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Basaula D, Hay B, Wright M, Hall L, Easdon A, McWiggan P, Yeo A, Ungureanu E, Kron T. Additive manufacturing of patient specific bolus for radiotherapy: large scale production and quality assurance. Phys Eng Sci Med 2024; 47:551-561. [PMID: 38285272 PMCID: PMC11166743 DOI: 10.1007/s13246-024-01385-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 01/07/2024] [Indexed: 01/30/2024]
Abstract
Bolus is commonly used to improve dose distributions in radiotherapy in particular if dose to skin must be optimised such as in breast or head and neck cancer. We are documenting four years of experience with 3D printed bolus at a large cancer centre. In addition to this we review the quality assurance (QA) program developed to support it. More than 2000 boluses were produced between Nov 2018 and Feb 2023 using fused deposition modelling (FDM) printing with polylactic acid (PLA) on up to five Raise 3D printers. Bolus is designed in the radiotherapy treatment planning system (Varian Eclipse), exported to an STL file followed by pre-processing. After checking each bolus with CT scanning initially we now produce standard quality control (QC) wedges every month and whenever a major change in printing processes occurs. A database records every bolus printed and manufacturing details. It takes about 3 days from designing the bolus in the planning system to delivering it to treatment. A 'premium' PLA material (Spidermaker) was found to be best in terms of homogeneity and CT number consistency (80 HU +/- 8HU). Most boluses were produced for photon beams (93.6%) with the rest used for electrons. We process about 120 kg of PLA per year with a typical bolus weighing less than 500 g and the majority of boluses 5 mm thick. Print times are proportional to bolus weight with about 24 h required for 500 g material deposited. 3D printing using FDM produces smooth and reproducible boluses. Quality control is essential but can be streamlined.
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Affiliation(s)
- Deepak Basaula
- Peter MacCallum Cancer Centre, Department of Physical Sciences, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Barry Hay
- Peter MacCallum Cancer Centre, Department of Radiation Engineering, Melbourne, Australia
| | - Mark Wright
- Peter MacCallum Cancer Centre, Department of Radiation Engineering, Melbourne, Australia
| | - Lisa Hall
- Peter MacCallum Cancer Centre, Department of Radiation Therapy, Melbourne, Australia
| | - Alan Easdon
- Peter MacCallum Cancer Centre, Department of Radiation Engineering, Melbourne, Australia
| | - Peter McWiggan
- Peter MacCallum Cancer Centre, Department of Radiation Engineering, Melbourne, Australia
| | - Adam Yeo
- Peter MacCallum Cancer Centre, Department of Physical Sciences, 305 Grattan Street, Melbourne, VIC, 3000, Australia
- School of Applied Sciences, RMIT University, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Elena Ungureanu
- Peter MacCallum Cancer Centre, Department of Physical Sciences, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Tomas Kron
- Peter MacCallum Cancer Centre, Department of Physical Sciences, 305 Grattan Street, Melbourne, VIC, 3000, Australia.
- School of Applied Sciences, RMIT University, Melbourne, Australia.
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia.
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
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Gugliandolo SG, Pillai SP, Rajendran S, Vincini MG, Pepa M, Pansini F, Zaffaroni M, Marvaso G, Alterio D, Vavassori A, Durante S, Volpe S, Cattani F, Jereczek-Fossa BA, Moscatelli D, Colosimo BM. 3D-printed boluses for radiotherapy: influence of geometrical and printing parameters on dosimetric characterization and air gap evaluation. Radiol Phys Technol 2024; 17:347-359. [PMID: 38351260 PMCID: PMC11128404 DOI: 10.1007/s12194-024-00782-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 05/27/2024]
Abstract
The work investigates the implementation of personalized radiotherapy boluses by means of additive manufacturing technologies. Boluses materials that are currently used need an excessive amount of human intervention which leads to reduced repeatability in terms of dosimetry. Additive manufacturing can solve this problem by eliminating the human factor in the process of fabrication. Planar boluses with fixed geometry and personalized boluses printed starting from a computed tomography scan of a radiotherapy phantom were produced. First, a dosimetric characterization study on planar bolus designs to quantify the effects of print parameters such as infill density and geometry on the radiation beam was made. Secondly, a volumetric quantification of air gap between the bolus and the skin of the patient as well as dosimetric analyses were performed. The optimization process according to the obtained dosimetric and airgap results allowed us to find a combination of parameters to have the 3D-printed bolus performing similarly to that in conventional use. These preliminary results confirm those in the relevant literature, with 3D-printed boluses showing a dosimetric performance similar to conventional boluses with the additional advantage of being perfectly conformed to the patient geometry.
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Affiliation(s)
- Simone Giovanni Gugliandolo
- Department of Mechanical Engineering, Politecnico di Milano, Via La Masa, 1, 20156, Milano, Italy
- Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci, 32, 20133, Milano, Italy
| | | | - Shankar Rajendran
- Department of Mechanical Engineering, Politecnico di Milano, Via La Masa, 1, 20156, Milano, Italy
| | - Maria Giulia Vincini
- Division of Radiation Oncology, IEO European Institute of Oncology, IRCCS, Milano, Italy
| | - Matteo Pepa
- Division of Radiation Oncology, IEO European Institute of Oncology, IRCCS, Milano, Italy
- Clinical Department, Bioengineering Unit, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Floriana Pansini
- Unit of Medical Physics, IEO European Institute of Oncology, IRCCS, Milano, Italy
| | - Mattia Zaffaroni
- Division of Radiation Oncology, IEO European Institute of Oncology, IRCCS, Milano, Italy
| | - Giulia Marvaso
- Division of Radiation Oncology, IEO European Institute of Oncology, IRCCS, Milano, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy
| | - Daniela Alterio
- Division of Radiation Oncology, IEO European Institute of Oncology, IRCCS, Milano, Italy
| | - Andrea Vavassori
- Division of Radiation Oncology, IEO European Institute of Oncology, IRCCS, Milano, Italy
| | - Stefano Durante
- Division of Radiation Oncology, IEO European Institute of Oncology, IRCCS, Milano, Italy
| | - Stefania Volpe
- Division of Radiation Oncology, IEO European Institute of Oncology, IRCCS, Milano, Italy
| | - Federica Cattani
- Division of Radiation Oncology, IEO European Institute of Oncology, IRCCS, Milano, Italy
- Unit of Medical Physics, IEO European Institute of Oncology, IRCCS, Milano, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO European Institute of Oncology, IRCCS, Milano, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy
| | - Davide Moscatelli
- Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci, 32, 20133, Milano, Italy
| | - Bianca Maria Colosimo
- Department of Mechanical Engineering, Politecnico di Milano, Via La Masa, 1, 20156, Milano, Italy.
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Ashenafi M, Jeong S, Wancura JN, Gou L, Webster MJ, Zheng D. A quick guide on implementing and quality assuring 3D printing in radiation oncology. J Appl Clin Med Phys 2023; 24:e14102. [PMID: 37501315 PMCID: PMC10647979 DOI: 10.1002/acm2.14102] [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: 05/22/2023] [Revised: 06/23/2023] [Accepted: 07/08/2023] [Indexed: 07/29/2023] Open
Abstract
As three-dimensional (3D) printing becomes increasingly common in radiation oncology, proper implementation, usage, and ongoing quality assurance (QA) are essential. While there have been many reports on various clinical investigations and several review articles, there is a lack of literature on the general considerations of implementing 3D printing in radiation oncology departments, including comprehensive process establishment and proper ongoing QA. This review aims to guide radiation oncology departments in effectively using 3D printing technology for routine clinical applications and future developments. We attempt to provide recommendations on 3D printing equipment, software, workflow, and QA, based on existing literature and our experience. Specifically, we focus on three main applications: patient-specific bolus, high-dose-rate (HDR) surface brachytherapy applicators, and phantoms. Additionally, cost considerations are briefly discussed. This review focuses on point-of-care (POC) printing in house, and briefly touches on outsourcing printing via mail-order services.
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Affiliation(s)
- Michael Ashenafi
- Department of Radiation OncologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Seungkyo Jeong
- Department of Applied MathematicsUniversity of RochesterRochesterNew YorkUSA
| | - Joshua N. Wancura
- Department of Radiation OncologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Lang Gou
- Department of Radiation OncologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Matthew J. Webster
- Department of Radiation OncologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Dandan Zheng
- Department of Radiation OncologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
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Development of a customisable 3D-printed intra-oral stent for head-and-neck radiotherapy. Tech Innov Patient Support Radiat Oncol 2022; 23:1-7. [PMID: 35813156 PMCID: PMC9260300 DOI: 10.1016/j.tipsro.2022.06.001] [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: 03/25/2022] [Revised: 05/25/2022] [Accepted: 06/13/2022] [Indexed: 11/20/2022] Open
Abstract
Advanced radiotherapy techniques have improved head-and-neck treatments. More improvements are possible with intra-oral stents stabilising sensitive anatomy. MRI imaging shows new modular 3D printed stents provide stable displacement. Modular stents achieve positive outcomes within standard treatment workflow.
Intra-oral stents (including mouth-pieces and bite blocks) can be used to displace adjacent non-involved oral tissue and reduce radiation side effects from radiotherapy treatments for head-and-neck cancer. In this study, a modular and customisable 3D printed intra-oral stent was designed, fabricated and evaluated, to utilise the advantages of the 3D printing process without the interruption of clinical workflow associated with printing time. The stent design used a central mouth-opening and tongue-depressing main piece, with optional cheek displacement pieces in three different sizes, plus an anchor point for moulding silicone to fit individual patients’ teeth. A magnetic resonance imaging (MRI) study of one healthy participant demonstrated the tissue displacement effects of the stent, while providing a best-case indication of its comfort.
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Simpson-Page E, Coogan P, Kron T, Lowther N, Murray R, Noble C, Smith I, Wilks R, Crowe SB. Webinar and survey on quality management principles within the Australian and New Zealand ACPSEM Workforce. Phys Eng Sci Med 2022; 45:679-685. [PMID: 35834171 DOI: 10.1007/s13246-022-01160-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Healthcare relies upon the accurate and safe delivery of patient care. This is only achievable when systems are developed to ensure high quality, robust outcomes, for instance quality management systems. The concept of quality management can take on a different meaning depending on the context in which it is found. To add complication, the amount of education required for quality management will vary depending on one's exposure to the implementation of quality systems. In part to address these issues, the Australasian College of Physical Scientists and Engineers in Medicine (ACPSEM) Queensland Branch held a quality management webinar for members and non-members across Australia and New Zealand. The purpose of the webinar was to educate and facilitate discussion regarding the application of quality management principles for the ACPSEM profession. In conjunction, a pre- and post-webinar survey was conducted to gain an insight into existing knowledge and attitudes within the professions governed by the ACPSEM and students undertaking related studies. This paper authored by the webinar speakers reintroduces the quality management principles that were discussed in webinar, exemplifies the importance of quality management skills within the ACPSEM professions and presents the results of the surveys, promoting the need for more educational resources on quality management tools.
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Affiliation(s)
- Emily Simpson-Page
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia.
| | - Paul Coogan
- Q-TRaCE, Department of Nuclear Medicine & Specialised PET Services Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Tomas Kron
- Physical Sciences Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Nicholas Lowther
- Wellington Blood & Cancer Centre, Wellington Hospital, Wellington, New Zealand
| | - Rebecca Murray
- Herston Biofabrication Institute, Metro North Hospital and Health Service, Brisbane, Australia
| | - Christopher Noble
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia
| | - Ian Smith
- St. Andrews War Memorial Hospital, Brisbane, Australia
| | - Rachael Wilks
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Herston Biofabrication Institute, Metro North Hospital and Health Service, Brisbane, Australia.,School of Information Technology and Electrical Engineering, University of Queensland, Brisbane, Australia
| | - Scott B Crowe
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Herston Biofabrication Institute, Metro North Hospital and Health Service, Brisbane, Australia.,School of Information Technology and Electrical Engineering, University of Queensland, Brisbane, Australia.,School of Chemistry and Physics, Queensland University of Technology, Brisbane, Australia
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