cancer.
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119:. The neutron is uncharged and damages cells by direct effect on nuclear structures. Malignant tumors tend to have low oxygen levels and thus can be resistant to low LET radiation. This gives an advantage to neutrons in certain situations. One advantage is a generally shorter treatment cycle. To kill the same number of cancerous cells, neutrons require one third the
96:. Most fast neutron therapy beams are produced by reactors, cyclotrons (d+Be) and linear accelerators. Neutron therapy is currently available in Germany, Russia, South Africa and the United States. In the United States, one treatment center is operational, in Seattle, Washington. The Seattle center uses a cyclotron which produces a proton beam impinging upon a
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152:. By comparison, the charged particles produced at a site of a neutron interaction may deliver their energy at a rate of 30–80 keV/μm. The amount of energy deposited as the particles traverse a section of tissue is referred to as the linear energy transfer (LET). X-rays produce low LET radiation, and neutrons produce high LET radiation.
479:
Kubota N, Suzuki M, Furusawa Y, Ando K, Koike S, Kanai T, Yatagai F, Ohmura M, Tatsuzaki H, Matsubara S, et al. A comparison of biological effects of modulated carbon-ions and fast neutrons in human osteosarcoma cells. International
Journal of Radiation Oncology, Biology, Physics, Volume 33, Issue 1,
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systems to measure the dose, along with the MLC and other beam shaping devices. The advantage of having a beam transport and gantry are that the cyclotron can remain stationary, and the radiation source can be rotated around the patient. Along with varying the orientation of the treatment couch which
255:
that produces fast neutrons from directing 50.5 MeV protons onto a beryllium target. The UW Cyclotron is equipped with a gantry mounted delivery system an MLC to produce shaped fields. The UW Neutron system is referred to as the
Clinical Neutron Therapy System (CNTS). The CNTS is typical of most
155:
Because the electrons produced from X-rays have high energy and low LET, when they interact with a cell typically only a few ionizations will occur. It is likely then that the low LET radiation will cause only single strand breaks of the DNA helix. Single strand breaks of DNA molecules can be readily
391:
While the CNTS accelerates protons, the KCC facility produces its neutron beam by accelerating 48.5 MeV deuterons onto a beryllium target. This method produces a neutron beam with depth dose characteristics roughly similar to those of a 4 MV photon beam. The deuterons are accelerated using
451:
Feng-Yi Yang, Wen-Yuan Chang, Jia-Je Li, Hsin-Ell Wang, Jyh-Cheng Chen, and Chi-Wei Chang."Pharmacokinetic
Analysis and Uptake of 18F-FBPA-Fr After Ultrasound-Induced Blood–Brain Barrier Disruption for Potential Enhancement of Boron Delivery for Neutron Capture Therapy" Journal of Nuclear Medicine
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Forman J, Ben-Josef E, Bolton SE, Prokop S and Tekyi-Mensah S . A randomized prospective trial of sequential neutron-photon vs. photon-neutron irradiation in organ confined prostate cancer. International
Journal of Radiation Oncology, Biology, Physics, Volume 54, Issue 2, Supplement 1, 1 October
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Theron T, Slabbert J, Serafin A and Böhm L. The merits of cell kinetic parameters for the assessment of intrinsic cellular radiosensitivity to photon and high linear energy transfer neutron irradiation. International
Journal of Radiation Oncology, Biology, Physics, Volume 37, Issue 2, 15 January
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neutron therapy center first treated patients in 1976, and since that time has treated over 3,000 patients. In 2004, the
Northern Illinois University began managing the center. The neutrons produced by the linear accelerator at Fermilab have the highest energies available in the US and among the
329:
During treatment, only the patient remains inside the treatment room (called a vault) and the therapists will remotely control the treatment, viewing the patient via video cameras. Each delivery of a set neutron beam geometry is referred to as a treatment field or beam. The treatment delivery is
242:
Several centers around the world have used fast neutrons for treating cancer. Due to lack of funding and support, at present only three are active in the USA. The
University of Washington and the Gershenson Radiation Oncology Center operate fast neutron therapy beams and both are equipped with a
233:
No cancer therapy is without the risk of side effects. Neutron therapy is a very powerful nuclear scalpel that has to be utilized with exquisite care. For instance, some of the most remarkable cures it has been able to achieve are with cancers of the head and neck. Many of these cancers cannot
395:
The KCC facility is also equipped with an MLC beam shaping device, the only other neutron therapy center in the USA besides the CNTS. The MLC at the KCC facility has been supplemented with treatment planning software that allows for the implementation of
Intensity Modulated Neutron Radiotherapy
338:
The neutron therapy facility at the
Gershenson Radiation Oncology Center at Karmanos Cancer Center/Wayne State University (KCC/WSU) in Detroit bears some similarities to the CNTS at the University of Washington, but also has many unique characteristics. This unit was decommissioned in 2011.
163:
DNA repair mechanisms are quite efficient, and during a cell's lifetime many thousands of single strand DNA breaks will be repaired. A sufficient dose of ionizing radiation, however, delivers so many DNA breaks that it overwhelms the capability of the cellular mechanisms to cope.
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Pignol JP, Slabbert J and Binns P. Monte Carlo simulation of fast neutron spectra: Mean lineal energy estimation with an effectiveness function and correlation to RBE. International
Journal of Radiation Oncology, Biology, Physics, Volume 49, Issue 1, 1 January 2001, Pages
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Russell KJ, Caplan RJ, Laramore GE, et al. Photon versus fast neutron external beam radiotherapy in the treatment of locally advanced prostate cancer: results of a randomized prospective trial. International Journal of Radiation Oncology, Biology, Physics 28(1): 47–54,
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Douglas JG, Laramore GE, Austin-Seymour M, Koh WJ, Lindsley KL, Cho P and Griffin TW. Neutron radiotherapy for adenoid cystic carcinoma of minor salivary glands. International Journal of Radiation Oncology, Biology, Physics, Volume 36, Issue 1, 1 August 1996, Pages
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Haraf DJ, Rubin SJ, Sweeney P, Kuchnir FT, Sutton HG, Chodak GW and Weichselbaum RR. Photon neutron mixed-beam radiotherapy of locally advanced prostate cancer. International Journal of Radiation Oncology, Biology, Physics, Volume 33, Issue 1, 30 August 1995, Pages
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Prott FJ, Micke O, Pötter R, Haverkamp U, Schüller P and Willich N. 2137 Results of fast neutron therapy of adenoid cystic carcinoma of the salivary glands. International Journal of Radiation Oncology, Biology, Physics, Volume 39, Issue 2, Supplement 1, 1997, Page
177:) of fast neutrons is 4 times that of X-rays, meaning 1 rad of fast neutrons is equal to 4 rads of X-rays. The RBE of neutrons is also energy dependent, so neutron beams produced with different energy spectra at different facilities will have different RBE values.
156:
repaired, and so the effect on the target cell is not necessarily lethal. By contrast, the high LET charged particles produced from neutron irradiation cause many ionizations as they traverse a cell, and so double-strand breaks of the DNA molecule are possible.
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Laramore GE, Krall JM, Griffin TW, Duncan W, Richter MP, Saroja KR, Maor MH, Davis LW. Neutron versus photon irradiation for unresectable salivary gland tumors: final report of an RTOG-MRC randomized clinical trial. Int J Radiat Oncol Biol Phys. 1993 Sep
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A beamline transports the proton beam from the cyclotron to a gantry system. The gantry system contains magnets for deflecting and focusing the proton beam onto the beryllium target. The end of the gantry system is referred to as the head, and contains
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Farr JB, Maughan RL, Yudelev M, Blosser E, Brandon J, Horste T Compact multileaf collimator for conformal and intensity modulated fast neutron therapy: Electromechanical design and validation Medical Physics – September 2006 – Volume 33, Issue 9, pp.
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K.J. Stelzer, K.L. Lindsley, P.S. Cho, G.E. Laramore and T.W. Griffin. Fast Neutron Radiotherapy: The University of Washington Experience and Potential Use of Concomitant Boost with Boron Neutron Capture. Radiation Protection Dosimetry 70:471–475
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Warenius HM, White R, Peacock JH, Hanson J, Richard A. Britten, Murray D. The Influence of Hypoxia on the Relative Sensitivity of Human Tumor Cells to 62.5 MeV (p→Be) Fast Neutrons and 4 MeV Photons. Radiation Research 154, 54–63
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as protons. Another advantage is the established ability of neutrons to better treat some cancers, such as salivary gland, adenoid cystic carcinomas and certain types of brain tumors, especially high-grade gliomas
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Brahme A, Eenmaa J, Lindback S, Montelius A, Wootton P. Neutron beam characteristics from 50 MeV protons on beryllium using a continuously variable multi-leaf collimator. Radiother Oncol. 1983 Aug;1(1):65–76.
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MacDougall RH, Orr JA, Kerr GR, and Duncan W. Fast neutron treatment for squamous cell carcinoma of the head and neck: final report of Edinburgh randomised trial. BMJ. 1990 December 1; 301(6763): 1241–1242.
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the patient is positioned on, variation of the gantry position allows radiation to be directed from virtually any angle, allowing sparing of normal tissue and maximum radiation dose to the tumor.
115:(LET). X-rays produce low LET radiation, and protons and neutrons produce high LET radiation. Low LET radiation damages cells predominantly through the generation of reactive oxygen species, see
111:
kills cancer cells in two ways depending on the effective energy of the radiative source. The amount of energy deposited as the particles traverse a section of tissue is referred to as the
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planned to deliver the radiation as effectively as possible, and usually results in fields that conform to the shape of the gross target, with any extension to cover microscopic disease.
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Buchholz TA, Laramore GE, Griffin BR, et al.: The role of fast neutron radiation therapy in the management of advanced salivary gland malignant neoplasms. Cancer 69 (11): 2779–88, 1992.
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a gantry mounted superconducting cyclotron (GMSCC), eliminating the need for extra beam steering magnets and allowing the neutron source to rotate a full 360° around the patient couch.
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Schematic of a treatment field delivery. The patient couch has been rotated, along with the gantry so the neutron beam will enter obliquely, to give maximum sparing of normal tissue.
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Santanam, L., T. He, et al. (2007). "Intensity modulated neutron radiotherapy for the treatment of adenocarcinoma of the prostate." Int J Radiat Oncol Biol Phys 68(5): 1546–1556.
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Douglas JD, Koh WJ, Austin-Seymour, M, Laramore GE. Treatment of Salivary Gland Neoplasms with fast neutron Radiotherapy. Arch Otolaryngol Head Neck Surg Vol 129 944–948 Sep 2003
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Saroja KR, Mansell J, Hendrickson FR, et al.: An update on malignant salivary gland tumors treated with neutrons at Fermilab. Int J Radiat Oncol Biol Phys 13 (9): 1319–25, 1987.
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Asgarali S, Errington RD, Jones AS. The treatment of recurrence following fast neutron therapy for head and neck malignancy. Clin Otolaryngol Allied Sci. 1996 Jun;21(3):274-7.
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neutron therapy systems. A large, well shielded building is required to cut down on radiation exposure to the general public and to house the necessary equipment.
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Wambersie A, Richard F, Breteau N. Development of fast neutron therapy worldwide. Radiobiological, clinical and technical aspects. Acta Oncol. 1994;33(3):261-74.
822:. Midwest Institute for Neutron Therapy at Fermilab. International Journal of Radiation Oncology, Biology, Physics, Volume 34, Issue 1, 1 January 1996, Page 269
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Krüll A, Schwarz R, Engenhart R, et al.: European results in neutron therapy of malignant salivary gland tumors. Bull Cancer Radiother 83 (Suppl): 125-9s, 1996
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Laramore GE. Fast neutron radiotherapy for inoperable salivary gland tumors: is it the treatment of choice?Int J Radiat Oncol Biol Phys. 1987 Sep;13(9):1421-3.
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Keyhandokht Shahri, Laleh Motavalli, and Hashem Hakimabad."Neutron Applications in Cancer Treatment" Hellenic Journal of Nuclear Medicine 14:2(May–August 2011)
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KCC/WSU has more experience than anyone in the world using neutron therapy for prostate cancer, having treated nearly 1,000 patients during the past 10 years.
193:, making the effects of the radiation more damaging. Tumor cells typically have a lower oxygen content than normal tissue. This medical condition is known as
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Farr JB. A compact multileaf collimator for conventional and intensity modulated fast neutron therapy Medical Physics April 2004 Volume 31, Issue 4, p. 951
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Goodsell DS. Fundamentals of Cancer Medicine The Molecular Perspective: Double-Stranded DNA Breaks The Oncologist, Vol. 10, No. 5, 361–362, May 2005
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396:(IMNRT), a recent advance in neutron beam therapy which allows for more radiation dose to the targeted tumor site than 3-D neutron therapy.
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and therefore the oxygen effect acts to decrease the sensitivity of tumor tissue. The oxygen effect may be quantitatively described by the
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Vaupel P, Harrison L. Tumor Hypoxia: Causative Factors, Compensatory Mechanisms, and Cellular Response The Oncologist 2004;9(suppl 5):4–9
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Farr, J. B., R. L. Maughan, et al. (2007). "Radiologic validation of a fast neutron multileaf collimator." Med Phys 34(9): 3475–3484.
201:(OER). Generally it is believed that neutron irradiation overcomes the effect of tumor hypoxia, although there are counterarguments.
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of double-strand breaks are much more difficult for a cell to repair, and more likely to lead to cell death.
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has been shown through randomized trials. Fast neutron therapy has been applied successfully against
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Johns HE and Cunningham JR. The Physics of Radiology. Charles C Thomas 3rd edition 1978
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Example of a treatment neutron field collimated using a neutron MLC
170:(e.g. carbon ions) makes use of the similarly high LET of C ions.
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720:"The neutron-therapy saga: a cautionary tale – MedicalPhysicsWeb"
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Schematic of the KCC/WSU gantry mounted superconducting cyclotron
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Revival of a unique and proven cancer treatment, neutron therapy
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University of Washington (UW) Radiation Oncology Department
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Multi-Leaf Collimator (MLC) used to shape the neutron beam
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Multi-Leaf Collimator (MLC) to shape the neutron beam.
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Comparison of Low LET electrons and High LET electrons
1422: Also known as sealed-source radiation therapy.
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The Radiation Oncology Department operates a proton
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875:. NIU Institute for Neutron Therapy. Archived from
846:. NIU Institute for Neutron Therapy. Archived from
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Patient treating room for neutron radiation therapy
29:
663:Adenoid Cystic Carcinoma Neutron Radiation Therapy
415:The Fermilab center was decommissioned in 2013.
1416: Also known as external-beam radiotherapy.
334:Karmanos Cancer Center / Wayne State University
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209:The efficacy of neutron beams for use on
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221:have also been treated. Various other
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1124:Selective internal radiation therapy
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915:FermiLab Neutron Therapy overview
88:typically between 50 and 70
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1007:Stereotactic radiation therapy
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1428: Also known as systemic
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490:German Cancer Research Center
480:30 August 1995, Pages 135–141
425:Boron neutron capture therapy
1457:Radiation therapy procedures
1394:Radiation treatment planning
1379:Percentage depth dose curve
668:September 25, 2006, at the
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1404:Tissue to Air Ratio (TAR)
870:"Neutrons Against Cancer"
219:Adenoid cystic carcinomas
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1364:Oxygen enhancement ratio
1319:Dose verification system
645:NCI Salivary Cancer Page
344:MLC on KCC/WSU cyclotron
261:Univ. of Washington CNTS
247:University of Washington
199:Oxygen Enhancement Ratio
788:July 20, 2011, at the
412:highest in the world
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113:linear energy transfer
1324:Dose-volume histogram
215:salivary gland tumors
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84:utilizes high energy
1384:Radiation oncologist
1374:Pencil-beam scanning
1349:Multileaf collimator
1199:ibritumomab tiuxetan
850:on December 20, 2008
238:Fast neutron centers
225:have been examined.
223:head and neck tumors
189:in a cell acts as a
142:Compton interactions
82:Fast neutron therapy
30:Fast neutron therapy
1389:Radiation Therapist
1259:Radiation proctitis
1118:Plaque radiotherapy
993:Orthovoltage X-rays
882:on November 4, 2009
511:1997, Pages 423–428
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1194:Radioimmunotherapy
998:Megavoltage X-rays
988:Superficial X-rays
951:Radiation oncology
650:2007-02-04 at the
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1359:Neutron generator
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168:Heavy ion therapy
109:Radiation therapy
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16:(Redirected from
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1093:Brachytherapy
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726:on 2015-01-09
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643:See also the
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205:Clinical uses
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181:Oxygen effect
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1430:radioisotope
1344:Monitor unit
1314:Dose profile
1284:Features and
1150:radiotherapy
1130: /
1126: /
1067:fast neutron
1066:
1005: /
1003:Radiosurgery
896:
884:. Retrieved
877:the original
864:
852:. Retrieved
848:the original
838:
827:
818:Cohen L and
814:
805:
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748:
739:
728:. Retrieved
724:the original
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328:
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276:UW Cyclotron
250:
241:
232:
229:Side effects
208:
184:
172:
166:
162:
154:
139:
107:
81:
80:
1234:Tomotherapy
1132:TheraSphere
1128:SIR-Spheres
1017:Gamma Knife
970:Teletherapy
1446:Categories
1304:Bragg peak
1247:Conditions
1179:Lexidronam
1164:Iobenguane
1012:Cyberknife
844:"About Us"
730:2014-12-08
431:References
158:DNA repair
104:Advantages
48:ICD-10-PCS
1334:Isocenter
1329:Dosimetry
1286:equipment
1120: (I)
961:therapies
886:April 24,
854:April 24,
762:3313–3320
323:dosimetry
253:cyclotron
98:beryllium
92:to treat
1432:therapy.
1339:Mobetron
1222:electron
1101:Prostate
1035:electron
959:Specific
820:Lennox A
786:Archived
666:Archived
648:Archived
419:See also
409:Fermilab
100:target.
86:neutrons
1452:Neutron
1294:BEAMnrc
1181: (
1166: (
1134: (
501:251–260
52:D?0?5ZZ
1369:Pencil
1227:TARGIT
1077:proton
1054:hadron
980:photon
709:(1997)
539:(2000)
187:oxygen
94:cancer
1299:Bolus
1210:Other
880:(PDF)
873:(PDF)
681:87–93
549:1993.
70:[
63:92.26
58:ICD-9
888:2010
856:2010
559:3–14
407:The
1309:D50
1052:by
1033:by
978:by
607:309
175:RBE
146:keV
128:LET
90:MeV
1448::
1189:Sr
1183:Sm
1111:Pd
217:.
150:μm
1185:)
1174:Y
1170:)
1168:I
1154:3
1138:)
1136:Y
1106:I
943:e
936:t
929:v
890:.
858:.
733:.
148:/
74:]
20:)
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