1
|
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.
Collapse
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.
| |
Collapse
|
2
|
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.
Collapse
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.
| |
Collapse
|
3
|
Wakabayashi K, Monzen H, Doi H, Inagaki T, Sonomura T. Initial Clinical Experience of a Novel Shapeable Bolus for Radiotherapy in a Patient With a Facial Cutaneous Squamous Cell Carcinoma: A Case Report. Cureus 2024; 16:e57415. [PMID: 38694646 PMCID: PMC11061871 DOI: 10.7759/cureus.57415] [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] [Accepted: 03/29/2024] [Indexed: 05/04/2024] Open
Abstract
Radiation therapy with X-rays for skin cancer uses a bolus to increase the surface dose. Commercial gel sheet boluses adhere poorly to the patient's body because of surface irregularities. This causes an air gap and reduces the surface dose. We have developed a novel shapeable bolus (HM bolus; Hayakawa Rubber Co., Ltd., Hiroshima, Japan), and we describe the first clinical application of this bolus here. The case was an 82-year-old male with a facial cutaneous squamous cell carcinoma. The postoperative radiotherapy plan using the HM bolus provided a more uniform dose to the target compared with a plan without the HM bolus. The HM bolus adhered stably to the patient's skin, and there were no issues with its clinical use.
Collapse
Affiliation(s)
- Kazuki Wakabayashi
- Department of Central Radiology, Wakayama Medical University Hospital, Wakayama, JPN
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, Osakasayama, JPN
| | - Hajime Monzen
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, Osakasayama, JPN
| | - Hiroshi Doi
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osakasayama, JPN
| | - Takaya Inagaki
- Department of Radiology, Wakayama Medical University, Wakayama, JPN
| | - Tetsuo Sonomura
- Department of Radiology, Wakayama Medical University, Wakayama, JPN
| |
Collapse
|
4
|
Dibs K, Gogineni E, Jhawar SM, Baliga S, Grecula JC, Mitchell DL, Palmer J, Haglund K, Andraos TY, Zoller W, Ewing A, Bonomi M, Bhateja P, Tinoco G, Liebner D, Rocco JW, Old M, Gamez ME, Chakravarti A, Konieczkowski DJ, Blakaj DM. Scalp Irradiation with 3D-Milled Bolus: Initial Dosimetric and Clinical Experience. Cancers (Basel) 2024; 16:688. [PMID: 38398079 PMCID: PMC10887235 DOI: 10.3390/cancers16040688] [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: 01/09/2024] [Revised: 01/31/2024] [Accepted: 02/04/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND AND PURPOSE A bolus is required when treating scalp lesions with photon radiation therapy. Traditional bolus materials face several issues, including air gaps and setup difficulty due to irregular, convex scalp geometry. A 3D-milled bolus is custom-formed to match individual patient anatomy, allowing improved dose coverage and homogeneity. Here, we describe the creation process of a 3D-milled bolus and report the outcomes for patients with scalp malignancies treated with Volumetric Modulated Arc Therapy (VMAT) utilizing a 3D-milled bolus. MATERIALS AND METHODS Twenty-two patients treated from 2016 to 2022 using a 3D-milled bolus and VMAT were included. Histologies included squamous cell carcinoma (n = 14, 64%) and angiosarcoma (n = 8, 36%). A total of 7 (32%) patients were treated in the intact and 15 (68%) in the postoperative setting. The median prescription dose was 66.0 Gy (range: 60.0-69.96). RESULTS The target included the entire scalp for 8 (36%) patients; in the remaining 14 (64%), the median ratio of planning target volume to scalp volume was 35% (range: 25-90%). The median dose homogeneity index was 1.07 (range: 1.03-1.15). Six (27%) patients experienced acute grade 3 dermatitis and one (5%) patient experienced late grade 3 skin ulceration. With a median follow-up of 21.4 months (range: 4.0-75.4), the 18-month rates of locoregional control and overall survival were 75% and 79%, respectively. CONCLUSIONS To our knowledge, this is the first study to report the clinical outcomes for patients with scalp malignancies treated with the combination of VMAT and a 3D-milled bolus. This technique resulted in favorable clinical outcomes and an acceptable toxicity profile in comparison with historic controls and warrants further investigation in a larger prospective study.
Collapse
Affiliation(s)
- Khaled Dibs
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
| | - Emile Gogineni
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
| | - Sachin M. Jhawar
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
| | - Sujith Baliga
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
| | - John C. Grecula
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
| | - Darrion L. Mitchell
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
| | - Joshua Palmer
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
| | - Karl Haglund
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
| | - Therese Youssef Andraos
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
| | - Wesley Zoller
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
| | - Ashlee Ewing
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
| | - Marcelo Bonomi
- Department of Medical Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (M.B.); (P.B.); (G.T.); (D.L.)
| | - Priyanka Bhateja
- Department of Medical Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (M.B.); (P.B.); (G.T.); (D.L.)
| | - Gabriel Tinoco
- Department of Medical Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (M.B.); (P.B.); (G.T.); (D.L.)
| | - David Liebner
- Department of Medical Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (M.B.); (P.B.); (G.T.); (D.L.)
| | - James W. Rocco
- Department of Otolaryngology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (J.W.R.); (M.O.)
| | - Matthew Old
- Department of Otolaryngology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (J.W.R.); (M.O.)
| | - Mauricio E. Gamez
- Department of Radiation Oncology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA;
| | - Arnab Chakravarti
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
| | - David J. Konieczkowski
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
| | - Dukagjin M. Blakaj
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
| |
Collapse
|
5
|
Dąbrowska-Szewczyk E, Zawadzka A, Kowalczyk P, Podgórski R, Saworska G, Głowacki M, Kukołowicz P, Brzozowska B. Low-density 3D-printed boluses with honeycomb infill 3D-printed boluses in radiotherapy. Phys Med 2023; 110:102600. [PMID: 37167778 DOI: 10.1016/j.ejmp.2023.102600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/05/2023] [Accepted: 04/30/2023] [Indexed: 05/13/2023] Open
Abstract
PURPOSE Dosimetric characteristics of 3D-printed plates using different infill percentage and materials was the purpose of our study. METHODS Test plates with 5%, 10%, 15% and 20% honeycomb structure infill were fabricated using TPU and PLA polymers. The Hounsfield unit distribution was determined using a Python script. Percentage Depth Dose (PDD) distribution in the build-up region was measured with the Markus plane-parallel ionization chamber for an open 10x10 cm2 field of 6 MV. PDD was measured at a depth of 1 mm, 5 mm, 10 mm and 15 mm. Measurements were compared with Eclipse treatment planning system calculations using AAA and Acuros XB algorithms. RESULTS The mean HU for CT scans of 3D-printed TPU plates increased with percentage infill increase from -739 HU for 5% to -399 HU for 20%. Differences between the average HU for TPU and PLA did not exceed 2% for all percentage infills. Even using a plate with the lowest infill PDD at 1 mm depth increase from 44.7% (without a plate) to 76.9% for TPU and 76.6% for PLA. Infill percentage did not affect the dose at depths greater than 5 mm. Differences between measurements and TPS calculations were less than 4.1% for both materials, regardless of the infill percentage and depth. CONCLUSIONS The use of 3D-printed light boluses increases the dose in the build-up region, which was shown based on the dosimetric measurements and TPS calculations.
Collapse
Affiliation(s)
- Edyta Dąbrowska-Szewczyk
- Biomedical Physics Division, Faculty of Physics, University of Warsaw, 5 L. Pasteur Street, 02-093 Warsaw, Poland; Medical Physics Department, The Maria Skłodowska-Curie National Research Institute of Oncology in Warsaw, 5 WK Roentgen Street, 02-781 Warsaw, Poland
| | - Anna Zawadzka
- Medical Physics Department, The Maria Skłodowska-Curie National Research Institute of Oncology in Warsaw, 5 WK Roentgen Street, 02-781 Warsaw, Poland
| | - Piotr Kowalczyk
- Warsaw University of Technology, Faculty of Chemical and Process Engineering, Department of Biotechnology and Bioprocess Engineering, Waryńskiego 1, 00-645 Warsaw, Poland; Centre of Advanced Materials and Technologies CEZAMAT, Poleczki 19, 02-822 Warsaw, Poland
| | - Rafał Podgórski
- Warsaw University of Technology, Faculty of Chemical and Process Engineering, Department of Biotechnology and Bioprocess Engineering, Waryńskiego 1, 00-645 Warsaw, Poland
| | - Gabriela Saworska
- Biomedical Physics Division, Faculty of Physics, University of Warsaw, 5 L. Pasteur Street, 02-093 Warsaw, Poland
| | - Maksymilian Głowacki
- Biomedical Physics Division, Faculty of Physics, University of Warsaw, 5 L. Pasteur Street, 02-093 Warsaw, Poland
| | - Paweł Kukołowicz
- Medical Physics Department, The Maria Skłodowska-Curie National Research Institute of Oncology in Warsaw, 5 WK Roentgen Street, 02-781 Warsaw, Poland
| | - Beata Brzozowska
- Biomedical Physics Division, Faculty of Physics, University of Warsaw, 5 L. Pasteur Street, 02-093 Warsaw, Poland.
| |
Collapse
|
6
|
Yu S, Ahn SH, Choi SH, Ahn WS, Jung IH. Clinical Application of a Customized 3D-Printed Bolus in Radiation Therapy for Distal Extremities. Life (Basel) 2023; 13:life13020362. [PMID: 36836718 PMCID: PMC9962406 DOI: 10.3390/life13020362] [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: 12/27/2022] [Revised: 01/19/2023] [Accepted: 01/19/2023] [Indexed: 01/31/2023] Open
Abstract
In radiation therapy (RT) for skin cancer, tissue-equivalent substances called boluses are widely used to ensure the delivery of an adequate dose to the skin surface and to provide a radioprotective effect for normal tissue. The aim of this study was to develop a new type of three-dimensional (3D) bolus for RT involving body parts with irregular geometries and to evaluate its clinical feasibility. Two 3D-printed boluses were designed for two patients with squamous cell carcinoma (SCC) of their distal extremities based on computed tomography (CT) images and printed with polylactic acid (PLA). The clinical feasibility of the boluses was evaluated by measuring the in vivo skin dose at the tumor site with optically stimulated luminescence detectors (OSLDs) and comparing the results with the prescribed and calculated doses from the Eclipse treatment planning system (TPS). The average measured dose distribution for the two patients was 94.75% of the prescribed dose and 98.8% of the calculated dose. In addition, the average measured dose during repeated treatments was 189.5 ± 3.7 cGy, thus demonstrating the excellent reproducibility of the proposed approach. Overall, the customized 3D-printed boluses for the RT of distal extremities accurately delivered doses to skin tumors with improved reproducibility.
Collapse
Affiliation(s)
- Suah Yu
- Department of Radiological Science, Kangwon National University, Samcheok 25949, Republic of Korea
- Korea Institute of Radiological & Medical Sciences, Seoul 01812, Republic of Korea
| | - So Hyun Ahn
- Ewha Medical Research Institute, College of Medicine, Ewha Womans University, Seoul 07804, Republic of Korea
- Correspondence: (S.H.A.); (W.S.A.); Tel.: +82-02-6986-6305 (S.H.A.); +82-033-610-5315 (W.S.A.)
| | - Sang Hyoun Choi
- Korea Institute of Radiological & Medical Sciences, Seoul 01812, Republic of Korea
| | - Woo Sang Ahn
- Department of Radiation Oncology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung 25440, Republic of Korea
- Correspondence: (S.H.A.); (W.S.A.); Tel.: +82-02-6986-6305 (S.H.A.); +82-033-610-5315 (W.S.A.)
| | - In-hye Jung
- Department of Radiation Oncology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung 25440, Republic of Korea
| |
Collapse
|
7
|
Albantow CE, Brown SJ. Three-dimensional printer use in the Australian and New Zealand radiation therapy setting. J Med Radiat Sci 2022; 69:492-501. [PMID: 36097141 DOI: 10.1002/jmrs.613] [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: 09/14/2021] [Accepted: 07/10/2022] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION This cross-sectional survey aimed to collect data from radiation therapy departments around Australia and New Zealand to establish a baseline of 3D printer and product use. METHODS Each department in Australia and New Zealand was contacted to determine the most appropriate person to answer the survey. A Microsoft Forms link to the survey was sent to the individual. The survey contained 47 questions in relation to what 3D printing device departments had (if any), how it was being utilised, and what 3D printed products were in use. RESULTS A total of 112 departments completed the survey (100% response rate), with 22.3% reporting 3D printer ownership, and thirty-four departments (30.4%) outsourcing 3D printed products. The primary use of 3D printers was bolus production (60.9%). Public departments represented 84% of printer ownership, while private departments were the greatest users of outsourced 3D printed products (91.4%). 3D Slicer was the most common software used for Digital Imaging and Communications in Medicine (DICOM) file conversion (42.3%), while polylactic acid (PLA) and acrylonitrile butadiene styrene (ABS) were the most common filaments in use, 46% and 14%, respectively. CONCLUSION This research established a baseline for 3D printer and product use within the Australian and New Zealand radiotherapy setting.
Collapse
Affiliation(s)
- Christine E Albantow
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, New South Wales, Australia
| | | |
Collapse
|
8
|
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.
Collapse
|
9
|
Gill A, Smith W, Hirst A, Sabet M, Alkhatib Z, Gill S, Rowshanfarzad P. Comparison of conventional versus customised Eurosil-4 Pink bolus for radiotherapy of the chest wall. PLoS One 2022; 17:e0267741. [PMID: 35511918 PMCID: PMC9071134 DOI: 10.1371/journal.pone.0267741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 04/13/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction In radiotherapy, the presence of air gaps near a tumour can lead to underdose to the tumour. In this study, the impact of air gaps on dose to the surface was evaluated. 3D-printing was used to construct a Eurosil-4 Pink bolus customised to the patient and its dosimetric properties were compared with that of Paraffin wax bolus. Methods Surface dose was measured for flat sheets of Eurosil-4 Pink bolus with different thicknesses. Different air gap thicknesses were inserted between the bolus and the surface, and dose was measured for each air gap using 10 cm × 10 cm fields. This was repeated with the effective field size calculated from the patient plan. Surface dose was measured for varying angles of incidence. A customised chest phantom was used to compare dose for two customised Eurosil-4 Pink boluses, and commonly used Paraffin wax bolus. Results The surface dose was found to be highest for 1.1 cm thick bolus. The decrease in surface dose for the Eurosil-4 Pink bolus was minimal for the 10 cm × 10 cm field, but higher for the effective field size and larger angles of incidence. For instance, the dose was reduced by 6.2% as a result of 1 cm air gap for the effective field size and 60 degree angle of incidence. The doses measured using Gafchromic film under the customised Eurosil-4 Pink boluses were similar to that of the Paraffin wax bolus, and higher than prescribed dose. Conclusions The impact of air gaps can be significant for small field sizes and oblique beams. A customised Eurosil-4 Pink bolus has promising physical and dosimetric properties to ensure sufficient dose to the tumour, even for treatments where larger impact of air gaps is suspected.
Collapse
Affiliation(s)
- Ashlesha Gill
- School of Physics, Mathematics and Computing, The University of Western Australia, Perth, WA, Australia
- * E-mail:
| | - Warwick Smith
- Department of Radiation Oncology, Sir Charles Gairdner Hospital (SCGH), Perth, WA, Australia
| | - Andrew Hirst
- School of Physics, Mathematics and Computing, The University of Western Australia, Perth, WA, Australia
| | - Mahsheed Sabet
- School of Physics, Mathematics and Computing, The University of Western Australia, Perth, WA, Australia
- Department of Radiation Oncology, Sir Charles Gairdner Hospital (SCGH), Perth, WA, Australia
| | - Zaid Alkhatib
- Department of Radiation Oncology, Sir Charles Gairdner Hospital (SCGH), Perth, WA, Australia
| | - Suki Gill
- School of Physics, Mathematics and Computing, The University of Western Australia, Perth, WA, Australia
- Department of Radiation Oncology, Sir Charles Gairdner Hospital (SCGH), Perth, WA, Australia
| | - Pejman Rowshanfarzad
- School of Physics, Mathematics and Computing, The University of Western Australia, Perth, WA, Australia
| |
Collapse
|
10
|
Bridger CA, Reich PD, Caraça Santos AM, Douglass MJJ. A dosimetric comparison of CT- and photogrammetry- generated 3D printed HDR brachytherapy surface applicators. Phys Eng Sci Med 2022; 45:125-134. [PMID: 35020174 DOI: 10.1007/s13246-021-01092-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/10/2021] [Indexed: 11/30/2022]
Abstract
In this study, we investigate whether an acceptable dosimetric plan can be obtained for a brachytherapy surface applicator designed using photogrammetry and compare the plan quality to a CT-derived applicator. The nose region of a RANDO anthropomorphic phantom was selected as the treatment site due to its high curvature. Photographs were captured using a Nikon D5600 DSLR camera and reconstructed using Agisoft Metashape while CT data was obtained using a Canon Aquillion scanner. Virtual surface applicators were designed in Blender and printed with PLA plastic. Treatment plans with a prescription dose of 3.85 Gy × 10 fractions with 100% dose to PTV on the bridge of the nose at 2 mm depth were generated separately using AcurosBV in the Varian BrachyVision TPS. PTV D98%, D90% and V100%, and OAR D0.1cc, D2cc and V50% dose metrics and dwell times were evaluated, with the applicator fit assessed by air-gap volume measurements. Both types of surface applicators were printed with minimal defects and visually fitted well to the target area. The measured air-gap volume between the photogrammetry applicator and phantom surface was 44% larger than the CT-designed applicator, with a mean air gap thickness of 3.24 and 2.88 mm, respectively. The largest difference in the dose metric observed for the PTV and OAR was the PTV V100% of - 1.27% and skin D0.1cc of - 0.28%. PTV D98% and D90% and OAR D2cc and V50% for the photogrammetry based plan were all within 0.5% of the CT based plan. Total dwell times were also within 5%. A 3D printed surface applicator for the nose was successfully constructed using photogrammetry techniques. Although it produced a larger air gap between the surface applicator and phantom surface, a clinically acceptable dose plan was created with similar PTV and OAR dose metrics to the CT-designed applicator. Additional future work is required to comprehensively evaluate its suitability in a clinically environment.
Collapse
Affiliation(s)
- Corey A Bridger
- School of Physical Sciences, The University of Adelaide, North Terrace, Adelaide, SA, 5005, Australia. .,Department of Medical Physics, Radiation Oncology, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia.
| | - Paul D Reich
- School of Physical Sciences, The University of Adelaide, North Terrace, Adelaide, SA, 5005, Australia.,Department of Medical Physics, Radiation Oncology, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
| | - Alexandre M Caraça Santos
- School of Physical Sciences, The University of Adelaide, North Terrace, Adelaide, SA, 5005, Australia.,Department of Medical Physics, Radiation Oncology, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
| | - Michael J J Douglass
- School of Physical Sciences, The University of Adelaide, North Terrace, Adelaide, SA, 5005, Australia.,Department of Medical Physics, Radiation Oncology, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
McCallum S, Maresse S, Fearns P. Evaluating 3D-printed Bolus Compared to Conventional Bolus Types Used in External Beam Radiation Therapy. Curr Med Imaging 2021; 17:820-831. [PMID: 33530912 DOI: 10.2174/1573405617666210202114336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 12/05/2020] [Accepted: 12/08/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND When treating superficial tumors with external beam radiation therapy, bolus is often used. Bolus increases surface dose, reduces dose to underlying tissue, and improves dose homogeneity. INTRODUCTION The conventional bolus types used clinically in practice have some disadvantages. The use of Three-Dimensional (3D) printing has the potential to create more effective boluses. CT data is used for dosimetric calculations for these treatments and often to manufacture the customized 3D-printed bolus. PURPOSE The aim of this review is to evaluate the published studies that have compared 3D-printed bolus against conventional bolus types. METHODS AND RESULTS A systematic search of several databases and a further appraisal for relevance and eligibility resulted in the 14 articles used in this review. The 14 articles were analyzed based on their comparison of 3D-printed bolus and at least one conventional bolus type. CONCLUSION The findings of this review indicated that 3D-printed bolus has a number of advantages. Compared to conventional bolus types, 3D-printed bolus was found to have equivalent or improved dosimetric measures, positional accuracy, fit, and uniformity. 3D-printed bolus was also found to benefit workflow efficiency through both time and cost effectiveness. However, factors such as patient comfort and staff perspectives need to be further explored to support the use of 3Dprinted bolus in routine practice.
Collapse
Affiliation(s)
- Stephanie McCallum
- Medical Radiation Science, Faculty of Science and Engineering, Curtin University, Perth, Australia
| | - Sharon Maresse
- Medical Radiation Science, Faculty of Science and Engineering, Curtin University, Perth, Australia
| | - Peter Fearns
- Medical Radiation Science, Faculty of Science and Engineering, Curtin University, Perth, Australia
| |
Collapse
|
13
|
Casto Z, Liu M, Lenards N, Hunzeker A, Zoller W, Blakaj DM. Multiple case dosimetric evaluation of VMAT scalp irradiation using 3D milled bolus. Med Dosim 2021; 46:324-327. [PMID: 33992490 DOI: 10.1016/j.meddos.2021.03.007] [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: 12/08/2020] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
Adequate dose homogeneity and full prescription dose delivery to the scalp still remains a dosimetric problem during scalp irradiation due to the anatomical shape of the cranium. Confounding variables such as gravity, the irregular and convex shape of the cranium, air gaps between scalp surface and commercial bolus, and potential inconsistencies in a 3D printed bolus can negatively impact the dose delivered to the scalp surface during scalp irradiation. The purpose of this retrospective case study was to implement the use of a 3D milled rigid bolus technique combined with volumetric modulated arc therapy (VMAT) treatment planning and evaluate the dosimetric efficacy in delivering dose to the surface of the scalp. The 8-patient retrospective case study consisted of patients with a scalp lesion treated using a 3D milled bolus, VMAT, 6 megavoltage (MV) photon beams, and aligned for treatment using daily conebeam computed tomography (CT) and 6° of freedom couch positioning. Dose volume histograms (DVHs) were used to evaluate maximum dose delivered to the planning target volumes (PTVs) while the dose homogeneity index (DHI) was calculated and compared to that of an ideal value of 1. The researchers evaluated the minimum dose delivered to the individual PTVs after plan normalization. The researchers found that the 3D milled bolus coupled with volumetric modulated arc therapy increased surface dose homogeneity, while also increasing the percentage of planning target volumes receiving full prescription dose. With statistically significant results, patient specific 3D milled rigid bolus offers a viable bolus option for treatment of superficial scalp lesions when combined with volumetric modulated arc therapy treatment planning. However, a larger sample size used in a scientific research study across multiple institutions would be desirable to validate these case study findings.
Collapse
Affiliation(s)
- Zachary Casto
- Medical Dosimetry Program at the University of Wisconsin - La Crosse, WI 43113, USA.
| | - Michal Liu
- Medical Dosimetry Program at the University of Wisconsin - La Crosse, WI 43113, USA
| | - Nishele Lenards
- Medical Dosimetry Program at the University of Wisconsin - La Crosse, WI 43113, USA
| | - Ashley Hunzeker
- Medical Dosimetry Program at the University of Wisconsin - La Crosse, WI 43113, USA
| | - Wesley Zoller
- Medical Dosimetry Program at the University of Wisconsin - La Crosse, WI 43113, USA
| | - Dukagjin M Blakaj
- Medical Dosimetry Program at the University of Wisconsin - La Crosse, WI 43113, USA
| |
Collapse
|
14
|
Gomez G, Baeza M, Mateos JC, Rivas JA, Simon FJL, Ortega DM, de Los Ángeles Flores Carrión M, Del Campo ER, Gómez-Cía T, Guerra JLL. A three-dimensional printed customized bolus: adapting to the shape of the outer ear. ACTA ACUST UNITED AC 2021; 26:211-217. [PMID: 34211771 DOI: 10.5603/rpor.a2021.0030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 02/02/2021] [Indexed: 11/25/2022]
Abstract
Background The skin-sparing effect of megavoltage-photon beams in radiotherapy (RT) reduces the target coverage of superficial tumours. Consequently, a bolus is widely used to enhance the target coverage for superficial targets. This study evaluates a three-dimensional (3D)-printed customized bolus for a very irregular surface, the outer ear. Materials and methods We fabricated a bolus using a computed tomography (CT) scanner and evaluated its efficacy. The head of an Alderson Rando phantom was scanned with a CT scanner. Two 3D boluses of 5- and 10-mm thickness were designed to fit on the surface of the ear. They were printed by the Stratasys Objet260 Connex3 using the malleable "rubber-like" photopolymer Agilus. CT simulations of the Rando phantom with and without the 3D and commercial high density boluses were performed to evaluate the dosimetric properties of the 3D bolus. The prescription dose to the outer ear was 50 Gy at 2 Gy/fraction. Results We observed that the target coverage was slightly better with the 3D bolus of 10mm compared with the commercial one (D98% 98.2% vs. 97.6%).The maximum dose was reduced by 6.6% with the 3D bolus and the minimum dose increased by 5.2% when comparing with the commercial bolus. In addition, the homogeneity index was better for the 3D bolus (0.041 vs. 0.073). Conclusion We successfully fabricated a customized 3D bolus for a very irregular surface. The target coverage and dosimetric parameters were at least comparable with a commercial bolus. Thus, the use of malleable materials can be considered for the fabrication of customized boluses in cases with complex anatomy.
Collapse
Affiliation(s)
- Gorka Gomez
- Biomedical Informatics, Biomedical Engineering and Health Economy, Institute of Biomedicine of Seville (IBIS)/Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
| | - Montserrat Baeza
- Radiation Physics, University Hospital Virgen del Rocio, Seville, Spain
| | | | | | | | - Diego Mesta Ortega
- Department of Radiation Oncology, University Hospital Virgen del Rocio, Seville, Spain
| | | | - Eleonor Rivin Del Campo
- Department of Radiation Oncology, Tenon University Hospital, Hôpitaux Universitaires Est Parisien, Sorbonne University Medical Faculty, Paris, France
| | - Tomas Gómez-Cía
- Instituto de Biomedicina de Sevilla (IBIS/HUVR/CSIC/Universidad de Sevilla), Seville, Spain.,Department of Plastic Surgery, University Hospital Virgen del Rocio, Seville, Spain
| | - Jose Luis Lopez Guerra
- Department of Radiation Oncology, University Hospital Virgen del Rocio, Seville, Spain.,Instituto de Biomedicina de Sevilla (IBIS/HUVR/CSIC/Universidad de Sevilla), Seville, Spain
| |
Collapse
|
15
|
eXaSkin: A novel high-density bolus for 6MV X-rays radiotherapy. Phys Med 2020; 80:42-46. [PMID: 33096418 DOI: 10.1016/j.ejmp.2020.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/04/2020] [Accepted: 09/01/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To evaluate eXaSkin, a novel high-density bolus alternative to commercial tissue-equivalent Superflab, for 6MV photon-beam radiotherapy. MATERIALS AND METHODS We delivered a 10 × 10 cm2 open field at 90° and head-and-neck clinical plan, generated with the volumetric modulated arc therapy (VMAT) technique, to an anthropomorphic phantom in three scenarios: with no bolus on the phantom's surface, with Superflab, and with eXaSkin. In each scenario, we measured dose to a central planning target volume (PTV) in the nasopharynx region with an ionization chamber, and we measured dose to the skin, at three different positions within the vicinity of a neck lymph node PTV, with MOSkin™, a semiconductor dosimeter. Measurements were compared against calculations with the treatment planning system (TPS). RESULTS For the static field, MOSkin results underneath the eXaSkin were in agreement with calculations to within 1.22%; for VMAT, to within 5.68%. Underneath Superflab, those values were 3.36% and 11.66%. The inferior agreement can be explained by suboptimal adherence of Superflab to the phantom's surface as well as difficulties in accurately reproducing its placement between imaging and treatment session. In all scenarios, dose measured at the central target agreed to within 1% with calculations. CONCLUSIONS eXaSkin was shown to have superior adaptation to the phantom's surface, producing minimal air gaps between the skin surface and bolus, allowing for accurate positioning and reproducibility of set-up conditions. eXaSkin with its high density material provides sufficient build-up to achieve full skin dose with less material thickness than Superflab.
Collapse
|
16
|
Aoyama T, Uto K, Shimizu H, Ebara M, Kitagawa T, Tachibana H, Suzuki K, Kodaira T. Physical and dosimetric characterization of thermoset shape memory bolus developed for radiotherapy. Med Phys 2020; 47:6103-6112. [PMID: 33012062 PMCID: PMC7821231 DOI: 10.1002/mp.14516] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE We developed a thermoset shape memory bolus (shape memory bolus) made from poly-ε-caprolactone (PCL) polymer. This study aimed to investigate whether the shape memory bolus can be applied to radiotherapy as a bolus that conformally adheres to the body surface, can be created in a short time, and can be reused. METHODS The shape memory bolus was developed by cross-linking tetrabranch PCL with reactive acrylate end groups. Dice similarity coefficient (DSC) was used to evaluate shape memory characterization before deformation and after restoration. In addition, the degree of adhesion to the body surface and crystallization time were calculated. Moreover, dosimetric characterization was evaluated using the water equivalent phantom and an Alderson RANDO phantom. RESULTS The DSC value between before deformation and after restoration was close to 1. The degree of adhesion of the shape memory bolus (1.9%) was improved compared with the conventional bolus (45.6%) and was equivalent to three-dimensional (3D) printer boluses (1.3%-3.5%). The crystallization time was approximately 1.5 min, which was clinically acceptable. The dose calculation accuracy, dose distribution, and dose index were the equivalent compared with 3D boluses. CONCLUSION The shape memory bolus has excellent adhesion to the body surface, can be created in a short time, and can be reused. In addition, the shape memory bolus needs can be made from low-cost materials and no quality control systems are required for individual clinical departments, and it is useful as a bolus for radiotherapy.
Collapse
Affiliation(s)
- Takahiro Aoyama
- Department of Radiation Oncology, Aichi Cancer Center, 1-1 Kanokoden, Chikusa-Ku, Nagoya, Aichi, 464-8681, Japan.,Graduate School of Medicine, Aichi Medical University, 1-1 Yazako-karimata, Nagakute, Aichi, 480-1195, Japan
| | - Koichiro Uto
- Research Center for Functional Materials, National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki, 305-0044, Japan
| | - Hidetoshi Shimizu
- Department of Radiation Oncology, Aichi Cancer Center, 1-1 Kanokoden, Chikusa-Ku, Nagoya, Aichi, 464-8681, Japan
| | - Mitsuhiro Ebara
- Research Center for Functional Materials, National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki, 305-0044, Japan
| | - Tomoki Kitagawa
- Department of Radiation Oncology, Aichi Cancer Center, 1-1 Kanokoden, Chikusa-Ku, Nagoya, Aichi, 464-8681, Japan
| | - Hiroyuki Tachibana
- Department of Radiation Oncology, Aichi Cancer Center, 1-1 Kanokoden, Chikusa-Ku, Nagoya, Aichi, 464-8681, Japan
| | - Kojiro Suzuki
- Department of Radiology, Aichi Medical University, 1-1 Yazako-karimata, Nagakute, Aichi, 480-1195, Japan
| | - Takeshi Kodaira
- Department of Radiation Oncology, Aichi Cancer Center, 1-1 Kanokoden, Chikusa-Ku, Nagoya, Aichi, 464-8681, Japan
| |
Collapse
|
17
|
Low JM, Lee NJ, Sprow G, Chlebik A, Olch A, Darrow K, Bowlin K, Wong KK. Scalp and Cranium Radiation Therapy Using Modulation (SCRUM) and Bolus. Adv Radiat Oncol 2020; 5:936-942. [PMID: 33083656 PMCID: PMC7557138 DOI: 10.1016/j.adro.2020.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/31/2020] [Accepted: 03/09/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose A bolus is usually required to ensure radiation dose coverage of extensive superficial tumors of the scalp or skull. Oftentimes, these boluses are challenging to make and are nonreproducible, so an easier method was sought. Methods and Materials Thermoplastic sheets are widely available in radiation oncology clinics and can serve as bolus. Two template cutouts were designed for anterior and posterior halves to encompass the cranium of children and adults. Results The created bolus was imaged using computed tomography, which demonstrated good conformity and minimal air gaps. Conclusions Although making a bolus for treating superficial tumors of the scalp or head and neck is challenging, the presented technique enables thermoplastic to be used as a bolus and is quick, easy, and reproducible.
Collapse
Affiliation(s)
- Justin M. Low
- Long School of Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Nicole J.H. Lee
- Touro University California College of Osteopathic Medicine, Vallejo, California
| | - Grant Sprow
- Albert Einstein College of Medicine, Bronx, New York
| | - Alisha Chlebik
- Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, California
| | - Arthur Olch
- Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, California
- Department of Radiation Oncology, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Kaleb Darrow
- University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee
| | - Kristine Bowlin
- Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, California
| | - Kenneth K. Wong
- Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, California
- Department of Radiation Oncology, Keck School of Medicine of the University of Southern California, Los Angeles, California
- Corresponding author: Kenneth K. Wong, MD
| |
Collapse
|
18
|
Dyer BA, Campos DD, Hernandez DD, Wright CL, Perks JR, Lucero SA, Bewley AF, Yamamoto T, Zhu X, Rao SS. Characterization and clinical validation of patient-specific three-dimensional printed tissue-equivalent bolus for radiotherapy of head and neck malignancies involving skin. Phys Med 2020; 77:138-145. [PMID: 32829102 DOI: 10.1016/j.ejmp.2020.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 08/06/2020] [Accepted: 08/09/2020] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Megavoltage radiotherapy to irregular superficial targets is challenging due to the skin sparing effect. We developed a three-dimensional bolus (3DB) program to assess the clinical impact on dosimetric and patient outcomes. MATERIALS AND METHODS Planar commercial bolus (PCB) and 3DB density, clarity, and net bolus effect were rigorously evaluated prior to clinical implementation. After IRB approval, patients with cutaneous or locally advanced malignancies deemed to require bolus for radiotherapy treatment were treated with custom 3DB. RESULTS The mean density of 3DB and PCB was of 1.07 g/cm 3 and 1.12 g/cm3, respectively. 3DB optic clarity was superior versus PCB at any material thickness. Phantom measurements of superficial dose with 3DB and PCB showed excellent bolus effect for both materials. 3DB reduced air gaps compared with PCB - particularly in irregular areas such as the ear, nose, and orbit. A dosimetric comparison of 3DB and PCB plans showed equivalent superficial homogeneity for 3DB and PCB (3DB median HI 1.249, range 1.111-1.300 and PCB median HI 1.165, range 1.094-1.279), but better conformity with 3DB (3DB median CI 0.993, range 0.962-0.993) versus PCB (PCB median CI 0.977, range 0.601-0.991). Patient dose measurements using 3DB confirm the delivered superficial dose was within 1% of the intended prescription (95% CI 97-102%; P = 0.11). CONCLUSIONS 3DB improves radiotherapy plan conformity, reduces air gap volume in irregular superficial areas which could affect superficial dose delivery, and provides excellent dose coverage to irregular superficial targets.
Collapse
Affiliation(s)
- Brandon A Dyer
- University of Washington, Department of Radiation Oncology, Seattle, WA, United States.
| | - David D Campos
- University of California Davis Comprehensive Cancer Center, Department of Radiation Oncology, Sacramento, CA, United States
| | - Daniel D Hernandez
- University of California Davis Comprehensive Cancer Center, Department of Radiation Oncology, Sacramento, CA, United States; University of California Davis, Department of Physics, Davis, CA, United States
| | - Cari L Wright
- University of California Davis Comprehensive Cancer Center, Department of Radiation Oncology, Sacramento, CA, United States
| | - Julian R Perks
- University of California Davis Comprehensive Cancer Center, Department of Radiation Oncology, Sacramento, CA, United States
| | - Steven A Lucero
- University of California Davis, Department of Biomedical Engineering, Electrical & Mechanical Prototyping, Davis, CA, United States
| | - Arnaud F Bewley
- University of California Davis, Department of Otolaryngology Head & Neck Surgery, Sacramento, CA, United States
| | - Tokihiro Yamamoto
- University of California Davis Comprehensive Cancer Center, Department of Radiation Oncology, Sacramento, CA, United States
| | - Xiandong Zhu
- University of California Davis, Department of Physics, Davis, CA, United States
| | - Shyam S Rao
- University of California Davis Comprehensive Cancer Center, Department of Radiation Oncology, Sacramento, CA, United States.
| |
Collapse
|
19
|
Shiinoki T, Fujii F, Fujimoto K, Yuasa Y, Sera T. A novel dynamic robotic moving phantom system for patient-specific quality assurance in real-time tumor-tracking radiotherapy. J Appl Clin Med Phys 2020; 21:16-28. [PMID: 32281265 PMCID: PMC7386190 DOI: 10.1002/acm2.12876] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 12/29/2020] [Accepted: 03/10/2020] [Indexed: 12/25/2022] Open
Abstract
In this study, we assess a developed novel dynamic moving phantom system that can reproduce patient three-dimensional (3D) tumor motion and patient anatomy, and perform patient-specific quality assurance (QA) of respiratory-gated radiotherapy using SyncTraX. Three patients with lung cancer were enrolled in a study. 3D printing technology was adopted to obtain individualized lung phantoms using CT images. A water-equivalent phantom (WEP) with the 3D-printed plate lung phantom was set at the tip of the robotic arm. The log file that recorded the 3D positions of the lung tumor was used as the input to the dynamic robotic moving phantom. The WEP was driven to track 3D respiratory motion. Respiratory-gated radiotherapy was performed for driving the WEP. The tracking accuracy was calculated as the differences between the actual and measured positions. For the absolute dose and dose distribution, the differences between the planned and measured doses were calculated. The differences between the planned and measured absolute doses were <1.0% at the isocenter and <4.0% for the lung region. The gamma pass ratios of γ3 mm/3% and γ2 mm/2% under the conditions of gating and no-gating were 99.9 ± 0.1% and 90.1 ± 8.5%, and 97.5 ± 0.9% and 68.6 ± 17.8%, respectively, for all the patients. Furthermore, for all the patients, the mean ± SD of the root mean square values of the positional error were 0.11 ± 0.04 mm, 0.33 ± 0.04 mm, and 0.20 ± 0.04 mm in the LR, AP, and SI directions, respectively. Finally, we showed that patient-specific QA of respiratory-gated radiotherapy using SyncTraX can be performed under realistic conditions using the moving phantom.
Collapse
Affiliation(s)
- Takehiro Shiinoki
- Department of Radiation Oncology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan
| | - Fumitake Fujii
- Department of Mechanical Engineering, Graduate School of Science and Technology for innovation, Yamaguchi University, Ube, Yamaguchi, Japan
| | - Koya Fujimoto
- Department of Radiation Oncology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan
| | - Yuki Yuasa
- Department of Radiation Oncology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan
| | - Tatsuhiro Sera
- Department of Radiological Technology, Yamaguchi University Hospital, Ube, Yamaguchi, Japan
| |
Collapse
|
20
|
Albantow C, Hargrave C, Brown A, Halsall C. Comparison of 3D printed nose bolus to traditional wax bolus for cost-effectiveness, volumetric accuracy and dosimetric effect. J Med Radiat Sci 2020; 67:54-63. [PMID: 32011102 PMCID: PMC7063257 DOI: 10.1002/jmrs.378] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 12/12/2019] [Accepted: 12/12/2019] [Indexed: 11/21/2022] Open
Abstract
Introduction Three‐dimensional printing technology has the potential to streamline custom bolus production in radiotherapy. This study evaluates the volumetric, dosimetric and cost differences between traditional wax and 3D printed versions of nose bolus. Method Nose plaster impressions from 24 volunteers were CT scanned and planned. Planned virtual bolus was manufactured in wax and created in 3D print (100% and 18% shell infill density) for comparison. To compare volume variations and dosimetry, each constructed bolus was CT scanned and a plan replicating the reference plan fields generated. Bolus manufacture time and material costs were analysed. Results Mean volume differences between the virtual bolus (VB) and wax, and the VB and 18% and 100% 3D shells were −3.05 ± 11.06 cm3, −1.03 ± 8.09 cm3 and 1.31 ± 2.63 cm3, respectively. While there was no significant difference for the point and mean doses between the 100% 3D shell filled with water and the VB plans (P> 0.05), the intraclass coefficients for these dose metrics for the 100% 3D shell filled with wax compared to VB doses (0.69–0.96) were higher than those for the 18% and 100% 3D shell filled with water and the wax (0.48–0.88). Average costs for staff time and materials were higher for the wax ($138.54 and $20.49, respectively) compared with the 3D shell prints ($10.58 and $13.87, respectively). Conclusion Three‐dimensional printed bolus replicated the VB geometry with less cost for manufacture than wax bolus. When shells are printed with 100% infill density, 3D bolus dosimetrically replicates the reference plan.
Collapse
Affiliation(s)
- Christine Albantow
- Radiation Therapy, Townsville Cancer Centre, Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Catriona Hargrave
- Radiation Oncology, Princess Alexandra Hospital - Raymond Tce Campus, South Brisbane, Queensland, Australia.,Faculty of Health, School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Amy Brown
- Radiation Therapy, Townsville Cancer Centre, Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | | |
Collapse
|
21
|
Guthier CV, Devlin PM, Harris TC, O'Farrell DA, Cormack RA, Buzurovic I. Development and clinical implementation of semi-automated treatment planning including 3D printable applicator holders in complex skin brachytherapy. Med Phys 2020; 47:869-879. [PMID: 31855280 DOI: 10.1002/mp.13975] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 12/04/2019] [Accepted: 12/09/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE High-dose-rate brachytherapy (HDR-BT) is a treatment option for malignant skin diseases compared to external beam radiation therapy, HDR-BT provides improved target coverage, better organ sparing, and has comparable treatment times. This is especially true for large clinical targets with complex topologies. To standardize and improve the quality and efficacy of the treatments, a novel streamlined treatment approach in complex skin HDR-BT was developed and implemented. This approach consists of auto generated treatment plans and a 3D printable applicator holder (3D-AH). MATERIALS AND METHODS The in-house developed planning system automatically segments computed tomography simulation images (a), optimizes a treatment plan (b), and generates a model of the 3D-AH (c). The 3D-AH is used as an immobilization device for the flexible Freiburg flap applicator used to deliver treatment. The developed, automated planning is compared against the standard clinical plan generation process for a flat 10 × 10 cm2 field, curved fields with radii of 4, 6, and 8 cm, and a representative clinical case. The quality of the 3D print is verified via an additional CT of the flap applicator latched into the holder, followed by an automated rigid registration with the original planning CT. Finally, the methodology is implemented and tested clinically under an IRB approval. RESULTS All automatically generated plans were reviewed and accepted for clinical use. For the clinical workflow, the coverage achieved at a prescription depth for the flat 4, 6, and 8 cm applicator was (100.0 ± 4.9)%, (100.0 ± 4.9)%, (96.0 ± 0.3)%, and (98.4 ± 0.3)%, respectively. For auto planning, the coverage was (99.9 ± 0.3)%, (100.0 ± 0.2)%, (100.0 ± 0.3)%, and (100.1 ± 0.2)%. For the clinical test case, the D90 for the clinical workflow and auto planning was found to be 93.5% and 100.29% of the prescribed dose, respectively. Processing of the patient's CT to generate trajectories and positions as well as the 3D model of the applicator took <5 min. CONCLUSION This workflow automates time intensive catheter digitizing and treatment planning. Compared to printing full applicators, the use of 3D-AH reduces the complexity of the 3D prints, the amount of the material to be used, the time of 3D printing, and amount of quality assurance required. The proposed methodology improves the overall treatment plan quality in complex HDR-BT and impact patient treatment outcomes potentially.
Collapse
Affiliation(s)
- Christian V Guthier
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, 02215, USA
| | - Phillip M Devlin
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, 02215, USA
| | - Thomas C Harris
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, 02215, USA
| | - Desmond A O'Farrell
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, 02215, USA
| | - Robert A Cormack
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, 02215, USA
| | - Ivan Buzurovic
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, 02215, USA
| |
Collapse
|
22
|
LeCompte MC, Chung SA, McKee MM, Marshall TG, Frizzell B, Parker M, Blackstock AW, Farris MK. Simple and Rapid Creation of Customized 3-dimensional Printed Bolus Using iPhone X True Depth Camera. Pract Radiat Oncol 2019; 9:e417-e421. [PMID: 30926481 DOI: 10.1016/j.prro.2019.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/06/2019] [Accepted: 03/19/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Three-dimensional printing has produced customized bolus during radiation therapy for superficial tumors along irregular skin surfaces. In comparison, traditional bolus materials are often difficult to manipulate for a proper fit. Current 3-dimensional printed boluses are made from either preexisting computed tomography scans or complex surface scanning methods. Herein, we introduce an inexpensive, convenient approach to generate a 3-dimensional printed bolus from surface scanning technology available in common smartphones. METHODS AND MATERIALS A three-dimensional printed bolus was designed using surface scans from iPhone X true depth cameras and a low-cost 3-dimensional printer. The percentage density infill was adjusted to achieve tissue equivalence. To evaluate the clinical feasibility, fit against the skin surface and radiation dose distribution were compared with those of the traditional bolus. RESULTS We fabricated a customized 3-dimensional printed bolus for different areas of the face using an iPhone X camera and inexpensive commercially available 3-dimensional printer. When printed at 100% density, the bolus material approximated soft tissue/water and provided an equivalent dose distribution to that found with standard bolus materials on direct comparison. The bolus material is inexpensive and produces an ideal fit with the scanned anatomy. CONCLUSIONS We present a simplified method of highly customized bolus production that requires minimal experience with computer modeling programs and can be accomplished with an iPhone true depth camera.
Collapse
Affiliation(s)
- Michael C LeCompte
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
| | - Scotty A Chung
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Mahta Mirzaei McKee
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Travis G Marshall
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Bart Frizzell
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Mandy Parker
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - A William Blackstock
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Michael K Farris
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| |
Collapse
|
23
|
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.
Collapse
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
| |
Collapse
|
24
|
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.
Collapse
|
25
|
Zou W, Burgdorf B, Yue NJ, Yin L, Zhang M, Khan A, Jabbour SK, McDonough J, Dong L, Teo BKK. Efficient double-scattering proton therapy with a patient-specific bolus. Phys Med 2018; 50:1-6. [PMID: 29891088 PMCID: PMC10865432 DOI: 10.1016/j.ejmp.2018.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 05/01/2018] [Accepted: 05/03/2018] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Passive scattering proton radiotherapy utilizes beam-specific compensators to shape the dose to the distal end of the tumor target. These compensators typically require therapists to enter the treatment room to mount between beams. This study investigates a novel approach that utilizes a single patient-specific bolus to accomplish the role of multi-field compensators to improve the efficiency of the treatment delivery. METHODS Ray-tracing from the proton virtual source was used to convert the beam-specific compensators (mounted on the gantry nozzle) into an equivalent bolus thickness on the patient surface. The field bolus contours were combined to create a single bolus. A 3D acrylic bolus was milled for a head phantom. The dose distribution of the compensator plan was compared to the bolus plan using 3D Gamma analysis and film measurements. Boluses for two clinical patients were also designed. RESULTS The calculated phantom dose distribution of the original proton compensator plan was shown to be equivalent to the plan with the surface bolus. Film irradiations with the proton bolus also confirmed the dosimetric equivalence of the two techniques. The dose distribution equivalency of the bolus plans for the clinical patients were demonstrated. CONCLUSIONS We presented a novel approach that uses a single patient-specific bolus to replace patient compensators during passive scattering proton delivery. This approach has the potential to reduce the treatment time, the compensator manufacturing costs, the risk of potential collision between the compensator and the patient/couch, and the waste of compensator material.
Collapse
Affiliation(s)
- Wei Zou
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, United States.
| | - Brendan Burgdorf
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Ning J Yue
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ 08903, United States
| | - Lingshu Yin
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Miao Zhang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Atif Khan
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ 08903, United States
| | - James McDonough
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Lei Dong
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Boon-Keng Kevin Teo
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, United States
| |
Collapse
|
26
|
Robar JL, Moran K, Allan J, Clancey J, Joseph T, Chytyk-Praznik K, MacDonald RL, Lincoln J, Sadeghi P, Rutledge R. Intrapatient study comparing 3D printed bolus versus standard vinyl gel sheet bolus for postmastectomy chest wall radiation therapy. Pract Radiat Oncol 2017; 8:221-229. [PMID: 29452866 DOI: 10.1016/j.prro.2017.12.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/11/2017] [Accepted: 12/20/2017] [Indexed: 11/16/2022]
Abstract
PURPOSE This patient study evaluated the use of 3-dimensional (3D) printed bolus for chest wall radiation therapy compared with standard sheet bolus with regard to accuracy of fit, surface dose measured in vivo, and efficiency of patient setup. By alternating bolus type over the course of therapy, each patient served as her own control. METHODS AND MATERIALS For 16 patients undergoing chest wall radiation therapy, a custom 5.0 mm thick bolus was designed based on the treatment planning computed tomography scan and 3D printed using polylactic acid. Cone beam computed tomography scanning was used to image and quantify the accuracy of fit of the 2 bolus types with regard to air gaps between the bolus and skin. As a quality assurance measure for the 3D printed bolus, optically stimulated luminescent dosimetry provided in vivo comparison of surface dose at 7 points on the chest wall. Durations of patient setup and image guidance were recorded and compared. RESULTS In 13 of 16 patients, the bolus was printed without user intervention, and the median print time was 12.6 hours. The accuracy of fit of the bolus to the chest wall was improved significantly relative to standard sheet bolus, with the frequency of air gaps 5 mm or greater reduced from 30% to 13% (P < .001) and maximum air gap dimension diminished from 0.5 ± 0.3 to 0.3 ± 0.3 mm on average. Surface dose was within 3% for both standard sheet and 3D printed bolus. On average, the use of 3D printed bolus reduced the setup time from 104 to 76 seconds. CONCLUSIONS This study demonstrates 3D printed bolus in postmastectomy radiation therapy improves fit of the bolus and reduces patient setup time marginally compared with standard vinyl gel sheet bolus. The time savings on patient setup must be weighed against the considerable time needed for the 3D printing process.
Collapse
Affiliation(s)
- James L Robar
- Department of Radiation Oncology, Dalhousie University, Halifax, Canada; Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Canada; Nova Scotia Health Authority, Halifax, Canada.
| | | | - James Allan
- Nova Scotia Health Authority, Halifax, Canada
| | | | - Tami Joseph
- Nova Scotia Health Authority, Halifax, Canada
| | - Krista Chytyk-Praznik
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Canada; Nova Scotia Health Authority, Halifax, Canada
| | - R Lee MacDonald
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Canada
| | - John Lincoln
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Canada
| | - Parisa Sadeghi
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Canada
| | - Robert Rutledge
- Department of Radiation Oncology, Dalhousie University, Halifax, Canada; Nova Scotia Health Authority, Halifax, Canada
| |
Collapse
|
27
|
Kamomae T, Shimizu H, Nakaya T, Okudaira K, Aoyama T, Oguchi H, Komori M, Kawamura M, Ohtakara K, Monzen H, Itoh Y, Naganawa S. Three-dimensional printer-generated patient-specific phantom for artificial in vivo dosimetry in radiotherapy quality assurance. Phys Med 2017; 44:205-211. [PMID: 29102154 DOI: 10.1016/j.ejmp.2017.10.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 09/11/2017] [Accepted: 10/14/2017] [Indexed: 12/21/2022] Open
Abstract
Pretreatment intensity-modulated radiotherapy quality assurance is performed using simple rectangular or cylindrical phantoms; thus, the dosimetric errors caused by complex patient-specific anatomy are absent in the evaluation objects. In this study, we construct a system for generating patient-specific three-dimensional (3D)-printed phantoms for radiotherapy dosimetry. An anthropomorphic head phantom containing the bone and hollow of the paranasal sinus is scanned by computed tomography (CT). Based on surface rendering data, a patient-specific phantom is formed using a fused-deposition-modeling-based 3D printer, with a polylactic acid filament as the printing material. Radiophotoluminescence glass dosimeters can be inserted in the 3D-printed phantom. The phantom shape, CT value, and absorbed doses are compared between the actual and 3D-printed phantoms. The shape difference between the actual and printed phantoms is less than 1 mm except in the bottom surface region. The average CT value of the infill region in the 3D-printed phantom is -6 ± 18 Hounsfield units (HU) and that of the vertical shell region is 126 ± 18 HU. When the same plans were irradiated, the dose differences were generally less than 2%. These results demonstrate the feasibility of the 3D-printed phantom for artificial in vivo dosimetry in radiotherapy quality assurance.
Collapse
Affiliation(s)
- Takeshi Kamomae
- Department of Therapeutic Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
| | - Hidetoshi Shimizu
- Department of Radiation Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-Ku, Nagoya 464-8681, Aichi, Japan
| | - Takayoshi Nakaya
- Department of Radiological Technology, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8560, Japan
| | - Kuniyasu Okudaira
- Department of Radiological Technology, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8560, Japan
| | - Takahiro Aoyama
- Department of Radiation Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-Ku, Nagoya 464-8681, Aichi, Japan
| | - Hiroshi Oguchi
- Department of Radiological and Medical Laboratory Sciences, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-Minami, Higashi-ku, Nagoya 461-8673, Japan
| | - Masataka Komori
- Department of Radiological and Medical Laboratory Sciences, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-Minami, Higashi-ku, Nagoya 461-8673, Japan
| | - Mariko Kawamura
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Kazuhiro Ohtakara
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Hajime Monzen
- Department of Medical Physics, Graduate School of Medical Science, Kindai University, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka 589-8511, Japan
| | - Yoshiyuki Itoh
- Department of Therapeutic Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| |
Collapse
|
28
|
Oh SA, Lee CM, Lee MW, Lee YS, Lee GH, Kim SH, Kim SK, Park JW, Yea JW. Fabrication of a Patient-Customized Helmet with a Three-Dimensional Printer for Radiation Therapy of Scalp. ACTA ACUST UNITED AC 2017. [DOI: 10.14316/pmp.2017.28.3.100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Se An Oh
- Department of Radiation Oncology, Yeungnam University Medical Center, Daegu, Korea
| | | | | | | | | | - Seong Hoon Kim
- Department of Radiation Oncology, Yeungnam University Medical Center, Daegu, Korea
| | - Sung Kyu Kim
- Department of Radiation Oncology, Yeungnam University Medical Center, Daegu, Korea
| | - Jae Won Park
- Department of Radiation Oncology, Yeungnam University Medical Center, Daegu, Korea
| | - Ji Woon Yea
- Department of Radiation Oncology, Yeungnam University Medical Center, Daegu, Korea
| |
Collapse
|