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  • 1
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    Online Resource
    On-site multi-component intervention to improve productivity and reduce the economic and personal burden of neck pain in Swiss office-workers (NEXpro): protocol for a cluster-randomized controlled trial
    Springer Science and Business Media LLC ; 2020
    In:  BMC Musculoskeletal Disorders Vol. 21, No. 1 ( 2020-12)
    Details
    In: BMC Musculoskeletal Disorders, Springer Science and Business Media LLC, Vol. 21, No. 1 ( 2020-12)
    Abstract: Non-specific neck pain and headache are major economic and individual burden in office-workers. The aim of this study is to investigate the effect of a multi-component intervention combining workstation ergonomics, health promotion information group workshops, neck exercises, and an app to enhance intervention adherence to assess possible reductions in the economic and individual burden of prevalent and incident neck pain and headache in office workers. Methods/design This study is a stepped wedge cluster-randomized controlled trial. Eligible participants will be any office-worker aged 18–65 years from two Swiss organisations in the Cantons of Zurich and Aargau, working more than 25 h a week in predominantly sedentary office work and without serious health conditions of the neck. One hundred twenty voluntary participants will be assigned to 15 clusters which, at randomly selected time steps, switch from the control to the intervention group. The intervention will last 12 weeks and comprises workstation ergonomics, health promotion information group workshops, neck exercises and an adherence app. The primary outcome will be health-related productivity losses (presenteeism, absenteeism) using the Work Productivity and Activity Impairment Questionnaire. Secondary outcomes are neck disability and pain (measured by the Neck Disability Index, and muscle strength and endurance measures), headache (measured by the short-form headache impact test), psychosocial outcomes (e.g. job-stress index, Fear-Avoidance Beliefs Questionnaire), workplace outcomes (e.g. workstation ergonomics), adherence to intervention, and additional measures (e.g. care-seeking). Measurements will take place at baseline, 4 months, 8 months, and 12 months after commencement. Data will be analysed on an intention to treat basis and per protocol. Primary and secondary outcomes will be examined using linear mixed-effects models. Discussion To the authors’ knowledge, this study is the first that investigates the impact of a multi-component intervention combining current evidence of effective interventions with an adherence app to assess the potential benefits on productivity, prevalent and incident neck pain, and headache. The outcomes will impact the individual, their workplace, as well as private and public policy by offering evidence for treatment and prevention of neck pain and headache in office-workers. Trial registration ClinicalTrials.gov, NCT04169646 . Registered 15 November 2019 - Retrospectively registered.
    Type of Medium: Online Resource
    ISSN: 1471-2474
    URL: Article
    DOI: 10.1186/s12891-020-03388-x
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2041355-5
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  • 2
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    Part 2: Dynamic mixed beam radiotherapy ( DYMBER ): Photon dynamic trajectories combined with modulated electron beams
    Wiley ; 2018
    In:  Medical Physics Vol. 45, No. 9 ( 2018-09), p. 4213-4226
    Details
    In: Medical Physics, Wiley, Vol. 45, No. 9 ( 2018-09), p. 4213-4226
    Abstract: The purpose of this study was to develop a treatment technique for dynamic mixed beam radiotherapy ( DYMBER ) utilizing increased degrees of freedom (DoF) of a conventional treatment unit including different particle types (photons and electrons), intensity and energy modulation and dynamic gantry, table, and collimator rotations. Methods A treatment planning process has been developed to create DYMBER plans combining photon dynamic trajectories ( DT s) and step and shoot electron apertures collimated with the photon multileaf collimator ( pMLC ). A gantry‐table path is determined for the photon DT s with minimized overlap of the organs at risk ( OAR s) with the target. In addition, an associated dynamic collimator rotation is established with minimized area between the pMLC leaves and the target contour. pMLC sequences of photon DT s and electron pMLC apertures are then simultaneously optimized using direct aperture optimization (DAO). Subsequently, the final dose distribution of the electron pMLC apertures is calculated using the Swiss Monte Carlo Plan ( SMCP ). The pMLC sequences of the photon DT s are then re‐optimized with a finer control point resolution and with the final electron dose distribution taken into account. Afterwards, the final photon dose distribution is calculated also using the SMCP and summed together with the one of the electrons. This process is applied for a brain and two head and neck cases. The resulting DYMBER dose distributions are compared to those of dynamic trajectory radiotherapy ( DTRT ) plans consisting only of photon DT s and clinically applied VMAT plans. Furthermore, the deliverability of the DYMBER plans is verified in terms of dosimetric accuracy, delivery time and collision avoidance. For this purpose, The DYMBER plans are delivered to Gafchromic EBT3 films placed in an anthropomorphic head phantom on a Varian TrueBeam linear accelerator. Results For each case, the dose homogeneity in the target is similar or better for DYMBER compared to DTRT and VMAT . Averaged over all three cases, the mean dose to the parallel OAR s is 16% and 28% lower, D 2% to the serial OAR s is 17% and 37% lower and V 10% to normal tissue is 12% and 4% lower for the DYMBER plans compared to the DTRT and VMAT plans, respectively. The DYMBER plans are delivered without collision and with a 4–5 min longer delivery time than the VMAT plans. The absolute dose measurements are compared to calculation by gamma analysis using 2% (global)/2 mm criteria with passing rates of at least 99%. Conclusions A treatment technique for DYMBER has been successfully developed and verified for its deliverability. The dosimetric superiority of DYMBER over DTRT and VMAT indicates utilizing increased DoF to be the key to improve brain and head and neck radiation treatments in future.
    Type of Medium: Online Resource
    ISSN: 0094-2405 , 2473-4209
    URL: Issue
    URL: Article
    DOI: 10.1002/mp.2018.45.issue-9
    DOI: 10.1002/mp.13085
    Language: English
    Publisher: Wiley
    Publication Date: 2018
    detail.hit.zdb_id: 1466421-5
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  • 3
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    Independent Monte-Carlo dose calculation for MLC based CyberKnife radiotherapy
    IOP Publishing ; 2017
    In:  Physics in Medicine & Biology Vol. 63, No. 1 ( 2017-12-19), p. 015015-
    Details
    In: Physics in Medicine & Biology, IOP Publishing, Vol. 63, No. 1 ( 2017-12-19), p. 015015-
    Type of Medium: Online Resource
    ISSN: 1361-6560
    URL: Article
    DOI: 10.1088/1361-6560/aa97f8
    Language: Unknown
    Publisher: IOP Publishing
    Publication Date: 2017
    detail.hit.zdb_id: 1473501-5
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  • 4
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    Development of an extended Macro Monte Carlo method for efficient and accurate dose calculation in magnetic fields
    Wiley ; 2020
    In:  Medical Physics Vol. 47, No. 12 ( 2020-12), p. 6519-6530
    Details
    In: Medical Physics, Wiley, Vol. 47, No. 12 ( 2020-12), p. 6519-6530
    Abstract: Progress in the field of magnetic resonance (MR)‐guided radiotherapy has triggered the need for fast and accurate dose calculation in presence of magnetic fields. The aim of this work is to satisfy this need by extending the macro Monte Carlo (MMC) method to enable dose calculation for photon, electron, and proton beams in a magnetic field. Methods The MMC method is based on the transport of particles in macroscopic steps through an absorber by sampling the relevant physical quantities from a precalculated database containing probability distribution functions. To enable MMC particle transport in a magnetic field, a transformation accounting for the Lorentz force is applied for each macro step by rotating the sampled position and direction around the magnetic field vector. The transformed position and direction distributions on local geometries are validated against full MC for electron and proton pencil beams. To enable photon dose calculation, an in‐house MC algorithm is used for photon transport and interaction. Emerging secondary charged particles are passed to MMC for transport and energy deposition. The extended MMC dose calculation accuracy and efficiency is assessed by comparison with EGSnrc (photon and electron beams) and Geant4 (proton beam) calculated dose distributions of different energies and homogeneous magnetic fields for broad beams impinging on water phantoms with bone and lung inhomogeneities. Results The geometric transformation on the local geometries is able to reproduce the results of full MC for all investigated settings (difference in mean value and standard deviation 〈 1%). Macro Monte Carlo calculated dose distributions in a homogeneous magnetic field are in agreement with EGSnrc and Geant4, respectively, with gamma passing rates 〉 99.6% (global 2%, 2 mm and 10% threshold criteria) for all situations. MMC achieves a substantial efficiency gain of up to a factor of 21 (photon beam), 66 (electron beam), and 356 (proton beam) compared to EGSnrc or Geant4. Conclusion Efficient and accurate dose calculation in magnetic fields was successfully enabled by utilizing the developed extended MMC transport method for photon, electron, and proton beams.
    Type of Medium: Online Resource
    ISSN: 0094-2405 , 2473-4209
    URL: Issue
    URL: Article
    DOI: 10.1002/mp.v47.12
    DOI: 10.1002/mp.14542
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 1466421-5
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  • 5
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    Forward treatment planning for modulated electron radiotherapy (MERT) employing Monte Carlo methods
    Wiley ; 2014
    In:  Medical Physics Vol. 41, No. 3 ( 2014-03)
    Details
    In: Medical Physics, Wiley, Vol. 41, No. 3 ( 2014-03)
    Abstract: This paper describes the development of a forward planning process for modulated electron radiotherapy (MERT). The approach is based on a previously developed electron beam model used to calculate dose distributions of electron beams shaped by a photon multi leaf collimator (pMLC). Methods: As the electron beam model has already been implemented into the Swiss Monte Carlo Plan environment, the Eclipse treatment planning system (Varian Medical Systems, Palo Alto, CA) can be included in the planning process for MERT. In a first step, CT data are imported into Eclipse and a pMLC shaped electron beam is set up. This initial electron beam is then divided into segments, with the electron energy in each segment chosen according to the distal depth of the planning target volume (PTV) in beam direction. In order to improve the homogeneity of the dose distribution in the PTV, a feathering process (Gaussian edge feathering) is launched, which results in a number of feathered segments. For each of these segments a dose calculation is performed employing the in‐house developed electron beam model along with the macro Monte Carlo dose calculation algorithm. Finally, an automated weight optimization of all segments is carried out and the total dose distribution is read back into Eclipse for display and evaluation. One academic and two clinical situations are investigated for possible benefits of MERT treatment compared to standard treatments performed in our clinics and treatment with a bolus electron conformal (BolusECT) method. Results: The MERT treatment plan of the academic case was superior to the standard single segment electron treatment plan in terms of organs at risk (OAR) sparing. Further, a comparison between an unfeathered and a feathered MERT plan showed better PTV coverage and homogeneity for the feathered plan, with V 95% increased from 90% to 96% and V 107% decreased from 8% to nearly 0%. For a clinical breast boost irradiation, the MERT plan led to a similar homogeneity in the PTV compared to the standard treatment plan while the mean body dose was lower for the MERT plan. Regarding the second clinical case, a whole breast treatment, MERT resulted in a reduction of the lung volume receiving more than 45% of the prescribed dose when compared to the standard plan. On the other hand, the MERT plan leads to a larger low‐dose lung volume and a degraded dose homogeneity in the PTV. For the clinical cases evaluated in this work, treatment plans using the BolusECT technique resulted in a more homogenous PTV and CTV coverage but higher doses to the OARs than the MERT plans. Conclusions: MERT treatments were successfully planned for phantom and clinical cases, applying a newly developed intuitive and efficient forward planning strategy that employs a MC based electron beam model for pMLC shaped electron beams. It is shown that MERT can lead to a dose reduction in OARs compared to other methods. The process of feathering MERT segments results in an improvement of the dose homogeneity in the PTV.
    Type of Medium: Online Resource
    ISSN: 0094-2405 , 2473-4209
    URL: Article
    DOI: 10.1118/1.4866227
    Language: English
    Publisher: Wiley
    Publication Date: 2014
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  • 6
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    Online Resource
    TriB-RT: Simultaneous optimization of photon, electron and proton beams
    IOP Publishing ; 2021
    In:  Physics in Medicine & Biology Vol. 66, No. 4 ( 2021-02-21), p. 045006-
    Details
    In: Physics in Medicine & Biology, IOP Publishing, Vol. 66, No. 4 ( 2021-02-21), p. 045006-
    Abstract: Purpose. To develop a novel treatment planning process (TPP) with simultaneous optimization of modulated photon, electron and proton beams for improved treatment plan quality in radiotherapy. Methods. A framework for fluence map optimization of Monte Carlo (MC) calculated beamlet dose distributions is developed to generate treatment plans consisting of photon, electron and spot scanning proton fields. Initially, in-house intensity modulated proton therapy (IMPT) plans are compared to proton plans created by a commercial treatment planning system (TPS). A triple beam radiotherapy (TriB-RT) plan is generated for an exemplary academic case and the dose contributions of the three particle types are investigated. To investigate the dosimetric potential, a TriB-RT plan is compared to an in-house IMPT plan for two clinically motivated cases. Benefits of TriB-RT for a fixed proton beam line with a single proton field are investigated. Results. In-house optimized IMPT are of at least equal or better quality than TPS-generated proton plans, and MC-based optimization shows dosimetric advantages for inhomogeneous situations. Concerning TriB-RT, for the academic case, the resulting plan shows substantial contribution of all particle types. For the clinically motivated case, improved sparing of organs at risk close to the target volume is achieved compared to IMPT (e.g. myelon and brainstem D m a x −37%) at cost of an increased low dose bath (healthy tissue V 10% +22%). In the scenario of a fixed proton beam line, TriB-RT plans are able to compensate the loss in degrees of freedom to substantially improve plan quality compared to a single field proton plan. Conclusion. A novel TPP which simultaneously optimizes photon, electron and proton beams was successfully developed. TriB-RT shows the potential for improved treatment plan quality and is especially promising for cost-effective single-room proton solutions with a fixed beamline in combination with a conventional linac delivering photon and electron fields.
    Type of Medium: Online Resource
    ISSN: 0031-9155 , 1361-6560
    URL: Article
    DOI: 10.1088/1361-6560/ab936f
    RVK:
    WA 15000
    Language: Unknown
    Publisher: IOP Publishing
    Publication Date: 2021
    detail.hit.zdb_id: 1473501-5
    SSG: 12
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  • 7
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    Online Resource
    Beamlet based direct aperture optimization for MERT using a photon MLC
    Wiley ; 2014
    In:  Medical Physics Vol. 41, No. 12 ( 2014-12)
    Details
    In: Medical Physics, Wiley, Vol. 41, No. 12 ( 2014-12)
    Abstract: A beamlet based direct aperture optimization (DAO) for modulated electron radiotherapy (MERT) using photon multileaf collimator (pMLC) shaped electron fields is developed and investigated. Methods: The Swiss Monte Carlo Plan (SMCP) allows the calculation of dose distributions for pMLC shaped electron beams. SMCP is interfaced with the Eclipse TPS (Varian Medical Systems, Palo Alto, CA) which can thus be included into the inverse treatment planning process for MERT. This process starts with the import of a CT‐scan into Eclipse, the contouring of the target and the organs at risk (OARs), and the choice of the initial electron beam directions. For each electron beam, the number of apertures, their energy, and initial shape are defined. Furthermore, the DAO requires dose–volume constraints for the structures contoured. In order to carry out the DAO efficiently, the initial electron beams are divided into a grid of beamlets. For each of those, the dose distribution is precalculated using a modified electron beam model, resulting in a dose list for each beamlet and energy. Then the DAO is carried out, leading to a set of optimal apertures and corresponding weights. These optimal apertures are now converted into pMLC shaped segments and the dose calculation for each segment is performed. For these dose distributions, a weight optimization process is launched in order to minimize the differences between the dose distribution using the optimal apertures and the pMLC segments. Finally, a deliverable dose distribution for the MERT plan is obtained and loaded back into Eclipse for evaluation. For an idealized water phantom geometry, a MERT treatment plan is created and compared to the plan obtained using a previously developed forward planning strategy. Further, MERT treatment plans for three clinical situations (breast, chest wall, and parotid metastasis of a squamous cell skin carcinoma) are created using the developed inverse planning strategy. The MERT plans are compared to clinical standard treatment plans using photon beams and the differences between the optimal and the deliverable dose distributions are determined. Results: For the idealized water phantom geometry, the inversely optimized MERT plan is able to obtain the same PTV coverage, but with an improved OAR sparing compared to the forwardly optimized plan. Regarding the right‐sided breast case, the MERT plan is able to reduce the lung volume receiving more than 30% of the prescribed dose and the mean lung dose compared to the standard plan. However, the standard plan leads to a better homogeneity within the CTV. The results for the left‐sided thorax wall are similar but also the dose to the heart is reduced comparing MERT to the standard treatment plan. For the parotid case, MERT leads to lower doses for almost all OARs but to a less homogeneous dose distribution for the PTV when compared to a standard plan. For all cases, the weight optimization successfully minimized the differences between the optimal and the deliverable dose distribution. Conclusions: A beamlet based DAO using multiple beam angles is implemented and successfully tested for an idealized water phantom geometry and clinical situations.
    Type of Medium: Online Resource
    ISSN: 0094-2405 , 2473-4209
    URL: Article
    DOI: 10.1118/1.4901638
    Language: English
    Publisher: Wiley
    Publication Date: 2014
    detail.hit.zdb_id: 1466421-5
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  • 8
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    Online Resource
    Simultaneous optimization of photons and electrons for mixed beam radiotherapy
    IOP Publishing ; 2017
    In:  Physics in Medicine & Biology Vol. 62, No. 14 ( 2017-06-26), p. 5840-5860
    Details
    In: Physics in Medicine & Biology, IOP Publishing, Vol. 62, No. 14 ( 2017-06-26), p. 5840-5860
    Type of Medium: Online Resource
    ISSN: 1361-6560
    URL: Article
    DOI: 10.1088/1361-6560/aa70c5
    Language: Unknown
    Publisher: IOP Publishing
    Publication Date: 2017
    detail.hit.zdb_id: 1473501-5
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  • 9
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    Monte Carlo based beam model using a photon MLC for modulated electron radiotherapy
    Wiley ; 2014
    In:  Medical Physics Vol. 41, No. 2 ( 2014-02)
    Details
    In: Medical Physics, Wiley, Vol. 41, No. 2 ( 2014-02)
    Abstract: Modulated electron radiotherapy (MERT) promises sparing of organs at risk for certain tumor sites. Any implementation of MERT treatment planning requires an accurate beam model. The aim of this work is the development of a beam model which reconstructs electron fields shaped using the Millennium photon multileaf collimator (MLC) (Varian Medical Systems, Inc., Palo Alto, CA) for a Varian linear accelerator (linac). Methods: This beam model is divided into an analytical part (two photon and two electron sources) and a Monte Carlo (MC) transport through the MLC. For dose calculation purposes the beam model has been coupled with a macro MC dose calculation algorithm. The commissioning process requires a set of measurements and precalculated MC input. The beam model has been commissioned at a source to surface distance of 70 cm for a Clinac 23EX (Varian Medical Systems, Inc., Palo Alto, CA) and a TrueBeam linac (Varian Medical Systems, Inc., Palo Alto, CA). For validation purposes, measured and calculated depth dose curves and dose profiles are compared for four different MLC shaped electron fields and all available energies. Furthermore, a measured two‐dimensional dose distribution for patched segments consisting of three 18 MeV segments, three 12 MeV segments, and a 9 MeV segment is compared with corresponding dose calculations. Finally, measured and calculated two‐dimensional dose distributions are compared for a circular segment encompassed with a C‐shaped segment. Results: For 15 × 34, 5 × 5, and 2 × 2 cm 2 fields differences between water phantom measurements and calculations using the beam model coupled with the macro MC dose calculation algorithm are generally within 2% of the maximal dose value or 2 mm distance to agreement (DTA) for all electron beam energies. For a more complex MLC pattern, differences between measurements and calculations are generally within 3% of the maximal dose value or 3 mm DTA for all electron beam energies. For the two‐dimensional dose comparisons, the differences between calculations and measurements are generally within 2% of the maximal dose value or 2 mm DTA. Conclusions : The results of the dose comparisons suggest that the developed beam model is suitable to accurately reconstruct photon MLC shaped electron beams for a Clinac 23EX and a TrueBeam linac. Hence, in future work the beam model will be utilized to investigate the possibilities of MERT using the photon MLC to shape electron beams.
    Type of Medium: Online Resource
    ISSN: 0094-2405 , 2473-4209
    URL: Article
    DOI: 10.1118/1.4861711
    Language: English
    Publisher: Wiley
    Publication Date: 2014
    detail.hit.zdb_id: 1466421-5
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  • 10
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    Online Resource
    Benchmarking Monte-Carlo dose calculation for MLC CyberKnife treatments
    Springer Science and Business Media LLC ; 2019
    In:  Radiation Oncology Vol. 14, No. 1 ( 2019-12)
    Details
    In: Radiation Oncology, Springer Science and Business Media LLC, Vol. 14, No. 1 ( 2019-12)
    Abstract: Vendor-independent Monte Carlo (MC) dose calculation (IDC) for patient-specific quality assurance of multi-leaf collimator (MLC) based CyberKnife treatments is used to benchmark and validate the commercial MC dose calculation engine for MLC based treatments built into the CyberKnife treatment planning system (Precision MC). Methods The benchmark included dose profiles in water in 15 mm depth and depth dose curves of rectangular MLC shaped fields ranging from 7.6 mm × 7.7 mm to 115.0 mm  × 100.1 mm, which were compared between IDC, Precision MC and measurements in terms of dose difference and distance to agreement. Dose distributions of three phantom cases and seven clinical lung cases were calculated using both IDC and Precision MC. The lung PTVs ranged from 14 cm 3 to 93 cm 3 . Quantitative comparison of these dose distributions was performed using dose-volume parameters and 3D gamma analysis with 2% global dose difference and 1 mm distance criteria and a global 10% dose threshold. Time to calculate dose distributions was recorded and efficiency was assessed. Results Absolute dose profiles in 15 mm depth in water showed agreement between Precision MC and IDC within 3.1% or 1 mm. Depth dose curves agreed within 2.3% / 1 mm. For the phantom and clinical lung cases, mean PTV doses differed from − 1.0 to + 2.3% between IDC and Precision MC and gamma passing rates were  〉  =98.1% for all multiple beam treatment plans. For the lung cases, lung V20 agreed within ±1.5%. Calculation times ranged from 2.2 min (for 39 cm 3 PTV at 1.0 × 1.0 × 2.5 mm 3 native CT resolution) to 8.1 min (93 cm 3 at 1.1 × 1.1 × 1.0 mm 3 ), at 2% uncertainty for Precision MC for the 7 examined lung cases and 4–6 h for IDC, which, however, is not optimized for efficiency but used as a gold standard for accuracy. Conclusions Both accuracy and efficiency of Precision MC in the context of MLC based planning for the CyberKnife M6 system were benchmarked against MC based IDC framework. Precision MC is used in clinical practice at our institute.
    Type of Medium: Online Resource
    ISSN: 1748-717X
    URL: Article
    DOI: 10.1186/s13014-019-1370-5
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2019
    detail.hit.zdb_id: 2224965-5
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