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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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Wang X, Zhao J, Xiang Z, Wang X, Zeng Y, Luo T, Yan X, Zhang Z, Wang F, Liu L. 3D-printed bolus ensures the precise postmastectomy chest wall radiation therapy for breast cancer. Front Oncol 2022; 12:964455. [PMID: 36119487 PMCID: PMC9478602 DOI: 10.3389/fonc.2022.964455] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To investigate the values of a 3D-printed bolus ensuring the precise postmastectomy chest wall radiation therapy for breast cancer. Methods and materials In the preclinical study on the anthropomorphic phantom, the 3D-printed bolus was used for dosimetry and fitness evaluation. The dosimetric parameters of planning target volume (PTV) were assessed, including Dmin, Dmax, Dmean, D95%, homogeneity index (HI), conformity index (CI), and organs at risk (OARs). The absolute percentage differences (|%diff|) between the theory and fact skin dose were also estimated, and the follow-up was conducted for potential skin side effects. Results In preclinical studies, a 3D-printed bolus can better ensure the radiation coverage of PTV (HI 0.05, CI 99.91%), the dose accuracy (|%diff| 0.99%), and skin fitness (mean air gap 1.01 mm). Of the 27 eligible patients, we evaluated the radiation dose parameter (median(min–max): Dmin 4967(4789–5099) cGy, Dmax 5447(5369–5589) cGy, Dmean 5236(5171–5323) cGy, D95% 5053(4936–5156) cGy, HI 0.07 (0.06–0.17), and CI 99.94% (97.41%–100%)) and assessed the dose of OARs (ipsilateral lung: Dmean 1341(1208–1385) cGy, V5 48.06%(39.75%–48.97%), V20 24.55%(21.58%–26.93%), V30 18.40%(15.96%–19.16%); heart: Dmean 339(138–640) cGy, V30 1.10%(0%–6.14%), V40 0.38%(0%–4.39%); spinal cord PRV: Dmax 639(389–898) cGy). The skin doses in vivo were Dtheory 208.85(203.16–212.53) cGy, Dfact 209.53(204.14–214.42) cGy, and |%diff| 1.77% (0.89–2.94%). Of the 360 patients enrolled in the skin side effect follow-up study (including the above 27 patients), grade 1 was the most common toxicity (321, 89.2%), some of which progressing to grade 2 or grade 3 (32, 8.9% or 7, 1.9%); the radiotherapy interruption rate was 1.1%. Conclusion A 3D-printed bolus can guarantee the precise radiation dose on skin surface, good fitness to skin, and controllable acute skin toxicity, which possesses a great clinical application value in postmastectomy chest call radiation therapy for breast cancer.
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Affiliation(s)
- Xiran Wang
- Department of Head and Neck and Mammary Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Jianling Zhao
- Department of Radiotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Zhongzheng Xiang
- Department of Head and Neck and Mammary Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Xuetao Wang
- Department of Radiotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Yuanyuan Zeng
- Department of Head and Neck and Mammary Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Ting Luo
- Department of Head and Neck and Mammary Oncology, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu, China
| | - Xi Yan
- Department of Head and Neck and Mammary Oncology, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu, China
| | - Zhuang Zhang
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Feng Wang
- Department of Head and Neck and Mammary Oncology, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Liu
- Department of Head and Neck and Mammary Oncology, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Lei Liu,
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Pollmann S, Toussaint A, Flentje M, Wegener S, Lewitzki V. Dosimetric Evaluation of Commercially Available Flat vs. Self-Produced 3D-Conformal Silicone Boluses for the Head and Neck Region. Front Oncol 2022; 12:881439. [PMID: 36033533 PMCID: PMC9399510 DOI: 10.3389/fonc.2022.881439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background Boluses are routinely used in radiotherapy to modify surface doses. Nevertheless, considerable dose discrepancies may occur in some cases due to fit inaccuracy of commercially available standard flat boluses. Moreover, due to the simple geometric design of conventional boluses, also surrounding healthy skin areas may be unintentionally covered, resulting in the unwanted dose buildup. With the fused deposition modeling (FDM) technique, there is a simple and possibly cost-effective way to solve these problems in routine clinical practice. This paper presents a procedure of self-manufacturing bespoke patient-specific silicone boluses and the evaluation of buildup and fit accuracy in comparison to standard rectangular commercially available silicone boluses. Methods 3D-conformal silicone boluses were custom-built to cover the surgical scar region of 25 patients who received adjuvant radiotherapy of head and neck cancer at the University Hospital Würzburg. During a standard CT-based planning procedure, a 5-mm-thick 3D bolus contour was generated to cover the radiopaque marked surgical scar with an additional safety margin. From these digital contours, molds were 3D printed and poured with silicone. Dose measurements for both types of boluses were performed with radiochromic films (EBT3) at three points per patient—at least one aimed to be in the high-dose area (scar) and one in the lower-dose area (spared healthy skin). Surface–bolus distance, which ideally should not be present, was determined from cone-beam CT performed for positioning control. The dosimetric influence of surface–bolus distance was also determined on slab phantom for different field sizes. The trial was performed with hardware that may be routinely available in every radiotherapy department, with the exception of the 3D printer. The required number of patients was determined based on the results of preparatory measurements with the help of the statistical consultancy of the University of Würzburg. The number of measuring points represents the total number of patients. Results In the high-dose area of the scar, there was a significantly better intended dose buildup of 2.45% (95%CI 0.0014–0.0477, p = 0.038, N = 30) in favor of a 3D-conformal bolus. Median distances between the body surface and bolus differed significantly between 3D-conformal and commercially available boluses (3.5 vs. 7.9 mm, p = 0.001). The surface dose at the slab phantom did not differ between commercially available and 3D-conformal boluses. Increasing the surface–bolus distance from 5 to 10 mm decreased the surface dose by approximately 2% and 11% in the 6 × 6- and 3 × 3-cm2 fields, respectively. In comparison to the commercially available bolus, an unintended dose buildup in the healthy skin areas was reduced by 25.9% (95%CI 19.5–32.3, p < 0.01, N = 37) using the 3D-conformal bolus limited to the region surrounding the surgical scar. Conclusions Using 3D-conformal boluses allows a comparison to the commercially available boluses’ dose buildup in the covered areas. Smaller field size is prone to a larger surface–bolus distance effect. Higher conformity of 3D-conformal boluses reduces this effect. This may be especially relevant for volumetric modulated arc therapy (VMAT) and intensity-modulated radiotherapy (IMRT) techniques with a huge number of smaller fields. High conformity of 3D-conformal boluses reduces an unintended dose buildup in healthy skin. The limiting factor in the conformity of 3D-conformal boluses in our setting was the immobilization mask, which was produced primarily for the 3D boluses. The mask itself limited tight contact of subsequently produced 3D-conformal boluses to the mask-covered body areas. In this respect, bolus adjustment before mask fabrication will be done in the future setting.
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Chatchumnan N, Kingkaew S, Aumnate C, Sanghangthum T. Development and dosimetric verification of 3D customized bolus in head and neck radiotherapy. JOURNAL OF RADIATION RESEARCH 2022; 63:428-434. [PMID: 35420693 PMCID: PMC9124618 DOI: 10.1093/jrr/rrac013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/05/2022] [Indexed: 06/14/2023]
Abstract
The commercial flat bolus cannot form perfect contact with the irregular surface of the patient's skin, resulting in an air gap. The purpose of this study was to evaluate the feasibility of using a 3D customized bolus from silicone rubber. The silicone rubber boluses were studied in basic characteristics. The 3D customized bolus was fabricated at the nose, cheek and neck regions. The point dose and planar dose differences were evaluated by comparing with virtual bolus. The hardness, thickness, density, Hounsfield unit (HU) and dose attenuation of the customized bolus were quite similar to a commercial bolus. When a 3D customized bolus was placed on the RANDO phantom, it can significantly increase buildup region doses and perfectly fit against the irregular surface shape. The average point dose differences of 3D customized bolus were -1.1%, while the commercial bolus plans showed -1.7%. The average gamma results for planar dose differences comparison of 3D customized bolus were 93.9%, while the commercial bolus plans were reduced to 91.9%. Overall, A silicone rubber bolus produced the feasible dosimetric properties and could save cost compared to a commercial bolus. The 3D printed customized bolus is a good buildup material and could potentially replace and improve treatment efficiency.
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Affiliation(s)
- Nichakan Chatchumnan
- Division of Radiation Oncology, Department of Radiology, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Sakda Kingkaew
- Division of Radiation Oncology, Department of Radiology, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Chuanchom Aumnate
- Metallurgy and Materials Science Research Institute Chulalongkorn University, Bangkok 10330, Thailand
| | - Taweap Sanghangthum
- Corresponding author. Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand. E-mail address:
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Malone C, Gill E, Lott T, Rogerson C, Keogh S, Mousli M, Carroll D, Kelly C, Gaffney J, McClean B. Evaluation of the quality of fit of flexible bolus material created using 3D printing technology. J Appl Clin Med Phys 2022; 23:e13490. [PMID: 35048501 PMCID: PMC8906215 DOI: 10.1002/acm2.13490] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/12/2021] [Accepted: 11/12/2021] [Indexed: 11/09/2022] Open
Abstract
Aims Materials and methods Results Conclusion
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Affiliation(s)
- Ciaran Malone
- St. Luke's Radiation Oncology Network Dublin, Ireland
| | - Elaine Gill
- St. Luke's Radiation Oncology Network Dublin, Ireland
| | - Tanith Lott
- St. Luke's Radiation Oncology Network Dublin, Ireland
| | | | - Sinead Keogh
- St. Luke's Radiation Oncology Network Dublin, Ireland
| | - Majed Mousli
- St. Luke's Radiation Oncology Network Dublin, Ireland
| | | | | | - John Gaffney
- St. Luke's Radiation Oncology Network Dublin, Ireland
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Wakabayashi K, Monzen H, Tamura M, Takei Y, Okuhata K, Anami S, Doi H, Nishimura Y. A novel real-time shapeable soft rubber bolus for clinical use in electron radiotherapy. Phys Med Biol 2021; 66. [PMID: 34438390 DOI: 10.1088/1361-6560/ac215b] [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: 05/15/2021] [Accepted: 08/26/2021] [Indexed: 11/12/2022]
Abstract
We have developed soft rubber (SR) bolus that can be shaped in real-time by heating flexibly and repeatedly. This study investigated whether the SR bolus could be used as an ideal bolus, such as not changing of the beam characteristics and homogeneity through the bolus and high plasticity to adhere a patient in addition to real-time shapeable and reusability, in electron radiotherapy. Percentage depth doses (PDDs) and lateral dose profiles (LDPs) were obtained for 4, 6, and 9 MeV electron beams and were compared between the SR and conventional gel boluses. For the LDP at depth of 90% dose, the penumbra as lateral distance between the 80% and 20% isodose lines (P80-20) and the width of 90% dose level (r90) were compared. To evaluate adhesion, the air gap volume between the boluses and nose of a head phantom was evaluated on CT image. The dose profiles along the center axis for the 6 MeV electron beam with SR, gel, and virtual boluses (thickness = 5 mm) on the head phantom were also calculated for the irradiation of 200 monitor unit with a treatment planning system and the depth of the maximum dose (dmax) and maximum dose (Dmax) were compared. The PDDs,P80-20, andr90between the SR and gel boluses corresponded well (within 2%, 0.4 mm, and 0.7 mm, respectively). The air gap volumes of the SR and gel boluses were 3.14 and 50.35 cm3, respectively. Thedmaxwith SR, gel and virtual boluses were 8.0, 6.0, and 7.0 mm (no bolus: 12.0 mm), and theDmaxvalues were 186.4, 170.6, and 186.8 cGy, respectively. The SR bolus had the equivalent electron beam characteristics and homogeneity to the gel bolus and achieved excellent adhesion to a body surface, which can be used in electron radiotherapy as an ideal bolus.
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Affiliation(s)
- Kazuki Wakabayashi
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511, Japan.,Department of Central Radiology, Wakayama Medical University Hospital, 811-1 Kimiidera, Wakayama, Wakayama, 641-8510, Japan
| | - Hajime Monzen
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Mikoto Tamura
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Yoshiki Takei
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511, Japan.,Department of Radiology, Kindai University Nara Hospital, 1248-1 Otoda-cho, Ikoma, Nara 630-0293, Japan
| | - Katsuya Okuhata
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Shimpei Anami
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-8510, Japan
| | - Hiroshi Doi
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, 377-2 Ohno-higashi, Osaka-Sayama, Osaka 589-8511, Japan
| | - Yasumasa Nishimura
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, 377-2 Ohno-higashi, Osaka-Sayama, Osaka 589-8511, Japan
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Robertson FM, Couper MB, Kinniburgh M, Monteith Z, Hill G, Pillai SA, Adamson DJA. Ninjaflex vs Superflab: A comparison of dosimetric properties, conformity to the skin surface, Planning Target Volume coverage and positional reproducibility for external beam radiotherapy. J Appl Clin Med Phys 2021; 22:26-33. [PMID: 33689216 PMCID: PMC8035556 DOI: 10.1002/acm2.13147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/20/2020] [Accepted: 12/01/2020] [Indexed: 11/22/2022] Open
Abstract
Background and purpose When planning and delivering radiotherapy, ideally bolus should be in direct contact with the skin surface. Varying air gaps between the skin surface and bolus material can result in discrepancies between the intended and delivered dose. This study assessed a three‐dimensional (3D) printed flexible bolus to determine whether it could improve conformity to the skin surface, reduce air gaps, and improve planning target volume coverage, compared to a commercial bolus material, Superflab. Materials and methods An anthropomorphic head phantom was CT scanned to generate photon and electron treatment plans using virtual bolus. Two 3D printing companies used the material Ninjaflex to print bolus for the head phantom, which we designated Ninjaflex1 and Ninjaflex2. The phantom was scanned a further 15 more times with the different bolus materials in situ allowing plan comparison of the virtual to physical bolus in terms of planning target volume coverage, dose at the prescription point, skin dose, and air gap volumes. Results Superflab produced a larger volume and a greater number of air gaps compared to both Ninjaflex1 and Ninjaflex2, with the largest air gap volume of 12.02 cm3. Our study revealed that Ninjaflex1 produced the least variation from the virtual bolus clinical goal values for all modalities, while Superflab displayed the largest variances in conformity, positional accuracy, and clinical goal values. For PTV coverage Superflab produced significant percentage differences for the VMAT and Electron3 plans when compared to the virtual bolus plans. Superflab also generated a significant difference in prescription point dose for the 3D conformal plan. Conclusion Compared to Superflab, both Ninjaflex materials improved conformity and reduced the variance between the virtual and physical bolus clinical goal values. Results illustrate that custom‐made Ninjaflex bolus could be useful clinically and may improve the accuracy of the delivered dose.
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Affiliation(s)
- Fiona M Robertson
- Radiotherapy Department, Ninewells Hospital & Medical School, NHS Tayside, Dundee, UK
| | - Megan B Couper
- Medical Physics Department, Ninewells Hospital & Medical School, Dundee, UK
| | - Margaret Kinniburgh
- Radiotherapy Department, Ninewells Hospital & Medical School, NHS Tayside, Dundee, UK
| | - Zoe Monteith
- Radiotherapy Department, Ninewells Hospital & Medical School, NHS Tayside, Dundee, UK
| | - Gareth Hill
- Radiotherapy Department, Ninewells Hospital & Medical School, NHS Tayside, Dundee, UK
| | | | - Douglas J A Adamson
- Radiotherapy Department, Ninewells Hospital & Medical School, NHS Tayside, Dundee, UK
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Wang X, Swann B, Reyhan M, Yue NJ, Singh R, McKenna MG. A novel approach to embed eye shields in customized bolus on nasal dorsum treatment for electron radiotherapy. Med Dosim 2020; 46:132-135. [PMID: 33097371 DOI: 10.1016/j.meddos.2020.09.008] [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: 09/15/2020] [Accepted: 09/30/2020] [Indexed: 11/20/2022]
Abstract
We aim to demonstrate the unique use of embedded lead eye shields in an electron wax bolus when treating the nasal dorsum. A patient presented to the clinic with squamous cell carcinoma of the nasal dorsum requiring treatment with en face electrons. A 3D customized wax bolus was designed and imported into the treatment planning system (TPS) to calculate the dose distribution. Due to high lens dose, the bolus was customized further to create 2 milled open slots in the wax, over the lens of eye, to allow lead sheets totaling 4 mm to be slid into the wax. The patient was brought back to the clinic to be scanned with the wax bolus fitting snugly over the nose, eyes, and cheek regions. The 3D milled insert holes were contoured on the CT in the TPS, assigned HU of 2758, to mimic the lead insertion. The lens dose with lead inserts was compared to the plan without lead insert. To further confirm the lens dose, EBT3 films were placed on the right and left eye under the bolus, and nose dorsum on the first day of treatment. The maximum dose of right lens, as calculated in the TPS with the simulated lead shields in place, decreased from 989.5cGy to 457cGy. The maximum dose of left lens decreased from 1085.4cGy to 501cGy. The dose readings from EBT3 films were in good agreement with the TPS, with deviation of 3.32%, 0.26%, and 3.44% for right lens, left lens, and nose, respectively. Daily positioning deviations compared to the plan were 0.65 ± 0.16cm and 0.63 ± 0.29cm for right eye and left eye, respectively. This novel device demonstrated the feasibility, in terms of dose calculation accuracy in the TPS and fabrication, of using customized bolus with lead inserts to conveniently shield the lens of the eyes in an electron treatment for the nose, enabling a streamlined daily setup.
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Affiliation(s)
- Xiao Wang
- Department of Radiation Oncology, Rutgers-Cancer Institute of New Jersey, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
| | - Beth Swann
- Department of Radiation Oncology, Rutgers-Robert Wood Johnson University Hospital, Hamilton, NJ, USA
| | - Meral Reyhan
- Department of Radiation Oncology, Rutgers-Cancer Institute of New Jersey, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Ning J Yue
- Department of Radiation Oncology, Rutgers-Cancer Institute of New Jersey, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Rachana Singh
- Department of Radiation Oncology, Rutgers-Cancer Institute of New Jersey, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Michael G McKenna
- Department of Radiation Oncology, Rutgers-Cancer Institute of New Jersey, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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9
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Improvement of flattenability using particle swarm optimizer for surface unfolding in bolus shaping. SN APPLIED SCIENCES 2020. [DOI: 10.1007/s42452-020-03330-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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10
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Lobo D, Banerjee S, Srinivas C, Ravichandran R, Putha SK, Prakash Saxena PU, Reddy S, Sunny J. Influence of Air Gap under Bolus in the Dosimetry of a Clinical 6 MV Photon Beam. J Med Phys 2020; 45:175-181. [PMID: 33487930 PMCID: PMC7810143 DOI: 10.4103/jmp.jmp_53_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/16/2020] [Accepted: 08/23/2020] [Indexed: 12/02/2022] Open
Abstract
Aim: In some situations of radiotherapy treatments requiring application of tissue-equivalent bolus material (e.g., gel bolus), due to material's rigid/semi-rigid nature, undesirable air gaps may occur beneath it because of irregularity of body surface. The purpose of this study was to evaluate the dosimetric parameters such as surface dose (Ds), depth of dose maximum (dmax), and depth dose along central axis derived from the percentage depth dose (PDD) curve of a 6 MV clinical photon beam in the presence of air gaps between the gel bolus and the treatment surface. Materials and Methods: A bolus holder was designed to hold the gel bolus sheet to create an air gap between the bolus and the radiation field analyzer's (RFA-300) water surface. PDD curves were taken for field sizes of 5 cm × 5 cm, 10 cm × 10 cm, 15 cm × 15 cm, 20 cm × 20 cm, and 25 cm × 25 cm, with different thicknesses of gel bolus (0.5, 1.0, and 1.5 cm) and air gap (from 0.0 to 3.0 cm), using a compact ionization chamber (CC13) with RFA-300 keeping 100 cm source-to-surface (water) distance. The dosimetric parameters, for example, “Ds,“ “dmax,“ and difference of PDD (maximum air gap vs. nil air gap), were analyzed from the obtained PDD curves. Results: Compared to ideal conditions of full contact of bolus with water surface, it has been found that there is a reduction in “Ds“ ranging from 14.8% to 3.2%, 14.9% to 1.1%, and 12.6% to 0.7% with the increase of field size for 0.5, 1.0, and 1.5 cm thickness of gel boluses, respectively, for maximum air gap. The “dmax“ shows a trend of moving away from the treatment surface, and the maximum shift was observed for smaller field size with thicker bolus and greater air gap. The effect of air gap on PDD is minimal (≤1%) beyond 0.4 cm depth for all bolus thicknesses and field sizes except for 5 cm × 5 cm with 1.5 cm bolus thickness. Conclusions: The measured data can be used to predict the probable effect on therapeutic outcome due to the presence of inevitable air gaps between the bolus and the treatment surface.
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Affiliation(s)
- Dilson Lobo
- Department of Radiation Oncology, Kasturba Medical College (A Constituent Institution of Manipal Academy of Higher Education), Mangalore, Karnataka, India
| | - Sourjya Banerjee
- Department of Radiation Oncology, Kasturba Medical College (A Constituent Institution of Manipal Academy of Higher Education), Mangalore, Karnataka, India
| | - Challapalli Srinivas
- Department of Radiation Oncology, Kasturba Medical College (A Constituent Institution of Manipal Academy of Higher Education), Mangalore, Karnataka, India
| | - Ramamoorthy Ravichandran
- Department of Radiation Oncology, Kasturba Medical College (A Constituent Institution of Manipal Academy of Higher Education), Mangalore, Karnataka, India
| | - Suman Kumar Putha
- Department of Radiation Oncology, Kasturba Medical College (A Constituent Institution of Manipal Academy of Higher Education), Mangalore, Karnataka, India
| | - P U Prakash Saxena
- Department of Radiation Oncology, Kasturba Medical College (A Constituent Institution of Manipal Academy of Higher Education), Mangalore, Karnataka, India
| | - Shreyas Reddy
- Department of Radiation Oncology, Kasturba Medical College (A Constituent Institution of Manipal Academy of Higher Education), Mangalore, Karnataka, India
| | - Johan Sunny
- Department of Radiation Oncology, Kasturba Medical College (A Constituent Institution of Manipal Academy of Higher Education), Mangalore, Karnataka, India
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Aras S, Tanzer İO, İkizceli T. Dosimetric Comparison of Superflab and Specially Prepared Bolus Materials Used in Radiotherapy Practice. Eur J Breast Health 2020; 16:167-170. [PMID: 32656515 PMCID: PMC7337918 DOI: 10.5152/ejbh.2020.5041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 11/18/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study compares standard commercial bolus material (Superflab) to custom prepared silicone dental impression material (CDIM) and play dough material (PDM) with respect to dosimetric properties and applicability by using ion chamber measurement and calculated dose values. MATERIALS AND METHODS The CDIM bolus was prepared by mixing dental impression silicone material with enough water to maintain a density of about 1.0 g/cm3. The prepared bolus material is applied on an RW3 solid phantom by covering 10x10 cm2 area with 0.5-1 cm thickness. Ion chamber measurements were performed separately with and without bolus material application. The setup was scanned in CT and the same procedure was repeated in the TPS using the scan data, in which the Pencil Beam Convolution dose calculation algorithm was used. To compare the effect of bolus material on tissue, the Superflab bolus and CDIM bolus were applied with 1 cm of thickness on postmastectomy scar and dose calculations on TPS were performed. RESULTS After comparison of the dosimetric values for Superflab, CDIM and PDM, we obtained statistically meaningful results between superflab and CDIM. For PDM, the results obtained with TPS and ion chamber measurements indicated that, it is not suitable to use in radiotherapy application due to its material properties. For the simulated skin dose values obtained at five random points on the scar tissue, the comparison of Superflab and CDIM TPS calculation results were not statistically significant. CONCLUSION The CDIM is easy to prepare and apply on irregular mastectomy scar tissue and it prevents formation of air gaps in the application surface. Especially for curved anatomical regions such as scar tissue, inclusion of the bolus material in treatment planning protocol will reduce dose uncertainty in application. It is safe to use CDIM as an alternative to Superflab in radiotherapy application, whereas PDM is not useful in clinical practice due to its material properties.
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Affiliation(s)
- Serhat Aras
- Medical Imaging Programme, University of Health Sciences, İstanbul, Turkey
| | - İhsan Oğuz Tanzer
- Biomedical Technology Programme, University of Health Sciences, İstanbul, Turkey
| | - Türkan İkizceli
- Department of Radiology, University of Health Sciences, Haseki Training and Research Hospital, İstanbul, Turkey
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Gunter AE, Burgoyne J, Park M, Kim N, Cao D, Mehta V. Novel application of vinylpolysiloxane hearing aid impression mold as patient-specific bolus for head and neck cancer radiotherapy. Clin Case Rep 2020; 8:944-949. [PMID: 32577239 PMCID: PMC7303862 DOI: 10.1002/ccr3.2731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 11/10/2019] [Accepted: 11/18/2019] [Indexed: 11/18/2022] Open
Abstract
Hearing aid impression material composed of vinylpolysiloxane is an ideal bolus material which may be used to aid in delivery of adjuvant radiation to complex surgical defects of the head and neck. It is affordable, easily accessed, and efficient.
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Affiliation(s)
- Anne Elizabeth Gunter
- Department of Radiation OncologySwedish Cancer InstituteSeattleWashington
- Present address:
Department of OtolaryngologyMadigan Army Medical CenterTacomaWashington
| | - John Burgoyne
- Department of Radiation OncologySwedish Cancer InstituteSeattleWashington
| | - Min Park
- Department of Radiation OncologySwedish Cancer InstituteSeattleWashington
| | - Namou Kim
- Department of Radiation OncologySwedish Cancer InstituteSeattleWashington
| | - Daliang Cao
- Department of Radiation OncologySwedish Cancer InstituteSeattleWashington
| | - Vivek Mehta
- Department of Radiation OncologySwedish Cancer InstituteSeattleWashington
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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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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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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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16
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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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17
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Zhao Y, Moran K, Yewondwossen M, Allan J, Clarke S, Rajaraman M, Wilke D, Joseph P, Robar JL. Clinical applications of 3-dimensional printing in radiation therapy. Med Dosim 2017; 42:150-155. [PMID: 28495033 DOI: 10.1016/j.meddos.2017.03.001] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 03/02/2017] [Indexed: 11/29/2022]
Abstract
Three-dimensional (3D) printing is suitable for the fabrication of complex radiotherapy bolus. Although investigated from dosimetric and feasibility standpoints, there are few reports to date of its use for actual patient treatment. This study illustrates the versatile applications of 3D printing in clinical radiation oncology through a selection of patient cases, namely, to create bolus for photon and modulated electron radiotherapy (MERT), as well as applicators for surface high-dose rate (HDR) brachytherapy. Photon boluses were 3D-printed to treat a recurrent squamous cell carcinoma (SCC) of the nasal septum and a basal cell carcinoma (BCC) of the posterior pinna. For a patient with a mycosis fungoides involving the upper face, a 3D-printed MERT bolus was used. To treat an SCC of the nose, a 3D-printed applicator for surface brachytherapy was made. The structures' fit to the anatomy and the radiotherapy treatment plans were assessed. Based on the treatment planning computed tomography (CT), the size of the largest air gap at the interface of the 3D-printed structure was 3 mm for the SCC of the nasal septum, 3 mm for the BCC of the pinna, 2 mm for the mycosis fungoides of the face, and 2 mm for the SCC of the nose. Acceptable treatment plans were obtained for the SCC of the nasal septum (95% isodose to 99.8% of planning target volume [PTV]), the BCC of the pinna (95% isodose to 97.7% of PTV), and the mycosis fungoides of the face (90% isodose to 92.5% of PTV). For the latter, compared with a plan with a uniform thickness bolus, the one featuring the MERT bolus achieved relative sparing of all the organs at risk (OARs) distal to the target volume, while maintaining similar target volume coverage. The surface brachytherapy plan for the SCC of the nose had adequate coverage (95% isodose to 95.6% of clinical target volume [CTV]), but a relatively high dose to the left eye, owing to its proximity to the tumor. 3D printing can be implemented effectively in the clinical setting to create highly conformal bolus for photon and MERT, as well as applicators for surface brachytherapy.
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Affiliation(s)
- Yizhou Zhao
- Department of Radiation Oncology, Dalhousie University, Queen Elizabeth II Health Sciences Centre, 5820 University Avenue, Halifax, Nova Scotia B3H 2Y9, Canada.
| | - Kathryn Moran
- Department of Radiation Oncology, Dalhousie University, Queen Elizabeth II Health Sciences Centre, 5820 University Avenue, Halifax, Nova Scotia B3H 2Y9, Canada
| | - Mammo Yewondwossen
- Department of Medical Physics, Dalhousie University, Queen Elizabeth II Health Sciences Centre, 5820 University Avenue, Halifax, Nova Scotia B3H 2Y9, Canada
| | - James Allan
- Department of Medical Physics, Dalhousie University, Queen Elizabeth II Health Sciences Centre, 5820 University Avenue, Halifax, Nova Scotia B3H 2Y9, Canada
| | - Scott Clarke
- Department of Medical Physics, Dalhousie University, Queen Elizabeth II Health Sciences Centre, 5820 University Avenue, Halifax, Nova Scotia B3H 2Y9, Canada
| | - Murali Rajaraman
- Department of Radiation Oncology, Dalhousie University, Queen Elizabeth II Health Sciences Centre, 5820 University Avenue, Halifax, Nova Scotia B3H 2Y9, Canada
| | - Derek Wilke
- Department of Radiation Oncology, Dalhousie University, Queen Elizabeth II Health Sciences Centre, 5820 University Avenue, Halifax, Nova Scotia B3H 2Y9, Canada
| | - Paul Joseph
- Department of Radiation Oncology, Dalhousie University, Queen Elizabeth II Health Sciences Centre, 5820 University Avenue, Halifax, Nova Scotia B3H 2Y9, Canada
| | - James L Robar
- Department of Medical Physics, Dalhousie University, Queen Elizabeth II Health Sciences Centre, 5820 University Avenue, Halifax, Nova Scotia B3H 2Y9, Canada
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Maruyama D, Yamazaki S, Honda E, Suzuki E, Hommatsu K, Oshiba R, Sato N. [Basic Study on Visibility and Water Equivalency of a New Colorless Transparent Bolus for Electron Radiotherapy]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2017; 73:194-201. [PMID: 28331147 DOI: 10.6009/jjrt.2017_jsrt_73.3.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Boluses used in electron radiotherapy need to have radiation field visibility and water equivalence. In this report, we have examined field visibility and water equivalence of a new colorless transparent bolus. We examined field visibility, water equivalence, and dose profile. Field visibility was evaluated by comparison to conventional bolus. Water equivalence was investigated by a measured fluence scaling factor. The dose profile was measured by using radiochromic film with the bolus and an ionization chamber in water. We confirmed that the irradiation field could clearly be seen through the transparent colorless bolus. The bolus did not cast a field edge as compared with the conventional bolus. The fluence scaling factor was less than 0.8% as compared to water. We confirmed that the colorless transparent bolus was treated as a water equivalent material. The percentage depth dose (PDD) measured by using radiochromic film with the bolus matched the PDD measured with an ionization chamber in water. R50 was less than 1 mm as compared to PDD measured with an ionization chamber. It was confirmed that the colorless transparent bolus can use to set up patient without losing visibility on flat ground planes. The fluence scaling factor and dose profile measured by using the bolus matched the results measured in water. Therefore, the new colorless transparent bolus has feasibility to improve patient setup efficiency and can improve calculation accuracy by using the fluence scaling factor.
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Affiliation(s)
- Daiki Maruyama
- Department of Medical Technology, Japanese Red Cross Medical Center
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Mahdavi H, Jabbari K, Roayaei M. Evaluation of various boluses in dose distribution for electron therapy of the chest wall with an inward defect. J Med Phys 2016; 41:38-44. [PMID: 27051169 PMCID: PMC4795416 DOI: 10.4103/0971-6203.177288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 12/19/2015] [Accepted: 12/19/2015] [Indexed: 11/26/2022] Open
Abstract
Delivering radiotherapy to the postmastectomy chest wall can be achieved using matched electron fields. Surgical defects of the chest wall change the dose distribution of electrons. In this study, the improvement of dose homogeneity using simple, nonconformal techniques of thermoplastic bolus application on a defect is evaluated. The proposed phantom design improves the capability of film dosimetry for obtaining dose profiles of a patient's anatomical condition. A modeled electron field of a patient with a postmastectomy inward surgical defect was planned. High energy electrons were delivered to the phantom in various settings, including no bolus, a bolus that filled the inward defect (PB0), a uniform thickness bolus of 5 mm (PB1), and two 5 mm boluses (PB2). A reduction of mean doses at the base of the defect was observed by any bolus application. PB0 increased the dose at central parts of the defect, reduced hot areas at the base of steep edges, and reduced dose to the lung and heart. Thermoplastic boluses that compensate a defect (PB0) increased the homogeneity of dose in a fixed depth from the surface; adversely, PB2 increased the dose heterogeneity. This study shows that it is practical to investigate dose homogeneity profiles inside a target volume for various techniques of electron therapy.
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Affiliation(s)
- Hoda Mahdavi
- Department of Radiotherapy, Seyed al-Shohada Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Keyvan Jabbari
- Department of Medical Physics and Engineering, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahnaz Roayaei
- Department of Radiotherapy, Seyed al-Shohada Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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Kim SW, Shin HJ, Kay CS, Son SH. A customized bolus produced using a 3-dimensional printer for radiotherapy. PLoS One 2014; 9:e110746. [PMID: 25337700 PMCID: PMC4206462 DOI: 10.1371/journal.pone.0110746] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 09/25/2014] [Indexed: 11/19/2022] Open
Abstract
Objective Boluses are used in high-energy radiotherapy in order to overcome the skin sparing effect. In practice though, commonly used flat boluses fail to make a perfect contact with the irregular surface of the patient’s skin, resulting in air gaps. Hence, we fabricated a customized bolus using a 3-dimensional (3D) printer and evaluated its feasibility for radiotherapy. Methods We designed two kinds of bolus for production on a 3D printer, one of which was the 3D printed flat bolus for the Blue water phantom and the other was a 3D printed customized bolus for the RANDO phantom. The 3D printed flat bolus was fabricated to verify its physical quality. The resulting 3D printed flat bolus was evaluated by assessing dosimetric parameters such as D1.5 cm, D5 cm, and D10 cm. The 3D printed customized bolus was then fabricated, and its quality and clinical feasibility were evaluated by visual inspection and by assessing dosimetric parameters such as Dmax, Dmin, Dmean, D90%, and V90%. Results The dosimetric parameters of the resulting 3D printed flat bolus showed that it was a useful dose escalating material, equivalent to a commercially available flat bolus. Analysis of the dosimetric parameters of the 3D printed customized bolus demonstrated that it is provided good dose escalation and good contact with the irregular surface of the RANDO phantom. Conclusions A customized bolus produced using a 3D printer could potentially replace commercially available flat boluses.
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Affiliation(s)
- Shin-Wook Kim
- Radiation Oncology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hun-Joo Shin
- Radiation Oncology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chul Seung Kay
- Radiation Oncology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seok Hyun Son
- Radiation Oncology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- * E-mail:
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Vyas V, Palmer L, Mudge R, Jiang R, Fleck A, Schaly B, Osei E, Charland P. On bolus for megavoltage photon and electron radiation therapy. Med Dosim 2013; 38:268-73. [PMID: 23582702 DOI: 10.1016/j.meddos.2013.02.007] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 02/06/2013] [Accepted: 02/19/2013] [Indexed: 11/19/2022]
Abstract
Frequently, in radiation therapy one must treat superficial lesions on cancer patients; these are at or adjacent to the skin. Megavoltage photon radiotherapy penetrates through the skin to irradiate deep-seated tumors, with skin-sparing property. Hence, to treat superficial lesions, one must use a layer of scattering material to feign as the skin surface. Although megavoltage electron beams are used for superficial treatments, one occasionally needs to enhance the dose near the surface. Such is the function of a "bolus," a natural or synthetically developed material that acts as a layer of tissue to provide a more effective treatment to the superficial lesions. Other uses of boluses are to correct for varying surface contours and to add scattering material around the patient's surface. Materials used as bolus vary from simple water to metal and include various mixtures and compounds. Even with the modernization of the technology for external-beam therapy and the emergence of various commercial boluses, the preparation and utilization of a bolus in clinical radiotherapy remains an art. Considering the varying experiences and practices, this paper briefly summarizes available boluses that have been proposed and are employed in clinical radiotherapy. Although this review is not exhaustive, it provides some initial guidance and answers questions that may arise in clinical practice.
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Affiliation(s)
- Vedang Vyas
- University of Waterloo, Waterloo, Ontario, Canada; Grand River Regional Cancer Centre, Kitchener, Ontario, Canada
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Nagata K, Lattimer JC, March JS. THE ELECTRON BEAM ATTENUATING PROPERTIES OF SUPERFLAB, PLAY-DOH, AND WET GAUZE, COMPARED TO PLASTIC WATER. Vet Radiol Ultrasound 2011; 53:96-100. [PMID: 22092982 DOI: 10.1111/j.1740-8261.2011.01866.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Koichi Nagata
- Pittsburgh Veterinary Specialty and Emergency Center Pittsburgh; PA
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Catalano G, Canino P, Cassinotti M, Pagella S, Piazzi V, Re S, Wizemann G, Bucci E. Ultrasound transmission gel as a bolus device for skin irradiation of irregular surfaces: technical note. Radiol Med 2010; 115:975-82. [PMID: 20352358 DOI: 10.1007/s11547-010-0546-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Accepted: 10/27/2009] [Indexed: 11/29/2022]
Abstract
PURPOSE This paper describes an uncommon radiation treatment of the external ear, with ultrasound (US) transmission gel used as bolus device to compensate for the irregularity of the target surface. MATERIALS AND METHODS Postoperative radiotherapy for cutaneous carcinoma was performed with a single high-energy electron beam directed over the ear auricle. Due to the irregular surface of the target, a "missing tissue" compensator was employed. Daily, after patient positioning, the concha was filled and flattened with US gel, and a dose of 54 Gy in 27 fractions was delivered. RESULTS Water equivalence of the gel was verified by comparing the gel's computed tomography (CT) number [Hounsfield units (HU)] and density with the corresponding values for water and another commercial bolus device. Whereas ultrasound gel and water had comparable values (HU: 0; density 1 g/cm(3) for both), the corresponding values for the commercial device were slightly higher (HU: 80; density 1.02 g/cm(3)). CONCLUSIONS Ultrasound gel proved to be an easy, fast and cheap compensating tool. Its water equivalence allows it to be used as an alternative to water, though easier to position and with lower risk of displacement. Thus, it is recommendable as a practical tool for most irregular sites. Further investigations are warranted to validate this solution in more complex irradiation techniques.
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Affiliation(s)
- G Catalano
- Unit of Radiotherapy, MultiMedica Clinical Institute, Viale Piemonte 70, 21053 Castellanza, Italy.
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