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Maxwell SK, Charles PH, Cassim N, Kairn T, Crowe SB. Assessing the fit of 3D printed bolus from CT, optical scanner and photogrammetry methods. Phys Eng Sci Med 2020; 43:601-607. [PMID: 32524442 DOI: 10.1007/s13246-020-00861-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 03/17/2020] [Indexed: 11/30/2022]
Abstract
Bolus plays an important role in the radiation therapy of superficial lesions and the application of 3D printing to its design can improve fit and dosimetry. This study quantitatively compares the fits of boluses designed from different imaging modalities. A head phantom was imaged using three systems: a CT simulator, a 3D optical scanner, and an interchangeable lens camera. Nose boluses were designed and 3D printed from each modality. A 3D printed phantom with air gaps of known thicknesses was used to calibrate mean HU to measure air gaps of unknown thickness and assess the fit of each bolus on the head phantom. The bolus created from the optical scanner data resulted in the best fit, with a mean air gap of 0.16 mm. Smoothing of the CT bolus resulted in a more clinically suitable model, comparable to that from the optical scanner method. The bolus produced from the photogrammetry method resulted in air gaps larger than 1 mm in thickness. The use of optical scanner and photogrammetry models have many advantages over the conventional bolus-from-CT method, however workflow should be refined to ensure accuracy if implemented clinically.
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Affiliation(s)
- S K Maxwell
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
| | - P H Charles
- Herston Biofabrication Institute, Brisbane, QLD, Australia.,Queensland University of Technology, Brisbane, QLD, Australia
| | - N Cassim
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - T Kairn
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Queensland University of Technology, Brisbane, QLD, Australia
| | - S B Crowe
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Queensland University of Technology, Brisbane, QLD, Australia
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3D printer-based novel intensity-modulated vaginal brachytherapy applicator: feasibility study. J Contemp Brachytherapy 2020; 12:17-26. [PMID: 32190066 PMCID: PMC7073342 DOI: 10.5114/jcb.2020.92407] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 12/18/2019] [Indexed: 12/14/2022] Open
Abstract
Purpose To design a novel high-dose-rate intracavitary applicator which may lead to enhanced dose modulation in the brachytherapy of gynecological cancers. Material and methods A novel brachytherapy applicator, auxiliary equipment and quality control phantom were modeled in SketchUp Pro 2017 modeling software and printed out from a MakerBot Replicator Z18 three-dimensional printer. As a printing material polylactic acid (PLA) filament was used and compensator materials including aluminum, stainless-steel and Cerrobend alloy were selected according to their radiation attenuation properties. To evaluate the feasibility of the novel applicator, two sets of measurements were performed in a Varian GammaMed iX Plus high-dose rate iridium-192 (192Ir) brachytherapy unit and all of the treatment plans were calculated in Varian BrachyVision treatment planning system v.8.9 with TG43-based formalism. In the first step, catheter and source-dwell positioning accuracy, reproducibility of catheter and source positions, linearity of relative dose with changing dwell times and compensator materials were tested to evaluate the mechanical stability of the designed applicator. In the second step, to validate the dosimetric accuracy of the novel applicator measured point dose and two-dimensional dose distributions in homogeneous medium were compared with calculated data in the treatment planning system using PTW VeriSoft v.5.1 software. Results In mechanical quality control tests source-dwell positioning accuracy and linearity of the designed applicator were measured as ≤ 0.5 mm and ≤ 1.5%, respectively. Reproducibility of the treatment planning was ≥ 97.7% for gamma evaluation criteria of 1 mm distance to agreement and 1% dose difference of local dose. In dosimetric quality control tests, maximum difference between measured and calculated point dose was found as 3.8% in homogeneous medium. In two-dimensional analysis, the number of passing points was greater than 90% for all measurements using gamma evaluation criteria of 3 mm distance to agreement and 3% dose difference of local dose. Conclusions The novel brachytherapy applicator met the necessary requirements in quality control tests.
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PLA as a suitable 3D printing thermoplastic for use in external beam radiotherapy. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2019; 42:1165-1176. [DOI: 10.1007/s13246-019-00818-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 11/05/2019] [Indexed: 11/26/2022]
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Ma C, Parsons D, Chen M, Jiang S, Hou Q, Gu X, Lu W. Electron modulated arc therapy (EMAT) using photon MLC for postmastectomy chest wall treatment I: Monte Carlo-based dosimetric characterizations. Phys Med 2019; 67:1-8. [PMID: 31606657 PMCID: PMC6925626 DOI: 10.1016/j.ejmp.2019.10.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/02/2019] [Accepted: 10/03/2019] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To study the dosimetric properties of electron arc beams delivered by photon-beam multi-leaf collimators (pMLC) in electron modulated arc therapy (EMAT) for postmastectomy chest wall treatments. METHODS Using the Monte Carlo method, we simulated a 2100EX Varian linear accelerator and verified the beam models in a water tank. Dosimetric characterizations were performed on cylindrical water phantoms of elliptical bases with various field sizes, arc ranges and source-to-surface distances (SSDs) for 6, 9 and 12 MeV beam energy. RESULTS The arc beam has a higher bremsstrahlung dose than the static beam at the isocenter due to crossfire, but choosing a field size greater than 5 cm effectively reduces the bremsstrahlung dose. The depths of the 90% maximum dose located at 1.7, 2.8 and 4.1 cm for 6, 9 and 12 MeV, respectively, are similar to those of the static beams and independent of the field size and arc range. CONCLUSION Based on the study, we recommend using the 5 cm field width for electron arc beams considering both bremsstrahlung dose at the isocenter and the arc profile penumbra. To ensure sufficient PTV edge coverage, we recommend a field length extension of at least 4 cm from PTV's edge for all beam energies and an arc extension of around 7°, 5°, and 5° for beam energies 6, 9, and 12 MeV, respectively. These dosimetric characterizations are the basis of pMLC-delivered EMAT treatment planning for postmastectomy chest wall patients.
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Affiliation(s)
- Chaoqiong Ma
- Key Lab for Radiation Physics and Technology of Education Ministry of China, Institute of Nuclear Science and Technology, Sichuan University, Chengdu, Sichuan 610064, China; Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
| | - David Parsons
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
| | - Mingli Chen
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
| | - Steve Jiang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
| | - Qing Hou
- Key Lab for Radiation Physics and Technology of Education Ministry of China, Institute of Nuclear Science and Technology, Sichuan University, Chengdu, Sichuan 610064, China
| | - Xuejun Gu
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
| | - Weiguo Lu
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA.
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Miloichikova I, Bulavskaya A, Cherepennikov Y, Gavrikov B, Gargioni E, Belousov D, Stuchebrov S. Feasibility of clinical electron beam formation using polymer materials produced by fused deposition modeling. Phys Med 2019; 64:188-194. [PMID: 31515019 DOI: 10.1016/j.ejmp.2019.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/17/2019] [Accepted: 07/17/2019] [Indexed: 10/26/2022] Open
Abstract
The main challenge in electron external beam radiation therapy with clinical accelerators is the absence of integrated systems to form irregular fields. The current approach to provide conformal irradiation is to use additional metallic shaping blocks, with inefficient and expensive workflows. This work presents a simple method to form therapeutic electron fields using 3D printed samples. These samples are manufactured by fused deposition modeling, which can affect crucial properties, such as material homogeneity, due to the presence of residual air-filled cavities. The applicability of this method was therefore investigated with a set of experiments and Monte Carlo simulations aimed at determining the electron depth dose distribution in polymer materials. The results show that therapeutic electron beams with energies 6-20 MeV can be effectively absorbed using these polymeric samples. The model developed in this study provides a way to assess the dose distribution in such materials and to calculate the appropriate thickness of polymer samples for therapeutic electron beam formation. It is shown that for total absorption of 6 MeV electron beams the material thickness should be at least 4 cm, while this value should be at least 8 cm for 12 MeV and 11 cm for 20 MeV, respectively. The results can be used to further develop 3D printing procedures for medical electron beam profile formation, allowing the creation of a collimator or absorber with patient-specific configuration using rapid prototyping systems, thus contributing to improve the accuracy of dose delivery in electron radiotherapy within a short manufacturing time.
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Affiliation(s)
- Irina Miloichikova
- National Research Tomsk Polytechnic University, Lenina Avenue 30, 634050 Tomsk, Russia; Cancer Research Institute of Tomsk NRMC RAS, Kooperativny Street 5, 634050 Tomsk, Russia.
| | - Angelina Bulavskaya
- National Research Tomsk Polytechnic University, Lenina Avenue 30, 634050 Tomsk, Russia
| | - Yury Cherepennikov
- National Research Tomsk Polytechnic University, Lenina Avenue 30, 634050 Tomsk, Russia
| | - Boris Gavrikov
- Moscow City Oncology Hospital №62, Istra 27, 143423 Moscow, Russia
| | - Elisabetta Gargioni
- University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Dmitrij Belousov
- Institute of Automation and Electrometry SB RAS, Academician Koptyug Avenue 1, 630090 Novosibirsk, Russia
| | - Sergei Stuchebrov
- National Research Tomsk Polytechnic University, Lenina Avenue 30, 634050 Tomsk, Russia
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Sasaki DK, McGeachy P, Alpuche Aviles JE, McCurdy B, Koul R, Dubey A. A modern mold room: Meshing 3D surface scanning, digital design, and 3D printing with bolus fabrication. J Appl Clin Med Phys 2019; 20:78-85. [PMID: 31454148 PMCID: PMC6753733 DOI: 10.1002/acm2.12703] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 07/30/2019] [Accepted: 08/01/2019] [Indexed: 11/28/2022] Open
Abstract
Purpose This case series represents an initial experience with implementing 3‐dimensional (3D) surface scanning, digital design, and 3D printing for bolus fabrication for patients with complex surface anatomy where traditional approaches are challenging. Methods and Materials For 10 patients requiring bolus in regions with complex contours, bolus was designed digitally from 3D surface scanning data or computed tomography (CT) images using either a treatment planning system or mesh editing software. Boluses were printed using a fused deposition modeling printer with polylactic acid. Quality assurance tests were performed for each printed bolus to verify density and shape. Results For 9 of 10 patients, digitally designed boluses were used for treatment with no issues. In 1 case, the bolus was not used because dosimetric requirements were met without the bolus. QA tests revealed that the bulk density was within 3% of the reference value for 9 of 12 prints, and with more judicious selection of print settings this could be increased. For these 9 prints, density uniformity was as good as or better than our traditional sheet bolus material. The average shape error of the pieces was less than 0.5 mm, and no issues with fit or comfort were encountered during use. Conclusions This study demonstrates that new technologies such as 3D surface scanning, digital design and 3D printing can be safely and effectively used to modernize bolus fabrication.
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Affiliation(s)
- David Kiyoshi Sasaki
- Department of Medical Physics, CancerCare Manitoba, Winnipeg, Manitoba, Canada.,Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Philip McGeachy
- Department of Medical Physics, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Jorge E Alpuche Aviles
- Department of Medical Physics, CancerCare Manitoba, Winnipeg, Manitoba, Canada.,Department of Physics and Astronomy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Boyd McCurdy
- Department of Medical Physics, CancerCare Manitoba, Winnipeg, Manitoba, Canada.,Department of Physics and Astronomy, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rashmi Koul
- Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Radiation Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Arbind Dubey
- Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Radiation Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
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Skinner L, Fahimian BP, Yu AS. Tungsten filled 3D printed field shaping devices for electron beam radiation therapy. PLoS One 2019; 14:e0217757. [PMID: 31216296 PMCID: PMC6584017 DOI: 10.1371/journal.pone.0217757] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 05/19/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose Electron radiotherapy is a labor-intensive treatment option that is complicated by the need for field shaping blocks. These blocks are typically made from casting Cerrobend alloys containing lead and cadmium. This is a highly toxic process with limited precision. This work aims to provide streamlined and more precise electron radiotherapy by 3D using printing techniques. Methods The 3D printed electron cutout consists of plastic shells filled with 2 mm diameter tungsten ball bearings. Five clinical Cerrobend defined field were compared to the planned fields by measuring the light field edge when mounted in the electron applicator on a linear accelerator. The dose transmitted through the 3D printed and Cerrobend cutouts was measured using an IC profiler ion chamber array with 6 MeV and 16 MeV beams. Dose profiles from the treatment planning system were also compared to the measured dose profiles. Centering and full width half maximum (FWHM) metrics were taken directly from the profiler software. Results The transmission of a 16MeV beam through a 12 mm thick layer of tungsten ball bearings agreed within 1% of a 15 mm thick Cerrobend block (measured with an ion chamber array). The radiation fields shaped by ball bearing filled 3D printed cutout were centered within 0.4 mm of the planned outline, whereas the Cerrobend cutout fields had shift errors of 1–3 mm, and shape errors of 0.5–2 mm. The average shift of Cerrobend cutouts was 2.3 mm compared to the planned fields (n = 5). Beam penumbra of the 3D printed cutouts was found to be equivalent to the 15 mm thick Cerrobend cutout. The beam profiles agreed within 1.2% across the whole 30 cm profile widths. Conclusions This study demonstrates that with a proper quality assurance procedure, 3D-printed cutouts can provide more accurate electron radiotherapy with reduced toxicity compared to traditional Cerrobend methods.
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Affiliation(s)
- Lawrie Skinner
- Department of Radiation Oncology, Stanford University, Palo Alto, CA, United States of America
| | - Benjamin P. Fahimian
- Department of Radiation Oncology, Stanford University, Palo Alto, CA, United States of America
| | - Amy S. Yu
- Department of Radiation Oncology, Stanford University, Palo Alto, CA, United States of America
- * E-mail:
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58
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Park JM, Son J, An HJ, Kim JH, Wu HG, Kim JI. Bio-compatible patient-specific elastic bolus for clinical implementation. ACTA ACUST UNITED AC 2019; 64:105006. [DOI: 10.1088/1361-6560/ab1c93] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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59
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The Role of 3D Printing in Medical Applications: A State of the Art. JOURNAL OF HEALTHCARE ENGINEERING 2019; 2019:5340616. [PMID: 31019667 PMCID: PMC6451800 DOI: 10.1155/2019/5340616] [Citation(s) in RCA: 206] [Impact Index Per Article: 41.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 02/26/2019] [Indexed: 02/07/2023]
Abstract
Three-dimensional (3D) printing refers to a number of manufacturing technologies that generate a physical model from digital information. Medical 3D printing was once an ambitious pipe dream. However, time and investment made it real. Nowadays, the 3D printing technology represents a big opportunity to help pharmaceutical and medical companies to create more specific drugs, enabling a rapid production of medical implants, and changing the way that doctors and surgeons plan procedures. Patient-specific 3D-printed anatomical models are becoming increasingly useful tools in today's practice of precision medicine and for personalized treatments. In the future, 3D-printed implantable organs will probably be available, reducing the waiting lists and increasing the number of lives saved. Additive manufacturing for healthcare is still very much a work in progress, but it is already applied in many different ways in medical field that, already reeling under immense pressure with regards to optimal performance and reduced costs, will stand to gain unprecedented benefits from this good-as-gold technology. The goal of this analysis is to demonstrate by a deep research of the 3D-printing applications in medical field the usefulness and drawbacks and how powerful technology it is.
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Baltz GC, Chi PM, Wong P, Wang C, Craft DF, Kry SF, Lin SSH, Garden AS, Smith SA, Howell RM. Development and validation of a 3D-printed bolus cap for total scalp irradiation. J Appl Clin Med Phys 2019; 20:89-96. [PMID: 30821903 PMCID: PMC6414136 DOI: 10.1002/acm2.12552] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 12/07/2018] [Accepted: 01/21/2019] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The goal of total scalp irradiation (TSI) is to deliver a uniform dose to the scalp, which requires the use of a bolus cap. Most current methods for fabricating bolus caps are laborious, yet still result in nonconformity and low reproducibility, which can lead to nonuniform irradiation of the scalp. We developed and validated patient-specific bolus caps for TSI using three-dimensional (3D) printing. METHODS AND MATERIALS 3D-printing materials were radiologically analyzed to identify a material with properties suitable for use as a bolus cap. A Python script was developed within a commercial treatment planning system to automate the creation of a ready-to-print, patient-specific 3D bolus cap model. A bolus cap was printed for an anthropomorphic head phantom using a commercial vendor and a computed tomography simulation of the anthropomorphic head phantom and bolus cap was used to create a volumetric-modulated arc therapy TSI treatment plan. The planned treatment was delivered to the head phantom and dosimetric validation was performed using thermoluminescent dosimeters (TLD). The developed procedure was used to create a bolus cap for a clinical TSI patient, and in vivo TLD measurements were acquired for several fractions. RESULTS Agilus-60 was validated as a new 3D-printing material suitable for use as bolus. A 3D-printed Agilus-60 bolus cap had excellent conformality to the phantom scalp, with a maximum air gap of 4 mm. TLD measurements showed that the bolus cap generated a uniform dose to the scalp within a 2.7% standard deviation, and the delivered doses agreed with calculated doses to within 2.4% on average. The patient bolus was conformal and the average difference between TLD measured and planned doses was 5.3%. CONCLUSIONS We have developed a workflow to 3D-print highly conformal bolus caps for TSI and demonstrated these caps can reproducibly generate a uniform dose to the scalp.
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Affiliation(s)
- Garrett C. Baltz
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
- Medical Physics ProgramThe University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical SciencesHoustonTXUSA
| | - Pai‐Chun Melinda Chi
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
- Medical Physics ProgramThe University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical SciencesHoustonTXUSA
| | - Pei‐Fong Wong
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
| | - Congjun Wang
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
- Medical Physics ProgramThe University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical SciencesHoustonTXUSA
| | - Daniel F. Craft
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
- Medical Physics ProgramThe University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical SciencesHoustonTXUSA
| | - Stephen F. Kry
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
- Medical Physics ProgramThe University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical SciencesHoustonTXUSA
| | - Stacy Sydney Hsinyi Lin
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
| | - Adam S. Garden
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
| | - Susan A. Smith
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
| | - Rebecca M. Howell
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
- Medical Physics ProgramThe University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical SciencesHoustonTXUSA
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Novel intraoperative radiotherapy utilizing prefabricated custom three-dimensionally printed high-dose-rate applicators. Brachytherapy 2019; 18:277-284. [PMID: 30803923 DOI: 10.1016/j.brachy.2019.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 01/27/2019] [Accepted: 01/30/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Intraoperative radiotherapy (IORT) is an effective strategy for the delivery of high doses of radiotherapy to a residual tumor or resection cavity with relative sparing of nearby healthy tissues. This strategy is an important component of the multimodality management of pediatric soft tissue sarcomas, particularly in cases where patients have received prior courses of external beam radiotherapy. PURPOSE Tumor beds with significant topographic irregularity remain a therapeutic challenge because existing IORT technologies are typically most reliable with flat surfaces. To address this limitation, we have developed a novel strategy to create custom, prefabricated high-dose-rate (HDR)-IORT applicators designed to match the shape of an anticipated surgical cavity. METHODS AND MATERIALS Silastic applicators are constructed using three-dimensional (3D) printing and are derived from volumetric segmentation of preoperative imaging. RESULTS HDR preplanning with the applicators improves dosimetric accuracy and minimizes incremental operative time. In this report, we describe the fabrication process for the 3D-printed applicators and detail our experience utilizing this strategy in two pediatric patients who underwent HDR-IORT as part of complex base of skull sarcoma resections. CONCLUSIONS Early experience suggests that usage of the custom applicators is feasible, versatile for a variety of clinical situations, and enables the uniform delivery of high superficial doses of radiotherapy to irregularly shaped surgical cavities.
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Kitamori H, Sumida I, Tsujimoto T, Shimamoto H, Murakami S, Ohki M. Evaluation of mouthpiece fixation devices for head and neck radiotherapy patients fabricated in PolyJet photopolymer by a 3D printer. Phys Med 2019; 58:90-98. [DOI: 10.1016/j.ejmp.2019.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/04/2019] [Accepted: 02/06/2019] [Indexed: 11/30/2022] Open
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Kong Y, Yan T, Sun Y, Qian J, Zhou G, Cai S, Tian Y. A dosimetric study on the use of 3D-printed customized boluses in photon therapy: A hydrogel and silica gel study. J Appl Clin Med Phys 2019; 20:348-355. [PMID: 30402935 PMCID: PMC6333182 DOI: 10.1002/acm2.12489] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/29/2018] [Accepted: 09/24/2018] [Indexed: 12/26/2022] Open
Abstract
PURPOSE The aim of the study was to compare the dose differences between two kinds of materials (silica gel and hydrogel) used to prepare boluses based on three-dimensional (3D) printing technologies and commercial bolus in head phantoms simulating nose, ear, and parotid gland radiotherapy. METHODS AND MATERIALS We used 3D printing technology to make silica gel and hydrogel boluses. To evaluate the clinical feasibility, intensity modulated radiation therapy (IMRT) plans were created for head phantoms that were bolus-free or had a commercial bolus, a silica gel bolus, or a hydrogel bolus. Dosimetry differences were compared in simulating nose, ear, and parotid gland radiotherapy separately. RESULTS The air gaps were smaller in the silica gel and hydrogel bolus than the commercial one. In nose plans, it was shown that the V95% (relative volume that is covered by at least 95% of the prescription dose) of the silica gel (99.86%) and hydrogel (99.95%) bolus were better than the commercial one (98.39%) and bolus-free (87.52%). Similarly, the homogeneity index (HI) and conformity index (CI) of the silica gel (0.06; 0.79) and hydrogel (0.058; 0.80) bolus were better than the commercial one (0.094; 0.72) and bolus-free (0.59; 0.53). The parameters of results (HI, CI, V95% ) were also better in 3D printing boluses than in the commercial bolus or without bolus in ear and parotid plans. CONCLUSIONS Silica gel and hydrogel boluses were not only good for fit and a high level of comfort and repeatability, but also had better parameters in IMRT plans. They could replace the commercial bolus for clinical use.
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Affiliation(s)
- Yuehong Kong
- Department of Radiotherapy and OncologyThe Second Affiliated Hospital of Soochow UniversitySuzhouChina
- Institute of Radiotherapy and OncologySoochow UniversitySuzhouChina
| | - Tengfei Yan
- Department of Radiotherapy and OncologyThe Second Affiliated Hospital of Soochow UniversitySuzhouChina
- Institute of Radiotherapy and OncologySoochow UniversitySuzhouChina
| | - Yanze Sun
- Department of Radiotherapy and OncologyThe Second Affiliated Hospital of Soochow UniversitySuzhouChina
- Institute of Radiotherapy and OncologySoochow UniversitySuzhouChina
| | - Jianjun Qian
- Department of Radiotherapy and OncologyThe Second Affiliated Hospital of Soochow UniversitySuzhouChina
- Institute of Radiotherapy and OncologySoochow UniversitySuzhouChina
| | - Gang Zhou
- Department of Radiotherapy and OncologyThe Second Affiliated Hospital of Soochow UniversitySuzhouChina
- Institute of Radiotherapy and OncologySoochow UniversitySuzhouChina
| | - Shang Cai
- Department of Radiotherapy and OncologyThe Second Affiliated Hospital of Soochow UniversitySuzhouChina
- Institute of Radiotherapy and OncologySoochow UniversitySuzhouChina
| | - Ye Tian
- Department of Radiotherapy and OncologyThe Second Affiliated Hospital of Soochow UniversitySuzhouChina
- Institute of Radiotherapy and OncologySoochow UniversitySuzhouChina
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An HJ, Kim MS, Kim J, Son J, Choi CH, Park JM, Kim JI. Geometric Evaluation of Patient-Specific 3D Bolus from 3D Printed Mold and Casting Method for Radiation Therapy. ACTA ACUST UNITED AC 2019. [DOI: 10.14316/pmp.2019.30.1.32] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Hyun Joon An
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Myeong Soo Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Jiseong Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Jaeman Son
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Chang Heon Choi
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Jong Min Park
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
- Robotics Research Laboratory for Extreme Environments, Advanced Institutes of Convergence Technology, Suwon, Korea
| | - Jung-in Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
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Dosimetric evaluation of respiratory gated volumetric modulated arc therapy for lung stereotactic body radiation therapy using 3D printing technology. PLoS One 2018; 13:e0208685. [PMID: 30586367 PMCID: PMC6306268 DOI: 10.1371/journal.pone.0208685] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 11/22/2018] [Indexed: 02/07/2023] Open
Abstract
Purpose This study aimed to evaluate the dosimetric accuracy of respiratory gated volumetric modulated arc therapy (VMAT) for lung stereotactic body radiation therapy (SBRT) under simulation conditions similar to the actual clinical situation using patient-specific lung phantoms and realistic target movements. Methods Six heterogeneous lung phantoms were fabricated using a 3D-printer (3DISON, ROKIT, Seoul, Korea) to be dosimetrically equivalent to actual target regions of lung SBRT cases treated via gated VMAT. They were designed to move realistically via a motion device (QUASAR, Modus Medical Devices, Canada). Using the lung phantoms and a homogeneous phantom (model 500–3315, Modus Medical Devices), film dosimetry was performed with and without respiratory gating for VMAT delivery (TrueBeam STx; Varian Medical Systems, Palo Alto, CA, USA). The measured results were analyzed with the gamma passing rates (GPRs) of 2%/1 mm criteria, by comparing with the calculated dose via the AXB and AAA algorithms of the Eclipse Treatment Planning System (version 10.0.28; Varian Medical Systems). Results GPRs were greater than the acceptance criteria 80% for all film measurements with the stationary and homogeneous phantoms in conventional QAs. Regardless of the heterogeneity of phantoms, there were no significant differences (p > 0.05) in GPRs obtained with and without target motions; the statistical significance (p = 0.031) was presented between both algorithms under the utilization of heterogeneous phantoms. Conclusions Dosimetric verification with heterogeneous patient-specific lung phantoms could be successfully implemented as the evaluation method for gated VMAT delivery. In addition, it could be dosimetrically confirmed that the AXB algorithm improved the dose calculation accuracy under patient-specific simulations using 3D printed lung phantoms.
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Craft DF, Balter P, Woodward W, Kry SF, Salehpour M, Ger R, Peters M, Baltz G, Traneus E, Howell RM. Design, fabrication, and validation of patient-specific electron tissue compensators for postmastectomy radiation therapy. Phys Imaging Radiat Oncol 2018; 8:38-43. [PMID: 33458415 PMCID: PMC7807570 DOI: 10.1016/j.phro.2018.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 11/09/2018] [Accepted: 11/13/2018] [Indexed: 11/17/2022] Open
Abstract
Background and purpose Postmastectomy radiotherapy (PMRT) is complex to plan and deliver, but could be improved with 3D-printed, patient-specific electron tissue compensators. The purposes of this study were to develop an algorithm to design patient-specific compensators that achieve clinical goals, to 3D-print the planned compensators, and validate calculated dose distributions with film and thermoluminescent dosimeter (TLD) measurements in 3D-printed phantoms of PMRT patients. Materials and methods An iterative algorithm was developed to design compensators corresponding to single-field, single-energy electron plans for PMRT patients. The 3D-printable compensators were designed to fit into the electron aperture, with cerrobend poured around it. For a sample of eight patients, calculated dose distributions for compensator plans were compared with patients’ (multi-field, multi-energy) clinical treatment plans. For all patients, dosimetric parameters were compared including clinical target volume (CTV), lung, and heart metrics. For validation, compensators were fabricated and irradiated for a set of six 3D-printed patient-specific phantoms. Dose distributions in the phantoms were measured with TLD and film. These measurements were compared with the treatment planning system calculated dose distributions. Results The compensator treatment plans achieved superior CTV coverage (97% vs 89% of the CTV receiving the prescription dose, p < 0.0025), and similar heart and lung doses (p > 0.35) to the conventional treatment plans. Average differences between calculated and measured TLD values were 2%, and average film profile differences were <2 mm. Conclusions We developed a new compensator based treatment methodology for PMRT and demonstrated its validity and superiority to conventional multi-field plans through end-to-end testing.
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Affiliation(s)
- Daniel F. Craft
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX 77030, USA
- Corresponding author at: Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 94, Houston, TX 77030, USA.
| | - Peter Balter
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX 77030, USA
| | - Wendy Woodward
- The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX 77030, USA
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Stephen F. Kry
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX 77030, USA
| | - Mohammad Salehpour
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX 77030, USA
| | - Rachel Ger
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX 77030, USA
| | - Mary Peters
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX 77030, USA
| | - Garrett Baltz
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX 77030, USA
| | - Erik Traneus
- RaySearch Laboratories AB, Stockholm 111 34, Sweden
| | - Rebecca M. Howell
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX 77030, USA
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Dipasquale G, Poirier A, Sprunger Y, Uiterwijk JWE, Miralbell R. Improving 3D-printing of megavoltage X-rays radiotherapy bolus with surface-scanner. Radiat Oncol 2018; 13:203. [PMID: 30340612 PMCID: PMC6194575 DOI: 10.1186/s13014-018-1148-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 10/03/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Computed tomography (CT) data used for patient radiotherapy planning can nowadays be used to create 3D-printed boluses. Nevertheless, this methodology requires a second CT scan and planning process when immobilization masks are used in order to fit the bolus under it for treatment. This study investigates the use of a high-grade surface-scanner to produce, prior to the planning CT scan, a 3D-printed bolus in order to increase the workflow efficiency, improve treatment quality and avoid extra radiation dose to the patient. METHODS The scanner capabilities were tested on a phantom and on volunteers. A phantom was used to produce boluses in the orbital region either from CT data (resolution ≈1 mm), or from surface-scanner images (resolution 0.05 mm). Several 3D-printing techniques and materials were tested. To quantify which boluses fit best, they were placed on the phantom and scanned by CT. Hounsfield Unit (HU) profiles were traced perpendicular to the phantom's surface. The minimum HU in the profiles was compared to the HU values for calibrated air-gaps. Boluses were then created from surface images of volunteers to verify the feasibility of surface-scanner use in-vivo. RESULTS Phantom based tests showed a better fit of boluses modeled from surface-scanner than from CT data. Maximum bolus-to-skin air gaps were 1-2 mm using CT models and always < 0.6 mm using surface-scanner models. Tests on volunteers showed good and comfortable fit of boluses produced from surface-scanner images acquired in 0.6 to 7 min. Even in complex surface regions of the body such as ears and fingers, the high-resolution surface-scanner was able to acquire good models. A breast bolus model generated from images acquired in deep inspiration breath hold was also successful. None of the 3D-printed bolus using surface-scanner models required enlarging or shrinking of the initial model acquired in-vivo. CONCLUSIONS Regardless of the material or printing technique, 3D-printed boluses created from high-resolution surface-scanner images proved to be superior in fitting compared to boluses created from CT data. Tests on volunteers were promising, indicating the possibility to improve overall radiotherapy treatments, primarily for megavoltage X-rays, using bolus modeled from a high-resolution surface-scanner even in regions of complex surface anatomy.
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Affiliation(s)
- Giovanna Dipasquale
- Department of Radiation Oncology, Geneva University Hospital, CH-1211, 14, Geneva, Switzerland.
| | | | | | | | - Raymond Miralbell
- Department of Radiation Oncology, Geneva University Hospital, CH-1211, 14, Geneva, Switzerland.,Faculty of Medicine, Geneva University, Geneva, Switzerland
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Workload implications for clinic workflow with implementation of three-dimensional printed customized bolus for radiation therapy: A pilot study. PLoS One 2018; 13:e0204944. [PMID: 30273403 PMCID: PMC6166970 DOI: 10.1371/journal.pone.0204944] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 09/16/2018] [Indexed: 11/19/2022] Open
Abstract
Bolus is commonly used in radiation therapy to improve radiation dose distribution to the target volume, but commercially available products do not always conform well to the patient surface. Tumor control may be compromised, particularly for superficial tumors, if bolus does not conform well and air gaps exist between the patient surface and the bolus. Three-dimensional (3D) printing technology allows the creation of highly detailed, variable shaped objects, making it an attractive and affordable option for customized, patient-specific bolus creation. The use of 3D printing in the clinical setting remains limited. Therefore, the objective of this study was to assess the implications on time and clinical fit using a workflow for 3D printing of customized bolus in companion animals with spontaneous tumors treated with radiation therapy. The primary aim of this study was to evaluate the time required to create a clinical 3D printed bolus. The secondary aims were to evaluate the clinical fit of the bolus and to verify the skin surface dose. Time to segmentation and 3D printing were documented, while the clinical fit of the bolus was assessed in comparison to the bolus created in the treatment planner. The mean and median time from segmentation to generation of 3D printed boluses was 6.15 h and 5.25 h, respectively. The 3D printed bolus was significantly less deviated from the planned bolus compared to the conventional bolus (p = 0.0078) with measured dose under the bolus within 5% agreement of expected dose in 88% of the measurements. Clinically acceptable 3D printed customized bolus was successfully created for treatment within one working day. The most significant impact on time is the 3D printing itself, which therefore has minimal implications on personnel and staffing. Quality assurance steps are recommended when implementing a 3D printing workflow to the radiotherapy clinic.
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Diamantopoulos S, Kagkiouzis I, Patatoukas G, Kypraiou E, Kouloulias V, Efstathopoulos E, Platoni K. Three dimensional printed electron beam modifier for total skin electron treatments. Med Dosim 2018; 44:173-178. [PMID: 31079619 DOI: 10.1016/j.meddos.2018.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 05/06/2018] [Accepted: 05/18/2018] [Indexed: 11/30/2022]
Abstract
Total Skin Electron Beam (TSEB) treatment, despite its proven effectiveness in skin malignancies, is a rather exhausting irradiation method, especially for feeble patients. In an effort to reduce treatment time by creating a clinically acceptable single TSEB field, various beam modifiers of different materials and shapes were tested. Using the TSEB immobilization device of our department and 3D printing technology, aluminum and thermoplastic modifiers were designed and constructed, according to the resulting profiles at treatment distance. Electron beam characteristics were measured and calculated both at SSD = 100 cm and at treatment level. Aluminum scatterers of the same thickness caused different modification according to the area of blocking. Aluminum modifiers reduced significantly central dose deposition for the same amount of MUs and therefore they expanded treatment time in undesirable levels. Plastic modifiers offer a good combination of field dimensions and treatment time. The final 3D printed modifier shaped the electron beam as desired resulting to a clinically acceptable 6 MeV field of 176 × 70 cm field with 10% inhomogeneity in vertical and 3% in the lateral dimension with adequate skin coverage at SSD = 400 cm. This modification offered approximately a two-minute treatment time reduction compared to the current technique. Underdosed areas appear near the edge of the field, but in regions that are far from the torso of the patient. Bremsstrahlung radiation was kept at clinically accepted levels (< 5%). This modification of the original six dual-field technique of our hospital could probably benefit fragile patients who could not easily tolerate a twenty-minute standing position without compromising the quality of their treatment.
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Affiliation(s)
- S Diamantopoulos
- 2nd Department of Radiology, Radiotherapy Unit, University General Hospital "Attikon", National and Kapodistrian University of Athens, Greece, 1 Rimini str., 12462 Chaidari, Greece.
| | - I Kagkiouzis
- 2nd Department of Radiology, Radiotherapy Unit, University General Hospital "Attikon", National and Kapodistrian University of Athens, Greece, 1 Rimini str., 12462 Chaidari, Greece
| | - G Patatoukas
- 2nd Department of Radiology, Radiotherapy Unit, University General Hospital "Attikon", National and Kapodistrian University of Athens, Greece, 1 Rimini str., 12462 Chaidari, Greece
| | - E Kypraiou
- 2nd Department of Radiology, Radiotherapy Unit, University General Hospital "Attikon", National and Kapodistrian University of Athens, Greece, 1 Rimini str., 12462 Chaidari, Greece
| | - V Kouloulias
- 2nd Department of Radiology, Radiotherapy Unit, University General Hospital "Attikon", National and Kapodistrian University of Athens, Greece, 1 Rimini str., 12462 Chaidari, Greece
| | - E Efstathopoulos
- 2nd Department of Radiology, Radiotherapy Unit, University General Hospital "Attikon", National and Kapodistrian University of Athens, Greece, 1 Rimini str., 12462 Chaidari, Greece
| | - K Platoni
- 2nd Department of Radiology, Radiotherapy Unit, University General Hospital "Attikon", National and Kapodistrian University of Athens, Greece, 1 Rimini str., 12462 Chaidari, Greece
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Ehler E, Craft D, Rong Y. 3D printing technology will eventually eliminate the need of purchasing commercial phantoms for clinical medical physics QA procedures. J Appl Clin Med Phys 2018; 19:8-12. [PMID: 29943910 PMCID: PMC6036387 DOI: 10.1002/acm2.12392] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 06/01/2018] [Accepted: 06/04/2018] [Indexed: 11/07/2022] Open
Affiliation(s)
- Eric Ehler
- Department of Radiation OncologyUniversity of MinnesotaMinneapolisMN55455USA
| | - Daniel Craft
- Department of Radiation PhysicsUniversity of Texas MD Anderson Cancer CenterHoustonTX77030USA
| | - Yi Rong
- Department of Radiation OncologyUniversity of California Davis Comprehensive Cancer CenterSacramentoCA95817USA
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Zou W, Burgdorf B, Yue NJ, Yin L, Zhang M, Khan A, Jabbour SK, McDonough J, Dong L, Teo BKK. Efficient double-scattering proton therapy with a patient-specific bolus. Phys Med 2018; 50:1-6. [PMID: 29891088 PMCID: PMC10865432 DOI: 10.1016/j.ejmp.2018.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 05/01/2018] [Accepted: 05/03/2018] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Passive scattering proton radiotherapy utilizes beam-specific compensators to shape the dose to the distal end of the tumor target. These compensators typically require therapists to enter the treatment room to mount between beams. This study investigates a novel approach that utilizes a single patient-specific bolus to accomplish the role of multi-field compensators to improve the efficiency of the treatment delivery. METHODS Ray-tracing from the proton virtual source was used to convert the beam-specific compensators (mounted on the gantry nozzle) into an equivalent bolus thickness on the patient surface. The field bolus contours were combined to create a single bolus. A 3D acrylic bolus was milled for a head phantom. The dose distribution of the compensator plan was compared to the bolus plan using 3D Gamma analysis and film measurements. Boluses for two clinical patients were also designed. RESULTS The calculated phantom dose distribution of the original proton compensator plan was shown to be equivalent to the plan with the surface bolus. Film irradiations with the proton bolus also confirmed the dosimetric equivalence of the two techniques. The dose distribution equivalency of the bolus plans for the clinical patients were demonstrated. CONCLUSIONS We presented a novel approach that uses a single patient-specific bolus to replace patient compensators during passive scattering proton delivery. This approach has the potential to reduce the treatment time, the compensator manufacturing costs, the risk of potential collision between the compensator and the patient/couch, and the waste of compensator material.
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Affiliation(s)
- Wei Zou
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, United States.
| | - Brendan Burgdorf
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Ning J Yue
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ 08903, United States
| | - Lingshu Yin
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Miao Zhang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Atif Khan
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ 08903, United States
| | - James McDonough
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Lei Dong
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Boon-Keng Kevin Teo
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, United States
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Moran K. Good Luck With That … Making Your Own Opportunities. J Med Imaging Radiat Sci 2018; 49:127-129. [DOI: 10.1016/j.jmir.2017.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 10/17/2017] [Indexed: 10/18/2022]
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Zavan R, McGeachy P, Madamesila J, Villarreal‐Barajas J, Khan R. Verification of Acuros XB dose algorithm using 3D printed low-density phantoms for clinical photon beams. J Appl Clin Med Phys 2018; 19:32-43. [PMID: 29575596 PMCID: PMC5978687 DOI: 10.1002/acm2.12299] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 10/21/2017] [Accepted: 12/06/2017] [Indexed: 11/09/2022] Open
Abstract
The transport-based dose calculation algorithm Acuros XB (AXB) has been shown to accurately account for heterogeneities primarily through comparisons with Monte Carlo simulations. This study aims to provide additional experimental verification of AXB for clinically relevant flattened and unflattened beam energies in low density phantoms of the same material. Polystyrene slabs were created using a bench-top 3D printer. Six slabs were printed at varying densities from 0.23 to 0.68 g/cm3 , corresponding to different density humanoid tissues. The slabs were used to form different single and multilayer geometries. Dose was calculated with Eclipse™ AXB 11.0.31 for 6MV, 15MV flattened and 6FFF (flattening filter free) energies for field sizes of 2 × 2 and 5 × 5 cm2 . EBT3 film was inserted into the phantoms, which were irradiated. Absolute dose profiles and 2D Gamma analyses were performed for 96 dose planes. For all single slab configurations and energies, absolute dose differences between the AXB calculation and film measurements remained <3% for both fields in the high-dose region, however, larger disagreement was seen within the penumbra. For the multilayered phantom, percentage depth dose with AXB was within 5% of discrete film measurements. The Gamma index at 2%/2 mm averaged 98% in all combinations of fields, phantoms and photon energies. The transport-based dose algorithm AXB is in good agreement with the experimental measurements for small field sizes using 6MV, 6FFF and 15MV beams adjacent to various low-density heterogeneous media. This work provides preliminary experimental grounds to support the use of AXB for heterogeneous dose calculation purposes.
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Affiliation(s)
- Rodolfo Zavan
- Department of Medical PhysicsTom Baker Cancer CenterCalgaryABCanada
| | - Philip McGeachy
- Department of Medical PhysicsTom Baker Cancer CenterCalgaryABCanada
| | | | | | - Rao Khan
- Department of Radiation OncologyWashington University School of MedicineSt. LouisMOUSA
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Clinical application of 3D-printed-step-bolus in post-total-mastectomy electron conformal therapy. Oncotarget 2018; 8:25660-25668. [PMID: 27784001 PMCID: PMC5421959 DOI: 10.18632/oncotarget.12829] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 10/19/2016] [Indexed: 11/25/2022] Open
Abstract
The 3D-printed boluses were used during the radiation therapy of the chest wall in six patients with breast cancer after modified radical mastectomy (MRM). We measured the in-vivo skin doses while both conventional and 3D-printed boluses were placed on the chest wall and compared the mean doses delivered to the ipsilateral lung and the heart. The homogeneity and conformity of the dose distribution in the chest wall for both types of boluses were also evaluated. The uniformity index on the chest skin was improved when the 3D-printed boluses were used, with the overall average skin dose being closer to the prescribed one in the former case (-0.47% versus -4.43%). On comparing the dose-volume histogram (DVH), it was found that the 3D-printed boluses resulted in a reduction in the mean dose to the ipsilateral lung by up to 20%. The precision of dose delivery was improved by 3% with the 3D-printed boluses; in contrast, the conventional step bolus resulted in a precision level of 5%. In conclusion, the use of the 3D-printed boluses resulted in better dose homogeneity and conformity to the chest wall as well as the sparing of the normal organs, especially the lung. This suggested that their routine use on the chest wall as a therapeutic approach during post-mastectomy radiation therapy offers numerous advantages over conventional step boluses.
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Diamantopoulos S, Kantemiris I, Patatoukas G, Dilvoi M, Efstathopoulos E, Kouloulias V, Platoni K. Theoretical and experimental determination of scaling factors in electron dosimetry for 3D-printed polylactic acid. Med Phys 2018; 45:1708-1714. [DOI: 10.1002/mp.12790] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 12/28/2017] [Accepted: 01/16/2018] [Indexed: 11/11/2022] Open
Affiliation(s)
- Stefanos Diamantopoulos
- 2nd Department of Radiology; University General Hospital “Attikon”; National and Kapodistrian University of Athens; 1 Rimini Street 12462 Chaidari Greece
- Medical Physics Department; Metropolitan Hospital; 9 Ethnarchou Makariou & 1 E. Venizelou Streets 18547 Neo Faliro Greece
| | - Ioannis Kantemiris
- Medical Physics Department; Metropolitan Hospital; 9 Ethnarchou Makariou & 1 E. Venizelou Streets 18547 Neo Faliro Greece
| | - Georgios Patatoukas
- 2nd Department of Radiology; University General Hospital “Attikon”; National and Kapodistrian University of Athens; 1 Rimini Street 12462 Chaidari Greece
| | - Maria Dilvoi
- 2nd Department of Radiology; University General Hospital “Attikon”; National and Kapodistrian University of Athens; 1 Rimini Street 12462 Chaidari Greece
| | - Efstathios Efstathopoulos
- 2nd Department of Radiology; University General Hospital “Attikon”; National and Kapodistrian University of Athens; 1 Rimini Street 12462 Chaidari Greece
| | - Vassilis Kouloulias
- 2nd Department of Radiology; University General Hospital “Attikon”; National and Kapodistrian University of Athens; 1 Rimini Street 12462 Chaidari Greece
| | - Kalliopi Platoni
- 2nd Department of Radiology; University General Hospital “Attikon”; National and Kapodistrian University of Athens; 1 Rimini Street 12462 Chaidari Greece
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Sharma A, Sasaki D, Rickey DW, Leylek A, Harris C, Johnson K, Alpuche Aviles JE, McCurdy B, Egtberts A, Koul R, Dubey A. Low-cost optical scanner and 3-dimensional printing technology to create lead shielding for radiation therapy of facial skin cancer: First clinical case series. Adv Radiat Oncol 2018; 3:288-296. [PMID: 30202798 PMCID: PMC6128099 DOI: 10.1016/j.adro.2018.02.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 01/04/2018] [Accepted: 02/07/2018] [Indexed: 11/19/2022] Open
Abstract
Purpose Three-dimensional printing has been implemented at our institution to create customized treatment accessories, including lead shields used during radiation therapy for facial skin cancer. To effectively use 3-dimensional printing, the topography of the patient must first be acquired. We evaluated a low-cost, structured-light, 3-dimensional, optical scanner to assess the clinical viability of this technology. Methods and materials For ease of use, the scanner was mounted to a simple gantry that guided its motion and maintained an optimum distance between the scanner and the object. To characterize the spatial accuracy of the scanner, we used a geometric phantom and an anthropomorphic head phantom. The geometric phantom was machined from plastic and included hemispherical and tetrahedral protrusions that were roughly the dimensions of an average forehead and nose, respectively. Polygon meshes acquired by the optical scanner were compared with meshes generated from high-resolution computed tomography images. Most optical scans contained minor artifacts. Using an algorithm that calculated the distances between the 2 meshes, we found that most of the optical scanner measurements agreed with those from the computed tomography scanner within approximately 1 mm for the geometric phantom and approximately 2 mm for the head phantom. We used this optical scanner along with 3-dimensional printer technology to create custom lead shields for 10 patients receiving orthovoltage treatments of nonmelanoma skin cancers of the face. Patient, tumor, and treatment data were documented. Results Lead shields created using this approach were accurate, fitting the contours of each patient's face. This process added to patient convenience and addressed potential claustrophobia and medical inability to lie supine. Conclusions The scanner was found to be clinically acceptable, and we suggest that the use of an optical scanner and 3-dimensional printer technology become the new standard of care to generate lead shielding for orthovoltage radiation therapy of nonmelanoma facial skin cancer.
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Affiliation(s)
- Ankur Sharma
- Department of Radiation Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
- Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - David Sasaki
- Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medical Physics, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Daniel W. Rickey
- Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medical Physics, CancerCare Manitoba, Winnipeg, Manitoba, Canada
- Department of Physics and Astronomy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ahmet Leylek
- Department of Radiation Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
- Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Chad Harris
- Department of Medical Physics, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Kate Johnson
- Department of Radiation Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
- Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jorge E. Alpuche Aviles
- Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medical Physics, CancerCare Manitoba, Winnipeg, Manitoba, Canada
- Department of Physics and Astronomy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Boyd McCurdy
- Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medical Physics, CancerCare Manitoba, Winnipeg, Manitoba, Canada
- Department of Physics and Astronomy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Andy Egtberts
- Department of Medical Physics, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Rashmi Koul
- Department of Radiation Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
- Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Arbind Dubey
- Department of Radiation Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
- Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
- Corresponding author. CancerCare Manitoba, ON 3258–675 McDermot Ave., Winnipeg, Manitoba R3E 0V9, Canada.
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Robar JL, Moran K, Allan J, Clancey J, Joseph T, Chytyk-Praznik K, MacDonald RL, Lincoln J, Sadeghi P, Rutledge R. Intrapatient study comparing 3D printed bolus versus standard vinyl gel sheet bolus for postmastectomy chest wall radiation therapy. Pract Radiat Oncol 2017; 8:221-229. [PMID: 29452866 DOI: 10.1016/j.prro.2017.12.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/11/2017] [Accepted: 12/20/2017] [Indexed: 11/16/2022]
Abstract
PURPOSE This patient study evaluated the use of 3-dimensional (3D) printed bolus for chest wall radiation therapy compared with standard sheet bolus with regard to accuracy of fit, surface dose measured in vivo, and efficiency of patient setup. By alternating bolus type over the course of therapy, each patient served as her own control. METHODS AND MATERIALS For 16 patients undergoing chest wall radiation therapy, a custom 5.0 mm thick bolus was designed based on the treatment planning computed tomography scan and 3D printed using polylactic acid. Cone beam computed tomography scanning was used to image and quantify the accuracy of fit of the 2 bolus types with regard to air gaps between the bolus and skin. As a quality assurance measure for the 3D printed bolus, optically stimulated luminescent dosimetry provided in vivo comparison of surface dose at 7 points on the chest wall. Durations of patient setup and image guidance were recorded and compared. RESULTS In 13 of 16 patients, the bolus was printed without user intervention, and the median print time was 12.6 hours. The accuracy of fit of the bolus to the chest wall was improved significantly relative to standard sheet bolus, with the frequency of air gaps 5 mm or greater reduced from 30% to 13% (P < .001) and maximum air gap dimension diminished from 0.5 ± 0.3 to 0.3 ± 0.3 mm on average. Surface dose was within 3% for both standard sheet and 3D printed bolus. On average, the use of 3D printed bolus reduced the setup time from 104 to 76 seconds. CONCLUSIONS This study demonstrates 3D printed bolus in postmastectomy radiation therapy improves fit of the bolus and reduces patient setup time marginally compared with standard vinyl gel sheet bolus. The time savings on patient setup must be weighed against the considerable time needed for the 3D printing process.
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Affiliation(s)
- James L Robar
- Department of Radiation Oncology, Dalhousie University, Halifax, Canada; Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Canada; Nova Scotia Health Authority, Halifax, Canada.
| | | | - James Allan
- Nova Scotia Health Authority, Halifax, Canada
| | | | - Tami Joseph
- Nova Scotia Health Authority, Halifax, Canada
| | - Krista Chytyk-Praznik
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Canada; Nova Scotia Health Authority, Halifax, Canada
| | - R Lee MacDonald
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Canada
| | - John Lincoln
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Canada
| | - Parisa Sadeghi
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Canada
| | - Robert Rutledge
- Department of Radiation Oncology, Dalhousie University, Halifax, Canada; Nova Scotia Health Authority, Halifax, Canada
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Woods K, Ayan AS, Woollard J, Gupta N. Quality assurance for a six degrees-of-freedom table using a 3D printed phantom. J Appl Clin Med Phys 2017; 19:115-124. [PMID: 29159920 PMCID: PMC5768004 DOI: 10.1002/acm2.12227] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 09/07/2017] [Accepted: 10/17/2017] [Indexed: 12/31/2022] Open
Abstract
Purpose To establish a streamlined end‐to‐end test of a 6 degrees‐of‐freedom (6DoF) robotic table using a 3D printed phantom for periodic quality assurance. Methods A 3D printed phantom was fabricated with translational and rotational offsets and an imbedded central ball‐bearing (BB). The phantom underwent each step of the radiation therapy process: CT simulation in a straight orientation, plan generation using the treatment planning software, setup to offset marks at the linac, registration and corrected 6DoF table adjustments via hidden target test, delivery of a Winston‐Lutz test to the BB, and verification of table positioning via field and laser lights. The registration values, maximum total displacement of the combined Winston‐Lutz fields, and a pass or fail criterion of the laser and field lights were recorded. The quality assurance process for each of the three linacs were performed for the first 30 days. Results Within a 95% confidence interval, the overall uncertainty values for both translation and rotation were below 1.0 mm and 0.5° for each linac respectively. When combining the registration values and other uncertainties for all three linacs, the average deviations were within 2.0 mm and 1.0° of the designed translation and rotation offsets of the 3D print respectively. For all three linacs, the maximum total deviation for the Winston‐Lutz test did not exceed 1.0 mm. Laser and light field verification was within tolerance every day for all three linacs given the latest guidance documentation for table repositioning. Conclusion The 3D printer is capable of accurately fabricating a quality assurance phantom for 6DoF positioning verification. The end‐to‐end workflow allows for a more efficient test of the 6DoF mechanics while including other important tests needed for routine quality assurance.
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Affiliation(s)
- Kyle Woods
- Department of Radiation Oncology, Ohio State University, Columbus, OH, USA
| | - Ahmet S Ayan
- Department of Radiation Oncology, Ohio State University, Columbus, OH, USA
| | - Jeffrey Woollard
- Department of Radiation Oncology, Ohio State University, Columbus, OH, USA
| | - Nilendu Gupta
- Department of Radiation Oncology, Ohio State University, Columbus, OH, USA
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Chiu T, Tan J, Brenner M, Gu X, Yang M, Westover K, Strom T, Sher D, Jiang S, Zhao B. Three-dimensional printer-aided casting of soft, custom silicone boluses (SCSBs) for head and neck radiation therapy. Pract Radiat Oncol 2017; 8:e167-e174. [PMID: 29452869 DOI: 10.1016/j.prro.2017.11.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/03/2017] [Accepted: 11/06/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Custom tissue compensators provide dosimetric advantages for treating superficial or complex anatomy, but currently available fabrication technology is expensive or impractical for most clinical operations and yields compensators that are difficult for patients to tolerate. We aimed to develop an inexpensive, clinically feasible workflow for generating patient-specific, soft, custom silicone boluses (SCSBs) for head-and-neck (HN) radiation therapy. METHODS AND MATERIALS We developed a method using 3-dimensional printed parts for generating SCSBs for the treatment of HN cancers. The clinical workflow for generation of SCSBs was characterized inclusive of patient simulation to treatment in terms of resource time and cost. Dosimetric properties such as percentage depth dose and dose profiles were measured for SCSBs using GaF films. Comprehensive measurements were also conducted on an HN phantom. SCSBs were generated and used for electron or photon based radiation treatments of 7 HN patients with lesions at nose, cheek, eye, or ears. In vivo dose measurements with optically simulated luminescence dosimeters were performed. RESULTS Total design and fabrication time from patient simulation to radiation treatment start required approximately 1 week, with fabrication constituting 1 to 2 working days depending on bolus surface area, volume, and complexity. Computed tomography and dosimetric properties of the soft bolus were similar to water. In vivo dose measurements on 7 treated patients confirmed that the dose deposition conformed to planned doses. Material costs were lower than currently available hard plastic boluses generated with 3-dimensional printing technology. All treated patients tolerated SCSBs for the duration of therapy. CONCLUSIONS Generation and use of SCSBs for clinical use is feasible and effective for the treatment of HN cancers.
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Affiliation(s)
- Tsuicheng Chiu
- Department of Radiation Oncology, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - Jun Tan
- Department of Radiation Oncology, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - Mathew Brenner
- Department of Radiation Oncology, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - Xuejun Gu
- Department of Radiation Oncology, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - Ming Yang
- Department of Radiation Oncology, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - Kenneth Westover
- Department of Radiation Oncology, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - Tobin Strom
- Department of Radiation Oncology, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - David Sher
- Department of Radiation Oncology, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - Steve Jiang
- Department of Radiation Oncology, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - Bo Zhao
- Department of Radiation Oncology, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas.
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Hogstrom KR, Carver RL, Chambers EL, Erhart K. Introduction to passive electron intensity modulation. J Appl Clin Med Phys 2017; 18:10-19. [PMID: 28875590 PMCID: PMC5689915 DOI: 10.1002/acm2.12163] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/19/2017] [Accepted: 06/28/2017] [Indexed: 11/23/2022] Open
Abstract
This work introduces a new technology for electron intensity modulation, which uses small area island blocks within the collimating aperture and small area island apertures in the collimating insert. Due to multiple Coulomb scattering, electrons contribute dose under island blocks and lateral to island apertures. By selecting appropriate lateral positions and diameters of a set of island blocks and island apertures, for example, a hexagonal grid with variable diameter circular island blocks, intensity modulated beams can be produced for appropriate air gaps between the intensity modulator (position of collimating insert) and the patient. Such a passive radiotherapy intensity modulator for electrons (PRIME) is analogous to using physical attenuators (metal compensators) for intensity modulated x‐ray therapy (IMXT). For hexagonal spacing, the relationship between block (aperture) separation (r) and diameter (d) and the local intensity reduction factor (IRF) is discussed. The PRIME principle is illustrated using pencil beam calculations for select beam geometries in water with half beams modulated by 70%–95% and for one head and neck field of a patient treated with bolus electron conformal therapy. Proof of principle is further illustrated by showing agreement between measurement and calculation for a prototype PRIME. Potential utilization of PRIME for bolus electron conformal therapy, segmented‐field electron conformal therapy, modulated electron radiation therapy, and variable surface geometries is discussed. Further research and development of technology for the various applications is discussed. In summary, this paper introduces a practical, new technology for electron intensity modulation in the clinic, demonstrates proof of principle, discusses potential clinical applications, and suggests areas of further research and development.
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Affiliation(s)
- Kenneth R Hogstrom
- Mary Bird Perkins Cancer Center, Baton Rouge, LA, USA.,Department of Physics and Astronomy, Louisiana State University, Baton Rouge, LA, USA
| | - Robert L Carver
- Mary Bird Perkins Cancer Center, Baton Rouge, LA, USA.,Department of Physics and Astronomy, Louisiana State University, Baton Rouge, LA, USA
| | - Erin L Chambers
- Department of Physics and Astronomy, Louisiana State University, Baton Rouge, LA, USA
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Ricotti R, Ciardo D, Pansini F, Bazani A, Comi S, Spoto R, Noris S, Cattani F, Baroni G, Orecchia R, Vavassori A, Jereczek-Fossa BA. Dosimetric characterization of 3D printed bolus at different infill percentage for external photon beam radiotherapy. Phys Med 2017; 39:25-32. [PMID: 28711185 DOI: 10.1016/j.ejmp.2017.06.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/09/2017] [Accepted: 06/09/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE 3D printing is rapidly evolving and further assessment of materials and technique is required for clinical applications. We evaluated 3D printed boluses with acrylonitrile butadiene styrene (ABS) and polylactide (PLA) at different infill percentage. MATERIAL AND METHODS A low-cost 3D printer was used. The influence of the air inclusion within the 3D printed boluses was assessed thoroughly both with treatment planning system (TPS) and with physical measurements. For each bolus, two treatment plans were calculated with Monte Carlo algorithm, considering the computed tomography (CT) scan of the 3D printed bolus or modelling the 3D printed bolus as a virtual bolus structure with a homogeneous density. Depth dose measurements were performed with Gafchromic films. RESULTS High infill percentage corresponds to high density and high homogeneity within bolus material. The approximation of the bolus in the TPS as a homogeneous material is satisfying for infill percentages greater than 20%. Measurements performed with PLA boluses are more comparable to the TPS calculated profiles. For boluses printed at 40% and 60% infill, the discrepancies between calculated and measured dose distribution are within 5%. CONCLUSIONS 3D printing technology allows modulating the shift of the build-up region by tuning the infill percentage of the 3D printed bolus in order to improve superficial target coverage.
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Affiliation(s)
- Rosalinda Ricotti
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Delia Ciardo
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy.
| | - Floriana Pansini
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Alessia Bazani
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Stefania Comi
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Ruggero Spoto
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Samuele Noris
- Corso di Laurea in Tecniche di radiologia medica, per immagini e radioterapia, University of Milan, Milan, Italy
| | - Federica Cattani
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Guido Baroni
- Dipartimento di Elettronica Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy; Bioengineering Unit, Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | - Roberto Orecchia
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Department of Medical Imaging and Radiation Sciences, European Institute of Oncology, Milan, Italy
| | - Andrea Vavassori
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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Individualized 3D scanning and printing for non-melanoma skin cancer brachytherapy: a financial study for its integration into clinical workflow. J Contemp Brachytherapy 2017; 9:270-276. [PMID: 28725252 PMCID: PMC5509979 DOI: 10.5114/jcb.2017.68134] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 04/15/2017] [Indexed: 01/17/2023] Open
Abstract
Purpose Skin cancer is the most common tumor in the population. There are different therapeutic modalities. Brachytherapy is one of the techniques used, in which it is necessary to build customized moulds for some patients. Currently, these moulds are made by hand using rudimentary techniques. We present a new procedure based on 3D printing and the analysis of the clinical workflow. Material and methods Moulds can be made either by hand or by automated 3D printing. For making moulds by hand, a patient’s alginate negative is created and, from that, the gypsum cast and customized moulds are made by hand from the patient’s negative template. The new process is based on 3D printing. The first step is to take a 3D scan of the surface of the patient and then, 3D modelling software is used to obtain an accurate anatomical reconstruction of the treatment area. We present the clinical workflow using 3D scanning and printing technology, comparing its costs with the usual custom handmade mould protocol. Results The time spent for the new process is 6.25 hours, in contrast to the time spent for the conventional process, which is 9.5 hours. We found a 34% reduction in time required to create a mould for brachytherapy treatment. The labor cost of the conventional process is 211.5 vs. 152.5 hours, so the reduction is 59 hours. There is also a 49.5% reduction in the financial costs, mostly due to lack of need of a computed tomography (CT) scan of the gypsum and the mould. 3D scanning and printing offers financial benefits and reduces the clinical workload. Conclusions As the present project demonstrates, through the application of 3D printing technologies, the costs and time spent during the process in the clinical workload in brachytherapy treatment are reduced. Overall, 3D printing is a promising technique for brachytherapy that might be well received in the community.
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Fujimoto K, Shiinoki T, Yuasa Y, Hanazawa H, Shibuya K. Efficacy of patient-specific bolus created using three-dimensional printing technique in photon radiotherapy. Phys Med 2017; 38:1-9. [PMID: 28610688 DOI: 10.1016/j.ejmp.2017.04.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 04/17/2017] [Accepted: 04/17/2017] [Indexed: 11/18/2022] Open
Abstract
PURPOSE A commercially available bolus ("commercial-bolus") does not make complete contact with the irregularly shaped patient skin. This study aims to customise a patient-specific three-dimensional (3D) bolus using a 3D printing technique ("3D-bolus") and to evaluate its clinical feasibility for photon radiotherapy. METHODS The 3D-bolus was designed using a treatment planning system (TPS) in Digital Imaging and Communications in Medicine-Radiotherapy (DICOM-RT) format, and converted to stereolithographic format for printing. To evaluate its physical characteristics, treatment plans were created for water-equivalent phantoms that were bolus-free, or had a flat-form printed 3D-bolus, a TPS-designed bolus ("virtual-bolus"), or a commercial-bolus. These plans were compared based on the percentage depth dose (PDD) and target-volume dose volume histogram (DVH) measurements. To evaluate the clinical feasibility, treatment plans were created for head phantoms that were bolus-free or had a 3D-bolus, a virtual-bolus, or a commercial-bolus. These plans were compared based on the target volume DVH. RESULTS In the physical evaluation, the 3D-bolus provided effective dose coverage in the build-up region, which was equivalent to the commercial-bolus. With regard to the clinical feasibility, the air gaps were lesser with the 3D-bolus when compared to the commercial-bolus. Furthermore, the prescription dose could be delivered appropriately to the target volume. The 3D-bolus has potential use for air-gap reduction compared to the commercial-bolus and facilitates target-volume dose coverage and homogeneity improvement. CONCLUSIONS A 3D-bolus produced using a 3D printing technique is comparable to a commercial-bolus applied to an irregular-shaped skin surface.
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Affiliation(s)
- Koya Fujimoto
- Department of Radiation Oncology, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minamikogushi, Yamaguchi 755-8535, Japan; Department of Radiological Technology, Yamaguchi University Hospital, 1-1-1 Minamikogushi, Yamaguchi 755-8535, Japan
| | - Takehiro Shiinoki
- Department of Radiation Oncology, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minamikogushi, Yamaguchi 755-8535, Japan.
| | - Yuki Yuasa
- Department of Radiation Oncology, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minamikogushi, Yamaguchi 755-8535, Japan; Department of Radiological Technology, Yamaguchi University Hospital, 1-1-1 Minamikogushi, Yamaguchi 755-8535, Japan
| | - Hideki Hanazawa
- Department of Radiation Oncology, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minamikogushi, Yamaguchi 755-8535, Japan
| | - Keiko Shibuya
- Department of Radiation Oncology, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minamikogushi, Yamaguchi 755-8535, Japan
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Leng S, McGee K, Morris J, Alexander A, Kuhlmann J, Vrieze T, McCollough CH, Matsumoto J. Anatomic modeling using 3D printing: quality assurance and optimization. 3D Print Med 2017; 3:6. [PMID: 29782614 PMCID: PMC5954797 DOI: 10.1186/s41205-017-0014-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 04/05/2017] [Indexed: 12/12/2022] Open
Abstract
Background The purpose of this study is to provide a framework for the development of a quality assurance (QA) program for use in medical 3D printing applications. An interdisciplinary QA team was built with expertise from all aspects of 3D printing. A systematic QA approach was established to assess the accuracy and precision of each step during the 3D printing process, including: image data acquisition, segmentation and processing, and 3D printing and cleaning. Validation of printed models was performed by qualitative inspection and quantitative measurement. The latter was achieved by scanning the printed model with a high resolution CT scanner to obtain images of the printed model, which were registered to the original patient images and the distance between them was calculated on a point-by-point basis. Results A phantom-based QA process, with two QA phantoms, was also developed. The phantoms went through the same 3D printing process as that of the patient models to generate printed QA models. Physical measurement, fit tests, and image based measurements were performed to compare the printed 3D model to the original QA phantom, with its known size and shape, providing an end-to-end assessment of errors involved in the complete 3D printing process. Measured differences between the printed model and the original QA phantom ranged from -0.32 mm to 0.13 mm for the line pair pattern. For a radial-ulna patient model, the mean distance between the original data set and the scanned printed model was -0.12 mm (ranging from -0.57 to 0.34 mm), with a standard deviation of 0.17 mm. Conclusions A comprehensive QA process from image acquisition to completed model has been developed. Such a program is essential to ensure the required accuracy of 3D printed models for medical applications.
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Affiliation(s)
- Shuai Leng
- 1Department of Radiology, 200 First Street SW, Mayo Clinic, Rochester, 55901 MN USA
| | - Kiaran McGee
- 1Department of Radiology, 200 First Street SW, Mayo Clinic, Rochester, 55901 MN USA
| | - Jonathan Morris
- 1Department of Radiology, 200 First Street SW, Mayo Clinic, Rochester, 55901 MN USA
| | - Amy Alexander
- 1Department of Radiology, 200 First Street SW, Mayo Clinic, Rochester, 55901 MN USA
| | - Joel Kuhlmann
- Division of Engineering, 200 First Street SW, Mayo Clinic, Rochester, 55901 MN USA
| | - Thomas Vrieze
- 1Department of Radiology, 200 First Street SW, Mayo Clinic, Rochester, 55901 MN USA
| | - Cynthia H McCollough
- 1Department of Radiology, 200 First Street SW, Mayo Clinic, Rochester, 55901 MN USA
| | - Jane Matsumoto
- 1Department of Radiology, 200 First Street SW, Mayo Clinic, Rochester, 55901 MN USA
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Jones EL, Tonino Baldion A, Thomas C, Burrows T, Byrne N, Newton V, Aldridge S. Introduction of novel 3D-printed superficial applicators for high-dose-rate skin brachytherapy. Brachytherapy 2017; 16:409-414. [DOI: 10.1016/j.brachy.2016.11.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 10/23/2016] [Accepted: 11/07/2016] [Indexed: 10/20/2022]
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Sato K, Takeda K, Dobashi S, Kadoya N, Ito K, Chiba M, Kishi K, Yanagawa I, Jingu K. Evaluation of the Positional Accuracy and Dosimetric Properties of a Three-dimensional Printed Device for Head and Neck Immobilization. Nihon Hoshasen Gijutsu Gakkai Zasshi 2017; 73:57-65. [PMID: 28111399 DOI: 10.6009/jjrt.2017_jsrt_73.1.57] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Our aim was to investigate the feasibility of a three-dimensional (3D) -printed head-and-neck (HN) immobilization device by comparing its positional accuracy and dosimetric properties with those of a conventional immobilization device (CID). We prepared a 3D-printed immobilization device (3DID) consisting of a mask and headrest with acrylonitrile-butadiene-styrene resin developed from the computed tomography data obtained by imaging a HN phantom. For comparison, a CID comprising a thermoplastic mask and headrest was prepared using the same HN phantom. We measured the setup error using the ExacTrac X-ray image system. Furthermore, using the ionization chamber and the water-equivalent phantom, we measured the changes in the dose due to the difference in the immobilization device material from the photon of 4 MV and 6 MV. The positional accuracy of the two devices were almost similar in each direction except in the vertical, lateral, and pitch directions (t-test, p<0.0001), and the maximum difference was 1 mm, and 1°. The standard deviations were not statistically different in each direction except in the longitudinal (F-test, p=0.034) and roll directions (F-test, p<0.0001). When the thickness was the same, the dose difference was almost similar at a 50 mm depth. At a 1 mm depth, the 3DID-plate had a 2.9-4.2% lower dose than the CID-plate. This study suggested that the positional accuracy and dosimetric properties of 3DID were almost similar to those of CID.
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Łukowiak M, Jezierska K, Boehlke M, Więcko M, Łukowiak A, Podraza W, Lewocki M, Masojć B, Falco M. Utilization of a 3D printer to fabricate boluses used for electron therapy of skin lesions of the eye canthi. J Appl Clin Med Phys 2017; 18:76-81. [PMID: 28291910 PMCID: PMC5689892 DOI: 10.1002/acm2.12013] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 10/02/2016] [Indexed: 11/20/2022] Open
Abstract
This work describes the use of 3D printing technology to create individualized boluses for patients treated with electron beam therapy for skin lesions of the eye canthi. It aimed to demonstrate the effectiveness of 3D-printed over manually fabricated paraffin boluses. The study involved 11 patients for whom the construction of individual boluses were required. CT scans of the fabricated 3D-printed boluses and paraffin boluses were acquired and superimposed onto patient CT scans to compare their fitting, bolus homogeneity, and underlying dose distribution. To quantify the level of matching, multiple metrics were utilized. Matching Level Index (ML) values ranged from 0 to 100%, where 100% indicated a perfect fit between the reference bolus (planned in treatment planning system) and 3D-printed and paraffin bolus. The average ML (± 1 SD) of the 3D-printed boluses was 95.1 ± 2.1%, compared to 46.0 ± 10.1% for the manually fabricated paraffin bolus. Correspondingly, mean doses were closer to the prescribed doses, and dose spreads were less for the dose distributions from the 3D-printed boluses, as compared to those for the manually fabricated paraffin boluses. It was concluded that 3D-printing technology is a viable method for fabricating boluses for small eye lesions and provides boluses superior to our boluses manually fabricated from paraffin sheets.
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Affiliation(s)
- Magdalena Łukowiak
- Department of Medical PhysicsWest Pomeranian Oncology CenterSzczecinPoland
| | - Karolina Jezierska
- Department of Medical PhysicsPomeranian Medical UniversitySzczecinPoland
| | - Marek Boehlke
- Department of Medical PhysicsWest Pomeranian Oncology CenterSzczecinPoland
| | - Marzena Więcko
- Department of Medical PhysicsWest Pomeranian Oncology CenterSzczecinPoland
| | - Adam Łukowiak
- Department of Medical DevicesSamodzielny Publiczny Wojewódzki Szpital Zespolony im. Marii Skłodowskiej–CurieSzczecinPoland
| | - Wojciech Podraza
- Department of Medical PhysicsPomeranian Medical UniversitySzczecinPoland
| | - Mirosław Lewocki
- Department of Medical PhysicsWest Pomeranian Oncology CenterSzczecinPoland
| | - Bartłomiej Masojć
- Department of RadiotherapyWest Pomeranian Oncology CenterSzczecinPoland
| | - Michał Falco
- Department of RadiotherapyWest Pomeranian Oncology CenterSzczecinPoland
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88
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Park SY, Choi CH, Park JM, Chun M, Han JH, Kim JI. A Patient-Specific Polylactic Acid Bolus Made by a 3D Printer for Breast Cancer Radiation Therapy. PLoS One 2016; 11:e0168063. [PMID: 27930717 PMCID: PMC5145239 DOI: 10.1371/journal.pone.0168063] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 11/23/2016] [Indexed: 11/19/2022] Open
Abstract
Purpose The aim of this study was to assess the feasibility and advantages of a patient-specific breast bolus made using a 3D printer technique. Methods We used the anthropomorphic female phantom with breast attachments, which volumes are 200, 300, 400, 500 and 650 cc. We simulated the treatment for a right breast patient using parallel opposed tangential fields. Treatment plans were used to investigate the effect of unwanted air gaps under bolus on the dose distribution of the whole breast. The commercial Super-Flex bolus and 3D-printed polylactic acid (PLA) bolus were applied to investigate the skin dose of the breast with the MOSFET measurement. Two boluses of 3 and 5 mm thicknesses were selected. Results There was a good agreement between the dose distribution for a virtual bolus generated by the TPS and PLA bolus. The difference in dose distribution between the virtual bolus and Super-Flex bolus was significant within the bolus and breast due to unwanted air gaps. The average differences between calculated and measured doses in a 200 and 300 cc with PLA bolus were not significant, which were -0.7% and -0.6% for 3mm, and -1.1% and -1.1% for 5 mm, respectively. With the Super-Flex bolus, however, significant dose differences were observed (-5.1% and -3.2% for 3mm, and -6.3% and -4.2% for 5 mm). Conclusion The 3D-printed solid bolus can reduce the uncertainty of the daily setup and help to overcome the dose discrepancy by unwanted air gaps in the breast cancer radiation therapy.
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Affiliation(s)
- So-Yeon Park
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chang Heon Choi
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jong Min Park
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
- Center for Convergence Research on Robotics, Advance Institutes of Convergence Technology, Suwon, Republic of Korea
| | - MinSoo Chun
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Hye Han
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung-in Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
- * E-mail:
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89
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Ricotti R, Vavassori A, Bazani A, Ciardo D, Pansini F, Spoto R, Sammarco V, Cattani F, Baroni G, Orecchia R, Jereczek-Fossa BA. 3D-printed applicators for high dose rate brachytherapy: Dosimetric assessment at different infill percentage. Phys Med 2016; 32:1698-1706. [PMID: 27592531 DOI: 10.1016/j.ejmp.2016.08.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 08/17/2016] [Accepted: 08/20/2016] [Indexed: 01/17/2023] Open
Abstract
PURPOSE Dosimetric assessment of high dose rate (HDR) brachytherapy applicators, printed in 3D with acrylonitrile butadiene styrene (ABS) at different infill percentage. MATERIALS AND METHODS A low-cost, desktop, 3D printer (Hamlet 3DX100, Hamlet, Dublin, IE) was used for manufacturing simple HDR applicators, reproducing typical geometries in brachytherapy: cylindrical (common in vaginal treatment) and flat configurations (generally used to treat superficial lesions). Printer accuracy was investigated through physical measurements. The dosimetric consequences of varying the applicator's density by tuning the printing infill percentage were analysed experimentally by measuring depth dose profiles and superficial dose distribution with Gafchromic EBT3 films (International Specialty Products, Wayne, NJ). Dose distributions were compared to those obtained with a commercial superficial applicator. RESULTS Measured printing accuracy was within 0.5mm. Dose attenuation was not sensitive to the density of the material. Surface dose distribution comparison of the 3D printed flat applicators with respect to the commercial superficial applicator showed an overall passing rate greater than 94% for gamma analysis with 3% dose difference criteria, 3mm distance-to-agreement criteria and 10% dose threshold. CONCLUSION Low-cost 3D printers are a promising solution for the customization of the HDR brachytherapy applicators. However, further assessment of 3D printing techniques and regulatory materials approval are required for clinical application.
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Affiliation(s)
- Rosalinda Ricotti
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy.
| | - Andrea Vavassori
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Alessia Bazani
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Delia Ciardo
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Floriana Pansini
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Ruggero Spoto
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Vittorio Sammarco
- Tecniche di radiologia medica, per immagini e radioterapia, University of Milan, Milan, Italy
| | - Federica Cattani
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Guido Baroni
- Dipartimento di Elettronica Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy; Bioengineering Unit, Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | - Roberto Orecchia
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Scientific Directorate, European Institute of Oncology, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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90
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Zhu X, Driewer J, Li S, Verma V, Lei Y, Zhang M, Zhang Q, Zheng D, Cullip T, Chang SX, Wang AZ, Zhou S, Enke CA. Technical Note: Fabricating Cerrobend grids with 3D printing for spatially modulated radiation therapy: A feasibility study. Med Phys 2016; 42:6269-73. [PMID: 26520719 DOI: 10.1118/1.4932223] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Grid therapy has promising applications in the radiation treatment of large tumors. However, research and applications of grid therapy are limited by the accessibility of the specialized blocks that produce the grid of pencil-like radiation beams. In this study, a Cerrobend grid block was fabricated using the 3D printing technique. METHODS A grid block mold was designed with flared tubes which follow the divergence of the beam. The mold was 3D printed using a resin with the working temperature below 230 °C. The melted Cerrobend liquid at 120 °C was cast into the resin mold to yield a block with a thickness of 7.4 cm. At the isocenter plane, the grid had a hexagonal pattern, with each pencil beam diameter of 1.4 cm; the distance between the beam centers was 2.1 cm. RESULTS The dosimetric properties of the grid block were studied using small field dosimeters: a pinpoint ionization chamber and a stereotactic diode. For a 6 MV photon beam, its valley-to-peak ratio was 20% at dmax and 30% at 10 cm depth; the output factor was 84.9% at dmax and 65.1% at 10 cm depth. CONCLUSIONS This study demonstrates that it is feasible to implement 3D printing technique in applying grid therapy in clinic.
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Affiliation(s)
- Xiaofeng Zhu
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska 68154
| | - Joseph Driewer
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska 68154
| | - Sicong Li
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska 68154
| | - Vivek Verma
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska 68154
| | - Yu Lei
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska 68154
| | - Mutian Zhang
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska 68154
| | - Qinghui Zhang
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska 68154
| | - Dandan Zheng
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska 68154
| | - Timothy Cullip
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27514
| | - Sha X Chang
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27514
| | - Andrew Z Wang
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27514
| | - Sumin Zhou
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska 68154
| | - Charles A Enke
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska 68154
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Clinical implementation of 3D printing in the construction of patient specific bolus for electron beam radiotherapy for non-melanoma skin cancer. Radiother Oncol 2016; 121:148-153. [PMID: 27475278 DOI: 10.1016/j.radonc.2016.07.011] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 07/08/2016] [Accepted: 07/18/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND PURPOSE Creating an individualized tissue equivalent material build-up (i.e. bolus) for electron beam radiation therapy is complex and highly labour-intensive. We implemented a new clinical workflow in which 3D printing technology is used to create the bolus. MATERIAL AND METHODS A patient-specific bolus is designed in the treatment planning system (TPS) and a shell around it is created in the TPS. The shell is printed and subsequently filled with silicone rubber to make the bolus. Before clinical implementation we performed a planning study with 11 patients to evaluate the difference in tumour coverage between the designed 3D-print bolus and the clinically delivered plan with manually created bolus. For the first 15 clinical patients a second CT scan with the 3D-print bolus was performed to verify the geometrical accuracy. RESULTS The planning study showed that the V85% of the CTV was on average 97% (3D-print) vs 88% (conventional). Geometric comparison of the 3D-print bolus to the originally contoured bolus showed a high similarity (DSC=0.89). The dose distributions on the second CT scan with the 3D print bolus in position showed only small differences in comparison to the original planning CT scan. CONCLUSIONS The implemented workflow is feasible, patient friendly, safe, and results in high quality dose distributions. This new technique increases time efficiency.
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Lin J, Lin MH, Hall A, Zhang B, Singh D, Regine WF. Comparison of bolus electron conformal therapy plans to traditional electron and proton therapy to treat melanoma in the medial canthus. Pract Radiat Oncol 2016; 6:105-9. [DOI: 10.1016/j.prro.2015.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 09/22/2015] [Accepted: 09/23/2015] [Indexed: 11/27/2022]
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93
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Characterizing 3D printing in the fabrication of variable density phantoms for quality assurance of radiotherapy. Phys Med 2016; 32:242-7. [DOI: 10.1016/j.ejmp.2015.09.013] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 09/15/2015] [Accepted: 09/19/2015] [Indexed: 11/20/2022] Open
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Burleson S, Baker J, Hsia AT, Xu Z. Use of 3D printers to create a patient-specific 3D bolus for external beam therapy. J Appl Clin Med Phys 2015; 16:5247. [PMID: 26103485 PMCID: PMC5690114 DOI: 10.1120/jacmp.v16i3.5247] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 12/22/2014] [Accepted: 12/17/2014] [Indexed: 11/23/2022] Open
Abstract
The purpose of this paper is to demonstrate that an inexpensive 3D printer can be used to manufacture patient‐specific bolus for external beam therapy, and to show we can accurately model this printed bolus in our treatment planning system for accurate treatment delivery. Percent depth‐dose measurements and tissue maximum ratios were used to determine the characteristics of the printing materials, acrylonitrile butadiene styrene and polylactic acid, as bolus material with physical density of 1.04 and 1.2 g/cm3, and electron density of 3.38×1023electrons/cm3 and 3.80×1023 electrons/cm3, respectively. Dose plane comparisons using Gafchromic EBT2 film and the RANDO phantom were used to verify accurate treatment planning. We accurately modeled a printing material in Eclipse treatment planning system, assigning it a Hounsfield unit of 260. We were also able to verify accurate treatment planning using gamma analysis for dose plane comparisons. With gamma criteria of 5% dose difference and 2 mm DTA, we were able to have 86.5% points passing, and with gamma criteria of 5% dose difference and 3 mm DTA, we were able to have 95% points passing. We were able to create a patient‐specific bolus using an inexpensive 3D printer and model it in our treatment planning system for accurate treatment delivery. PACS numbers: 87.53.Jw, 87.53.Kn, 87.56.ng
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95
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Zou W, Fisher T, Zhang M, Kim L, Chen T, Narra V, Swann B, Singh R, Siderit R, Yin L, Teo BKK, McKenna M, McDonough J, Ning YJ. Potential of 3D printing technologies for fabrication of electron bolus and proton compensators. J Appl Clin Med Phys 2015; 16:4959. [PMID: 26103473 PMCID: PMC5690113 DOI: 10.1120/jacmp.v16i3.4959] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 01/12/2015] [Accepted: 12/17/2014] [Indexed: 11/29/2022] Open
Abstract
In electron and proton radiotherapy, applications of patient-specific electron bolus or proton compensators during radiation treatments are often necessary to accommodate patient body surface irregularities, tissue inhomogeneity, and variations in PTV depths to achieve desired dose distributions. Emerging 3D printing technologies provide alternative fabrication methods for these bolus and compensators. This study investigated the potential of utilizing 3D printing technologies for the fabrication of the electron bolus and proton compensators. Two printing technologies, fused deposition modeling (FDM) and selective laser sintering (SLS), and two printing materials, PLA and polyamide, were investigated. Samples were printed and characterized with CT scan and under electron and proton beams. In addition, a software package was developed to convert electron bolus and proton compensator designs to printable Standard Tessellation Language file format. A phantom scalp electron bolus was printed with FDM technology with PLA material. The HU of the printed electron bolus was 106.5 ± 15.2. A prostate patient proton compensator was printed with SLS technology and polyamide material with -70.1 ± 8.1 HU. The profiles of the electron bolus and proton compensator were compared with the original designs. The average over all the CT slices of the largest Euclidean distance between the design and the fabricated bolus on each CT slice was found to be 0.84 ± 0.45 mm and for the compensator to be 0.40 ± 0.42 mm. It is recommended that the properties of specific 3D printed objects are understood before being applied to radiotherapy treatments.
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Affiliation(s)
- Wei Zou
- Rutgers Cancer Institute of New Jersey.
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