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Takanen S, Ianiro A, Pinnarò P, Infusino E, Marucci L, Soriani A, Sanguineti G, Iaccarino G. A Customized 3D-Printed Bolus for High-Risk Breast Cancer with Skin Infiltration: A Pilot Study. Curr Oncol 2024; 31:5224-5232. [PMID: 39330014 PMCID: PMC11431794 DOI: 10.3390/curroncol31090386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 08/30/2024] [Accepted: 09/04/2024] [Indexed: 09/28/2024] Open
Abstract
BACKGROUND In high-risk breast cancer patients with skin infiltration, the administration of a uniform dose to superficial tissues is fundamental in order to reduce local skin relapse. A personalized bolus may prevent the potential inadequate dose distribution of a standard bolus due to air gaps between the bolus and the skin. In this pilot study, we introduced into clinical practice the use of a personalized 3D-printed bolus filled with ultrasound transmission gel. METHODS Seven patients undergoing radiotherapy after mastectomy were selected. A 3D-printed bolus dosimetric assessment was performed with MOSFET dosimeters on an anthropomorphic phantom and, subsequently, on three selected cases with increasing bolus shape irregularity. Acute/late toxicity and local control were assessed. RESULTS Overall, for the clinical cases, the percentage median difference between the measured and calculated doses was -2.7% (-7.0-4.9%). The median follow-up was 21 months. After two years, one patient showed G2 pain, one patient manifested G1 telangiectasia, one patient showed G1 hyperpigmentation, and two patients had no relevant toxicity. CONCLUSIONS A personalized 3D-printed bolus filled with ultrasound gel may easily reproduce the standard bolus' consistency and provide accurate coverage of the target area with tolerable acute/late toxicity grades. This is a pilot study, and further investigations are needed.
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Affiliation(s)
- Silvia Takanen
- Radiation Oncology Department, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy (L.M.)
| | - Anna Ianiro
- Medical Physics Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (E.I.)
| | - Paola Pinnarò
- Radiation Oncology Department, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy (L.M.)
| | - Erminia Infusino
- Medical Physics Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (E.I.)
| | - Laura Marucci
- Radiation Oncology Department, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy (L.M.)
| | - Antonella Soriani
- Medical Physics Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (E.I.)
| | - Giuseppe Sanguineti
- Radiation Oncology Department, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy (L.M.)
| | - Giuseppe Iaccarino
- Medical Physics Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (E.I.)
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Owen J, Pareek V, Sasaki D, Cooke A, Koul R, Dubey A. Use of 3D printing technology for custom bolus fabrication in the management of palmar or plantar fibromatosis with radiotherapy: A retrospective case series. J Med Imaging Radiat Sci 2024; 55:101747. [PMID: 39241662 DOI: 10.1016/j.jmir.2024.101747] [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: 02/10/2024] [Revised: 08/08/2024] [Accepted: 08/09/2024] [Indexed: 09/09/2024]
Abstract
PURPOSE Palmar or plantar fibromatosis is a benign fibroproliferative disorder affecting the fascia of the hands or feet. Management involves surgery, typically reserved for cases where progression limits function. Retrospective series demonstrate that radiation therapy (RT) can stabilize the disease course in many patients and improve symptoms in some cases. RT techniques vary between the use of electrons and superficial or orthovoltage photons and often require lead cutouts or custom boluses. We present a new approach demonstrating the implementation and effectiveness of three-dimensional (3D)-printed bolus material in patients receiving RT for fibromatosis. MATERIALS AND METHODS A total of 3 patients, one with plantar and two with palmar fibromatosis, were treated with radiation using 3D-printed boluses over the past year. Bolus's design was based on computed tomography (CT) imaging data. Palmar patients were treated with a single en-face electron field, with a two-part accessory as a bolus and an immobilization device encasing the hand. The plantar case required 6MV photons delivered with a Volumetric Modulated Arc Therapy (VMAT) technique to cover the deeper target volume adequately. Dose and fractionation were based on guidelines from the Royal College of Radiologists in the United Kingdom. CT was used to assess printed shape and density accuracy. RESULTS The mean deviations in shape between the printed bolus pieces and their designs were all less than 0.4 mm. The differences in mean Hounsefield units (HU) between the printed boluses and their expected values were between 7 and 44 HU. No significant issues were encountered when applying the bolus to patients. The thermoluminescent dosimeters (TLD) used demonstrated dose accuracy to within TLD precision (5 %). CONCLUSIONS 3D printing bolus technology represents a novel approach to treating fibromatosis with radiation. It offers superior dosimetry through the reduction of air gaps and by permitting custom bolus thickness. Also, it simplifies clinical set-up by acting as an immobilization device and a visual aid for daily field placement.
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Affiliation(s)
- Justin Owen
- Department of Radiation Oncology, CancerCare Manitoba, Winnipeg, MB, Canada.
| | - Vibhay Pareek
- Department of Radiation Oncology, CancerCare Manitoba, Winnipeg, MB, Canada.
| | - David Sasaki
- Department of Medical Physics, CancerCare Manitoba, Winnipeg, MB, Canada.
| | - Andrew Cooke
- Department of Radiation Oncology, CancerCare Manitoba, Winnipeg, MB, Canada.
| | - Rashmi Koul
- Department of Radiation Oncology, CancerCare Manitoba, Winnipeg, MB, Canada.
| | - Arbind Dubey
- Department of Radiation Oncology, CancerCare Manitoba, Winnipeg, MB, Canada.
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3
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Barcena AJR, Ravi P, Kundu S, Tappa K. Emerging Biomedical and Clinical Applications of 3D-Printed Poly(Lactic Acid)-Based Devices and Delivery Systems. Bioengineering (Basel) 2024; 11:705. [PMID: 39061787 PMCID: PMC11273440 DOI: 10.3390/bioengineering11070705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 07/06/2024] [Accepted: 07/07/2024] [Indexed: 07/28/2024] Open
Abstract
Poly(lactic acid) (PLA) is widely used in the field of medicine due to its biocompatibility, versatility, and cost-effectiveness. Three-dimensional (3D) printing or the systematic deposition of PLA in layers has enabled the fabrication of customized scaffolds for various biomedical and clinical applications. In tissue engineering and regenerative medicine, 3D-printed PLA has been mostly used to generate bone tissue scaffolds, typically in combination with different polymers and ceramics. PLA's versatility has also allowed the development of drug-eluting constructs for the controlled release of various agents, such as antibiotics, antivirals, anti-hypertensives, chemotherapeutics, hormones, and vitamins. Additionally, 3D-printed PLA has recently been used to develop diagnostic electrodes, prostheses, orthoses, surgical instruments, and radiotherapy devices. PLA has provided a cost-effective, accessible, and safer means of improving patient care through surgical and dosimetry guides, as well as enhancing medical education through training models and simulators. Overall, the widespread use of 3D-printed PLA in biomedical and clinical settings is expected to persistently stimulate biomedical innovation and revolutionize patient care and healthcare delivery.
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Affiliation(s)
- Allan John R. Barcena
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
- College of Medicine, University of the Philippines Manila, Manila 1000, Philippines
| | - Prashanth Ravi
- Department of Radiology, University of Cincinnati, Cincinnati, OH 45219, USA;
| | - Suprateek Kundu
- Department of Biostatistics, Division of Basic Science Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Karthik Tappa
- Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Jung KH, Han DH, Lee KY, Kim JO, Ahn WS, Baek CH. Evaluating the performance of thermoplastic 3D bolus used in radiation therapy. Appl Radiat Isot 2024; 209:111329. [PMID: 38701594 DOI: 10.1016/j.apradiso.2024.111329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 04/05/2024] [Accepted: 04/20/2024] [Indexed: 05/05/2024]
Abstract
A 3D-printed bolus is being developed to deliver accurate doses to superficial cancers. In this study, flexible thermoplastic filaments, specifically PLA, TPU, PETG, and HIPS, were fabricated into boluses and then compared to commercial bolus for the variation of the dose elevation region of photon beams. The experimental results indicate that the maximum dose depth is similar, and the consistent trend of the percentage depth dose confirms the potential usage as a build-up bolus.
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Affiliation(s)
- Kyung Hwan Jung
- Department of Health Medical Science, Kangwon National University, South Korea
| | - Dong Hee Han
- Department of Health Medical Science, Kangwon National University, South Korea
| | - Ki Yoon Lee
- Department of Health Medical Science, Kangwon National University, South Korea
| | - Jang Oh Kim
- Department of Radiological Science, Kangwon National University, South Korea
| | - Woo Sang Ahn
- Department of Radiation Oncology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, South Korea
| | - Cheol Ha Baek
- Department of Radiological Science, Kangwon National University, South Korea.
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Kharfi F, Benkahila K, Boulkhessaim F, Betka A, Meziri A, Khelfa S, Ghediri N. Implementation of 3D Printing and Modeling Technologies for the Fabrication of Dose Boluses for External Radiotherapy at the CLCC of Sétif, Algeria. Technol Cancer Res Treat 2024; 23:15330338241266479. [PMID: 39043036 PMCID: PMC11271100 DOI: 10.1177/15330338241266479] [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: 04/02/2024] [Revised: 05/03/2024] [Accepted: 06/19/2024] [Indexed: 07/25/2024] Open
Abstract
Objective: In external radiotherapy, dose boluses and compensators are used for treatment of irregular facial topography surfaces. In such cases, skewed isodose curves need to be addressed using a bolus that gives the deep dose distribution a shape adapted to the anatomical structures to be protected or irradiated. The combination of 3D modeling and printing technologies is a promising alternative to the conventional inaccurate and uncomfortable bolus fabrication technique. In this work, the proposed technologies will be used in the design and fabrication of high-performance and high-accuracy boluses that respond to the main constraints on metrology, adhesion to the patient's surface, comfort, and dose delivery. Methods: As a first phase in the implementation of the proposed solution, 3D printing materials, to be used in the fabrication of radiotherapy boluses, were selected and characterized to check how they respond to the required criteria on functionality, safety, and quality. Results: The obtained results show that among the studied materials, thermoplastic polyurethane (TPU) was found to be slightly more suitable than polylactic acid (PLA) for the fabrication of 3D printing boluses but for some kinds of treatments, PLA may be preferred despite its relative rigidity. Conclusion: In this work, procedures for dose bolus fabrication were proposed, and necessary data were obtained for some available 3D printing materials (TPU and PLA) that can be used for targeted applications. This achievement is a major step toward the final implementation of 3D modeling and printing technologies for the efficient fabrication of radiotherapy dose boluses.
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Affiliation(s)
- Faycal Kharfi
- Department of Physics, Faculty of Sciences, Setif1 University-Ferhat Abbas, Setif, Algeria
- Laboratory of Dosing, Analysis and Characterization with High Resolution, Setif1 University-Ferhat Abbas, Setif, Algeria
| | - Karim Benkahila
- Laboratory of Dosing, Analysis and Characterization with High Resolution, Setif1 University-Ferhat Abbas, Setif, Algeria
- Department of Radiotherapy, Fighting Against Cancer Medical Centre of Setif, Setif, Algeria
| | - Foued Boulkhessaim
- Department of Radiotherapy, Fighting Against Cancer Medical Centre of Setif, Setif, Algeria
- Department of Medicine, Faculty of Medicine, Setif1 University-Ferhat Abbas, Setif, Algeria
| | - Abderrahim Betka
- Department of Physics, Faculty of Sciences, Setif1 University-Ferhat Abbas, Setif, Algeria
- Laboratory of Dosing, Analysis and Characterization with High Resolution, Setif1 University-Ferhat Abbas, Setif, Algeria
| | - Amina Meziri
- Department of Radiotherapy, Fighting Against Cancer Medical Centre of Setif, Setif, Algeria
| | - Sara Khelfa
- Department of Radiotherapy, Fighting Against Cancer Medical Centre of Setif, Setif, Algeria
| | - Noussaiba Ghediri
- Department of Physics, Faculty of Sciences, Setif1 University-Ferhat Abbas, Setif, Algeria
- Laboratory of Dosing, Analysis and Characterization with High Resolution, Setif1 University-Ferhat Abbas, Setif, Algeria
- Department of Radiotherapy, Fighting Against Cancer Medical Centre of El-Oued, El-Oued, Algeria
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Chen XM, Xu CD, Zeng LP, Huang XT, Chen AQ, Liu L, Lin LW, Jia LC, Li H, Jiang XB. Analysis of Individualized Silicone Rubber Bolus Using Fan Beam Computed Tomography in Postmastectomy Radiotherapy: A Dosimetric Evaluation and Skin Acute Radiation Dermatitis Survey. Technol Cancer Res Treat 2024; 23:15330338241229367. [PMID: 38297814 PMCID: PMC10832424 DOI: 10.1177/15330338241229367] [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: 08/15/2023] [Revised: 11/28/2023] [Accepted: 01/03/2024] [Indexed: 02/02/2024] Open
Abstract
Objective: To investigate the dosimetric effects of using individualized silicone rubber (SR) bolus on the target area and organs at risk (OARs) during postmastectomy radiotherapy (PMRT), as well as evaluate skin acute radiation dermatitis (ARD). Methods: A retrospective study was performed on 30 patients with breast cancer. Each patient was prepared with an individualized SR bolus of 3 mm thickness. Fan-beam computed tomography (FBCT) was performed at the first and second fractions, and then once a week for a total of 5 times. Dosimetric metrics such as homogeneity index (HI), conformity index (CI), skin dose (SD), and OARs including the heart, lungs, and spinal cord were compared between the original plan and the FBCTs. The acute side effects were recorded. Results: In targets' dosimetric metrics, there were no significant differences in Dmean and V105% between planning computed tomography (CT) and actual treatments (P > .05), while the differences in D95%, V95%, HI, and CI were statistically significant (P < .05). In OARs, there were no significant differences between the Dmean, V5, and V20 of the affected lung, V5 of the heart and Dmax of the spinal cord (P > .05) except the V30 of affected lung, which was slightly lower than the planning CT (P < .05). In SD, both Dmax and Dmean in actual treatments were increased than plan A, and the difference was statistically significant (P < .05), while the skin-V20 and skin-V30 has no difference. Among the 30 patients, only one patient had no skin ARD, and 5 patients developed ARD of grade 2, while the remaining 24 patients were grade 1. Conclusion: The OR bolus showed good anastomoses and high interfraction reproducibility with the chest wall, and did not cause deformation during irradiation. It ensured accurate dose delivery of the target and OARs during the treatment, which may increase SD by over 101%. In this study, no cases of grade 3 skin ARD were observed. However, the potential of using OR bolus to reduce grade 1 and 2 skin ARD warrants further investigation with a larger sample size.
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Affiliation(s)
- Xue-mei Chen
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Chen-di Xu
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Li-ping Zeng
- Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, Guangdong Province, P.R. China
| | - Xiao-tong Huang
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Ao-qiang Chen
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Lu Liu
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Liu-wen Lin
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Le-cheng Jia
- Shenzhen United Imaging Research Institute of Innovative Medical Equipment, Shenzhen, Guangdong Province, P.R. China
| | - Hua Li
- Shenzhen United Imaging Research Institute of Innovative Medical Equipment, Shenzhen, Guangdong Province, P.R. China
| | - Xiao-bo Jiang
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
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Ashenafi M, Jeong S, Wancura JN, Gou L, Webster MJ, Zheng D. A quick guide on implementing and quality assuring 3D printing in radiation oncology. J Appl Clin Med Phys 2023; 24:e14102. [PMID: 37501315 PMCID: PMC10647979 DOI: 10.1002/acm2.14102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/23/2023] [Accepted: 07/08/2023] [Indexed: 07/29/2023] Open
Abstract
As three-dimensional (3D) printing becomes increasingly common in radiation oncology, proper implementation, usage, and ongoing quality assurance (QA) are essential. While there have been many reports on various clinical investigations and several review articles, there is a lack of literature on the general considerations of implementing 3D printing in radiation oncology departments, including comprehensive process establishment and proper ongoing QA. This review aims to guide radiation oncology departments in effectively using 3D printing technology for routine clinical applications and future developments. We attempt to provide recommendations on 3D printing equipment, software, workflow, and QA, based on existing literature and our experience. Specifically, we focus on three main applications: patient-specific bolus, high-dose-rate (HDR) surface brachytherapy applicators, and phantoms. Additionally, cost considerations are briefly discussed. This review focuses on point-of-care (POC) printing in house, and briefly touches on outsourcing printing via mail-order services.
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Affiliation(s)
- Michael Ashenafi
- Department of Radiation OncologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Seungkyo Jeong
- Department of Applied MathematicsUniversity of RochesterRochesterNew YorkUSA
| | - Joshua N. Wancura
- Department of Radiation OncologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Lang Gou
- Department of Radiation OncologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Matthew J. Webster
- Department of Radiation OncologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Dandan Zheng
- Department of Radiation OncologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
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8
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Diaz-Merchan JA, Español-Castro C, Martinez-Ovalle SA, Vega-Carrillo HR. Bolus 3D printing for radiotherapy with conventional PLA, ABS and TPU filaments: Theoretical-experimental study. Appl Radiat Isot 2023; 199:110908. [PMID: 37385052 DOI: 10.1016/j.apradiso.2023.110908] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/02/2023] [Accepted: 06/21/2023] [Indexed: 07/01/2023]
Abstract
A theoretical-experimental study of the interaction of electron beams with 3 filaments conventionally used for 3D printing is presented in this paper. Pieces of polylactic acid (PLA), acrylonitrile butadiene styrene (ABS) and thermoplastic polyurethane (TPU) are studied using Monte Carlo simulation with Geant4 and experimental measurements with plane-parallel ionization chambers and radiochromic films. Using different printing parameters and computed tomography, the presence of air gaps and the uniformity in the bolus density made with the different materials are evaluated. The main parameters in the Percentage Depth Dose (PDDs) are determined, the manufacturing process is standardized and the printing profiles are generated for each of the materials in order to obtain uniform attenuation characteristics in the pieces and improve adaptation to irregular anatomical areas.
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Affiliation(s)
- J A Diaz-Merchan
- Grupo de Física Nuclear Aplicada y Simulación, Universidad Pedagógica y Tecnológica de Colombia, Avenida Central del Norte 39-115, Tunja, Boyacá, Colombia; Centro de Cancerología de Boyacá, Avenida Universitaria 4671, Tunja, Colombia.
| | - C Español-Castro
- Grupo de Física Nuclear Aplicada y Simulación, Universidad Pedagógica y Tecnológica de Colombia, Avenida Central del Norte 39-115, Tunja, Boyacá, Colombia
| | - S A Martinez-Ovalle
- Grupo de Física Nuclear Aplicada y Simulación, Universidad Pedagógica y Tecnológica de Colombia, Avenida Central del Norte 39-115, Tunja, Boyacá, Colombia; Centro de Cancerología de Boyacá, Avenida Universitaria 4671, Tunja, Colombia
| | - H R Vega-Carrillo
- Unidad Académica de Estudios Nucleares, Universidad Autónoma de Zacatecas, C. Cipres 10, Fracc. La Peñuela, 98060, Zacatecas, Zac, Mexico
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Diaz-Merchan JA, Martinez-Ovalle SA, Vega-Carrillo HR. Development of a 3D printing process of bolus using BolusCM material for radiotherapy with electrons. Appl Radiat Isot 2023; 199:110899. [PMID: 37321051 DOI: 10.1016/j.apradiso.2023.110899] [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: 02/24/2023] [Revised: 05/01/2023] [Accepted: 06/07/2023] [Indexed: 06/17/2023]
Abstract
This work presents the optimized parameters of 3D printing for print bolus using BolusCM material. Printing parameters were selected of the homogeneity and absence of air gaps. The dosimetric features of printed bolus were measured with a plane-parallel ionization chamber and EBT3 radiochromic film. Measured features were compared with those estimated with Monte Carlo methods. BolusCM shows good characteristics to be used as bolus material in radiotherapy with electrons, where the printing process allows personalizing the bolus in function of patient characteristics. The material low-cost, the 3D printing and the dosimetric features are few of the advantages of using BolusCM material in radiotherapy with electrons in skin cancer treatment.
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Affiliation(s)
- J A Diaz-Merchan
- Grupo de Física Nuclear Aplicada y Simulación Universidad Pedagógica y Tecnológica de Colombia, Avenida Central del Norte 39-115, Tunja, Boyacá, Colombia; Centro de Cancerología de Boyacá, Avenida Universitaria 46-7, Tunja, Boyacá, Colombia.
| | - S A Martinez-Ovalle
- Grupo de Física Nuclear Aplicada y Simulación Universidad Pedagógica y Tecnológica de Colombia, Avenida Central del Norte 39-115, Tunja, Boyacá, Colombia; Centro de Cancerología de Boyacá, Avenida Universitaria 46-7, Tunja, Boyacá, Colombia
| | - H R Vega-Carrillo
- Unidad Académica de Estudios Nucleares, Universidad Autónoma de Zacatecas, C. Cipres 10, Fracc. La Peñuela, 98060, Zacatecas, Zac, Mexico
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10
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Miéville FA, Pitteloud N, Achard V, Lamanna G, Pisaturo O, Tercier PA, Allal AS. Post-mastectomy radiotherapy: Impact of bolus thickness and irradiation technique on skin dose. Z Med Phys 2023:S0939-3889(23)00041-7. [PMID: 37150728 DOI: 10.1016/j.zemedi.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/27/2023] [Accepted: 03/08/2023] [Indexed: 05/09/2023]
Abstract
PURPOSE To determine 10 MV IMRT and VMAT based protocols with a daily bolus targeting a skin dose of 45 Gy in order to replace the 6 MV tangential fields with a 5 mm thick bolus on alternate days method for post-mastectomy radiotherapy. METHOD We measured the mean surface dose along the chest wall PTV as a function of different bolus thicknesses for sliding window IMRT and VMAT plans. We analyzed surface dose profiles and dose homogeneities and compared them to our standard 6 MV strategy. All measurements were performed on a thorax phantom with Gafchromic films while dosimetric plans were computed using the Acuros XB algorithm (Varian). RESULTS We obtained the best compromise between measured surface dose (mean dose and homogeneity) and skin toxicity threshold obtained from the literature using a daily 3 mm thick bolus. Mean surface doses were 91.4 ± 2.8% [85.7% - 95.4%] and 92.2 ± 2.3% [85.6% - 95.2%] of the prescribed dose with IMRT and VMAT techniques, respectively. Our standard 6 MV alternate days 5 mm thick bolus leads to 89.0 ± 3.7% [83.6% - 95.5%]. Mean dose differences between measured and TPS results were < 3.2% for depths as low as 2 mm depth. CONCLUSION 10 MV IMRT-based protocols with a daily 3 mm thick bolus produce a surface dose comparable to the standard 6 MV 5 mm thick bolus on alternate days method but with an improved surface dose homogeneity. This allows for a better control of skin toxicity and target volume coverage.
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Affiliation(s)
- Frédéric A Miéville
- Department of Radiation Oncology, Hôpital Fribourgeois, 2-6 Chemin des Pensionnats, 1752 Villars-sur-Glâne, Fribourg, Switzerland.
| | - Nicolas Pitteloud
- Department of Radiation Oncology, Hôpital Fribourgeois, 2-6 Chemin des Pensionnats, 1752 Villars-sur-Glâne, Fribourg, Switzerland
| | - Vérane Achard
- Department of Radiation Oncology, Hôpital Fribourgeois, 2-6 Chemin des Pensionnats, 1752 Villars-sur-Glâne, Fribourg, Switzerland
| | - Giorgio Lamanna
- Department of Radiation Oncology, Hôpital Fribourgeois, 2-6 Chemin des Pensionnats, 1752 Villars-sur-Glâne, Fribourg, Switzerland
| | - Olivier Pisaturo
- Department of Radiation Oncology, Hôpital Fribourgeois, 2-6 Chemin des Pensionnats, 1752 Villars-sur-Glâne, Fribourg, Switzerland
| | - Pierre-Alain Tercier
- Department of Radiation Oncology, Hôpital Fribourgeois, 2-6 Chemin des Pensionnats, 1752 Villars-sur-Glâne, Fribourg, Switzerland
| | - Abdelkarim S Allal
- Department of Radiation Oncology, Hôpital Fribourgeois, 2-6 Chemin des Pensionnats, 1752 Villars-sur-Glâne, Fribourg, Switzerland
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11
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Arribas EM, Kelil T, Santiago L, Ali A, Chadalavada SC, Chepelev L, Ghodadra A, Ionita CN, Lee J, Ravi P, Ryan JR, Sheikh AM, Rybicki FJ, Ballard DH. Radiological Society of North America (RSNA) 3D Printing Special Interest Group (SIG) clinical situations for which 3D printing is considered an appropriate representation or extension of data contained in a medical imaging examination: breast conditions. 3D Print Med 2023; 9:8. [PMID: 36952139 PMCID: PMC10037829 DOI: 10.1186/s41205-023-00171-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 03/07/2023] [Indexed: 03/24/2023] Open
Abstract
The use of medical 3D printing has expanded dramatically for breast diseases. A writing group composed of the Radiological Society of North America (RSNA) Special Interest Group on 3D Printing (SIG) provides updated appropriateness criteria for breast 3D printing in various clinical scenarios. Evidence-based appropriateness criteria are provided for the following clinical scenarios: benign breast lesions and high-risk breast lesions, breast cancer, breast reconstruction, and breast radiation (treatment planning and radiation delivery).
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Affiliation(s)
- Elsa M Arribas
- Division of Diagnostic Imaging, Department of Breast Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
| | - Tatiana Kelil
- Department of Radiology, University of California, 1600 Divisadero St, C250, Box 1667, San Francisco, CA, 94115, USA
| | - Lumarie Santiago
- Division of Diagnostic Imaging, Department of Breast Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Arafat Ali
- Diagnostic Radiology, Henry Ford Medical Group, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA
| | | | - Leonid Chepelev
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Anish Ghodadra
- UPMC Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Ciprian N Ionita
- Department of Biomedical Engineering, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, University at Buffalo School of Engineering and Applied Sciences, 8052 Clinical Translational Research Center, 875 Ellicott Street, Buffalo, NY, 14203, USA
| | - Joonhyuk Lee
- University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
| | - Prashanth Ravi
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Justin R Ryan
- 3D Innovations Lab, Rady Children's Hospital, San Diego, CA, USA
| | - Adnan M Sheikh
- Department of Medical Imaging, Ottawa Hospital Research Institute (OHRI), The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, K1H 8L6, Canada
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University, St Louis, MO, USA
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12
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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.
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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
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13
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Gong P, Dai G, Wu X, Wang X, Xie L, Xu S, Zhong R. Application of thermoplastic elastomer (TPE) bolus in postmastectomy radiotherapy. Breast 2022; 66:317-323. [PMID: 36463642 PMCID: PMC9719108 DOI: 10.1016/j.breast.2022.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/10/2022] [Accepted: 11/27/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To assess the planned dose, in vivo dosimetry, acute skin toxicity, pain, and distress using Thermoplastic Elastomer (TPE) bolus for postmastectomy radiotherapy (PMRT). MATERIAL AND METHODS Thirty-two PMRT patients with TPE bolus (17 patients for 25 fractions, 15 patients for the first 20 fractions) were selected for the study. The acute skin toxicity, pain, and psychological distress were assessed from the first treatment week to the fourth week after the end of treatment. At the first treatment, the MOSFET was used in vivo dosimetry measurement. RESULTS In vivo dosimetry with the bolus, the dose deviation ranged from -6.22% to -1.56% for 5 points. The presence of grade 1 and 2 skin toxicity reached its peak (70.0% and 13.3%) in the sixth week. Two patients (6.6%) with 25 fractions bolus experienced moist desquamation in the fifth and seventh week, with pain score 2 and 3, and interruptions of 3 and 5 days, respectively. The incidence of pain score 1, 2, and 3 peaked in the fifth (33.3%), fourth (33.3%), and seventh (10.0%) week. No patients experienced grade 3 skin toxicity and severe pain. One patient had significant anxiety, and two patients had significant depression. CONCLUSION The TPE bolus can accurately fit skin and improve the surface dose to more than 90%. Twenty fractions with TPE bolus had similar skin toxicity and pain to those without bolus and did not increase patients' distress and clinical workload, compared with the literature's data, which is an alternative to the 3D printing bolus for PMRT.
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Affiliation(s)
- Pan Gong
- Radiotherapy Physics and Technology Center, Cancer Center, West China School of Medicine, West China Hospital of Sichuan University, Chengdu, 610041, PR China
| | - Guyu Dai
- Radiotherapy Physics and Technology Center, Cancer Center, West China School of Medicine, West China Hospital of Sichuan University, Chengdu, 610041, PR China
| | - Xiaoyu Wu
- Department of Respiratory Critical Care Medicine/Thoracic Surgery, West China School of Medicine, West China Hospital of Sichuan University, Chengdu, 610041, PR China
| | - Xuetao Wang
- Radiotherapy Physics and Technology Center, Cancer Center, West China School of Medicine, West China Hospital of Sichuan University, Chengdu, 610041, PR China
| | - Li Xie
- Department of Radiotherapy/Department of Head and Neck Oncology, West China School of Medicine, West China Hospital of Sichuan University, Chengdu, 610041, PR China
| | - Shuni Xu
- Radiotherapy Physics and Technology Center, Cancer Center, West China School of Medicine, West China Hospital of Sichuan University, Chengdu, 610041, PR China
| | - Renming Zhong
- Radiotherapy Physics and Technology Center, Cancer Center, West China School of Medicine, West China Hospital of Sichuan University, Chengdu, 610041, PR China.
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14
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Wang X, Zhao J, Xiang Z, Wang X, Zeng Y, Luo T, Yan X, Zhang Z, Wang F, Liu L. 3D-printed bolus ensures the precise postmastectomy chest wall radiation therapy for breast cancer. Front Oncol 2022; 12:964455. [PMID: 36119487 PMCID: PMC9478602 DOI: 10.3389/fonc.2022.964455] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To investigate the values of a 3D-printed bolus ensuring the precise postmastectomy chest wall radiation therapy for breast cancer. Methods and materials In the preclinical study on the anthropomorphic phantom, the 3D-printed bolus was used for dosimetry and fitness evaluation. The dosimetric parameters of planning target volume (PTV) were assessed, including Dmin, Dmax, Dmean, D95%, homogeneity index (HI), conformity index (CI), and organs at risk (OARs). The absolute percentage differences (|%diff|) between the theory and fact skin dose were also estimated, and the follow-up was conducted for potential skin side effects. Results In preclinical studies, a 3D-printed bolus can better ensure the radiation coverage of PTV (HI 0.05, CI 99.91%), the dose accuracy (|%diff| 0.99%), and skin fitness (mean air gap 1.01 mm). Of the 27 eligible patients, we evaluated the radiation dose parameter (median(min–max): Dmin 4967(4789–5099) cGy, Dmax 5447(5369–5589) cGy, Dmean 5236(5171–5323) cGy, D95% 5053(4936–5156) cGy, HI 0.07 (0.06–0.17), and CI 99.94% (97.41%–100%)) and assessed the dose of OARs (ipsilateral lung: Dmean 1341(1208–1385) cGy, V5 48.06%(39.75%–48.97%), V20 24.55%(21.58%–26.93%), V30 18.40%(15.96%–19.16%); heart: Dmean 339(138–640) cGy, V30 1.10%(0%–6.14%), V40 0.38%(0%–4.39%); spinal cord PRV: Dmax 639(389–898) cGy). The skin doses in vivo were Dtheory 208.85(203.16–212.53) cGy, Dfact 209.53(204.14–214.42) cGy, and |%diff| 1.77% (0.89–2.94%). Of the 360 patients enrolled in the skin side effect follow-up study (including the above 27 patients), grade 1 was the most common toxicity (321, 89.2%), some of which progressing to grade 2 or grade 3 (32, 8.9% or 7, 1.9%); the radiotherapy interruption rate was 1.1%. Conclusion A 3D-printed bolus can guarantee the precise radiation dose on skin surface, good fitness to skin, and controllable acute skin toxicity, which possesses a great clinical application value in postmastectomy chest call radiation therapy for breast cancer.
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Affiliation(s)
- Xiran Wang
- Department of Head and Neck and Mammary Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Jianling Zhao
- Department of Radiotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Zhongzheng Xiang
- Department of Head and Neck and Mammary Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Xuetao Wang
- Department of Radiotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Yuanyuan Zeng
- Department of Head and Neck and Mammary Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Ting Luo
- Department of Head and Neck and Mammary Oncology, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu, China
| | - Xi Yan
- Department of Head and Neck and Mammary Oncology, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu, China
| | - Zhuang Zhang
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Feng Wang
- Department of Head and Neck and Mammary Oncology, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Liu
- Department of Head and Neck and Mammary Oncology, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Lei Liu,
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15
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Hsu EJ, Parsons D, Chiu T, Godley AR, Sher DJ, Vo DT. 3D printed integrated bolus/headrest for radiation therapy for malignancies involving the posterior scalp and neck. 3D Print Med 2022; 8:22. [PMID: 35844030 PMCID: PMC9290275 DOI: 10.1186/s41205-022-00152-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/04/2022] [Indexed: 11/30/2022] Open
Abstract
Background Malignancies of the head and neck region, encompassing cutaneous, mucosal, and sarcomatous histologies, are complex entities to manage, comprising of coordination between surgery, radiation therapy, and systemic therapy. Malignancies of the posterior scalp are particular challenging to treat with radiation therapy, given its irregular contours and anatomy as well as the superficial location of the target volume. Bolus material is commonly used in radiation therapy to ensure that the dose to the skin and subcutaneous tissue is appropriate and adequate, accounting for the buildup effect of megavoltage photon treatment. The use of commercially available bolus material on the posterior scalp potentially creates air gaps between the bolus and posterior scalp. Case presentations In this report, we created and utilized a custom 3D-printed integrated bolus and headrest for 5 patients to irradiate malignancies involving the posterior scalp, including those with cutaneous squamous cell carcinoma, melanoma, malignant peripheral nerve sheath tumor, and dermal sarcoma. Treatment setup was consistently reproducible, and patients tolerated treatment well without any unexpected adverse effects. Conclusions We found that the use of this custom 3D-printed integrated bolus/headrest allowed for comfortable, consistent, and reproducible treatment set up while minimizing the risk of creating significant air gaps and should be considered in the radiotherapeutic management of patients with posterior scalp malignancies. Supplementary Information The online version contains supplementary material available at 10.1186/s41205-022-00152-w.
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Affiliation(s)
- Eric J Hsu
- Department of Radiation Oncology, Division of Clinical Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, 75390, USA
| | - David Parsons
- Department of Radiation Oncology, Division of Medical Physics and Engineering, UT Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Tsuicheng Chiu
- Department of Radiation Oncology, Division of Medical Physics and Engineering, UT Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Andrew R Godley
- Department of Radiation Oncology, Division of Medical Physics and Engineering, UT Southwestern Medical Center, Dallas, TX, 75390, USA
| | - David J Sher
- Department of Radiation Oncology, Division of Clinical Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Dat T Vo
- Department of Radiation Oncology, Division of Clinical Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, 75390, USA.
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16
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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.
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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
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17
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Wang KM, Rickards AJ, Bingham T, Tward JD, Price RG. Technical note: Evaluation of a silicone-based custom bolus for radiation therapy of a superficial pelvic tumor. J Appl Clin Med Phys 2022; 23:e13538. [PMID: 35084098 PMCID: PMC8992939 DOI: 10.1002/acm2.13538] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 10/20/2021] [Accepted: 12/20/2021] [Indexed: 11/07/2022] Open
Abstract
Purpose Use of standard‐of‐care radiation therapy boluses may result in air‐gaps between the target surface and bolus, as they may not adequately conform to each patient's unique topography. Such air‐gaps can be particularly problematic in cases of superficial pelvic tumor radiation, as the density variation may result in the radiation delivered to the target site being inconsistent with the prescribed dose. To increase bolus fit and thereby dose predictability and homogeneity, we designed and produced a custom silicone bolus for evaluation against the clinical standard. Methods A custom bolus was created for the pelvic regions of both an anthropomorphic phantom and a pelvic patient with squamous cell carcinoma of the penile shaft. Molds were designed using computed tomography (CT) scans, then 3D‐printed and cast with silicone rubber to yield the boluses. Air‐gap measurements were performed on custom and standard‐of‐care Superflab gel sheet boluses by analyzing total volume between the bolus and target surface, as measured from CT scans. Therapeutic doses of radiation were delivered to both boluses. Radiation dose was measured and compared to the expected dose using nine optically stimulated luminescent dosimeters (OSLDs) placed on the phantom. Results Mean air‐gap volume between the bolus and phantom was decreased from 314 ± 141 cm3 with the standard bolus to 4.56 ± 1.59 cm3 using the custom device. In the case of the on‐treatment patient, air‐gap volume was reduced from 169 cm3 with the standard bolus to 46.1 cm3 with the custom. Dosimetry testing revealed that the mean absolute difference between expected and received doses was 5.69%±4.56% (15.1% maximum) for the standard bolus and 1.91%±1.31% (3.51% maximum) for the custom device. Areas of greater dose difference corresponded to areas of larger air‐gap. Conclusions The custom bolus reduced air‐gap and increased predictability of radiation dose delivered compared to the standard bolus. The custom bolus could increase the certainty of prescribed dose‐delivery of radiation therapy for superficial tumors.
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Affiliation(s)
- Karissa M Wang
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
| | - Amanda J Rickards
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
| | - Trevor Bingham
- Department of Chemistry, Weber State University, Ogden, Utah, USA
| | - Jonathan D Tward
- Huntsman Cancer Institute, Salt Lake City, Utah, USA.,Department of Radiation Oncology, University of Utah, Salt Lake City, Utah, USA
| | - Ryan G Price
- Huntsman Cancer Institute, Salt Lake City, Utah, USA.,Department of Radiation Oncology, University of Utah, Salt Lake City, Utah, USA
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18
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Zhang Y, Huang Y, Ding S, Liang J, Kuang J, Mao Q, Ying W, Shu Y, Li J, Jiang C. A clinical trial to compare a 3D-printed bolus with a conventional bolus with the aim of reducing cardiopulmonary exposure in postmastectomy patients with volumetric modulated arc therapy. Cancer Med 2021; 11:1037-1047. [PMID: 34939343 PMCID: PMC8855922 DOI: 10.1002/cam4.4496] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/13/2021] [Accepted: 12/03/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND We compared the dosimetry, application, and acute toxicity of a 3D-printed and a conventional bolus for postmastectomy radiotherapy (PMRT) with volumetric modulated arc therapy (VMAT). Materials and Methods Eligible patients (n = 75) with PMRT breast cancer were randomly selected to receive VMAT with a conventional bolus or a 3D-printed bolus. The primary endpoint was a 10% decrease in the mean heart dose to left-sided breast cancer patients. The secondary endpoint was a 5% decrease in the mean ipsilateral lung dose to all patients. A comparative analysis was carried out of the dosimetry, normal tissue complication probability (NTCP), acute skin toxicity, and radiation pneumonitis. RESULTS Compared to a conventional bolus, the mean heart dose in left-sided breast cancer was reduced by an average of 0.8 Gy (5.5 ± 1.3 Gy vs. 4.7 ± 0.8 Gy, p = 0.035) and the mean dose to the ipsilateral lung was also reduced by an average of 0.8 Gy (12.4 ± 1.0 Gy vs. 11.6 ± 0.8 Gy, p < 0.001). The values for V50Gy of the PTV of the chest wall for the 3D-printed and conventional boluses were 95.4 ± 0.6% and 94.8 ± 0.8% (p = 0.026) and the values for the CI of the entire PTV were 0.83 ± 0.02 and 0.80 ± 0.03 (p < 0.001), respectively. The NTCP for the 3D-printed bolus was also reduced to an average of 0.14% (0.32 ± 0.19% vs. 0.18 ± 0.11%, p = 0.017) for the heart and 0.45% (3.70 ± 0.67% vs. 3.25 ± 0.18%, p < 0.001) for the ipsilateral lung. Grade 2 and Grade 1 radiation pneumonitis were 0.0% versus 7.5% and 14.3% versus 20.0%, respectively (p = 0.184). CONCLUSIONS The 3D-printed bolus may reduce cardiopulmonary exposure in postmastectomy patients with volumetric modulated arc therapy.
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Affiliation(s)
- Yun Zhang
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, PR China
| | - Yuling Huang
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, PR China
| | - Shenggou Ding
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, PR China
| | - Jinghui Liang
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, PR China
| | - Jie Kuang
- School of Public Health, Nanchang University, Nanchang, PR China
| | - Qingfeng Mao
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, PR China
| | - Weiliang Ying
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, PR China
| | - Yuxian Shu
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, PR China
| | - Jingao Li
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, PR China.,Key Laboratory of Personalized Diagnosis and Treatment of Nasopharyngeal Carcinoma Nanchang, Nanchang, PR China.,Medical College of Nanchang University, Nanchang, PR China
| | - Chunling Jiang
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, PR China.,Key Laboratory of Personalized Diagnosis and Treatment of Nasopharyngeal Carcinoma Nanchang, Nanchang, PR China.,Medical College of Nanchang University, Nanchang, PR China
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19
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Kermavnar T, Shannon A, O'Sullivan KJ, McCarthy C, Dunne CP, O'Sullivan LW. Three-Dimensional Printing of Medical Devices Used Directly to Treat Patients: A Systematic Review. 3D PRINTING AND ADDITIVE MANUFACTURING 2021; 8:366-408. [PMID: 36655011 PMCID: PMC9828627 DOI: 10.1089/3dp.2020.0324] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Until recently, three-dimensional (3D) printing/additive manufacturing has not been used extensively to create medical devices intended for actual clinical use, primarily on patient safety and regulatory grounds. However, in recent years there have been advances in materials, printers, and experience, leading to increased clinical use. The aim of this study was to perform a structured systematic review of 3D-printed medical devices used directly in patient treatment. A search of 13 databases was performed to identify studies of 3D-printed medical devices, detailing fabrication technology and materials employed, clinical application, and clinical outcome. One hundred and ten papers describing one hundred and forty medical devices were identified and analyzed. A considerable increase was identified in the use of 3D printing to produce medical devices directly for clinical use in the past 3 years. This is dominated by printing of patient-specific implants and surgical guides for use in orthopedics and orthopedic oncology, but there is a trend of increased use across other clinical specialties. The prevailing material/3D-printing technology used were titanium alloy/electron beam melting for implants, and polyamide/selective laser sintering or polylactic acid/fused deposition modeling for surgical guides and instruments. A detailed analysis across medical applications by technology and materials is provided, as well as a commentary regarding regulatory aspects. In general, there is growing familiarity with, and acceptance of, 3D printing in clinical use.
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Affiliation(s)
| | - Alice Shannon
- School of Design, University of Limerick, Limerick, Ireland
| | | | - Conor McCarthy
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Colum P. Dunne
- Confirm Smart Manufacturing Centre, University of Limerick, Limerick, Ireland
| | - Leonard W. O'Sullivan
- School of Design, University of Limerick, Limerick, Ireland
- School of Medicine, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
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20
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Lu Y, Song J, Yao X, An M, Shi Q, Huang X. 3D Printing Polymer-based Bolus Used for Radiotherapy. Int J Bioprint 2021; 7:414. [PMID: 34805595 PMCID: PMC8600301 DOI: 10.18063/ijb.v7i4.414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/21/2021] [Indexed: 12/24/2022] Open
Abstract
Bolus is a kind of auxiliary device used in radiotherapy for the treatment of superficial lesions such as skin cancer. It is commonly used to increase skin dose and overcome the skin-sparing effect. Despite the availability of various commercial boluses, there is currently no bolus that can form full contact with irregular surface of patients' skin, and incomplete contact would result in air gaps. The resulting air gaps can reduce the surface radiation dose, leading to a discrepancy between the delivered dose and planned dose. To avoid this limitation, the customized bolus processed by three-dimensional (3D) printing holds tremendous potential for making radiotherapy more efficient than ever before. This review mainly summarized the recent development of polymers used for processing bolus, 3D printing technologies suitable for polymers, and customization of 3D printing bolus. An ideal material for customizing bolus should not only have the feature of 3D printability for customization, but also possess radiotherapy adjuvant performance as well as other multiple compound properties, including tissue equivalence, biocompatibility, antibacterial activity, and antiphlogosis.
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Affiliation(s)
- Ying Lu
- Laboratory of Biomaterial Surface and Interface, School of Materials Science and Engineering, Taiyuan University of Technology, Taiyuan 030024, Shanxi Province, China.,Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan 030032, Shanxi Province, China
| | - Jianbo Song
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan 030032, Shanxi Province, China
| | - Xiaohong Yao
- Laboratory of Biomaterial Surface and Interface, School of Materials Science and Engineering, Taiyuan University of Technology, Taiyuan 030024, Shanxi Province, China
| | - Meiwen An
- Institute of Applied Mechanics and Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, Shanxi Province, China
| | - Qinying Shi
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan 030032, Shanxi Province, China
| | - Xiaobo Huang
- Laboratory of Biomaterial Surface and Interface, School of Materials Science and Engineering, Taiyuan University of Technology, Taiyuan 030024, Shanxi Province, China
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21
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Kaidar-Person O, Dahn HM, Nichol AM, Boersma LJ, de Ruysscher D, Meattini I, Pignol JP, Aristei C, Belkacemi Y, Benjamin D, Bese N, Coles CE, Franco P, Ho AY, Hol S, Jagsi R, Kirby AM, Marrazzo L, Marta GN, Moran MS, Nissen HD, Strnad V, Zissiadis Y, Poortmans PM, Offersen BV. A Delphi study and International Consensus Recommendations: The use of bolus in the setting of postmastectomy radiation therapy for early breast cancer. Radiother Oncol 2021; 164:115-121. [PMID: 34563607 DOI: 10.1016/j.radonc.2021.09.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 01/01/2023]
Abstract
Bolus serves as a tissue equivalent material that shifts the 95-100% isodose line towards the skin and subcutaneous tissue. The need for bolus for all breast cancer patients planned for postmastectomy radiation therapy (PMRT) has been questioned. The work was initiated by the faculty of the European SocieTy for Radiotherapy & Oncology (ESTRO) breast cancer courses and represents a multidisciplinary international breast cancer expert collaboration to optimize PMRT. Due to the lack of randomised trials evaluating the benefits of bolus, we designed a stepwise project to evaluate the existing evidence about the use of bolus in the setting of PMRT to achieve an international consensus for the indications of bolus in PMRT, based on the Delphi method.
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Affiliation(s)
- Orit Kaidar-Person
- Breast Cancer Radiation Therapy Unit, at Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; GROW-School for Oncology and Developmental Biology (Maastro), Maastricht University, Maastricht, The Netherlands.
| | - Hannah M Dahn
- Department of Radiation Oncology, Dalhousie University, Halifax, Canada
| | - Alan M Nichol
- Department of Radiation Oncology, BC Cancer - Vancouver, Vancouver, Canada
| | - Liesbeth J Boersma
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Dirk de Ruysscher
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence; Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi; Florence, Italy
| | | | - Cynthia Aristei
- Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Yazid Belkacemi
- Department of Radiation Oncology and Henri Mondor Breast Center, University of Paris-Est (UPEC), Creteil, France, INSERM Unit 955, Creteil, France
| | - Dori Benjamin
- Department of Physics, Radiation Oncology, Sheba Medical Center, Ramat Gan, Israel
| | - Nuran Bese
- Acibadem Mehmet Ali Aydinlar University, Research Institute of Senology Istanbul, Turkey
| | | | - Pierfrancesco Franco
- Department of Translational Medicine, University of Eastern Piedmont and Department of Radiation Oncology, University Hospital "Maggiore della Carità,", Novara, Italy
| | - Alice Y Ho
- Harvard Medical School, Department of Radiation Oncology, Massachusetts General Hospital, Boston, USA
| | - Sandra Hol
- Instituut Verbeeten, Tilburg, The Netherlands
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, USA
| | - Anna M Kirby
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, UK
| | - Livia Marrazzo
- Medical Physics Unit, Careggi University Hospital, Florence, Italy
| | - Gustavo N Marta
- Department of Radiation Oncology - Hospital Sírio-Libanês, São Paulo, Brazil
| | | | | | - Vratislav Strnad
- Dept. of Radiation Oncology, University Hospital Erlangen, Germany
| | | | | | - Birgitte V Offersen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
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22
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Wang X, Wang X, Xiang Z, Zeng Y, Liu F, Shao B, He T, Ma J, Yu S, Liu L. The Clinical Application of 3D-Printed Boluses in Superficial Tumor Radiotherapy. Front Oncol 2021; 11:698773. [PMID: 34490095 PMCID: PMC8416990 DOI: 10.3389/fonc.2021.698773] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/23/2021] [Indexed: 02/05/2023] Open
Abstract
During the procedure of radiotherapy for superficial tumors, the key to treatment is to ensure that the skin surface receives an adequate radiation dose. However, due to the presence of the built-up effect of high-energy rays, equivalent tissue compensators (boluses) with appropriate thickness should be placed on the skin surface to increase the target radiation dose. Traditional boluses do not usually fit the skin perfectly. Wet gauze is variable in thickness day to day which results in air gaps between the skin and the bolus. These unwanted but avoidable air gaps lead to a decrease of the radiation dose in the target area and can have a poor effect on the outcome. Three-dimensional (3D) printing, a new rising technology named “additive manufacturing” (AM), could create physical models with specific shapes from digital information by using special materials. It has been favored in many fields because of its advantages, including less waste, low-cost, and individualized design. It is not an exception in the field of radiotherapy, personalized boluses made through 3D printing technology also make up for a number of shortcomings of the traditional commercial bolus. Therefore, an increasing number of researchers have tried to use 3D-printed boluses for clinical applications rather than commercial boluses. Here, we review the 3D-printed bolus’s material selection and production process, its clinical applications, and potential radioactive dermatitis. Finally, we discuss some of the challenges that still need to be addressed with the 3D-printed boluses.
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Affiliation(s)
- Xiran Wang
- Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Xuetao Wang
- Department of Radiotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Zhongzheng Xiang
- Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuanyuan Zeng
- Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Fang Liu
- Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Bianfei Shao
- Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Tao He
- Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Jiachun Ma
- Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Siting Yu
- Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Liu
- Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, China
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23
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Zhang C, Hu W, Zhou Q, He J, Wang H, Qiu K, Wang L, Li X. The possibility of developing customized 3D-printed silicone hydrogel bolus for post-mastectomy radiotherapy. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2021. [DOI: 10.1080/16878507.2021.1962629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Caixun Zhang
- Department of Radiotherapy, Renmin Hospital of Wuhan University, Wuhan, P .R. China
| | - Weiguo Hu
- Department of Oncology Center, Renmin Hospital of Wuhan University, Wuhan, P .R. China
| | - Qing Zhou
- Department of Ultrasound, Renmin Hospital of Wuhan University, Wuhan, P .R. China
| | - Junxiang He
- Department of Radiotherapy, Renmin Hospital of Wuhan University, Wuhan, P .R. China
| | - Hao Wang
- Department of Ultrasound, Renmin Hospital of Wuhan University, Wuhan, P .R. China
| | - Kehu Qiu
- Department of Oncology Center, Renmin Hospital of Wuhan University, Wuhan, P .R. China
| | - Luzhou Wang
- Department of Radiotherapy, Renmin Hospital of Wuhan University, Wuhan, P .R. China
| | - Xiangpan Li
- Department of Radiotherapy, Renmin Hospital of Wuhan University, Wuhan, P .R. China
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24
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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.
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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
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25
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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.
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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
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26
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Sakai Y, Tanooka M, Okada W, Sano K, Nakamura K, Shibata M, Ueda Y, Mizuno H, Tanaka M. Characteristics of a bolus created using thermoplastic sheets for postmastectomy radiation therapy. Radiol Phys Technol 2021; 14:179-185. [PMID: 33837911 DOI: 10.1007/s12194-021-00618-2] [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: 01/31/2021] [Revised: 03/19/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
This study applied a "shell bolus," an immobilizing thermoplastic shell locally thickened with extra layers over the radiation target, during postmastectomy radiation therapy (PMRT). We performed ion chamber and film measurements for a solid water phantom for thermoplastic sheets and a gel bolus for dosimetric characterization using a 6-MV X-ray flattening-filter-free (FFF) beam. The air gaps between the body surface for the gel and shell bolus were measured using computed tomography (CT) images in patients who underwent PMRT. This included seven and 13 patients treated with the gel and shell boluses, respectively. A comparison of the dose differences between a 10-mm gel bolus and a 9.6-mm-thick thermoplastic sheet at the surface and 5 cm below the surface showed a 4.2% higher surface dose and 0.5% lower dose at 5-cm depth for the thermoplastic sheet compared to those for the gel bolus. The mean (p = 0.029) and maximum (p < 0.001) air gaps of the shell bolus were significantly thinner than those of the gel bolus. Thus, the shell bolus provided a close fit and robust bolus effect. In addition, the shell bolus reduced respiratory motion and eliminated the need for skin marking. Therefore, this system can be effectively used as a bolus for PMRT.
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Affiliation(s)
- Yusuke Sakai
- Radiation Therapy Center, Takarazuka City Hospital, 4-5-1 Kohama, Takarazuka, Hyogo, 665-0827, Japan.
| | - Masao Tanooka
- Radiation Therapy Center, Takarazuka City Hospital, 4-5-1 Kohama, Takarazuka, Hyogo, 665-0827, Japan
| | - Wataru Okada
- Radiation Therapy Center, Takarazuka City Hospital, 4-5-1 Kohama, Takarazuka, Hyogo, 665-0827, Japan
| | - Keisuke Sano
- Radiation Therapy Center, Takarazuka City Hospital, 4-5-1 Kohama, Takarazuka, Hyogo, 665-0827, Japan
| | - Kenji Nakamura
- Radiation Therapy Center, Takarazuka City Hospital, 4-5-1 Kohama, Takarazuka, Hyogo, 665-0827, Japan
| | - Mayuri Shibata
- Radiation Therapy Center, Takarazuka City Hospital, 4-5-1 Kohama, Takarazuka, Hyogo, 665-0827, Japan
| | - Yoshihiro Ueda
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 537-8567, Japan
| | - Hirokazu Mizuno
- Division of Central Radiology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Masahiro Tanaka
- Radiation Therapy Center, Takarazuka City Hospital, 4-5-1 Kohama, Takarazuka, Hyogo, 665-0827, Japan
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27
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Robertson FM, Couper MB, Kinniburgh M, Monteith Z, Hill G, Pillai SA, Adamson DJA. Ninjaflex vs Superflab: A comparison of dosimetric properties, conformity to the skin surface, Planning Target Volume coverage and positional reproducibility for external beam radiotherapy. J Appl Clin Med Phys 2021; 22:26-33. [PMID: 33689216 PMCID: PMC8035556 DOI: 10.1002/acm2.13147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/20/2020] [Accepted: 12/01/2020] [Indexed: 11/22/2022] Open
Abstract
Background and purpose When planning and delivering radiotherapy, ideally bolus should be in direct contact with the skin surface. Varying air gaps between the skin surface and bolus material can result in discrepancies between the intended and delivered dose. This study assessed a three‐dimensional (3D) printed flexible bolus to determine whether it could improve conformity to the skin surface, reduce air gaps, and improve planning target volume coverage, compared to a commercial bolus material, Superflab. Materials and methods An anthropomorphic head phantom was CT scanned to generate photon and electron treatment plans using virtual bolus. Two 3D printing companies used the material Ninjaflex to print bolus for the head phantom, which we designated Ninjaflex1 and Ninjaflex2. The phantom was scanned a further 15 more times with the different bolus materials in situ allowing plan comparison of the virtual to physical bolus in terms of planning target volume coverage, dose at the prescription point, skin dose, and air gap volumes. Results Superflab produced a larger volume and a greater number of air gaps compared to both Ninjaflex1 and Ninjaflex2, with the largest air gap volume of 12.02 cm3. Our study revealed that Ninjaflex1 produced the least variation from the virtual bolus clinical goal values for all modalities, while Superflab displayed the largest variances in conformity, positional accuracy, and clinical goal values. For PTV coverage Superflab produced significant percentage differences for the VMAT and Electron3 plans when compared to the virtual bolus plans. Superflab also generated a significant difference in prescription point dose for the 3D conformal plan. Conclusion Compared to Superflab, both Ninjaflex materials improved conformity and reduced the variance between the virtual and physical bolus clinical goal values. Results illustrate that custom‐made Ninjaflex bolus could be useful clinically and may improve the accuracy of the delivered dose.
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Affiliation(s)
- Fiona M Robertson
- Radiotherapy Department, Ninewells Hospital & Medical School, NHS Tayside, Dundee, UK
| | - Megan B Couper
- Medical Physics Department, Ninewells Hospital & Medical School, Dundee, UK
| | - Margaret Kinniburgh
- Radiotherapy Department, Ninewells Hospital & Medical School, NHS Tayside, Dundee, UK
| | - Zoe Monteith
- Radiotherapy Department, Ninewells Hospital & Medical School, NHS Tayside, Dundee, UK
| | - Gareth Hill
- Radiotherapy Department, Ninewells Hospital & Medical School, NHS Tayside, Dundee, UK
| | | | - Douglas J A Adamson
- Radiotherapy Department, Ninewells Hospital & Medical School, NHS Tayside, Dundee, UK
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28
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Scott J, Dundas K, Surjan Y, King O, Arumugam S, Deshpande S, Udovitch M, Lee M. Quantifying and Assessing the Dosimetric Impact of Changing Gas Volumes Throughout the Course of VMAT Radiation Therapy of Upper Gastrointestinal Tumors. Adv Radiat Oncol 2021; 6:100650. [PMID: 34195488 PMCID: PMC8233468 DOI: 10.1016/j.adro.2021.100650] [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: 06/28/2020] [Revised: 12/07/2020] [Accepted: 01/05/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose This retrospective patient study assessed the consistency of abdominal gas presence throughout radiation therapy for patients with upper gastrointestinal cancer and determined the impact of variations in gas volume on the calculated dose distribution of volumetric modulated arc therapy. Methods and Materials Eight patients with pancreatic cancer were included for analysis. A plan library consisting of 3 reference plans per patient (Ref0.0, Ref0.5, and Ref1.0) was created based on planning computed tomography (CT) with density overrides of 0.0, 0.5, and 1.0 applied to gas volumes, respectively. Corresponding cone beam CT (CBCT) data sets were obtained and density overrides were applied to enable fractional dose calculation. Variation in gas volume relative to initial volume determined from CT was assessed. Dose metrics for targets and organs at risk were compared between the accumulated CBCT dose and the planned dose of the 3 reference plans for each patient. Results There was a significant decrease in gas present from CT to treatment CBCT, with a mean decrease in volume of 48.6% for the entire cohort. Dosimetrically, all accumulated target and organ-at-risk parameters, aside from the kidneys, exhibited the smallest mean deviation from the Ref0.0 plan and largest mean deviation from the Ref1.0 plan. A statistically significant difference in mean accumulated dose to Ref0.0 and Ref1.0 was observed for the dose delivered to 95% of the planning target volume. Conclusions Significant variation in gas volumes from CT to treatment can occur throughout volumetric modulated arc therapy for pancreatic cancer. Through the use of a plan library, it was determined that initial assessment of a patient's treatment plan with an assigned gas density of 0.0 provided the most accurate prediction of the accumulated dose.
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Affiliation(s)
- Joshua Scott
- University of Newcastle, Newcastle, New South Wales, Australia.,Liverpool-Macarthur Cancer Therapy Centre, Liverpool and Campbelltown, New South Wales, Australia
| | - Kylie Dundas
- Liverpool-Macarthur Cancer Therapy Centre, Liverpool and Campbelltown, New South Wales, Australia.,Ingham Institute, Liverpool, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
| | - Yolanda Surjan
- University of Newcastle, Newcastle, New South Wales, Australia
| | - Odette King
- Liverpool-Macarthur Cancer Therapy Centre, Liverpool and Campbelltown, New South Wales, Australia
| | - Sankar Arumugam
- Liverpool-Macarthur Cancer Therapy Centre, Liverpool and Campbelltown, New South Wales, Australia.,Ingham Institute, Liverpool, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
| | - Shrikant Deshpande
- Liverpool-Macarthur Cancer Therapy Centre, Liverpool and Campbelltown, New South Wales, Australia.,Ingham Institute, Liverpool, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
| | - Mark Udovitch
- Liverpool-Macarthur Cancer Therapy Centre, Liverpool and Campbelltown, New South Wales, Australia
| | - Mark Lee
- Liverpool-Macarthur Cancer Therapy Centre, Liverpool and Campbelltown, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
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29
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Kaginelli S, Rajesh R, Gopenath TS, Basalingappa K. Simulated three-dimensional printing printed polyamide based PA2200 immovable device for cancer patients undergoing radiotherapy. JOURNAL OF RADIATION AND CANCER RESEARCH 2021. [DOI: 10.4103/jrcr.jrcr_28_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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30
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Characterization of 3D-printed bolus produced at different printing parameters. Med Dosim 2020; 46:157-163. [PMID: 33172711 DOI: 10.1016/j.meddos.2020.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/17/2020] [Accepted: 10/20/2020] [Indexed: 11/20/2022]
Abstract
We aimed to analyze the effects of printing parameters on characterization of three-dimensional (3D) printed bolus used in external beam radiotherapy. Two sets of measurements were performed to investigate the dosimetric and physical characterization of 3D-printed bolus at different printing parameters. In the first step, boluses were produced at different infill-percentages, infill-patterns and printing directions. Two-dimensional (2D) dose measurements were performed in Elekta Versa HD linear accelerator using 6 MV photon energy. Measured 2D dose maps for both printed and reference bolus materials were compared using the 2D gamma analysis method. Additionally, patient-specific bolus was produced with defined optimum printing parameters for anthropomorphic head and neck phantom. Then, point dose measurements were performed to evaluate the feasibility of printed bolus in clinical use. In the second step, physical measurements were carried out to evaluate the printing accuracy, the mean hounsfield unit (HU) value and the weight of 3D-printed boluses. According to our measurement, infill-percentage, infill-pattern and printing direction significantly changed the dosimetric and physical properties of the 3D-printed bolus independently. Maximum gamma passing rate at 1.5 and 5 cm depths were found as 93.8% and 98.8%, respectively, for 60% infill-percentage, sunglass fill infill-pattern and horizontal printing direction. The printing accuracy of the products was within 0.4 mm. Dosimetric and physical properties of the printed bolus material changed significantly with the selected printing parameters. Therefore, it is important to note that each combination of these printing parameters that will be used in the production of patient-specific bolus should be investigated separately.
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31
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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.
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Verification using in vivo optically stimulated luminescent dosimetry of the predicted skin surface dose in patients receiving postmastectomy radiotherapy. Med Dosim 2020; 46:e1-e6. [PMID: 33941320 DOI: 10.1016/j.meddos.2020.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/14/2020] [Accepted: 10/01/2020] [Indexed: 11/21/2022]
Abstract
The purpose of this study was to evaluate whether dose to the skin surface underneath bolus, was accurately predicted by a 3D treatment planning system (TPS) in patients receiving 50 Gy/25# postmastectomy radiotherapy (PMRT) using optically stimulated luminescent dosimetry (OSLD) for verification. In vivo dosimetry using OSLDs was performed in 20 consecutive patients receiving PMRT. An array of 9 OSLDs were applied to the chest wall or neobreast in a grid arrangement. Dosimetry data were recorded on 3 separate treatment fractions, averaged, and extrapolated to 25 fractions. On the 3D TPS, the predicted dose was calculated using the departmental planning algorithm at points corresponding to the OSLDs. The mean within patient difference between the planned and measured dose at each of the 9 points was calculated and Bland-Altman limits of agreement used to quantify the extent of agreement. Paired t-tests were used to test for evidence of systematic bias at each point. The coefficient of variation of the 3 OSLD readings per patient at each of the 9 points was low for 8 points (≤4.4%) demonstrating comparable dose received per fraction at these points. The mean ratio between the in vivo measured extrapolated OSLD (IVME OSLD) dose and the planned TPS dose ranged between 0.97 and 0.99 across all points (standard deviation range 0.05 to 0.08). The mean within patient difference between the IVME OSLD and planned TPS was <1 Gy at 7 of the 9 points and the t-test for evidence of systematic bias was significant (p = 0.03) at only 1 of the 9 points. Our commercially available 3D TPS closely predicted PMRT skin surface dose underneath bolus as verified by OSLDs. At all sites, the average ratio of delivered to predicted dose was >0.97 but <1. This practical and feasible OSLD assessment of only 3 of 25 fractions facilitates quality assurance of a TPS in predicting skin surface dose under bolus.
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Ehler ED, Sterling DA. 3D printed copper-plastic composite material for use as a radiotherapy bolus. Phys Med 2020; 76:202-206. [DOI: 10.1016/j.ejmp.2020.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 05/25/2020] [Accepted: 07/06/2020] [Indexed: 10/23/2022] Open
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Rooney MK, Rosenberg DM, Braunstein S, Cunha A, Damato AL, Ehler E, Pawlicki T, Robar J, Tatebe K, Golden DW. Three-dimensional printing in radiation oncology: A systematic review of the literature. J Appl Clin Med Phys 2020; 21:15-26. [PMID: 32459059 PMCID: PMC7484837 DOI: 10.1002/acm2.12907] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/16/2020] [Accepted: 04/23/2020] [Indexed: 12/21/2022] Open
Abstract
Purpose/objectives Three‐dimensional (3D) printing is recognized as an effective clinical and educational tool in procedurally intensive specialties. However, it has a nascent role in radiation oncology. The goal of this investigation is to clarify the extent to which 3D printing applications are currently being used in radiation oncology through a systematic review of the literature. Materials/methods A search protocol was defined according to preferred reporting items for systematic reviews and meta‐analyses (PRISMA) guidelines. Included articles were evaluated using parameters of interest including: year and country of publication, experimental design, sample size for clinical studies, radiation oncology topic, reported outcomes, and implementation barriers or safety concerns. Results One hundred and three publications from 2012 to 2019 met inclusion criteria. The most commonly described 3D printing applications included quality assurance phantoms (26%), brachytherapy applicators (20%), bolus (17%), preclinical animal irradiation (10%), compensators (7%), and immobilization devices (5%). Most studies were preclinical feasibility studies (63%), with few clinical investigations such as case reports or series (13%) or cohort studies (11%). The most common applications evaluated within clinical settings included brachytherapy applicators (44%) and bolus (28%). Sample sizes for clinical investigations were small (median 10, range 1–42). A minority of articles described basic or translational research (11%) and workflow or cost evaluation studies (3%). The number of articles increased over time (P < 0.0001). While outcomes were heterogeneous, most studies reported successful implementation of accurate and cost‐effective 3D printing methods. Conclusions Three‐dimensional printing is rapidly growing in radiation oncology and has been implemented effectively in a diverse array of applications. Although the number of 3D printing publications has steadily risen, the majority of current reports are preclinical in nature and the few clinical studies that do exist report on small sample sizes. Further dissemination of ongoing investigations describing the clinical application of developed 3D printing technologies in larger cohorts is warranted.
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Affiliation(s)
- Michael K Rooney
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - David M Rosenberg
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Steve Braunstein
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - Adam Cunha
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - Antonio L Damato
- Department Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eric Ehler
- Department of Radiation Oncology, University of Minnesota, Minneapolis, MN, USA
| | - Todd Pawlicki
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, CA, USA
| | - James Robar
- Department of Radiation Oncology, Dalhousie University, Halifax, Canada.,Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Canada.,Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Ken Tatebe
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
| | - Daniel W Golden
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
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Three-Dimensional Printed Silicone Bite Blocks for Radiotherapy of Head and Neck Cancer—A Preliminary Study. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10051688] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Conventional methods that have been developed to immobilize the mouth and tongue for radiotherapy (RT) in head and neck cancer (HNC) treatment have been unsatisfactory. We, therefore, developed three-dimensional (3D), customizable, silicone bite blocks and examined their clinical feasibility. For HNC patients, before RT, the 3D printed bite blocks were fabricated based on primary computed tomography (CT) simulation images. The placement of the 3D bite blocks was followed by a secondary CT simulation before RT planning was finalized. Dosimetric parameters and positioning verification achieved with the propose bite blocks were compared with conventional universal oral corks. The 3D printed bite blocks were conformal to the occlusal surface, ensuring immobilization of the tongue without eliciting a gag reflex, and an elastic and firm texture that supports opening of the mouth, with a smooth surface with tolerable intraoral tactility. The dosimetry of patients using the proposed bite blocks showed better coverage of the planning target volume and surface of a tumour bed along with reduction in normal tissue doses. Good concordance of positioning by 3D printed bite blocks during the RT course was verified. The 3D printed bite blocks with silicone might be a customizable, safe, and practical advanced technology in RT for HNC.
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He C, Zhang S, Shi L. Three-Dimensionally-Precise Breast Conformal Device for IMRT in Breast Cancer Patients Treated With Breast-Conserving Surgery-A Pilot Randomized Controlled Trial. Technol Cancer Res Treat 2020; 19:1533033820971563. [PMID: 33174525 PMCID: PMC7672753 DOI: 10.1177/1533033820971563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/05/2020] [Accepted: 09/30/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To examine the accuracy and efficiency of breast radiotherapy after breast-conserving surgery of a novel 3-dimensional (3D) printing tissue compensator technology, the 3D-precise breast conformer, compared with a usual compensator and an unstructured compensator. METHODS This novel device is patented in China (patent No.: ZL2015 2 0259472.9). Thirty patients with breast cancer after breast-conserving surgery were randomly divided into 2 control groups (no compensator, NST group, and usual compensator, ST group) and 1 study group (3D-precise breast conformer, 3D-BCT group) (n = 10/group). Before radiotherapy, all patients were scanned in the same CT positioning conditions to prepare the treatment plans. RESULTS The 3D-BCT showed the best homogeneity index (HI) (0.08 ± 0.03) and conformity index (CI) (0.95 ± 0.03), while the NST group showed the worst HI (0.34 ± 0.07) and CI (0.78 ± 0.06), with the ST group between the 2 (HI: 0.15 ± 0.05; CI: 0.87 ± 0.04) (all P < 0.01). The common tissue compensation membrane could lead to 95-100% of the prescription dose covering 85-95% of the target volume, and the uniformity and conformability of the target dose were improved overall compared with the NST group. In the 3D-BCT group, 100% of the prescription dose covered the target volume of 95-100%. CONCLUSION The 3D-precision breast conformal device had the highest individualization, uniformity, and conformity. The V95, V98, CI, and HI of PTV were optimal in the 3D-BCT group, and an ideal isodose curve distribution of the breast and clavicle upper and lower target areas was achieved. This device could improve the surface dose and the efficacy of radiotherapy after breast-conserving surgery.
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Affiliation(s)
- Chunbo He
- Department of Radiation Oncology, The Fourth Hospital, Harbin Medical University, Harbin, China
| | - Shilin Zhang
- Department of Radiation Oncology, The Fourth Hospital, Harbin Medical University, Harbin, China
| | - Lei Shi
- Department of Radiation Oncology, The Fourth Hospital, Harbin Medical University, Harbin, China
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Sasaki DK, McGeachy P, Alpuche Aviles JE, McCurdy B, Koul R, Dubey A. A modern mold room: Meshing 3D surface scanning, digital design, and 3D printing with bolus fabrication. J Appl Clin Med Phys 2019; 20:78-85. [PMID: 31454148 PMCID: PMC6753733 DOI: 10.1002/acm2.12703] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 07/30/2019] [Accepted: 08/01/2019] [Indexed: 11/28/2022] Open
Abstract
Purpose This case series represents an initial experience with implementing 3‐dimensional (3D) surface scanning, digital design, and 3D printing for bolus fabrication for patients with complex surface anatomy where traditional approaches are challenging. Methods and Materials For 10 patients requiring bolus in regions with complex contours, bolus was designed digitally from 3D surface scanning data or computed tomography (CT) images using either a treatment planning system or mesh editing software. Boluses were printed using a fused deposition modeling printer with polylactic acid. Quality assurance tests were performed for each printed bolus to verify density and shape. Results For 9 of 10 patients, digitally designed boluses were used for treatment with no issues. In 1 case, the bolus was not used because dosimetric requirements were met without the bolus. QA tests revealed that the bulk density was within 3% of the reference value for 9 of 12 prints, and with more judicious selection of print settings this could be increased. For these 9 prints, density uniformity was as good as or better than our traditional sheet bolus material. The average shape error of the pieces was less than 0.5 mm, and no issues with fit or comfort were encountered during use. Conclusions This study demonstrates that new technologies such as 3D surface scanning, digital design and 3D printing can be safely and effectively used to modernize bolus fabrication.
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Affiliation(s)
- David Kiyoshi Sasaki
- Department of Medical Physics, CancerCare Manitoba, Winnipeg, Manitoba, Canada.,Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Philip McGeachy
- Department of Medical Physics, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Jorge E Alpuche Aviles
- Department of Medical Physics, CancerCare Manitoba, Winnipeg, Manitoba, Canada.,Department of Physics and Astronomy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Boyd McCurdy
- Department of Medical Physics, CancerCare Manitoba, Winnipeg, Manitoba, Canada.,Department of Physics and Astronomy, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rashmi Koul
- Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Radiation Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Arbind Dubey
- Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Radiation Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
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Obeid JP, Gutkin PM, Lewis J, Skinner L, Wang EB, Khodadoust MS, Kim YH, Weng WK, Hoppe RT, Hiniker SM. Volumetric Modulated Arc Therapy and 3-Dimensional Printed Bolus in the Treatment of Refractory Primary Cutaneous Gamma Delta Lymphoma of the Bilateral Legs. Pract Radiat Oncol 2019; 9:220-225. [DOI: 10.1016/j.prro.2019.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/11/2019] [Accepted: 02/25/2019] [Indexed: 02/07/2023]
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Photons Without Bolus Versus Electrons With Bolus After Upfront Mastectomy Without Immediate Reconstruction in Breast Cancer Patients. Int J Radiat Oncol Biol Phys 2019; 104:877-884. [DOI: 10.1016/j.ijrobp.2019.03.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/13/2019] [Accepted: 03/16/2019] [Indexed: 11/20/2022]
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Park JM, Son J, An HJ, Kim JH, Wu HG, Kim JI. Bio-compatible patient-specific elastic bolus for clinical implementation. ACTA ACUST UNITED AC 2019; 64:105006. [DOI: 10.1088/1361-6560/ab1c93] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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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.
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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
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An HJ, Kim MS, Kim J, Son J, Choi CH, Park JM, Kim JI. Geometric Evaluation of Patient-Specific 3D Bolus from 3D Printed Mold and Casting Method for Radiation Therapy. ACTA ACUST UNITED AC 2019. [DOI: 10.14316/pmp.2019.30.1.32] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Hyun Joon An
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Myeong Soo Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Jiseong Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Jaeman Son
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Chang Heon Choi
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Jong Min Park
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
- Robotics Research Laboratory for Extreme Environments, Advanced Institutes of Convergence Technology, Suwon, Korea
| | - Jung-in Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
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Park SY, Kang S, Park JM, An HJ, Oh DH, Kim JI. Development and dosimetric assessment of a patient-specific elastic skin applicator for high-dose-rate brachytherapy. Brachytherapy 2018; 18:224-232. [PMID: 30528742 DOI: 10.1016/j.brachy.2018.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/01/2018] [Accepted: 11/05/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE The purpose of this study was to develop a patient-specific elastic skin applicator and to evaluate its dosimetric characteristics for high-dose-rate (HDR) brachytherapy. METHODS AND MATERIALS We simulated the treatment of a nonmelanoma skin cancer on the nose. An elastic skin applicator was manufactured by pouring the Dragon Skin (Smooth-On Inc., Easton, PA) with a shore hardness of 10A into an applicator mold. The rigid skin applicator was printed using high-impact polystyrene with a shore hardness of 73D. HDR plans were generated using a Freiburg Flap (FF) applicator and patient-specific rigid and elastic applicators. For dosimetric assessment, dose-volumetric parameters for target volume and normal organs were evaluated. Global gamma evaluations were performed, comparing film measurements and treatment planning system calculations with various gamma criteria. The 10% low-dose threshold was applied. RESULTS The V120% values of the target volume were 56.9%, 70.3%, and 70.2% for HDR plans using FF, rigid, and elastic applicators, respectively. The maximum doses of the right eyeball were 21.7 Gy, 20.5 Gy, and 20.5 Gy for the HDR plans using FF, rigid, and elastic applicators, respectively. The average gamma passing rates were 82.5% ± 1.5%, 91.6% ± 0.8%, and 94.8% ± 0.2% for FF, rigid, and elastic applicators, respectively, with 3%/3 mm criterion. CONCLUSIONS Patient-specific elastic skin applicator showed better adhesion to irregular or curved body surfaces, resulting in better agreement between planned and delivered dose distributions. The applicator suggested in this study can be effectively implemented clinically.
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Affiliation(s)
- So-Yeon Park
- Department of Radiation Oncology, Veterans Health Service Medical Center, Seoul, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Seonghee Kang
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Jong Min Park
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea; Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea; Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; Center for Convergence Research on Robotics, Advance Institutes of Convergence Technology, Suwon, Republic of Korea
| | - Hyun Joon An
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Do Hoon Oh
- Department of Radiation Oncology, Myongji Hospital, Goyang, Republic of Korea
| | - Jung-In Kim
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea; Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea; Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Dipasquale G, Poirier A, Sprunger Y, Uiterwijk JWE, Miralbell R. Improving 3D-printing of megavoltage X-rays radiotherapy bolus with surface-scanner. Radiat Oncol 2018; 13:203. [PMID: 30340612 PMCID: PMC6194575 DOI: 10.1186/s13014-018-1148-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 10/03/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Computed tomography (CT) data used for patient radiotherapy planning can nowadays be used to create 3D-printed boluses. Nevertheless, this methodology requires a second CT scan and planning process when immobilization masks are used in order to fit the bolus under it for treatment. This study investigates the use of a high-grade surface-scanner to produce, prior to the planning CT scan, a 3D-printed bolus in order to increase the workflow efficiency, improve treatment quality and avoid extra radiation dose to the patient. METHODS The scanner capabilities were tested on a phantom and on volunteers. A phantom was used to produce boluses in the orbital region either from CT data (resolution ≈1 mm), or from surface-scanner images (resolution 0.05 mm). Several 3D-printing techniques and materials were tested. To quantify which boluses fit best, they were placed on the phantom and scanned by CT. Hounsfield Unit (HU) profiles were traced perpendicular to the phantom's surface. The minimum HU in the profiles was compared to the HU values for calibrated air-gaps. Boluses were then created from surface images of volunteers to verify the feasibility of surface-scanner use in-vivo. RESULTS Phantom based tests showed a better fit of boluses modeled from surface-scanner than from CT data. Maximum bolus-to-skin air gaps were 1-2 mm using CT models and always < 0.6 mm using surface-scanner models. Tests on volunteers showed good and comfortable fit of boluses produced from surface-scanner images acquired in 0.6 to 7 min. Even in complex surface regions of the body such as ears and fingers, the high-resolution surface-scanner was able to acquire good models. A breast bolus model generated from images acquired in deep inspiration breath hold was also successful. None of the 3D-printed bolus using surface-scanner models required enlarging or shrinking of the initial model acquired in-vivo. CONCLUSIONS Regardless of the material or printing technique, 3D-printed boluses created from high-resolution surface-scanner images proved to be superior in fitting compared to boluses created from CT data. Tests on volunteers were promising, indicating the possibility to improve overall radiotherapy treatments, primarily for megavoltage X-rays, using bolus modeled from a high-resolution surface-scanner even in regions of complex surface anatomy.
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Affiliation(s)
- Giovanna Dipasquale
- Department of Radiation Oncology, Geneva University Hospital, CH-1211, 14, Geneva, Switzerland.
| | | | | | | | - Raymond Miralbell
- Department of Radiation Oncology, Geneva University Hospital, CH-1211, 14, Geneva, Switzerland.,Faculty of Medicine, Geneva University, Geneva, Switzerland
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