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Basaula D, Hay B, Wright M, Hall L, Easdon A, McWiggan P, Yeo A, Ungureanu E, Kron T. Additive manufacturing of patient specific bolus for radiotherapy: large scale production and quality assurance. Phys Eng Sci Med 2024; 47:551-561. [PMID: 38285272 PMCID: PMC11166743 DOI: 10.1007/s13246-024-01385-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 01/07/2024] [Indexed: 01/30/2024]
Abstract
Bolus is commonly used to improve dose distributions in radiotherapy in particular if dose to skin must be optimised such as in breast or head and neck cancer. We are documenting four years of experience with 3D printed bolus at a large cancer centre. In addition to this we review the quality assurance (QA) program developed to support it. More than 2000 boluses were produced between Nov 2018 and Feb 2023 using fused deposition modelling (FDM) printing with polylactic acid (PLA) on up to five Raise 3D printers. Bolus is designed in the radiotherapy treatment planning system (Varian Eclipse), exported to an STL file followed by pre-processing. After checking each bolus with CT scanning initially we now produce standard quality control (QC) wedges every month and whenever a major change in printing processes occurs. A database records every bolus printed and manufacturing details. It takes about 3 days from designing the bolus in the planning system to delivering it to treatment. A 'premium' PLA material (Spidermaker) was found to be best in terms of homogeneity and CT number consistency (80 HU +/- 8HU). Most boluses were produced for photon beams (93.6%) with the rest used for electrons. We process about 120 kg of PLA per year with a typical bolus weighing less than 500 g and the majority of boluses 5 mm thick. Print times are proportional to bolus weight with about 24 h required for 500 g material deposited. 3D printing using FDM produces smooth and reproducible boluses. Quality control is essential but can be streamlined.
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Affiliation(s)
- Deepak Basaula
- Peter MacCallum Cancer Centre, Department of Physical Sciences, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Barry Hay
- Peter MacCallum Cancer Centre, Department of Radiation Engineering, Melbourne, Australia
| | - Mark Wright
- Peter MacCallum Cancer Centre, Department of Radiation Engineering, Melbourne, Australia
| | - Lisa Hall
- Peter MacCallum Cancer Centre, Department of Radiation Therapy, Melbourne, Australia
| | - Alan Easdon
- Peter MacCallum Cancer Centre, Department of Radiation Engineering, Melbourne, Australia
| | - Peter McWiggan
- Peter MacCallum Cancer Centre, Department of Radiation Engineering, Melbourne, Australia
| | - Adam Yeo
- Peter MacCallum Cancer Centre, Department of Physical Sciences, 305 Grattan Street, Melbourne, VIC, 3000, Australia
- School of Applied Sciences, RMIT University, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Elena Ungureanu
- Peter MacCallum Cancer Centre, Department of Physical Sciences, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Tomas Kron
- Peter MacCallum Cancer Centre, Department of Physical Sciences, 305 Grattan Street, Melbourne, VIC, 3000, Australia.
- School of Applied Sciences, RMIT University, Melbourne, Australia.
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia.
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
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Wang J, Xiang ZZ, Tan CF, Zeng YY, Yang T, Wei XY, Yu ST, Dai ZL, Xu NY, Liu L. Individualized 3D-printed bolus promotes precise postmastectomy radiotherapy in patients receiving breast reconstruction. Front Oncol 2023; 13:1239636. [PMID: 38152364 PMCID: PMC10751906 DOI: 10.3389/fonc.2023.1239636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 11/29/2023] [Indexed: 12/29/2023] Open
Abstract
Purpose To evaluate the efficacy and safety of 3D-printed tissue compensations in breast cancer patients receiving breast reconstruction and postmastectomy radiotherapy (PMRT). Methods and materials We enrolled patients with breast cancer receiving breast reconstruction and PMRT. The dose distribution of target and skin, conformability, and dose limit of organs at risk (OARs) were collected to evaluate the efficacy of the 3D-printed bolus. Radiation Therapy Oncology Group (RTOG) radiation injury classification was used to evaluated the skin toxicities. Results A total of 30 patients diagnosed between October 2019 to July 2021 were included for analysis. Among all the patients, the 3D-printed bolus could ensure the dose coverage of planning target volume (PTV) [homogeneity index (HI) 0.12 (range: 0.08-0.18)], and the mean doses of D99%, D98%, D95%, D50%, D2% and Dmean were 4606.29cGy, 4797.04cGy, 4943.32cGy, 5216.07cGy, 5236.10cGy, 5440.28cGy and 5462.10cGy, respectively. The bolus demonstrated an excellent conformability, and the mean air gaps between the bolus and the chest wall in five quadrants were 0.04cm, 0.18cm, 0.04cm, 0.04cm and 0.07cm, respectively. In addition, the bolus had acceptable dosage limit of OARs [ipsilateral lung: Dmean 1198.68 cGy, V5 46.10%, V20 21.66%, V30 16.31%); heart: Dmean 395.40 cGy, V30 1.02%, V40 0.22%; spinal cord planning risk volume (PRV): Dmax 1634 cGy] and skin toxicity (grade 1, 76.0%; grade 2, 21.0%; grade 3, 3.3%). Conclusion The 3D-printed bolus offers advantages in terms of dose uniformity and controllable skin toxicities in patients receiving breast reconstruction and PMRT. Further research is needed to comprehensively evaluate the effectiveness of the 3Dprinted bolus in this patient subset.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Lei Liu
- Division of Head & Neck Tumor Multimodality Treatment, Cancer Center, West, China Hospital, Sichuan University, Chengdu, Sichuan, China
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Johnston A, Callanan A. Recent Methods for Modifying Mechanical Properties of Tissue-Engineered Scaffolds for Clinical Applications. Biomimetics (Basel) 2023; 8:biomimetics8020205. [PMID: 37218791 DOI: 10.3390/biomimetics8020205] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/03/2023] [Accepted: 05/12/2023] [Indexed: 05/24/2023] Open
Abstract
The limited regenerative capacity of the human body, in conjunction with a shortage of healthy autologous tissue, has created an urgent need for alternative grafting materials. A potential solution is a tissue-engineered graft, a construct which supports and integrates with host tissue. One of the key challenges in fabricating a tissue-engineered graft is achieving mechanical compatibility with the graft site; a disparity in these properties can shape the behaviour of the surrounding native tissue, contributing to the likelihood of graft failure. The purpose of this review is to examine the means by which researchers have altered the mechanical properties of tissue-engineered constructs via hybrid material usage, multi-layer scaffold designs, and surface modifications. A subset of these studies which has investigated the function of their constructs in vivo is also presented, followed by an examination of various tissue-engineered designs which have been clinically translated.
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Affiliation(s)
- Andrew Johnston
- Institute for Bioengineering, School of Engineering, University of Edinburgh, Edinburgh EH9 3DW, UK
| | - Anthony Callanan
- Institute for Bioengineering, School of Engineering, University of Edinburgh, Edinburgh EH9 3DW, UK
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Miéville FA, Pitteloud N, Achard V, Lamanna G, Pisaturo O, Tercier PA, Allal AS. Post-mastectomy radiotherapy: Impact of bolus thickness and irradiation technique on skin dose. Z Med Phys 2023:S0939-3889(23)00041-7. [PMID: 37150728 DOI: 10.1016/j.zemedi.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/27/2023] [Accepted: 03/08/2023] [Indexed: 05/09/2023]
Abstract
PURPOSE To determine 10 MV IMRT and VMAT based protocols with a daily bolus targeting a skin dose of 45 Gy in order to replace the 6 MV tangential fields with a 5 mm thick bolus on alternate days method for post-mastectomy radiotherapy. METHOD We measured the mean surface dose along the chest wall PTV as a function of different bolus thicknesses for sliding window IMRT and VMAT plans. We analyzed surface dose profiles and dose homogeneities and compared them to our standard 6 MV strategy. All measurements were performed on a thorax phantom with Gafchromic films while dosimetric plans were computed using the Acuros XB algorithm (Varian). RESULTS We obtained the best compromise between measured surface dose (mean dose and homogeneity) and skin toxicity threshold obtained from the literature using a daily 3 mm thick bolus. Mean surface doses were 91.4 ± 2.8% [85.7% - 95.4%] and 92.2 ± 2.3% [85.6% - 95.2%] of the prescribed dose with IMRT and VMAT techniques, respectively. Our standard 6 MV alternate days 5 mm thick bolus leads to 89.0 ± 3.7% [83.6% - 95.5%]. Mean dose differences between measured and TPS results were < 3.2% for depths as low as 2 mm depth. CONCLUSION 10 MV IMRT-based protocols with a daily 3 mm thick bolus produce a surface dose comparable to the standard 6 MV 5 mm thick bolus on alternate days method but with an improved surface dose homogeneity. This allows for a better control of skin toxicity and target volume coverage.
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Affiliation(s)
- Frédéric A Miéville
- Department of Radiation Oncology, Hôpital Fribourgeois, 2-6 Chemin des Pensionnats, 1752 Villars-sur-Glâne, Fribourg, Switzerland.
| | - Nicolas Pitteloud
- Department of Radiation Oncology, Hôpital Fribourgeois, 2-6 Chemin des Pensionnats, 1752 Villars-sur-Glâne, Fribourg, Switzerland
| | - Vérane Achard
- Department of Radiation Oncology, Hôpital Fribourgeois, 2-6 Chemin des Pensionnats, 1752 Villars-sur-Glâne, Fribourg, Switzerland
| | - Giorgio Lamanna
- Department of Radiation Oncology, Hôpital Fribourgeois, 2-6 Chemin des Pensionnats, 1752 Villars-sur-Glâne, Fribourg, Switzerland
| | - Olivier Pisaturo
- Department of Radiation Oncology, Hôpital Fribourgeois, 2-6 Chemin des Pensionnats, 1752 Villars-sur-Glâne, Fribourg, Switzerland
| | - Pierre-Alain Tercier
- Department of Radiation Oncology, Hôpital Fribourgeois, 2-6 Chemin des Pensionnats, 1752 Villars-sur-Glâne, Fribourg, Switzerland
| | - Abdelkarim S Allal
- Department of Radiation Oncology, Hôpital Fribourgeois, 2-6 Chemin des Pensionnats, 1752 Villars-sur-Glâne, Fribourg, Switzerland
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Gong P, Dai G, Wu X, Wang X, Xie L, Xu S, Zhong R. Application of thermoplastic elastomer (TPE) bolus in postmastectomy radiotherapy. Breast 2022; 66:317-323. [PMID: 36463642 PMCID: PMC9719108 DOI: 10.1016/j.breast.2022.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/10/2022] [Accepted: 11/27/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To assess the planned dose, in vivo dosimetry, acute skin toxicity, pain, and distress using Thermoplastic Elastomer (TPE) bolus for postmastectomy radiotherapy (PMRT). MATERIAL AND METHODS Thirty-two PMRT patients with TPE bolus (17 patients for 25 fractions, 15 patients for the first 20 fractions) were selected for the study. The acute skin toxicity, pain, and psychological distress were assessed from the first treatment week to the fourth week after the end of treatment. At the first treatment, the MOSFET was used in vivo dosimetry measurement. RESULTS In vivo dosimetry with the bolus, the dose deviation ranged from -6.22% to -1.56% for 5 points. The presence of grade 1 and 2 skin toxicity reached its peak (70.0% and 13.3%) in the sixth week. Two patients (6.6%) with 25 fractions bolus experienced moist desquamation in the fifth and seventh week, with pain score 2 and 3, and interruptions of 3 and 5 days, respectively. The incidence of pain score 1, 2, and 3 peaked in the fifth (33.3%), fourth (33.3%), and seventh (10.0%) week. No patients experienced grade 3 skin toxicity and severe pain. One patient had significant anxiety, and two patients had significant depression. CONCLUSION The TPE bolus can accurately fit skin and improve the surface dose to more than 90%. Twenty fractions with TPE bolus had similar skin toxicity and pain to those without bolus and did not increase patients' distress and clinical workload, compared with the literature's data, which is an alternative to the 3D printing bolus for PMRT.
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Affiliation(s)
- Pan Gong
- Radiotherapy Physics and Technology Center, Cancer Center, West China School of Medicine, West China Hospital of Sichuan University, Chengdu, 610041, PR China
| | - Guyu Dai
- Radiotherapy Physics and Technology Center, Cancer Center, West China School of Medicine, West China Hospital of Sichuan University, Chengdu, 610041, PR China
| | - Xiaoyu Wu
- Department of Respiratory Critical Care Medicine/Thoracic Surgery, West China School of Medicine, West China Hospital of Sichuan University, Chengdu, 610041, PR China
| | - Xuetao Wang
- Radiotherapy Physics and Technology Center, Cancer Center, West China School of Medicine, West China Hospital of Sichuan University, Chengdu, 610041, PR China
| | - Li Xie
- Department of Radiotherapy/Department of Head and Neck Oncology, West China School of Medicine, West China Hospital of Sichuan University, Chengdu, 610041, PR China
| | - Shuni Xu
- Radiotherapy Physics and Technology Center, Cancer Center, West China School of Medicine, West China Hospital of Sichuan University, Chengdu, 610041, PR China
| | - Renming Zhong
- Radiotherapy Physics and Technology Center, Cancer Center, West China School of Medicine, West China Hospital of Sichuan University, Chengdu, 610041, PR China.
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