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Barcena AJR, Ravi P, Kundu S, Tappa K. Emerging Biomedical and Clinical Applications of 3D-Printed Poly(Lactic Acid)-Based Devices and Delivery Systems. Bioengineering (Basel) 2024; 11:705. [PMID: 39061787 PMCID: PMC11273440 DOI: 10.3390/bioengineering11070705] [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: 06/26/2024] [Revised: 07/06/2024] [Accepted: 07/07/2024] [Indexed: 07/28/2024] Open
Abstract
Poly(lactic acid) (PLA) is widely used in the field of medicine due to its biocompatibility, versatility, and cost-effectiveness. Three-dimensional (3D) printing or the systematic deposition of PLA in layers has enabled the fabrication of customized scaffolds for various biomedical and clinical applications. In tissue engineering and regenerative medicine, 3D-printed PLA has been mostly used to generate bone tissue scaffolds, typically in combination with different polymers and ceramics. PLA's versatility has also allowed the development of drug-eluting constructs for the controlled release of various agents, such as antibiotics, antivirals, anti-hypertensives, chemotherapeutics, hormones, and vitamins. Additionally, 3D-printed PLA has recently been used to develop diagnostic electrodes, prostheses, orthoses, surgical instruments, and radiotherapy devices. PLA has provided a cost-effective, accessible, and safer means of improving patient care through surgical and dosimetry guides, as well as enhancing medical education through training models and simulators. Overall, the widespread use of 3D-printed PLA in biomedical and clinical settings is expected to persistently stimulate biomedical innovation and revolutionize patient care and healthcare delivery.
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Affiliation(s)
- Allan John R. Barcena
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
- College of Medicine, University of the Philippines Manila, Manila 1000, Philippines
| | - Prashanth Ravi
- Department of Radiology, University of Cincinnati, Cincinnati, OH 45219, USA;
| | - Suprateek Kundu
- Department of Biostatistics, Division of Basic Science Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Karthik Tappa
- Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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2
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Ewongwo A, Niedermayr T, Kidd EA. Design approach and benefits of the 3D-printed vaginal individualized applicator (VIA). Brachytherapy 2024; 23:282-289. [PMID: 38402047 DOI: 10.1016/j.brachy.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/05/2024] [Accepted: 01/18/2024] [Indexed: 02/26/2024]
Abstract
PURPOSE Interstitial gynecologic brachytherapy necessitates precise needle placement, requiring time and expertise. We aimed to simplify interstitial procedures and facilitate optimal needle distribution with individualized vaginal templates to guide interstitial needles. MATERIALS/METHODS We developed the 3D-printed vaginal individualized applicator (VIA), a cylindrical template containing individualized internal channels that guide interstitial needles to cover the tumor extent. Eight patients underwent VIA only interstitial implants (VIA only), and five intact cervical cases were treated using tandem and customized VIA (VIA + T). Procedure length, number of needles utilized and dosimetric measures were evaluated. RESULTS VIA was successfully designed and used clinically for 24 procedures (8 VIA only, 16 VIA + T). Average procedure needle insertion time reduced from 80.9 min for traditional interstitial to 42.9 min for VIA only, approximately 47% shorter with a similar mean high risk CTV volume (28.3 cc VIA only vs. 32.4 cc) and excellent dosimetry with average CTV V100% (94.3% and 94.4%). VIA + T was particularly useful in patients with small vaginal canals and large tumor size. For the five VIA + T patients average tumor size was 68.0cc (range 26.6-143.5 cc). VIA + T procedures were approximately 20% shorter than hybrid procedures with other applicators with mean length of 20.1 min and an average of 6.8 needles (range 3-12). CONCLUSION Our novel 3D-printed VIA facilitates gynecologic interstitial brachytherapy by simplifying needle placement, reducing procedure time, and maintaining excellent dosimetry. VIA can be customized for various clinical scenarios, particularly beneficial for large tumors or small vaginal canals.
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Affiliation(s)
- Agnes Ewongwo
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | | | - Elizabeth A Kidd
- Department of Radiation Oncology, Stanford University, Stanford, CA.
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3
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Meftahi M, Song WY. The effect of vaginal cylinder inhomogeneity on the HDR brachytherapy dose calculations using Monte Carlo simulations. J Appl Clin Med Phys 2024; 25:e14228. [PMID: 38043126 PMCID: PMC10795442 DOI: 10.1002/acm2.14228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 10/07/2023] [Accepted: 11/02/2023] [Indexed: 12/05/2023] Open
Abstract
PURPOSE To analytically assess the heterogeneity effect of vaginal cylinders (VC) made of high-density plastics on dose calculations, considering the prescription point (surface or 5 mm beyond the surface), and benchmark the accuracy of a commercial model-based dose calculation (MBDC) algorithm using Monte Carlo (MC) simulations. METHODS AND MATERIALS The GEANT4 MC code was used to simulate a commercial 192 Ir HDR source and VC, with diameters ranging from 20 to 35 mm, inside a virtual water phantom. Standard plans were generated from a commercial treatment planning system [TPS-BrachyVision ACUROS (BV)] optimized for a treatment length of 5 cm through two dose calculation approaches: (1) assuming all the environment as water (i.e., Dw,w-MC & Dw,w-TG43 ) and (2) accounting for the heterogeneity of VC applicators (i.e., Dw,w-App-MC & Dw,w-App-MBDC ). The compared isodose lines, and dose & energy difference maps were extracted for analysis. In addition, the dose difference on the peripheral surface, along the applicator and at middle of treatment length, as well as apical tip was evaluated. RESULTS The Dw,w-App-MC results indicated that the VC heterogeneity can cause a dose reduction of (up to) % 6.8 on average (for all sizes) on the peripheral surface, translating to 1 mm shrinkage of the isodose lines compared to Dw,w-MC . In addition, the results denoted that BV overestimates the dose on the peripheral surface and apical tip of about 3.7% and 17.9%, respectively, (i.e., Dw,w-App-MBDC vs Dw,w-App-MC ) when prescribing to the surface. However, the difference between the two were negligible at the prescription point when prescribing to 5 mm beyond the surface. CONCLUSION The VCs' heterogeneity could cause dose reduction when prescribing dose to the surface of the applicator, and hence increases the level of uncertainty. Thus, reviewing the TG43 results, in addition to ACUROS, becomes prudent, when evaluating the surface coverage at the apex.
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Affiliation(s)
- Moeen Meftahi
- Department of Radiation OncologyVirginia Commonwealth UniversityRichmondVirginiaUSA
- Department of Radiation Oncology and Winship Cancer InstituteEmory UniversityAtlantaGeorgiaUSA
| | - William Y. Song
- Department of Radiation OncologyVirginia Commonwealth UniversityRichmondVirginiaUSA
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Segedin B, Kobav M, Zobec Logar HB. The Use of 3D Printing Technology in Gynaecological Brachytherapy-A Narrative Review. Cancers (Basel) 2023; 15:4165. [PMID: 37627193 PMCID: PMC10452889 DOI: 10.3390/cancers15164165] [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: 07/29/2023] [Revised: 08/13/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Radiation therapy, including image-guided adaptive brachytherapy based on magnetic resonance imaging, is the standard of care in locally advanced cervical and vaginal cancer and part of the treatment in other primary and recurrent gynaecological tumours. Tumour control probability increases with dose and brachytherapy is the optimal technique to increase the dose to the target volume while maintaining dose constraints to organs at risk. The use of interstitial needles is now one of the quality indicators for cervical cancer brachytherapy and needles should optimally be used in ≥60% of patients. Commercially available applicators sometimes cannot be used because of anatomical barriers or do not allow adequate target volume coverage due to tumour size or topography. Over the last five to ten years, 3D printing has been increasingly used for manufacturing of customised applicators in brachytherapy, with gynaecological tumours being the most common indication. We present the rationale, techniques and current clinical evidence for the use of 3D-printed applicators in gynaecological brachytherapy.
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Affiliation(s)
- Barbara Segedin
- Department of Radiation Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia; (M.K.); (H.B.Z.L.)
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Manja Kobav
- Department of Radiation Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia; (M.K.); (H.B.Z.L.)
| | - Helena Barbara Zobec Logar
- Department of Radiation Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia; (M.K.); (H.B.Z.L.)
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
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Fahimian BP, Liu W, Skinner L, Yu AS, Phillips T, Steers JM, DeMarco J, Fraass BA, Kamrava M. 3D printing in brachytherapy: A systematic review of gynecological applications. Brachytherapy 2023; 22:446-460. [PMID: 37024350 DOI: 10.1016/j.brachy.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/27/2022] [Accepted: 02/02/2023] [Indexed: 04/08/2023]
Abstract
PURPOSE To provide a systematic review of the applications of 3D printing in gynecological brachytherapy. METHODS Peer-reviewed articles relating to additive manufacturing (3D printing) from the 34 million plus biomedical citations in National Center for Biotechnology Information (NCBI/PubMed), and 53 million records in Web of Science (Clarivate) were queried for 3D printing applications. The results were narrowed sequentially to, (1) all literature in 3D printing with final publications prior to July 2022 (in English, and excluding books, proceedings, and reviews), and then to applications in, (2) radiotherapy, (3) brachytherapy, (4) gynecological brachytherapy. Brachytherapy applications were reviewed and grouped by disease site, with gynecological applications additionally grouped by study type, methodology, delivery modality, and device type. RESULTS From 47,541 3D printing citations, 96 publications met the inclusion criteria for brachytherapy, with gynecological clinical applications compromising the highest percentage (32%), followed by skin and surface (19%), and head and neck (9%). The distribution of delivery modalities was 58% for HDR (Ir-192), 35% for LDR (I-125), and 7% for other modalities. In gynecological brachytherapy, studies included design of patient specific applicators and templates, novel applicator designs, applicator additions, quality assurance and dosimetry devices, anthropomorphic gynecological applicators, and in-human clinical trials. Plots of year-to-year growth demonstrate a rapid nonlinear trend since 2014 due to the improving accessibility of low-cost 3D printers. Based on these publications, considerations for clinical use are provided. CONCLUSIONS 3D printing has emerged as an important clinical technology enabling customized applicator and template designs, representing a major advancement in the methodology for implantation and delivery in gynecological brachytherapy.
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Affiliation(s)
- Benjamin P Fahimian
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA.
| | - Wu Liu
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Lawrie Skinner
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Amy S Yu
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Tiffany Phillips
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jennifer M Steers
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - John DeMarco
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Benedick A Fraass
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Mitchell Kamrava
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
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Kozee M, Weygand J, Andreozzi JM, Hunt D, Perez BA, Graham JA, Redler G. Methodology for computed tomography characterization of commercially available 3D printing materials for use in radiology/radiation oncology. J Appl Clin Med Phys 2023:e13999. [PMID: 37096305 DOI: 10.1002/acm2.13999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/28/2023] [Accepted: 04/01/2023] [Indexed: 04/26/2023] Open
Abstract
3D printing in medical physics provides opportunities for creating patient-specific treatment devices and in-house fabrication of imaging/dosimetry phantoms. This study characterizes several commercial fused deposition 3D printing materials with some containing nonstandard compositions. It is important to explore their similarities to human tissues and other materials encountered in patients. Uniform cylinders with infill from 50 to 100% at six evenly distributed intervals were printed using 13 different filaments. A novel approach rotating infill angle 10o between each layer avoids unwanted patterns. Five materials contained high-Z/metallic components. A clinical CT scanner with a range of tube potentials (70, 80, 100, 120, 140 kVp) was used. Density and average Hounsfield unit (HU) were measured. A commercial GAMMEX phantom mimicking various human tissues provides a comparison. Utility of the lookup tables produced is demonstrated. A methodology for calibrating print materials/parameters for a desired HU is presented. Density and HU were determined for all materials as a function of tube voltage (kVp) and infill percentage. The range of HU (-732.0-10047.4 HU) and physical densities (0.36-3.52 g/cm3 ) encompassed most tissues/materials encountered in radiology/radiotherapy applications with many overlapping those of human tissues. Printing filaments doped with high-Z materials demonstrated increased attenuation due to the photoelectric effect with decreased kVp, as found in certain endogenous materials (e.g., bone). HU was faithfully reproduced (within one standard deviation) in a 3D-printed mimic of a commercial anthropomorphic phantom section. Characterization of commercially available 3D print materials facilitates custom object fabrication for use in radiology and radiation oncology, including human tissue and common exogenous implant mimics. This allows for cost reduction and increased flexibility to fabricate novel phantoms or patient-specific devices imaging and dosimetry purposes. A formalism for calibrating to specific CT scanner, printer, and filament type/batch is presented. Utility is demonstrated by printing a commercial anthropomorphic phantom copy.
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Affiliation(s)
- Madison Kozee
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Joseph Weygand
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | | | - Dylan Hunt
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Bradford A Perez
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Jasmine A Graham
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Gage Redler
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA
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Cooke CM, Flaxman TE, Sikora L, Miguel O, Singh SS. Individualized medicine using 3D printing technology in gynecology: a scoping review. 3D Print Med 2023; 9:6. [PMID: 36932284 PMCID: PMC10024374 DOI: 10.1186/s41205-023-00169-9] [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: 01/30/2023] [Accepted: 02/17/2023] [Indexed: 03/19/2023] Open
Abstract
OBJECTIVE Developments in 3-dimensional (3D) printing technology has made it possible to produce high quality, affordable 3D printed models for use in medicine. As a result, there is a growing assessment of this approach being published in the medical literature. The objective of this study was to outline the clinical applications of individualized 3D printing in gynecology through a scoping review. DATA SOURCES Four medical databases (Medline, Embase, Cochrane CENTRAL, Scopus) and grey literature were searched for publications meeting eligibility criteria up to 31 May 2021. STUDY ELIGIBILITY CRITERIA Publications were included if they were published in English, had a gynecologic context, and involved production of patient specific 3D printed product(s). STUDY APPRAISAL AND SYNTHESIS METHODS Studies were manually screened and assessed for eligibility by two independent reviewers and data were extracted using pre-established criteria using Covidence software. RESULTS Overall, 32 studies (15 abstracts,17 full text articles) were included in the scoping review. Most studies were either case reports (12/32,38%) or case series (15/32,47%). Gynecologic sub-specialties in which the 3D printed models were intended for use included: gynecologic oncology (21/32,66%), benign gynecology (6/32,19%), pediatrics (2/32,6%), urogynecology (2/32,6%) and reproductive endocrinology and infertility (1/32,3%). Twenty studies (63%) printed 5 or less models, 6/32 studies (19%) printed greater than 5 (up to 50 models). Types of 3D models printed included: anatomical models (11/32,34%), medical devices, (2/32,6%) and template/guide/cylindrical applicators for brachytherapy (19/32,59%). CONCLUSIONS Our scoping review has outlined novel clinical applications for individualized 3D printed models in gynecology. To date, they have mainly been used for production of patient specific 3D printed brachytherapy guides/applicators in patients with gynecologic cancer. However, individualized 3D printing shows great promise for utility in surgical planning, surgical education, and production of patient specific devices, across gynecologic subspecialties. Evidence supporting the clinical value of individualized 3D printing in gynecology is limited by studies with small sample size and non-standardized reporting, which should be the focus of future studies.
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Affiliation(s)
- Carly M Cooke
- Department of Obstetrics, Gynecology and Newborn Care, University of Ottawa, Ottawa, Ontario, Canada
| | - Teresa E Flaxman
- Department of Obstetrics, Gynecology and Newborn Care, University of Ottawa, Ottawa, Ontario, Canada
- Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Radiology, Radiation Oncology and Medical Physics, University of Ottawa, Ottawa, Ontario, Canada
| | - Lindsey Sikora
- Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada
| | - Olivier Miguel
- Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Radiology, Radiation Oncology and Medical Physics, University of Ottawa, Ottawa, Ontario, Canada
| | - Sukhbir S Singh
- Department of Obstetrics, Gynecology and Newborn Care, University of Ottawa, Ottawa, Ontario, Canada.
- Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
- Department of Obstetrics and Gynecology, The Ottawa Hospital, Riverside Campus, 1967 Riverside Dr., 7th Floor, Ottawa, Ontario, K1H 7W9, Canada.
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Meftahi M, Fields E, Guy C, Song WY. The Design of a Novel Direction Modulated Brachytherapy Vaginal Cylinder Applicator for Optimizing Coverage of the Apex. Med Phys 2022; 49:3926-3935. [DOI: 10.1002/mp.15666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 03/03/2022] [Accepted: 01/28/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Moeen Meftahi
- Department of Radiation Oncology Virginia Commonwealth University Richmond Virginia USA
| | - Emma Fields
- Department of Radiation Oncology Virginia Commonwealth University Richmond Virginia USA
| | - Christopher Guy
- Department of Radiation Oncology Virginia Commonwealth University Richmond Virginia USA
| | - William Y. Song
- Department of Radiation Oncology Virginia Commonwealth University Richmond Virginia USA
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Meyer-Szary J, Luis MS, Mikulski S, Patel A, Schulz F, Tretiakow D, Fercho J, Jaguszewska K, Frankiewicz M, Pawłowska E, Targoński R, Szarpak Ł, Dądela K, Sabiniewicz R, Kwiatkowska J. The Role of 3D Printing in Planning Complex Medical Procedures and Training of Medical Professionals-Cross-Sectional Multispecialty Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3331. [PMID: 35329016 PMCID: PMC8953417 DOI: 10.3390/ijerph19063331] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/18/2022] [Accepted: 03/05/2022] [Indexed: 12/19/2022]
Abstract
Medicine is a rapidly-evolving discipline, with progress picking up pace with each passing decade. This constant evolution results in the introduction of new tools and methods, which in turn occasionally leads to paradigm shifts across the affected medical fields. The following review attempts to showcase how 3D printing has begun to reshape and improve processes across various medical specialties and where it has the potential to make a significant impact. The current state-of-the-art, as well as real-life clinical applications of 3D printing, are reflected in the perspectives of specialists practicing in the selected disciplines, with a focus on pre-procedural planning, simulation (rehearsal) of non-routine procedures, and on medical education and training. A review of the latest multidisciplinary literature on the subject offers a general summary of the advances enabled by 3D printing. Numerous advantages and applications were found, such as gaining better insight into patient-specific anatomy, better pre-operative planning, mock simulated surgeries, simulation-based training and education, development of surgical guides and other tools, patient-specific implants, bioprinted organs or structures, and counseling of patients. It was evident that pre-procedural planning and rehearsing of unusual or difficult procedures and training of medical professionals in these procedures are extremely useful and transformative.
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Affiliation(s)
- Jarosław Meyer-Szary
- Department of Pediatric Cardiology and Congenital Heart Defects, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Marlon Souza Luis
- Department of Pediatric Cardiology and Congenital Heart Defects, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
- First Doctoral School, Medical University of Gdańsk, 80-211 Gdańsk, Poland
| | - Szymon Mikulski
- Department of Head and Neck Surgery, Singapore General Hospital, Singapore 169608, Singapore
| | - Agastya Patel
- First Doctoral School, Medical University of Gdańsk, 80-211 Gdańsk, Poland
- Department of General, Endocrine and Transplant Surgery, Faculty of Medicine, Medical University of Gdańsk, 80-214 Gdańsk, Poland
| | - Finn Schulz
- University Clinical Centre in Gdańsk, 80-952 Gdańsk, Poland
| | - Dmitry Tretiakow
- Department of Otolaryngology, Faculty of Medicine, Medical University of Gdańsk, 80-214 Gdańsk, Poland
| | - Justyna Fercho
- Neurosurgery Department, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Kinga Jaguszewska
- Department of Gynecology, Obstetrics and Neonatology, Division of Gynecology and Obstetrics, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Mikołaj Frankiewicz
- Department of Urology, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Ewa Pawłowska
- Department of Oncology and Radiotherapy, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Radosław Targoński
- 1st Department of Cardiology, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Łukasz Szarpak
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, 03-411 Warsaw, Poland
- Research Unit, Maria Sklodowska-Curie Bialystok Oncology Center, 15-027 Bialystok, Poland
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Katarzyna Dądela
- Department of Pediatric Cardiology, University Children's Hospital, Faculty of Medicine, Jagiellonian University Medical College, 30-663 Krakow, Poland
| | - Robert Sabiniewicz
- Department of Pediatric Cardiology and Congenital Heart Defects, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Joanna Kwiatkowska
- Department of Pediatric Cardiology and Congenital Heart Defects, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
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10
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Song WY, Robar JL, Morén B, Larsson T, Carlsson Tedgren Å, Jia X. Emerging technologies in brachytherapy. Phys Med Biol 2021; 66. [PMID: 34710856 DOI: 10.1088/1361-6560/ac344d] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/28/2021] [Indexed: 01/15/2023]
Abstract
Brachytherapy is a mature treatment modality. The literature is abundant in terms of review articles and comprehensive books on the latest established as well as evolving clinical practices. The intent of this article is to part ways and look beyond the current state-of-the-art and review emerging technologies that are noteworthy and perhaps may drive the future innovations in the field. There are plenty of candidate topics that deserve a deeper look, of course, but with practical limits in this communicative platform, we explore four topics that perhaps is worthwhile to review in detail at this time. First, intensity modulated brachytherapy (IMBT) is reviewed. The IMBT takes advantage ofanisotropicradiation profile generated through intelligent high-density shielding designs incorporated onto sources and applicators such to achieve high quality plans. Second, emerging applications of 3D printing (i.e. additive manufacturing) in brachytherapy are reviewed. With the advent of 3D printing, interest in this technology in brachytherapy has been immense and translation swift due to their potential to tailor applicators and treatments customizable to each individual patient. This is followed by, in third, innovations in treatment planning concerning catheter placement and dwell times where new modelling approaches, solution algorithms, and technological advances are reviewed. And, fourth and lastly, applications of a new machine learning technique, called deep learning, which has the potential to improve and automate all aspects of brachytherapy workflow, are reviewed. We do not expect that all ideas and innovations reviewed in this article will ultimately reach clinic but, nonetheless, this review provides a decent glimpse of what is to come. It would be exciting to monitor as IMBT, 3D printing, novel optimization algorithms, and deep learning technologies evolve over time and translate into pilot testing and sensibly phased clinical trials, and ultimately make a difference for cancer patients. Today's fancy is tomorrow's reality. The future is bright for brachytherapy.
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Affiliation(s)
- William Y Song
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - James L Robar
- Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Björn Morén
- Department of Mathematics, Linköping University, Linköping, Sweden
| | - Torbjörn Larsson
- Department of Mathematics, Linköping University, Linköping, Sweden
| | - Åsa Carlsson Tedgren
- Radiation Physics, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Oncology Pathology, Karolinska Institute, Stockholm, Sweden
| | - Xun Jia
- Innovative Technology Of Radiotherapy Computations and Hardware (iTORCH) Laboratory, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
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11
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A novel use of 3D-printed template in vaginal HDR brachytherapy. Brachytherapy 2021; 21:238-243. [PMID: 34702651 DOI: 10.1016/j.brachy.2021.09.005] [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: 07/01/2021] [Revised: 09/13/2021] [Accepted: 09/19/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE The High-Dose-Rate (HDR) vaginal cylinder treatment is typically designed using the initial CT, while the subsequent implants are verified using rudimentary methods (i.e., visual inspection, ruler measurements, etc.) and/or X-ray imaging. We are proposing the use of a 3D-printed individualized template that could provide simple and reproducible vaginal cylinder insertion. MATERIAL AND METHODS Six patients were included in the study with prescriptions of 6 Gy/fraction for 2 to 5 fractions (total 27 treatments). The first 1 to 2 treatments were delivered without the template and the rest with the CT-based 3D-printed templates. Cone beam CTs (CBCTs) were acquired to verify the cylinder placement for all treatments. D2cc of the bladder and rectum are recorded on both planning CT and the following on-treatment CBCTs. RESULTS By using the templates, the tip position variation on average (±1 SD) reduced from 0.8±0.5 cm to 0.6±0.4 cm, and angular difference decreased from 5.3±3.5° to 4.7±2.4°. The pitch and yaw deviation are reduced from 0.9 ± 5.8° and 0.4±2.9° to 0.0±3.9° and -0.2±3.0°, respectively. The deviation of D2cc to bladder from the plan reduced from 6±4% to 5±3%, and rectum from 5±2% to 4±4%. CONCLUSION The 3D-printed patient-specific cylinder templates could potentially improve the geometrical reproducibility of cylinder treatments at no cost of additional imaging. The D2cc for the bladder and rectum are determined by the treatment length rather than their respective volumes.
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