Remote controlled high dose rate brachytherapy

Critical Reviews in Oncology/Hematology

Volumn 22, Issue 2, 1996, Pages 127-150

  Nag, Subir ^a,d,e,f   Orton, Colin ^b   Thomadsen, Bruce ^c  

^a OHIO STATE UNIVERSITY   (United States)

^b WAYNE STATE UNIVERSITY   (United States)

^c UNIVERSITY OF WISCONSIN MADISON   (United States)

^d OHIO STATE UNIVERSITY   (United States)

^e ALBERT EINSTEIN COLLEGE OF MEDICINE   (United States)

^f MEMORIAL SLOAN KETTERING CANCER CENTER   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

BRACHYTHERAPY; CANCER RADIOTHERAPY; COST EFFECTIVENESS ANALYSIS; ESOPHAGUS CANCER; HEAD AND NECK CANCER; MEDICAL INSTRUMENTATION; RADIATION PROTECTION; REVIEW; SARCOMA; TUMOR;

EID: 0030004614     PISSN: 10408428     EISSN: None     Source Type: Journal    
DOI: 10.1016/1040-8428(95)00190-5     Document Type: Review

References (116)

1. Sievert RM. Two arrangements for reducing dangers in teleradium treatment. Acta Radiol 18:157-162, 1937.
2. Walstam R. Studies on therapeutic short-distance and intracavitary gamma beam techniques. Acta Radiol (suppl) 236:1-129, 1965.
3. Henschke UK, Hilaris BS, Mahan GD. Remote afterloading with intracavitary applicators. Radiology 83:344-345, 1964.
4. O'Connell D, Howard N, Joslin CA et al. A remotely-controlled unit for the treatment of uterine carcinoma. Lancet 2:570, 1965.
5. Wakabayashi M, Ohsawa T, Mitsuhashi H et al. High dose rate intracavitary radiotherapy using the RALSTRON. Introduction and Part I. (Treatment of carcinoma of the uterine cervix). Nippon Acta Radiol 31:340-378, 1971.
6. Mundinger F, Sauerwein K. Gamma Med: ein Gerat zur Bestrahlung von Himgeschwulsten mit Radioisotopen. Acta Radiol 5:48-52, 1966.
7. van't Hooft E. The Selectron. In: Shearer DR, ed. Recent Advances in Brachytherapy Physics, PM Monograph No.7. New York: American Institute of Physics, 1981; 167-177.
8. Nag S, Abitbol A, Clark D et al. High dose rate brachytherapy working group (HIBWOG) of North America. In: International Brachytherapy, Programme and Abstracts, 7th International Brachytherapy Working Conference, Baltimore, MD, 6-8 September, 1992. Veenendaal, The Netherlands: Nucletron International B.V., 1992; 525-526.
9. El-Mahdi A. International high dose rate co-operative group. Proceedings of the 7th International Brachytherapy Conference and Gammamed Users Meeting. Luzerne, Switzerland, 1992; 64.
10. Nag S, Abitbol A, Anderson LL et al. Consensus guidelines for high dose rate remote brachytherapy (HDR) in cervical, endometrial, and endobronchial tumors. Int J Radiat Oncol Biol Phys 27:1241-1244, 1993.
11. Nag S, Owen JB, Farnan N et al. Survey of brachytherapy practice in the United States: a report of the clinical research committee of the American Endocurietherapy Society. Int J Radiat Oncol Biol Phys, 31: 103-107, 1995.
12. Stitt J, Fowler J, Thomadsen B, Buchler D, Paliwal B, Kinsella T. High dose rate intracavitary brachytherapy for carcinoma of the cervix: the Madison System: 1. Clinical and radiobiological considerations. Int J Radiat Oncol Biol Phys 24:335-348, 1992.
13. Thomadsen B, Shahabi S, Stitt J et al. High dose rate intracavitary brachytherapy for carcinoma of the cervix: the Madison System: II. Procedural and physical considerations. Int J Radiat Oncol Biol Phys 24:349-351, 1992.
14. Bastin K, Buchler D, Thomadsen B, Stitt J. Heyman's-based model for high dose rate multitandem intracavitary brachytherapy. Endocur Hypertherm Oncol 9:9-13, 1993.
15. Tod M, Meredith W. A dosage system for use in the treatment of cancer of the uterine cervix. Br J Radiother 11:809, 1938.
16. McGinn C, Stitt J, Buchler D, Kinsella T. Intraoperative ultrasound guidance during high dose rate intracavitary brachytherapy of the uterine cervix and corpus. Int J Endocur Hypertherm Oncol 8:101-104, 1992.
17. van der Laarse R. Optimization of high dose rate brachytherapy. Activity - The Selectron User's Newsletter 2:14-15, 1989.
18. van der Laarse R, Edmundson G, Luthmann R, Prins T. Optimization of HDR brachytherapy dose distributions. Activity -The Selectron User's Newsletter 5:94-101, 1991.
19. Edmundson G. Geometry based optimization for stepping source implants, In: Martinez A, Orton C, Mould R, eds. Brachytherapy HDR and LDR. Columbia, MD: Nucletron, 1990; 184-192.
20. Bastin K, Podgorsak M, Thomadsen B. The transit dose component of high dose rate brachytherapy: direct measurements and clinical implications. Int J Radiat Oncol Biol Phys 26:695-702, 1993.
21. Glasgow G, Bourland JD, Grigsby PW, Meli JA, Weaver KA. Remote Afterloading Technology. AAPM Report No. 41. New York: American Association of Physicists in Medicine, 1993.
22. Goetsch S, Attix FH, Pearson D, Thomadsen B. Calibration of 192Ir high-dose-rate afterloading systems. Med Phys 18:462-467, 1991.
23. Goetsch S, Attix FH, DeWerd L, Thomadsen B. A new reentrant ionization chamber for the calibration of indium-192 high dose rate sources. Int J Radiat Oncol Biol Phys 24:167-170, 1992.
24. Hall EJ. Radiobiology for the Radiologist, 3rd Edition. Philadelphia: Lippincott, 1988; 244.
25. Brenner DJ, Hall EJ. Conditions for the equivalence of continuous to pulsed low dose rate brachytherapy. Int J Radiat Oncol Biol Phys 20:181-190, 1991.
26. Brenner DJ, Hall EJ. Fractionated high dose rate versus low dose rate regimens for intracavitary brachytherapy of the cervix. Br J Radiol 64:133-141, 1991.
27. Dale RG. The application of the linear-quadratic dose-effect equation to fractionated and protracted radiotherapy. Br J Radiol 58:515-528, 1985.
28. Fowler JF. Why shorter half-times for repair lead to greater damage in pulsed brachytherapy. Int J Radiat Oncol Biol Phys 26:353-356, 1993.
29. Thames HD. Effect-independent measures of tissue responses to fractionated irradiation. Int J Radiat Biol Phys 45:1-10, 1984.
30. Orton CG. High and low dose rate remote afterloading: a critical comparison. In: Sauer R, ed. International Radiation Therapy Techniques - Brachytherapy. Berlin: Springer-Verlag, 1991; 53-57.
31. Hall EJ. Radiobiology for the Radiologist, 3rd Edition. Philadelphia: Lippincott, 1988; 122.
32. Barendsen GW. Dose fractionation, dose rate and iso-effect relationships for normal tissue responses. Int J Radiat Oncol Biol Phys 8:1981-1997, 1982.
33. Orton, CG. Recent developments in time-dose modelling. Australasian Physical Eng Sci Med 14:57-64, 1991.
34. Dale RG. What minimum number of fractions is required with high dose-rate remote afterloading? Br J Radiol 60:301-302, 1987.
35. Dale RG. The use of small fraction numbers in high dose-rate gynecological afterloading: some radiobiological considerations. Br J Radiol 63:290-294, 1990.
36. Withers HR, Taylor JMG, Maciejewski B. The hazard of accelerated tumor clonogen repopulation during radiotherapy. Acta Oncol 27:131-146, 1988.
37. Orton CG, Seyedsadr M, Somnay A. Comparison of high and low dose rate remote afterloading for cervix cancer and the importance of fractionation. Int J Radiat Oncol Biol Phys 21:1425-1434, 1991.
38. Yankauer S. Two cases of lung tumour treated bronchoscopically. NY Med J, June 21:741-742, 1922.
39. Ormerod FC. Some notes on the treatment of carcinoma of the bronchus. J Larynx Otol 56:1-10, 1941.
40. George PJM, Hadly JM, Mantell BS et al. Medium dose rate endobronchial radiotherapy with cesium 137. Thorax 47:474-477, 1992.
41. Mendiondo OA, Dillon M, Beach LJ. Endobronchial brachytherapy in the treatment of recurrent bronchogenic carcinoma. Int J Radiat Oncol Biol Phys 9:579-582, 1983.
42. Hilaris BS, Martini N, Loumanen RK. Endobronchial interstitial implantation. Clin Bull 9:17-20, 1979.
43. Schray MF, McDougall JC, Martinez A et al. Management of malignant airway compromise with laser and low dose rate brachytherapy. Chest 93:264-269, 1988.
44. Joyner LR, Hauskins L. Iridium afterloading and Neodymium-YAG laser treatment of segmental and lobar intrabronchial malignant obstructions. Tumor Diagnostik Therapie 7:183-187, 1986.
45. Thomadsen BR, Houdek PV, van der Laarse R, et al: Treatment planning. In: Nag S, ed. High Dose Rate Brachytherapy: A Textbook. Armonk, NY: Futura Publishing Co., 1994, pp 79-145.
46. Speiser BL. High dose-rate endobronchial brachytherapy: whither goest thou? Int J Radiat Oncol Biol Phys 23:250, 1992.
47. Mehta MP, Petereit DG, Chosy L et al. Sequential comparison of low dose rate and hyperfractionated high dose rate endobronchial radiation for malignant airway occlusion. Int J Radiat Oncol Biol Phys 23:133-139, 1992.
48. Mehta MP, Speiser BL, Macha HN: High dose-rate brachytherapy for lung cancer. In: Nag S, ed. High Dose-Rate Brachytherapy: A Textbook. Armonk, NY: Futura Publishing Co., 1994, pp 295-320.
49. Aygun C, Weiner S, Scariato A et al. Treatment of non-small cell lung cancer with external beam radiotherapy and high dose rate brachytherapy. Int J Radiat Oncol Biol Phys 23:127-132, 1992.
50. Bastin KT, Mehta MP, Kinsella TJ. Thoracic volume radiation sparing following endobronchial brachytherapy: a quantitative analysis. Int J Radiat Oncol Biol Phys 25:703-707, 1993.
51. Sutedja T, Zoetmulder F, Zandwijk N. High dose rate brachytherapy improves resectability in squamous cell lung cancer. Chest 102:e-308-309, 1992.
52. Speiser BL, Spartling L. Radiation bronchitis and stenosis secondary to high dose rate endobronchial irradiation. Int J Radiat Oncol Biol Phys 25:589-597, 1993.
53. Speiser B, Spratling L. Fatal hemoptysis: complication or failure of treatment. Int J Radiat Oncol Biol Phys 25:925, 1993.
54. Bedwinek J, Petty A, B Hruton C et al. The use of high dose rate endobronchial brachytherapy to palliate symptomatic endobronchial recurrence of previously irradiated bronchogenic carcinoma. Int J Radiat Oncol Biol Phys 22:23-30, 1991.
55. Khanavkar B, Stern P, Alberti W et al. Complications associated with brachytherapy alone or with laser in lung cancer. Chest 99:1062-1065, 1991.
56. Mehta MP, Speiser BL, Macha HN. High dose rate brachytherapy for lung cancer. In: Nag S, ed. High Dose Rate Brachytherapy: A Textbook. Armonk, NY: Futura, 1994; 295-319.
57. Fu K, Phillips T. High-dose-rate versus low-dose-rate intracavitary brachytherapy for carcinoma of the cervix. Int J Radiat Oncol Biol Phys 19:791-796, 1990.
58. Joslin CA. The Cathetron as part of the radical management of cervix cancer. In: Bates TD, Berry RJ, eds. High Dose-Rate Afterloading in the Treatment of Cancer of the Uterus. Br J Radiol 17 (suppl 17): 11-16, 1980.
59. Rotte K. A randomized clinical trial comparing a high dose-rate with a conventional dose-rate afterloading machine (the Cathetron). Int J Radiat Oncol Biol Phys 9:931-937, 1983.
60. Arai T, Monta S, Kutsutani Y et al. Relationships between total iso-effect dose and number of fractions for the treatment of uterine cervical carcinoma by high dose-rate intracavitary irradiation. In: Bates TD, Berry RJ, eds. High Dose-Rate Afterloading in the Treatment of Cancer of the Uterus. Br J Radiol 17 (suppl 17):89-92, 1980.
61. Sato S, Yajima A, Suzuki M. Therapeutic results using high-dose-rate intracavitary irradiation in cases of cervical cancer. Gynecol Oncol 19:143-147, 1984.
62. Arai T, Nakano T, Morita S et al. High-dose-rate remote afterloading intracavitary radiation therapy for cancer of the uterine cervix: a 20-year experience. Cancer 69:175-180, 1992.
63. Akine Y, Karimoto H, Ogino T et al. High-dose-rate intracavitary irradiation in the treatment of carcinoma of the uterine cervix: early experience with 84 patients. Int J Radiat Oncol Biol Phys 14:893-898, 1988.
64. Chen M-S, Lin F-J, Hong C-H et al. High-dose-rate afterloading technique in the radiation treatment of uterine cervical cancer: 399 cases and 9 years' experience in Taiwan. Int J Radiat Oncol Biol Phys 20:915-919, 1991.
65. Orton CG. High dose rate versus low dose rate brachytherapy for gynecological cancer. Sem Radiat Oncol 3:232-239, 1993.
66. Shigematsu Y, Nishiyama K, Masaki N et al. Treatment of carcinoma of the uterine cervix by remotely controlled afterloading intracavitary radiotherapy with high-dose rate: a comparative study with a low-dose rate system. Int J Radiat Oncol Biol Phys 9:351-356, 1983.
67. Patel FD, Sharma SC, Pritam SN, Ghoshal S, Gupta B. Low dose rate versus high dose rate brachytherapy in the treatment of carcinoma of the uterine cervix: a clinical trial. Int J Radiat Oncol Biol Phys 28:335-341, 1993.
68. Jones GW, Lukka H. HDR versus LDR brachytherpy for squamous cell carcinoma of the cervix. An economic analysis. In: Mould RF, ed. International Brachytherapy. Veenendaal, The Netherlands: Nucletron International B.V., 1992; 516-519.
69. Bastin K, Buchler D, Stitt J et al. Comparative cost analysis of high dose rate versus low dose rate brachytherapy for gynecological cancer. Am J Clin Oncol 16:256-263, 1993.
70. Mandell LM, Nori D, Anderson LL, Hilaris BS. Postoperative vaginal radiation in endometrial cancer using a remote afterloading technique. Int J Radiat Oncol Biol Phys 11:473-478, 1985.
71. Stitt JA. High-dose-rate intracavitary brachytherapy for gynecologic malignancies. Oncology 6:59-79, 1992.
72. Peschel RE, Healey G, Smith RJ. High dose rate remote afterloading for endometrial cancer. Endocur Hypertherm Oncol 5:209-214, 1989.
73. Lybert MLM, van Putten WLJ, Ribot JG et al. Endometrial carcinoma: high dose rate brachytherapy in combination with external irradiation - a multivariate analysis of relapses. Radiother Oncol 16:245-252, 1989.
74. Sorbe BG, Smeds AC. Postoperative vaginal irradiation with high dose rate afterloading technique in endometrial carcinoma stage I. Int J Radiat Oncol Biol Phys 18:305-314, 1990.
75. Rotte K. Technique and results of HDR afterloading in cancer of the endometrium. In: Martinez AA, Orton CG, Mould RF, eds. Brachytherapy HDR and LDR. Columbia, MD: Nucletron, 1990; 68-79.
76. Rippa P, Seppo K, Kauppila MD. Comparison of Heyman packingand Cathetron afterloading methods in the treatment of endometrial cancer. Br J Radiol 58:437-441, 1985.
77. Stitt, JA. Dose specification for inoperable endometrial carcinoma: the Madison system. Activity/Int Selectron Brachyther J (suppl 2):32-34, 1991.
78. Kucera H, Weghaupt K. Treatment of inoperable endometrial carcinoma with intracavitary high dose rate iridium irradiation. Strahlenther Onkol 9:508-514, 1986.
79. Taina E. High versus low dose rate intracavitary radiotherapy in the treatment of carcinoma of the uterus. Acta Obstet Gynecol Scand 103 (suppl):1-17, 1981.
80. Snelling MD, Hambert HE. The treatment of carcinoma of the cervix and endometrium using the Cathetron at the Middlesex Hospital. Clin Radiol 30:253-258, 1979.
81. Sipila P, Kauppila A. Intracavitary irradiation of endometrial carcinoma using a high intensity Co-60 afterloading method. Acta Oncol 28:601-605, 1989.
82. Sorbe B, Frankendal B. Intracavitary irradiation of endometrial carcinoma stage I by a high dose rate afterloading technique. Gynecol Oncol 33:135-145, 1989.
83. Sorbe B, Kjelligren O, Stenson S. Prognosis of endometrial carcinoma stage I in two Swedish regions. A study with special regard to the effects of intracavitary irradiation with high dose rate afterloading technique. Acta Oncol 29:29-37, 1990.
84. Rui-fen Zhao et al. Combination of external irradiation and intracavitary cesium-37 radiotherapy for esopharyngeal carcinoma. Chin J Radiat One Phys Biol 2:85-87, 1990.
85. Flores AD, Rowland CG, Yin W-B. High dose rate brachyterapy of carcinoma of the esophagus. In: Nag S, ed. High Dose Rate Brachytherapy: A Textbook. Armonk, NY: Futura, 1994; 275-294.
86. Sur RK, Kochar R, Negi PS, Gupta BD. High dose rate intraluminal brachytherapy in palliation of esophageal carcinoma. Endocur Hypertherm Oncol 10:25-29, 1994.
87. Flores A, Nelems B, Evans K, Hay J, Stoller J, Jackson S. The impact of new radiotherapy modalities on the surgical management of cancer of the esophagus and cardia. Int J Radiat Oncol Biol Phys 17:937-944, 1989.
88. Rowland CG, Pagliero KM. Intracavitary irradiation in palliation of carcinoma of the esophagus and cardia. Lancet 2:981-983, 1985.
89. Hishikawa Y, Kamikonya N, Tanaka S et al. Radiotherapy of esophageal carcinoma; role of high dose rate intracavitary irradiation. Radiother Oncol 9:13-20, 1987.
90. Nag S, Tai DL, Gold RE. Biliary tract neoplasms: a simple management technique. Southern Med J 77:593-595, 1984.
91. Herskovic A, Heaston D, Engler MJ, Fishburn RJ, Jones RS, Noell KT. Irradiation of biliary carcinoma. Radiology 139:219-222, 1981.
92. Haffty BG, Mate TP, Greenwood LH, Peschel RE, Weissberg JB. Malignant biliary obstruction: intracavitary treatment with a high-dose-rate remote afterloading device. Radiology 164: 574-576, 1987.
93. Urban MS, Siegel JH, Pavlou W et al. Treatment of malignant biliary obstruction with a high-dose rate remote afterloading device using a 10F nasobiliary tube. Gastrointest Endosc 36:292-296, 1990.
94. Non D, Nag S, Rogers D, Vikram B. Remote afterloading high dose rate brachytherapy for carcinoma of the bile duct. In: Nag S, ed. High Dose Rate Brachytherapy: A Textbook. Armonk, NY: Futura, 1994; 331-338.
95. Harrison LB, Franzee F, Gaynor J et al. Results of a prospective randomized trial of adjuvant brachytherapy in the management of completely resected soft tissue sarcoma (abstract). Int J Radiat Oncol Biol Phys 24 (suppl 1):240, 1992.
96. Schray MF, Gunderson LL, Sim FH, Pritchard DJ, Shives TC, Yeakel PD. Integration of brachytherapy, resection, and external irradiation. Cancer 66:451-456, 1990.
97. Alekhteyar KM, Porter AT, Ryan C, Orton J, Forman D. Preliminary results of hyperfractionated high dose rate brachytherapy in soft-tissue sarcoma (abstract). Endocur Hypertherm Oncol 9:56, 1993.
98. Donath D, Clark C, Kaufmann MD, Evans C, Brown K. Post-operative adjuvant high dose rate brachytherapy in the treatment of poor-prognosis soft-tissue sarcoma (abstract). Endocur Hypertherm Oncol 9:48, 1993.
99. Nag S, Porter AT, Donath D. The role of high dose rate brachytherapy in the management of adult soft tissue sarcomas. In: Nag S, ed. High Dose Rate Brachytherapy: A Textbook. Armonk, NY: Futura, 1994; 393-398.
100. Gao Li, Xu Guo-zhen, Yin Wei-bo et al. Preliminary experience in HDR brachytherapy for 72 nasopharyngeal carcinoma patients. In: Mould RF, ed. Brachytherapy in the Peoples Republic of China. Kowloon: Nucletron Far East, 1992; E76-E81.
101. Levendag PC, Vikram B, Flores AD, Yin W-B. High dose rate brachytherapy for cancer of the head and neck. In: Nag S, ed. High Dose Rate Brachytherapy: A Textbook. Armonk, NY: Futura, 1994; 237-273.
102. Jolly DE, Nag S. Technique for construction of dental molds for high-dose-rate remote brachytherapy. Special Care Dentistry 12:219-224, 1992.
103. Nag S, Dixit S, Mountain R, Schuller D. Intraoperative high dose rate brachytherapy of head and neck cancer (abstract). Radiother Oncol 31 (suppl 1):S30, 1994.
104. Flamant F, Gerbaulet A, Nihoul-Fekete C et al. Long-term sequelae of conservative treatment by surgery, brachytherapy and chemotherapy for vulval and vaginal rhabdomyosarcoma in children. J Clin Oncol 8:1847-1853, 1990.
105. Fontanesi J, Kun L, Pao W et al. Brachytherapy as primary or 'boost' irradiation in 18 children with solid tumors. Endocur Hypertherm Oncol 7:195-200, 1991.
106. Gerbaulet AP, Esche BA, Hail CM et al. Conservative treatment for lower gynecological tract malignancies in children and adolescents: the Institut Gustave-Roussy experience. Int J Radiat Oncol Biol Phys 16:655-658, 1989.
107. Nag S, Grecula JC, Ruymann F. Aggressive chemotherapy, organ preserving surgery, and high dose rate remote brachytherapy in the treatment of rhabdomyosarcoma in infants and young children. Cancer 72:2769-2776, 1993.
108. Clarke DH, Vincini F, Jacobs H, Rowland CG, Kuske RR. High dose brachytherapy for breast cancer. In: Nag S, ed. High Dose Rate Brachytherapy: A Textbook. Armonk, NY: Futura, 1994; 321-329.
109. Gracia DM, Zamorano L, Mundinger F. High dose rate brachytherapy in the treatment of gliomas. In: Nag S, ed. High Dose Rate Brachytherapy: A Textbook. Armonk, NY: Futura, 1994; 215-235.
110. Kaufman N, Non D, Shank B, Linares L, Harrison L, Fass D, Enker W. Remote afterloading intraluminal brachytherapy in the treatment of rectal, rectosigmoid, and anal cancer: a feasibility study. Int J Radiat Oncol Biol Phys 17:663-668, 1989.
111. Mate T, Kovács G, Martinez A. High dose rate brachytherapy of the prostate. In: Nag S, ed. High Dose Rate Brachytherapy: A Textbook. Armonk, NY: Futura, 1994; 355-371.
112. Nori D, Williams H. Intraoperative brachytherapy: rationale and future directions. In: International Brachytherapy, Programme and Abstracts, 7th International Brachytherapy Working Conference, Baltimore, MD, 6-8 September, 1992. Veenendaal, The Netherlands: Nucletron International B.V., 1992; 132-137.
113. Nag S, Orton C. Development of intraoperative high dose rate brachytherapy for treatment of resected tumor beds in anesthetized patients. Endocur Hypertherm Oncol 9:187-193, 1993.
114. Dritschilo A, Harter KW, Thomas D et al. Intraoperative radiation therapy of hepatic metastases: technical aspects and report of a pilot study. Int J Radiat Oncol Biol Phys 14:1007-1011, 1988.
115. Lukas P, Kneschaurek P, Ries G et al. A new modality for intraoperative radiotherapy using a high dose rate afterloading unit. In: Proceedings of Sixth International High Dose Rate Remote Afterloading Conference, Budapest, Hungary, May 2-4, 1991; 62-66.
116. Hilaris BS, Moorthy C, Tchelebi A et al. Pilot study on combined hyperthermia and HDR interstitial brachytherapy in the management of superficial malignancies. In: International Brachytherapy, Programme and Abstracts, 7th International Brachytherapy Working Conference, Baltimore, MD, 6-8 September, 1992. Veenendaal, The Netherlands: Nucletron International B.V., 1992; 389-393.