Future developments

There is increasing use of sophisticated three-dimensional planning techniques incorporating CT or MRI scans to determine the dosage to the whole tumour and to critical normal tissues. As well as defining the dose in purely physical terms, the biological effects in different tissues may be expressed as biological effective doses.

Radiation exposure to staff has been reduced by the increased use of high-dose-rate remote after-loading machines. The complication rate following fractionated high-dose gynaecological insertions is less than that following manually inserted low-dose sources. Continuous low-dose-rate implants may be replaced by high-dose 'pulsed' insertions with optimization of the dose distribution and more homogeneous irradiation of the target volume.

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