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Farahani PK. Application of Tissue Engineering and Biomaterials in Nose Surgery. JPRAS Open 2024; 40:262-272. [PMID: 38708386 PMCID: PMC11067003 DOI: 10.1016/j.jpra.2023.11.001] [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: 10/21/2023] [Accepted: 11/05/2023] [Indexed: 05/07/2024] Open
Abstract
Surgery of the nose involves a series of operations that are directed at restoring the nasal anatomy and physiology. The extent or degree of reconstruction needed is dependent on the appearance-based requirement of the patients and the procedure exploited for the correction such that nasal airflow is preserved. Standard surgical approach includes the use of autologous tissue or implantation alloplastic bio or synthetic/fabricated construct materials to correct the defects. Over the years, tissue engineering has been proven to be a promising technique for reconstructing tissue and organ defects, including the nose. Recently, there has been keen interest in fabricating new tissues and organ scaffolds using 3D printing technology with good control over the micro-architecture and excellent interior architecture suitable for cell seeding. Unviability of the tissue and harvest-associated complications have increased the need for the investigation of tissue engineering based methods for nasal reconstruction using biomaterials, stem cells, and growth factors combined with 3D bioprinting. However, there are only a handful of studies vis-à-vis the application of cartilage tissue engineering, stem cells, and growth factors for the purpose. This review provides highlights about the available studies based on the application of stem cells, biomaterials, and growth factors for nasal reconstruction surgery, as there is limited recent information on the use of these entities in nasal surgeries.
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Basaula D, Hay B, Wright M, Hall L, Easdon A, McWiggan P, Yeo A, Ungureanu E, Kron T. Additive manufacturing of patient specific bolus for radiotherapy: large scale production and quality assurance. Phys Eng Sci Med 2024; 47:551-561. [PMID: 38285272 PMCID: PMC11166743 DOI: 10.1007/s13246-024-01385-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 01/07/2024] [Indexed: 01/30/2024]
Abstract
Bolus is commonly used to improve dose distributions in radiotherapy in particular if dose to skin must be optimised such as in breast or head and neck cancer. We are documenting four years of experience with 3D printed bolus at a large cancer centre. In addition to this we review the quality assurance (QA) program developed to support it. More than 2000 boluses were produced between Nov 2018 and Feb 2023 using fused deposition modelling (FDM) printing with polylactic acid (PLA) on up to five Raise 3D printers. Bolus is designed in the radiotherapy treatment planning system (Varian Eclipse), exported to an STL file followed by pre-processing. After checking each bolus with CT scanning initially we now produce standard quality control (QC) wedges every month and whenever a major change in printing processes occurs. A database records every bolus printed and manufacturing details. It takes about 3 days from designing the bolus in the planning system to delivering it to treatment. A 'premium' PLA material (Spidermaker) was found to be best in terms of homogeneity and CT number consistency (80 HU +/- 8HU). Most boluses were produced for photon beams (93.6%) with the rest used for electrons. We process about 120 kg of PLA per year with a typical bolus weighing less than 500 g and the majority of boluses 5 mm thick. Print times are proportional to bolus weight with about 24 h required for 500 g material deposited. 3D printing using FDM produces smooth and reproducible boluses. Quality control is essential but can be streamlined.
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Affiliation(s)
- Deepak Basaula
- Peter MacCallum Cancer Centre, Department of Physical Sciences, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Barry Hay
- Peter MacCallum Cancer Centre, Department of Radiation Engineering, Melbourne, Australia
| | - Mark Wright
- Peter MacCallum Cancer Centre, Department of Radiation Engineering, Melbourne, Australia
| | - Lisa Hall
- Peter MacCallum Cancer Centre, Department of Radiation Therapy, Melbourne, Australia
| | - Alan Easdon
- Peter MacCallum Cancer Centre, Department of Radiation Engineering, Melbourne, Australia
| | - Peter McWiggan
- Peter MacCallum Cancer Centre, Department of Radiation Engineering, Melbourne, Australia
| | - Adam Yeo
- Peter MacCallum Cancer Centre, Department of Physical Sciences, 305 Grattan Street, Melbourne, VIC, 3000, Australia
- School of Applied Sciences, RMIT University, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Elena Ungureanu
- Peter MacCallum Cancer Centre, Department of Physical Sciences, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Tomas Kron
- Peter MacCallum Cancer Centre, Department of Physical Sciences, 305 Grattan Street, Melbourne, VIC, 3000, Australia.
- School of Applied Sciences, RMIT University, Melbourne, Australia.
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia.
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
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Gugliandolo SG, Pillai SP, Rajendran S, Vincini MG, Pepa M, Pansini F, Zaffaroni M, Marvaso G, Alterio D, Vavassori A, Durante S, Volpe S, Cattani F, Jereczek-Fossa BA, Moscatelli D, Colosimo BM. 3D-printed boluses for radiotherapy: influence of geometrical and printing parameters on dosimetric characterization and air gap evaluation. Radiol Phys Technol 2024; 17:347-359. [PMID: 38351260 PMCID: PMC11128404 DOI: 10.1007/s12194-024-00782-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 05/27/2024]
Abstract
The work investigates the implementation of personalized radiotherapy boluses by means of additive manufacturing technologies. Boluses materials that are currently used need an excessive amount of human intervention which leads to reduced repeatability in terms of dosimetry. Additive manufacturing can solve this problem by eliminating the human factor in the process of fabrication. Planar boluses with fixed geometry and personalized boluses printed starting from a computed tomography scan of a radiotherapy phantom were produced. First, a dosimetric characterization study on planar bolus designs to quantify the effects of print parameters such as infill density and geometry on the radiation beam was made. Secondly, a volumetric quantification of air gap between the bolus and the skin of the patient as well as dosimetric analyses were performed. The optimization process according to the obtained dosimetric and airgap results allowed us to find a combination of parameters to have the 3D-printed bolus performing similarly to that in conventional use. These preliminary results confirm those in the relevant literature, with 3D-printed boluses showing a dosimetric performance similar to conventional boluses with the additional advantage of being perfectly conformed to the patient geometry.
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Affiliation(s)
- Simone Giovanni Gugliandolo
- Department of Mechanical Engineering, Politecnico di Milano, Via La Masa, 1, 20156, Milano, Italy
- Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci, 32, 20133, Milano, Italy
| | | | - Shankar Rajendran
- Department of Mechanical Engineering, Politecnico di Milano, Via La Masa, 1, 20156, Milano, Italy
| | - Maria Giulia Vincini
- Division of Radiation Oncology, IEO European Institute of Oncology, IRCCS, Milano, Italy
| | - Matteo Pepa
- Division of Radiation Oncology, IEO European Institute of Oncology, IRCCS, Milano, Italy
- Clinical Department, Bioengineering Unit, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Floriana Pansini
- Unit of Medical Physics, IEO European Institute of Oncology, IRCCS, Milano, Italy
| | - Mattia Zaffaroni
- Division of Radiation Oncology, IEO European Institute of Oncology, IRCCS, Milano, Italy
| | - Giulia Marvaso
- Division of Radiation Oncology, IEO European Institute of Oncology, IRCCS, Milano, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy
| | - Daniela Alterio
- Division of Radiation Oncology, IEO European Institute of Oncology, IRCCS, Milano, Italy
| | - Andrea Vavassori
- Division of Radiation Oncology, IEO European Institute of Oncology, IRCCS, Milano, Italy
| | - Stefano Durante
- Division of Radiation Oncology, IEO European Institute of Oncology, IRCCS, Milano, Italy
| | - Stefania Volpe
- Division of Radiation Oncology, IEO European Institute of Oncology, IRCCS, Milano, Italy
| | - Federica Cattani
- Division of Radiation Oncology, IEO European Institute of Oncology, IRCCS, Milano, Italy
- Unit of Medical Physics, IEO European Institute of Oncology, IRCCS, Milano, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO European Institute of Oncology, IRCCS, Milano, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy
| | - Davide Moscatelli
- Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci, 32, 20133, Milano, Italy
| | - Bianca Maria Colosimo
- Department of Mechanical Engineering, Politecnico di Milano, Via La Masa, 1, 20156, Milano, Italy.
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Bustillo JPO, Paino J, Barnes M, Cameron M, Rosenfeld AB, Lerch MLF. Characterization of selected additive manufacturing materials for synchrotron monochromatic imaging and broad-beam radiotherapy at the Australian synchrotron-imaging and medical beamline. Phys Med Biol 2024; 69:115055. [PMID: 38718813 DOI: 10.1088/1361-6560/ad48f7] [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: 01/19/2024] [Accepted: 05/08/2024] [Indexed: 05/31/2024]
Abstract
Objective.This study aims to characterize radiological properties of selected additive manufacturing (AM) materials utilizing both material extrusion and vat photopolymerization technologies. Monochromatic synchrotron x-ray images and synchrotron treatment beam dosimetry were acquired at the hutch 3B and 2B of the Australian Synchrotron-Imaging and Medical Beamline.Approach.Eight energies from 30 keV up to 65 keV were used to acquire the attenuation coefficients of the AM materials. Comparison of theoretical, and experimental attenuation data of AM materials and standard solid water for MV linac was performed. Broad-beam dosimetry experiment through attenuated dose measurement and a Geant4 Monte Carlo simulation were done for the studied materials to investigate its attenuation properties specific for a 4 tesla wiggler field with varying synchrotron radiation beam qualities.Main results.Polylactic acid (PLA) plus matches attenuation coefficients of both soft tissue and brain tissue, while acrylonitrile butadiene styrene, Acrylonitrile styrene acrylate, and Draft resin have close equivalence to adipose tissue. Lastly, PLA, co-polyester plus, thermoplastic polyurethane, and White resins are promising substitute materials for breast tissue. For broad-beam experiment and simulation, many of the studied materials were able to simulate RMI457 Solid Water and bolus within ±10% for the three synchrotron beam qualities. These results are useful in fabricating phantoms for synchrotron and other related medical radiation applications such as orthovoltage treatments.Significance and conclusion.These 3D printing materials were studied as potential substitutes for selected tissues such as breast tissue, adipose tissue, soft-tissue, and brain tissue useful in fabricating 3D printed phantoms for synchrotron imaging, therapy, and orthovoltage applications. Fabricating customizable heterogeneous anthropomorphic phantoms (e.g. breast, head, thorax) and pre-clinical animal phantoms (e.g. rodents, canine) for synchrotron imaging and radiotherapy using AM can be done based on the results of this study.
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Affiliation(s)
- John Paul O Bustillo
- Center for Medical Radiation Physics, University of Wollongong Australia, Wollongong, NSW 2522, Australia
- Department of Physical Sciences and Mathematics, College of Arts and Sciences, University of the Philippines Manila, Ermita, Manila City 1000, Metro Manila, The Philippines
| | - Jason Paino
- Center for Medical Radiation Physics, University of Wollongong Australia, Wollongong, NSW 2522, Australia
| | - Micah Barnes
- Center for Medical Radiation Physics, University of Wollongong Australia, Wollongong, NSW 2522, Australia
- Imaging and Medical Beamline, Australian Nuclear Science and Technology Organisation- Australian Synchrotron, Kulin Nation, Clayton, VIC 3168, Australia
| | - Matthew Cameron
- Imaging and Medical Beamline, Australian Nuclear Science and Technology Organisation- Australian Synchrotron, Kulin Nation, Clayton, VIC 3168, Australia
| | - Anatoly B Rosenfeld
- Center for Medical Radiation Physics, University of Wollongong Australia, Wollongong, NSW 2522, Australia
| | - Michael L F Lerch
- Center for Medical Radiation Physics, University of Wollongong Australia, Wollongong, NSW 2522, Australia
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Quiñones LÁ, Sánchez A, Pérez J, Seguro Á, Castro I, Castanedo M, Vicent D, Iborra MA. Thermoplastic polymers as water substitutes. Biomed Phys Eng Express 2024; 10:045009. [PMID: 38670074 DOI: 10.1088/2057-1976/ad43ee] [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: 01/10/2024] [Accepted: 04/26/2024] [Indexed: 04/28/2024]
Abstract
Background. New applications of 3D printing have recently appeared in the fields of radiotherapy and radiology, but the knowledge of many radiological characteristics of the compounds involved is still limited. Therefore, studies are needed to improve our understanding about the transport and interaction of ionizing radiation in these materials.Purpose. The purpose of this study is to perform an analysis of the most important radiation interaction parameters in thermoplastic materials used in Fused Deposition Modeling 3D printing. Additionally, we propose improvements to bring their characteristics closer to those of water and use them as water substitutes in applications such as radiodiagnosis, external radiotherapy, and brachytherapy.Methods. We have calculated different magnitudes as mass linear attenuation, mass energy absorption coefficients, as well as stopping power and electronic density of several thermoplastic materials along with various compounds that have been used as water substitutes and in a new proposed blend. To perform these computations, we have used the XCOM and ESTAR databases from NIST and the EGSnrc code for Montecarlo simulations.Results. From the representation of the calculated interaction parameters, we have been able to establish relationships between their properties and the proportion of certain chemical elements. In addition, studying these same characteristics in different commercial solutions used as substitutes for water phantoms allows us to extrapolate improvements for these polymers.Conclusion. The radiological characteristics of the analyzed thermoplastic materials can be improved by adding some chemical elements with atomic numbers higher than oxygen and by using polyethylene in new blends.
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Affiliation(s)
- Luis Ángel Quiñones
- Medical Physics Service, Hospital Universitario Puerta del Mar, Avda. Ana de Viya, No 21. 11009, Cádiz, Spain
| | - Andrea Sánchez
- Medical Physics Service, Hospital Universitario Puerta del Mar, Avda. Ana de Viya, No 21. 11009, Cádiz, Spain
| | - Joaquín Pérez
- Medical Physics Service, Hospital Universitario Puerta del Mar, Avda. Ana de Viya, No 21. 11009, Cádiz, Spain
| | - Álvaro Seguro
- Medical Physics Service, Hospital Universitario Puerta del Mar, Avda. Ana de Viya, No 21. 11009, Cádiz, Spain
| | - Ignacio Castro
- Medical Physics Service, Hospital Universitario Puerta del Mar, Avda. Ana de Viya, No 21. 11009, Cádiz, Spain
| | - Miguel Castanedo
- Medical Physics Service, Hospital Universitario Puerta del Mar, Avda. Ana de Viya, No 21. 11009, Cádiz, Spain
| | - Diana Vicent
- Medical Physics Service, Hospital Universitario Puerta del Mar, Avda. Ana de Viya, No 21. 11009, Cádiz, Spain
| | - María Amparo Iborra
- Medical Physics Service, Hospital Universitario Puerta del Mar, Avda. Ana de Viya, No 21. 11009, Cádiz, Spain
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Schulz JB, Dubrowski P, Gibson C, Yu AS, Skinner LB. A clinical solution for non-toxic 3D-printed photon blocks in external beam radiation therapy. J Appl Clin Med Phys 2024; 25:e14225. [PMID: 38213084 DOI: 10.1002/acm2.14225] [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: 06/08/2023] [Revised: 10/14/2023] [Accepted: 10/21/2023] [Indexed: 01/13/2024] Open
Abstract
PURPOSE A well-known limitation of multi-leaf collimators is that they cannot easily form island blocks. This can be important in mantle region therapy. Cerrobend photon blocks, currently used for supplementary shielding, are labor-intensive and error-prone. To address this, an innovative, non-toxic, automatically manufactured photon block using 3D-printing technology is proposed, offering a patient-specific and accurate alternative. METHODS AND MATERIALS The study investigates the development of patient-specific photon shielding blocks using 3D-printing for three different patient cases. A 3D-printed photon block shell filled with tungsten ball bearings (BBs) was designed to have similar dosimetric properties to Cerrobend standards. The generation of the blocks was automated using the Eclipse Scripting API and Python. Quality assurance was performed by comparing the expected and actual weight of the tungsten BBs used for shielding. Dosimetric and field geometry comparisons were conducted between 3D-printed and Cerrobend blocks, utilizing ionization chambers, imaging, and field geometry analysis. RESULTS The quality assurance assessment revealed a -1.3% average difference in the mass of tungsten ball bearings for different patients. Relative dose output measurements for three patient-specific blocks in the blocked region agreed within 2% of each other. Against the Treatment Planning System (TPS), both 3D-printed and Cerrobend blocks agreed within 2%. For each patient, 6 MV image profiles taken through the 3D-printed and Cerrobend blocks agreed within 1% outside high gradient regions. Jaccard distance analysis of the MV images against the TPS planned images, found Cerrobend blocks to have 15.7% dissimilarity to the TPS, while that of the 3D-printed blocks was 6.7%. CONCLUSIONS This study validates a novel, efficient 3D-printing method for photon block creation in clinical settings. Despite potential limitations, the benefits include reduced manual labor, automated processes, and greater precision. It holds potential for widespread adoption in radiation therapy, furthering non-toxic radiation shielding.
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Affiliation(s)
- Joseph B Schulz
- Department of Radiation Oncology, School of Medicine, Stanford University, Stanford, California, USA
| | - Piotr Dubrowski
- Department of Radiation Oncology, School of Medicine, Stanford University, Stanford, California, USA
| | - Clinton Gibson
- Department of Radiation Oncology, School of Medicine, Stanford University, Stanford, California, USA
| | - Amy S Yu
- Department of Radiation Oncology, School of Medicine, Stanford University, Stanford, California, USA
| | - Lawrie Basil Skinner
- Department of Radiation Oncology, School of Medicine, Stanford University, Stanford, California, USA
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Shimozato T. [6. Notes and Necessary Measurements for External High-energy Electron Radiation Therapy]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2024; 80:241-251. [PMID: 38382984 DOI: 10.6009/jjrt.2024-2313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Affiliation(s)
- Tomohiro Shimozato
- Faculty of Radiological Technology, Department of Health Science, Gifu University of Medical Science
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Karl AS, Steel JG, Warr GB. Regression fitting megavoltage depth dose curves to determine material relative electron density in radiotherapy. Phys Eng Sci Med 2023; 46:1387-1397. [PMID: 37733264 DOI: 10.1007/s13246-023-01306-8] [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] [Accepted: 07/19/2023] [Indexed: 09/22/2023]
Abstract
The relative electron density (RED) parameter is ubiquitous throughout radiotherapy for clinical dosimetry and treatment planning purposes as it provides a more accurate description of the relevant radiological properties over mass density alone. RED is in practice determined indirectly from calibrated CT Hounsfield Units (HU). While CT images provide useful 3D information, the spectral differences between CT and clinical LINAC beams may impact the validity of the CT-ED calibration, especially in the context of novel tissue-mimicking materials where deviations from biologically typical atomic number to atomic weight ratios 〈Z/A〉 occur and/or high-Z materials are present. A theoretical basis for determining material properties directly in a clinical beam spectrum via an electron-density equivalent pathlength (eEPL) method has been previously established. An experimental implementation of this approach is introduced whereby material-specific measured percentage depth dose curves (PDDs) are regressed to a PDD measured in a reference material (water), providing an inference of 〈Z/A〉, which when combined with the physical density provides a determination of RED. This method is validated over a range of tissue-mimicking materials and compared against the standard CT output, as well as compositional information obtained from the manufacturer's specifications. The measured PDD regression method shows consistent results against both manufacturer-provided and CT-derived values between 0.9 and 1.15 RED. Outside of this soft-tissue range a trend was observed whereby the 〈Z/A〉 determined becomes unrealistic indicating the method is no longer reporting RED alone and the assumptions around the eEPL model are constrained. Within the soft-tissue RED range of validity, the regression method provides a practical and robust characterisation for unknown materials in the clinical setting and may be used to improve on the CT derived RED where high Z material components are suspected.
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Affiliation(s)
- Anthony S Karl
- Mid North Coast Cancer Institute Coffs Harbour, Mid North Local Health District, Coffs Harbour Health Campus, Coffs Harbour, NSW, 2450, Australia.
| | - Jared G Steel
- Mid North Coast Cancer Institute Coffs Harbour, Mid North Local Health District, Coffs Harbour Health Campus, Coffs Harbour, NSW, 2450, Australia
| | - George B Warr
- Western Cancer Centre Dubbo, Dubbo Base Hospital, Western NSW Local Health District, Dubbo, NSW, 2830, Australia
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Sabzevari A, Rayat Pisheh H, Ansari M, Salati A. Progress in bioprinting technology for tissue regeneration. J Artif Organs 2023; 26:255-274. [PMID: 37119315 DOI: 10.1007/s10047-023-01394-z] [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: 01/03/2023] [Accepted: 04/09/2023] [Indexed: 05/01/2023]
Abstract
In recent years, due to the increase in diseases that require organ/tissue transplantation and the limited donor, on the other hand, patients have lost hope of recovery and organ transplantation. Regenerative medicine is one of the new sciences that promises a bright future for these patients by providing solutions to repair, improve function, and replace tissue. One of the technologies used in regenerative medicine is three-dimensional (3D) bioprinters. Bioprinting is a new strategy that is the basis for starting a global revolution in the field of medical sciences and has attracted much attention. 3D bioprinters use a combination of advanced biology and cell science, computer science, and materials science to create complex bio-hybrid structures for various applications. The capacity to use this technology can be demonstrated in regenerative medicine to make various connective tissues, such as skin, cartilage, and bone. One of the essential parts of a 3D bioprinter is the bio-ink. Bio-ink is a combination of biologically active molecules, cells, and biomaterials that make the printed product. In this review, we examine the main bioprinting strategies, such as inkjet printing, laser, and extrusion-based bioprinting, as well as some of their applications.
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Affiliation(s)
- Alireza Sabzevari
- Department of Biomedical Engineering, Meybod University, Meybod, Iran
| | | | - Mojtaba Ansari
- Department of Biomedical Engineering, Meybod University, Meybod, Iran.
| | - Amir Salati
- Tissue Engineering and Applied Cell Sciences Group, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
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Yu GB, Kwon J, Chae S, Lee SY, Jung S. Evaluations of patient-specific bolus fabricated by mold-and-cast method using computer numerical control machine tools†. JOURNAL OF RADIATION RESEARCH 2023; 64:973-981. [PMID: 37839093 PMCID: PMC10665306 DOI: 10.1093/jrr/rrad075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/19/2023] [Indexed: 10/17/2023]
Abstract
The patient-specific bolus fabricated by a mold-and-cast method using a 3D printer (3DP) and silicon rubber has been adopted in clinical practices. Manufacturing a mold using 3DP, however, can cause time delays due to failures during the 3D printing process. Thereby, we investigated an alternative method of the mold fabrication using computer numerical control (CNC) machine tools. Treatment plans were conducted concerning a keloid scar formed on the ear and nose. The bolus structures were determined in a treatment planning system (TPS), and the molds were fabricated using the same structure file but with 3DP and CNC independently. Boluses were then manufactured using each mold with silicone rubbers. We compared the geometrical difference between the boluses and the planned structure using computed tomography (CT) images of the boluses. In addition, dosimetric differences between the two measurements using each bolus and the differences between the measured and calculated dose from TPS were evaluated using an anthropomorphic head phantom. Geometrically, the CT images of the boluses fabricated by the 3DP mold and the CNC mold showed differences compared to the planned structure within 2.6 mm of Hausdorff distance. The relative dose difference between the measurements using either bolus was within 2.3%. In conclusion, the bolus made by the CNC mold benefits from a stable fabricating process, retaining the performance of the bolus made by the 3DP mold.
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Affiliation(s)
- Geum Bong Yu
- Department of Radiation Oncology, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 03080, Republic of Korea
| | - Jimin Kwon
- Department of Radiation Oncology, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto M5S 3G8, Ontario, Canada
| | - Seunghoon Chae
- Department of Radiation Oncology, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Sung Young Lee
- Department of Radiation Oncology, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Seongmoon Jung
- Department of Radiation Oncology, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 03080, Republic of Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Department of Nuclear Engineering, Ulsan National Institute of Science and Technology, Ulsan 44919, Republic of Korea
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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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Zhang C, Lewin W, Cullen A, Thommen D, Hill R. Evaluation of 3D-printed bolus for radiotherapy using megavoltage X-ray beams. Radiol Phys Technol 2023; 16:414-421. [PMID: 37294521 PMCID: PMC10435601 DOI: 10.1007/s12194-023-00727-0] [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: 02/16/2023] [Revised: 05/27/2023] [Accepted: 05/29/2023] [Indexed: 06/10/2023]
Abstract
A radiotherapy bolus is a tissue-equivalent material placed on the skin to adjust the surface dose of megavoltage X-ray beams used for treatment. In this study, the dosimetric properties of two 3D-printed filament materials, polylactic acid (PLA) and thermoplastic polyether urethane (TPU), used as radiotherapy boluses, were investigated. The dosimetric properties of PLA and TPU were compared with those of several conventional bolus materials and RMI457 Solid Water. Percentage depth-dose (PDD) measurements in the build-up region were performed for all materials using 6 and 10 MV photon treatment beams on Varian linear accelerators. The results showed that the differences in the PDDs of the 3D-printed materials from the RMI457 Solid Water were within 3%, whereas those of the dental wax and SuperFlab gel materials were within 5%. This indicates that PLA and TPU 3D-printed materials are suitable radiotherapy bolus materials.
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Affiliation(s)
- Chunsu Zhang
- Institute of Medical Physics, School of Physics, The University of Sydney, Sydney, NSW, 2006, Australia
- Arto Hardy Family Biomedical Innovation Hub, Chris O'Brien Lifehouse, Camperdown, NSW, 2050, Australia
| | - Will Lewin
- Arto Hardy Family Biomedical Innovation Hub, Chris O'Brien Lifehouse, Camperdown, NSW, 2050, Australia
| | - Ashley Cullen
- Institute of Medical Physics, School of Physics, The University of Sydney, Sydney, NSW, 2006, Australia
- Arto Hardy Family Biomedical Innovation Hub, Chris O'Brien Lifehouse, Camperdown, NSW, 2050, Australia
- Department of Radiation Oncology, Chris O'Brien Lifehouse, Missenden Rd, Camperdown,Sydney, NSW, 2050, Australia
| | - Daniel Thommen
- Institute of Medical Physics, School of Physics, The University of Sydney, Sydney, NSW, 2006, Australia
- Arto Hardy Family Biomedical Innovation Hub, Chris O'Brien Lifehouse, Camperdown, NSW, 2050, Australia
- Department of Radiation Oncology, Chris O'Brien Lifehouse, Missenden Rd, Camperdown,Sydney, NSW, 2050, Australia
| | - Robin Hill
- Institute of Medical Physics, School of Physics, The University of Sydney, Sydney, NSW, 2006, Australia.
- Arto Hardy Family Biomedical Innovation Hub, Chris O'Brien Lifehouse, Camperdown, NSW, 2050, Australia.
- Department of Radiation Oncology, Chris O'Brien Lifehouse, Missenden Rd, Camperdown,Sydney, NSW, 2050, Australia.
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13
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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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14
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Dąbrowska-Szewczyk E, Zawadzka A, Kowalczyk P, Podgórski R, Saworska G, Głowacki M, Kukołowicz P, Brzozowska B. Low-density 3D-printed boluses with honeycomb infill 3D-printed boluses in radiotherapy. Phys Med 2023; 110:102600. [PMID: 37167778 DOI: 10.1016/j.ejmp.2023.102600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/05/2023] [Accepted: 04/30/2023] [Indexed: 05/13/2023] Open
Abstract
PURPOSE Dosimetric characteristics of 3D-printed plates using different infill percentage and materials was the purpose of our study. METHODS Test plates with 5%, 10%, 15% and 20% honeycomb structure infill were fabricated using TPU and PLA polymers. The Hounsfield unit distribution was determined using a Python script. Percentage Depth Dose (PDD) distribution in the build-up region was measured with the Markus plane-parallel ionization chamber for an open 10x10 cm2 field of 6 MV. PDD was measured at a depth of 1 mm, 5 mm, 10 mm and 15 mm. Measurements were compared with Eclipse treatment planning system calculations using AAA and Acuros XB algorithms. RESULTS The mean HU for CT scans of 3D-printed TPU plates increased with percentage infill increase from -739 HU for 5% to -399 HU for 20%. Differences between the average HU for TPU and PLA did not exceed 2% for all percentage infills. Even using a plate with the lowest infill PDD at 1 mm depth increase from 44.7% (without a plate) to 76.9% for TPU and 76.6% for PLA. Infill percentage did not affect the dose at depths greater than 5 mm. Differences between measurements and TPS calculations were less than 4.1% for both materials, regardless of the infill percentage and depth. CONCLUSIONS The use of 3D-printed light boluses increases the dose in the build-up region, which was shown based on the dosimetric measurements and TPS calculations.
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Affiliation(s)
- Edyta Dąbrowska-Szewczyk
- Biomedical Physics Division, Faculty of Physics, University of Warsaw, 5 L. Pasteur Street, 02-093 Warsaw, Poland; Medical Physics Department, The Maria Skłodowska-Curie National Research Institute of Oncology in Warsaw, 5 WK Roentgen Street, 02-781 Warsaw, Poland
| | - Anna Zawadzka
- Medical Physics Department, The Maria Skłodowska-Curie National Research Institute of Oncology in Warsaw, 5 WK Roentgen Street, 02-781 Warsaw, Poland
| | - Piotr Kowalczyk
- Warsaw University of Technology, Faculty of Chemical and Process Engineering, Department of Biotechnology and Bioprocess Engineering, Waryńskiego 1, 00-645 Warsaw, Poland; Centre of Advanced Materials and Technologies CEZAMAT, Poleczki 19, 02-822 Warsaw, Poland
| | - Rafał Podgórski
- Warsaw University of Technology, Faculty of Chemical and Process Engineering, Department of Biotechnology and Bioprocess Engineering, Waryńskiego 1, 00-645 Warsaw, Poland
| | - Gabriela Saworska
- Biomedical Physics Division, Faculty of Physics, University of Warsaw, 5 L. Pasteur Street, 02-093 Warsaw, Poland
| | - Maksymilian Głowacki
- Biomedical Physics Division, Faculty of Physics, University of Warsaw, 5 L. Pasteur Street, 02-093 Warsaw, Poland
| | - Paweł Kukołowicz
- Medical Physics Department, The Maria Skłodowska-Curie National Research Institute of Oncology in Warsaw, 5 WK Roentgen Street, 02-781 Warsaw, Poland
| | - Beata Brzozowska
- Biomedical Physics Division, Faculty of Physics, University of Warsaw, 5 L. Pasteur Street, 02-093 Warsaw, Poland.
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15
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Biltekin F, Bäumer C, Esser J, Ghanem O, Ozyigit G, Timmermann B. Preclinical Dosimetry for Small Animal Radiation Research in Proton Therapy: A Feasibility Study. Int J Part Ther 2023; 10:13-22. [PMID: 37823014 PMCID: PMC10563666 DOI: 10.14338/ijpt-22-00035.1] [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: 10/04/2022] [Accepted: 02/10/2023] [Indexed: 10/13/2023] Open
Abstract
Purpose To evaluate the feasibility of the three-dimensional (3D) printed small animal phantoms in dosimetric verification of proton therapy for small animal radiation research. Materials and Methods Two different phantoms were modeled using the computed-tomography dataset of real rat and tumor-bearing mouse, retrospectively. Rat phantoms were designed to accommodate both EBT3 film and ionization chamber. A subcutaneous tumor-bearing mouse phantom was only modified to accommodate film dosimetry. All phantoms were printed using polylactic-acid (PLA) filament. Optimal printing parameters were set to create tissue-equivalent material. Then, proton therapy plans for different anatomical targets, including whole brain and total lung irradiation in the rat phantom and the subcutaneous tumor model in the mouse phantom, were created using the pencil-beam scanning technique. Point dose and film dosimetry measurements were performed using 3D-printed phantoms. In addition, all phantoms were analyzed in terms of printing accuracy and uniformity. Results Three-dimensionally printed phantoms had excellent uniformity over the external body, and printing accuracy was within 0.5 mm. According to our findings, two-dimensional dosimetry with EBT3 showed acceptable levels of γ passing rate for all measurements except for whole brain irradiation (γ passing rate, 89.8%). In terms of point dose analysis, a good agreement (<0.1%) was found between the measured and calculated point doses for all anatomical targets. Conclusion Three-dimensionally printed small animal phantoms show great potential for dosimetric verifications of clinical proton therapy for small animal radiation research.
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Affiliation(s)
- Fatih Biltekin
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
- West German Proton Therapy Centre Essen (WPE), Essen, Germany
| | - Christian Bäumer
- West German Proton Therapy Centre Essen (WPE), Essen, Germany
- West German Cancer Centre (WTZ), Essen, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
- TU Dortmund University, Department of Physics, Dortmund, Germany
| | - Johannes Esser
- West German Proton Therapy Centre Essen (WPE), Essen, Germany
- West German Cancer Centre (WTZ), Essen, Germany
| | - Osamah Ghanem
- West German Proton Therapy Centre Essen (WPE), Essen, Germany
- West German Cancer Centre (WTZ), Essen, Germany
| | - Gokhan Ozyigit
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Beate Timmermann
- West German Proton Therapy Centre Essen (WPE), Essen, Germany
- West German Cancer Centre (WTZ), Essen, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
- TU Dortmund University, Department of Physics, Dortmund, Germany
- Department of Particle Therapy, University Hospital Essen, Essen, Germany
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16
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Douglass M, Gorayski P, Patel S, Santos A. Synthetic cranial MRI from 3D optical surface scans using deep learning for radiation therapy treatment planning. Phys Eng Sci Med 2023; 46:367-375. [PMID: 36752996 PMCID: PMC10030422 DOI: 10.1007/s13246-023-01229-4] [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: 08/30/2022] [Accepted: 01/29/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND Optical scanning technologies are increasingly being utilised to supplement treatment workflows in radiation oncology, such as surface-guided radiotherapy or 3D printing custom bolus. One limitation of optical scanning devices is the absence of internal anatomical information of the patient being scanned. As a result, conventional radiation therapy treatment planning using this imaging modality is not feasible. Deep learning is useful for automating various manual tasks in radiation oncology, most notably, organ segmentation and treatment planning. Deep learning models have also been used to transform MRI datasets into synthetic CT datasets, facilitating the development of MRI-only radiation therapy planning. AIMS To train a pix2pix generative adversarial network to transform 3D optical scan data into estimated MRI datasets for a given patient to provide additional anatomical data for a select few radiation therapy treatment sites. The proposed network may provide useful anatomical information for treatment planning of surface mould brachytherapy, total body irradiation, and total skin electron therapy, for example, without delivering any imaging dose. METHODS A 2D pix2pix GAN was trained on 15,000 axial MRI slices of healthy adult brains paired with corresponding external mask slices. The model was validated on a further 5000 previously unseen external mask slices. The predictions were compared with the "ground-truth" MRI slices using the multi-scale structural similarity index (MSSI) metric. A certified neuro-radiologist was subsequently consulted to provide an independent review of the model's performance in terms of anatomical accuracy and consistency. The network was then applied to a 3D photogrammetry scan of a test subject to demonstrate the feasibility of this novel technique. RESULTS The trained pix2pix network predicted MRI slices with a mean MSSI of 0.831 ± 0.057 for the 5000 validation images indicating that it is possible to estimate a significant proportion of a patient's gross cranial anatomy from a patient's exterior contour. When independently reviewed by a certified neuro-radiologist, the model's performance was described as "quite amazing, but there are limitations in the regions where there is wide variation within the normal population." When the trained network was applied to a 3D model of a human subject acquired using optical photogrammetry, the network could estimate the corresponding MRI volume for that subject with good qualitative accuracy. However, a ground-truth MRI baseline was not available for quantitative comparison. CONCLUSIONS A deep learning model was developed, to transform 3D optical scan data of a patient into an estimated MRI volume, potentially increasing the usefulness of optical scanning in radiation therapy planning. This work has demonstrated that much of the human cranial anatomy can be predicted from the external shape of the head and may provide an additional source of valuable imaging data. Further research is required to investigate the feasibility of this approach for use in a clinical setting and further improve the model's accuracy.
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Affiliation(s)
- Michael Douglass
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia.
- Australian Bragg Centre for Proton Therapy and Research, SAHMRI, Adelaide, SA, 5000, Australia.
- School of Physical Sciences, University of Adelaide, Adelaide, SA, 5005, Australia.
| | - Peter Gorayski
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
- Australian Bragg Centre for Proton Therapy and Research, SAHMRI, Adelaide, SA, 5000, Australia
- University of South Australia, Allied Health & Human Performance, Adelaide, SA, 5000, Australia
| | - Sandy Patel
- Department of Radiology, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
| | - Alexandre Santos
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
- Australian Bragg Centre for Proton Therapy and Research, SAHMRI, Adelaide, SA, 5000, Australia
- School of Physical Sciences, University of Adelaide, Adelaide, SA, 5005, Australia
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17
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Robar JL, Kammerzell B, Hulick K, Kaiser P, Young C, Verzwyvelt V, Cheng X, Shepherd M, Orbovic R, Fedullo S, Majcher C, DiMarco S, Stasiak J. Novel multi jet fusion 3D-printed patient immobilization for radiation therapy. J Appl Clin Med Phys 2022; 23:e13773. [PMID: 36052990 DOI: 10.1002/acm2.13773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/25/2022] [Accepted: 08/11/2022] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Thermoplastic immobilizers are used routinely in radiation therapy to achieve positioning accuracy. These devices are variable in quality as they are dependent on the skill of the human fabricator. We examine the potential multi jet fusion (MJF) 3D printing for the production immobilizers with a focus on the surface dosimetry of several MJF-printed PA12-based material candidates. Materials are compared with the goal of minimizing surface dose with comparison to standard thermoplastic. We introduce a novel metamaterial design for the shell of the immobilizer, with the aims of mechanical robustness and low-dose buildup. We demonstrate first examples of adult and pediatric cranial and head-and-neck immobilizers. METHODS Three different PA12 materials were examined and compared to fused deposition modeling-printed polylactic acid (PLA), PLA with density lowered by adding hollow glass microspheres, and to perforated or perforated/stretched and solid status quo thermoplastic samples. Build-up dose measurements were made using a parallel plate chamber. A metamaterial design was established based on a packed hexagonal geometry. Radiochromic film dosimetry was performed to determine the dependence of surface dose on the metamaterial design. Full cranial and head-and-neck prototype immobilizers were designed, printed, and assessed with regard to dimensional accuracy. RESULTS Build-up dose measurements demonstrated the superiority of the PA12 material with a light fusing agent, which yielded a ∼15% dose reduction compared to other MJF materials. Metamaterial samples provided dose reductions ranging from 11% to 40% compared to stretched thermoplastic. MJF-printed immobilizers were produced reliably, demonstrated the versatility of digital design, and showed dimensional accuracy with 97% of sampled points within ±2 mm. CONCLUSIONS MJF is a promising technology for an automated fabrication of patient immobilizers. Material selection and metamaterial design can be leveraged to yield surface dose reduction of up to 40%. Immobilizer design is highly customizable, and the first examples of MJF-printed immobilizers demonstrate excellent dimensional accuracy.
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Affiliation(s)
- James L Robar
- Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada.,Nova Scotia Health, Halifax, Nova Scotia, Canada.,Adaptiiv Medical Technologies, Halifax, Nova Scotia, Canada
| | | | - Kevin Hulick
- HP, Vancouver, Washington, USA.,HP, Corvallis, Oregon, USA
| | - Pierre Kaiser
- HP, Vancouver, Washington, USA.,HP, Corvallis, Oregon, USA
| | - Calvin Young
- HP, Vancouver, Washington, USA.,HP, Corvallis, Oregon, USA
| | | | - Xin Cheng
- HP, Vancouver, Washington, USA.,HP, Corvallis, Oregon, USA
| | | | | | - Sara Fedullo
- Adaptiiv Medical Technologies, Halifax, Nova Scotia, Canada
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18
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Ganapathy A, Chen D, Elumalai A, Albers B, Tappa K, Jammalamadaka U, Hoegger MJ, Ballard DH. Guide for starting or optimizing a 3D printing clinical service. Methods 2022; 206:41-52. [PMID: 35964862 DOI: 10.1016/j.ymeth.2022.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 10/15/2022] Open
Abstract
Three-dimensional (3D) printing has applications in many fields and has gained substantial traction in medicine as a modality to transform two-dimensional scans into three-dimensional renderings. Patient-specific 3D printed models have direct patient care uses in surgical and procedural specialties, allowing for increased precision and accuracy in developing treatment plans and guiding surgeries. Medical applications include surgical planning, surgical guides, patient and trainee education, and implant fabrication. 3D printing workflow for a laboratory or clinical service that produces anatomic models and guides includes optimizing imaging acquisition and post-processing, segmenting the imaging, and printing the model. Quality assurance considerations include supervising medical imaging expert radiologists' guidance and self-implementing in-house quality control programs. The purpose of this review is to provide a workflow and guide for starting or optimizing laboratories and clinical services that 3D-print anatomic models or guides for clinical use.
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Affiliation(s)
- Aravinda Ganapathy
- School of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
| | - David Chen
- School of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
| | - Anusha Elumalai
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
| | - Brian Albers
- 3D Printing Center, Barnes Jewish Hospital, St. Louis, MO, USA.
| | - Karthik Tappa
- Anatomic 3D Printing and Visualization Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | | | - Mark J Hoegger
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
| | - David H Ballard
- School of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
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19
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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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20
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Chatchumnan N, Kingkaew S, Aumnate C, Sanghangthum T. Development and dosimetric verification of 3D customized bolus in head and neck radiotherapy. JOURNAL OF RADIATION RESEARCH 2022; 63:428-434. [PMID: 35420693 PMCID: PMC9124618 DOI: 10.1093/jrr/rrac013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/05/2022] [Indexed: 06/14/2023]
Abstract
The commercial flat bolus cannot form perfect contact with the irregular surface of the patient's skin, resulting in an air gap. The purpose of this study was to evaluate the feasibility of using a 3D customized bolus from silicone rubber. The silicone rubber boluses were studied in basic characteristics. The 3D customized bolus was fabricated at the nose, cheek and neck regions. The point dose and planar dose differences were evaluated by comparing with virtual bolus. The hardness, thickness, density, Hounsfield unit (HU) and dose attenuation of the customized bolus were quite similar to a commercial bolus. When a 3D customized bolus was placed on the RANDO phantom, it can significantly increase buildup region doses and perfectly fit against the irregular surface shape. The average point dose differences of 3D customized bolus were -1.1%, while the commercial bolus plans showed -1.7%. The average gamma results for planar dose differences comparison of 3D customized bolus were 93.9%, while the commercial bolus plans were reduced to 91.9%. Overall, A silicone rubber bolus produced the feasible dosimetric properties and could save cost compared to a commercial bolus. The 3D printed customized bolus is a good buildup material and could potentially replace and improve treatment efficiency.
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Affiliation(s)
- Nichakan Chatchumnan
- Division of Radiation Oncology, Department of Radiology, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Sakda Kingkaew
- Division of Radiation Oncology, Department of Radiology, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Chuanchom Aumnate
- Metallurgy and Materials Science Research Institute Chulalongkorn University, Bangkok 10330, Thailand
| | - Taweap Sanghangthum
- Corresponding author. Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand. E-mail address:
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21
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Brown K, Kupfer T, Harris B, Penso S, Khor R, Moseshvili E. Not all 3D-printed bolus is created equal: Variation between 3D-printed polylactic acid (PLA) bolus samples sourced from external manufacturers. J Med Radiat Sci 2022; 69:348-356. [PMID: 35506369 PMCID: PMC9442296 DOI: 10.1002/jmrs.591] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Polylactic acid (PLA) is a promising material for customised bolus 3D-printing in radiotherapy, however variations in printing techniques between external manufacturers could increase treatment uncertainties. This study aimed to assess consistency across various 3D-printed PLA samples from different manufacturers. METHODS Sample prints of dimensions 5 × 5 × 1 cm with 100% infill were acquired from multiple commercial 3D-printing services. All samples were CT scanned to determine average Hounsfield unit (HU) values and physical densities. The coefficient of equivalent thickness (CET) was obtained for both photons and electrons and dose attenuation compared to TPS calculations in Elekta Monaco v5.11. RESULTS Some samples showed warped edges up to 1.5 mm and extensive internal radiological defects only detectable with CT scanning. Physical densities ranged from 1.06 to 1.22 g cm-3 and HU values ranged from -5.1 to 221.0 HU. Measured CET values varied from 0.95 to 1.17 and TPS dose calculations were consistent with the variation in CET. Electron R50 and R90 shifted by up to 2 mm for every 1 cm of printed bolus, a clinically significant finding. Photon surface dose varied by up to 3%, while depth doses were within 1%. CONCLUSIONS 3D-printed PLA can have considerable variability in density, HU and CET values between samples and manufacturers. Centres looking to outsource 3D-printed bolus would benefit from clear, open communication with manufacturers and undertake stringent QA examination prior to implementation into the clinical environment.
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Affiliation(s)
- Kerryn Brown
- Department of Radiation Oncology, ONJ Centre, Austin Hospital, Heidelberg, Australia
| | - Tom Kupfer
- Department of Radiation Oncology, ONJ Centre, Austin Hospital, Heidelberg, Australia
| | - Benjamin Harris
- Department of Radiation Oncology, ONJ Centre, Austin Hospital, Heidelberg, Australia
| | - Sam Penso
- Department of Radiation Oncology, ONJ Centre, Austin Hospital, Heidelberg, Australia
| | - Richard Khor
- Department of Radiation Oncology, ONJ Centre, Austin Hospital, Heidelberg, Australia
| | - Eka Moseshvili
- Department of Radiation Oncology, ONJ Centre, Austin Hospital, Heidelberg, Australia.,Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.,Department of Radiation Oncology, GenesisCare, Shepparton, Australia
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22
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Cheng JC, Dubey A, Beck J, Sasaki D, Leylek A, Rathod S. Optical scan and 3D printing guided radiation therapy - an application and provincial experience in cutaneous nasal carcinoma. 3D Print Med 2022; 8:8. [PMID: 35348934 PMCID: PMC8966238 DOI: 10.1186/s41205-022-00136-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: 12/21/2021] [Accepted: 03/15/2022] [Indexed: 12/02/2022] Open
Abstract
Background Single field Orthovoltage radiation is an acceptable modality used for the treatment of nasal cutaneous cancer. However, this technique has dosimetric pitfalls and unnecessary excessive exposure of radiation to organs at risk (OAR). We present the clinical outcome of a case series of cutaneous nasal tumours using a novel technique incorporating an optical scanner and a 3-dimensional (3D) printer to deliver treatments using parallel opposed (POP) fields. Materials and methods The POP delivery method was validated using ion chamber and phantom measurements before implementation. A retrospective chart review of 26 patients treated with this technique between 2015 and 2019 was conducted. Patients’ demographics and treatment outcomes were gathered and tabulated. These patients first underwent an optical scan of their faces to collect topographical data. The data were then transcribed into 3D printing algorithms, and positive impressions of the faces were printed. Custom nose block bolus was made with wax encased in an acrylic shell; 4 cm thick using the printed face models. Custom lead shielding was also generated. Treatments were delivered using 250 KeV photons POP arrangement with 4 cm diameter circle applicator cone and prescribed to the midplane. Dose and fractionation were as per physician discretion. Results Phantom measurements at mid-plane were found to match the prescribed dose within ±0.5%. For the 26 cases in this review, the median age was 78.5 years, with 15 females and 11 males. 85% of cases had Basal cell carcinoma (BCC); 1 had squamous cell carcinoma (SCC), one had synchronous BCC + SCC, and 1 had Merkel cell carcinoma. Twenty-one cases had T1N0 disease, 4 had T2N0, and 1 had T3N0. Dose and fractionation delivered were 40Gy in 10 fractions for the majority of cases. The complete response rate at a median follow-up of 6 months was 88%; 1 patient had a refractory tumour, and one patient had a recurrence. Toxicities were minor with 81% with no reported side effects. Three patients experienced grade 3 skin toxicity. Conclusions Utilization of optic scanner and 3D printing technology, with the innovative approach of using POP orthovoltage beams, allows an effective and efficient way of treatment carcinomas of the nose with a high control rate and low toxicity profiles.
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Affiliation(s)
- Jui Chih Cheng
- Department of Radiation Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Arbind Dubey
- Department of Radiation Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - James Beck
- Department of Medical Physics, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - David Sasaki
- Department of Medical Physics, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Ahmet Leylek
- Department of Radiation Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Shrinivas Rathod
- Department of Radiation Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada.
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23
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Maerz M, Treutwein M, Nabo J, Dobler B. Three-dimensional printers applied for the production of beam blocks in total body irradiation treatment. J Appl Clin Med Phys 2022; 23:e13592. [PMID: 35290701 PMCID: PMC9121048 DOI: 10.1002/acm2.13592] [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: 10/07/2021] [Revised: 01/20/2022] [Accepted: 03/01/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose Total body irradiation (TBI) in extended source surface distance (SSD) is a common treatment technique before hematopoietic stem cell transplant. The lungs are organs at risk, which often are treated with a lower dose than the whole body. Methods This can be achieved by the application of blocks. Three‐dimensional (3D) printers are a modern tool to be used in the production process of these blocks. Results We demonstrate the applicability of a specific printer and printing material, describe the process, and evaluate the accuracy of the product. Conclusion The blocks and apertures were found to be applicable in clinical routine.
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Affiliation(s)
- Manuel Maerz
- Department of Radiotherapy, Regensburg University Medical Center, Regensburg, Germany
| | - Marius Treutwein
- Department of Radiotherapy, Regensburg University Medical Center, Regensburg, Germany
| | - Jan Nabo
- Department for Mathematics and Computer Science, Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany
| | - Barbara Dobler
- Department of Radiotherapy, Regensburg University Medical Center, Regensburg, Germany
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24
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Tan HQ, Koh CWY, Tan LKR, Lew KS, Chua CGA, Ang KW, Lee JCL, Park SY. A transit portal dosimetry method for respiratory gating quality assurance with a dynamic 3D printed tumor phantom. J Appl Clin Med Phys 2022; 23:e13560. [PMID: 35147283 PMCID: PMC9121038 DOI: 10.1002/acm2.13560] [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: 07/27/2021] [Revised: 12/27/2021] [Accepted: 01/29/2022] [Indexed: 11/21/2022] Open
Abstract
Backgrounds Respiratory gating is one of the motion management techniques that is used to deliver radiation dose to a tumor at a specific position under free breathing. However, due to the dynamic feedback process of this approach, regular equipment quality assurance (QA) and patient‐specific QA checks need to be performed. This work proposes a new QA methodology using electronic portal imaging detector (EPID) to determine the target localization accuracy of phase gating. Methods QA tools comprising 3D printed spherical tumor phantoms, programmable stages, and an EPID detector are characterized and assembled. Algorithms for predicting portal dose (PD) through moving phantoms are developed and verified using gamma analysis for two spherical tumor phantoms (2 cm and 4 cm), two different 6 MV volumetric modulated arc therapy plans, and two different gating windows (30%–70% and 40%–60%). Comparison between the two gating windows is then performed using the Wilcoxon signed‐rank test. An optimizer routine, which is used to determine the optimal window, based on maximal gamma passing rate (GPR), was applied to an actual breathing curve and breathing plan. This was done to ascertain if our method yielded a similar result with the actual gating window. Results High GPRs of more than 97% and 91% were observed when comparing the predicted PD with the measured PD in moving phantom at 2 mm/2% and 1 mm/1% levels, respectively. Analysis of gamma heatmaps shows an excellent agreement with the tumor phantom. The GPR of 40%–60% PD was significantly lower than that of the 30%–70% PD at the 1 mm/1% level (p = 0.0064). At the 2 mm/2% level, no significant differences were observed. The optimizer routine could accurately predict the center of the gating window to within a 10% range. Conclusion We have successfully performed and verified a new method for QA with the use of a moving phantom with EPID for phase gating with real‐time position management.
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Affiliation(s)
- Hong Qi Tan
- Division of Radiation Oncology, National Cancer Centre, Singapore, Singapore
| | - Calvin Wei Yang Koh
- Division of Radiation Oncology, National Cancer Centre, Singapore, Singapore
| | - Lloyd Kuan Rui Tan
- Division of Radiation Oncology, National Cancer Centre, Singapore, Singapore
| | - Kah Seng Lew
- Division of Radiation Oncology, National Cancer Centre, Singapore, Singapore
| | | | - Khong Wei Ang
- Division of Radiation Oncology, National Cancer Centre, Singapore, Singapore
| | - James Cheow Lei Lee
- Division of Radiation Oncology, National Cancer Centre, Singapore, Singapore.,Division of Physics and Applied Physics, Nanyang Technological University, Singapore, Singapore
| | - Sung Yong Park
- Division of Radiation Oncology, National Cancer Centre, Singapore, Singapore.,Oncology Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
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25
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Özseven A. Assessment of using electronic portal imaging device for analysing bolus material utilised in radiation therapy. OPEN CHEM 2022. [DOI: 10.1515/chem-2022-0126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
In this study, the feasibility of using electronic portal imaging device (EPID) as an analysing equipment for bolus material was evaluated in terms of its dosimetric parameters. Seven superflab bolus material samples, 4 samples of 0.5 cm (S1–S4) and 3 samples of 1 cm thickness (S5–S7), were analysed and compared with tissue equivalent water phantom, which was selected for reference material. Gamma analysis method was used to evaluate the dose distribution of the boluses. In addition, 487,204 point-dose values of each bolus were compared with the point-doses of corresponding reference material by using Spearman’s correlation coefficient analysis. The passing rates varied from 58.3 to 100% for 0.5 cm thick samples, and on the other hand, the passing rates of all the 1 cm thick boluses were 100%. All the correlation coefficient values were above 0.975. The correlation was statistically significant for all the samples (p < 0.001). The correlation coefficient of S4 bolus sample was the highest among the 0.5 cm thick bolus samples with a result of 0.989. Likewise, S5 and S6 bolus samples were the highest among the 1 cm thick ones with a result of 0.995. The results indicated that the material planned to be used as bolus can be evaluated with EPID in daily use.
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Affiliation(s)
- Alper Özseven
- Department of Radiation Oncology, Faculty of Medicine, Süleyman Demirel University , Isparta , PC: 32260 , Turkey
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26
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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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27
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Malone C, Gill E, Lott T, Rogerson C, Keogh S, Mousli M, Carroll D, Kelly C, Gaffney J, McClean B. Evaluation of the quality of fit of flexible bolus material created using 3D printing technology. J Appl Clin Med Phys 2022; 23:e13490. [PMID: 35048501 PMCID: PMC8906215 DOI: 10.1002/acm2.13490] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/12/2021] [Accepted: 11/12/2021] [Indexed: 11/09/2022] Open
Abstract
Aims Materials and methods Results Conclusion
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Affiliation(s)
- Ciaran Malone
- St. Luke's Radiation Oncology Network Dublin, Ireland
| | - Elaine Gill
- St. Luke's Radiation Oncology Network Dublin, Ireland
| | - Tanith Lott
- St. Luke's Radiation Oncology Network Dublin, Ireland
| | | | - Sinead Keogh
- St. Luke's Radiation Oncology Network Dublin, Ireland
| | - Majed Mousli
- St. Luke's Radiation Oncology Network Dublin, Ireland
| | | | | | - John Gaffney
- St. Luke's Radiation Oncology Network Dublin, Ireland
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28
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Bridger CA, Reich PD, Caraça Santos AM, Douglass MJJ. A dosimetric comparison of CT- and photogrammetry- generated 3D printed HDR brachytherapy surface applicators. Phys Eng Sci Med 2022; 45:125-134. [PMID: 35020174 DOI: 10.1007/s13246-021-01092-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/10/2021] [Indexed: 11/30/2022]
Abstract
In this study, we investigate whether an acceptable dosimetric plan can be obtained for a brachytherapy surface applicator designed using photogrammetry and compare the plan quality to a CT-derived applicator. The nose region of a RANDO anthropomorphic phantom was selected as the treatment site due to its high curvature. Photographs were captured using a Nikon D5600 DSLR camera and reconstructed using Agisoft Metashape while CT data was obtained using a Canon Aquillion scanner. Virtual surface applicators were designed in Blender and printed with PLA plastic. Treatment plans with a prescription dose of 3.85 Gy × 10 fractions with 100% dose to PTV on the bridge of the nose at 2 mm depth were generated separately using AcurosBV in the Varian BrachyVision TPS. PTV D98%, D90% and V100%, and OAR D0.1cc, D2cc and V50% dose metrics and dwell times were evaluated, with the applicator fit assessed by air-gap volume measurements. Both types of surface applicators were printed with minimal defects and visually fitted well to the target area. The measured air-gap volume between the photogrammetry applicator and phantom surface was 44% larger than the CT-designed applicator, with a mean air gap thickness of 3.24 and 2.88 mm, respectively. The largest difference in the dose metric observed for the PTV and OAR was the PTV V100% of - 1.27% and skin D0.1cc of - 0.28%. PTV D98% and D90% and OAR D2cc and V50% for the photogrammetry based plan were all within 0.5% of the CT based plan. Total dwell times were also within 5%. A 3D printed surface applicator for the nose was successfully constructed using photogrammetry techniques. Although it produced a larger air gap between the surface applicator and phantom surface, a clinically acceptable dose plan was created with similar PTV and OAR dose metrics to the CT-designed applicator. Additional future work is required to comprehensively evaluate its suitability in a clinically environment.
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Affiliation(s)
- Corey A Bridger
- School of Physical Sciences, The University of Adelaide, North Terrace, Adelaide, SA, 5005, Australia. .,Department of Medical Physics, Radiation Oncology, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia.
| | - Paul D Reich
- School of Physical Sciences, The University of Adelaide, North Terrace, Adelaide, SA, 5005, Australia.,Department of Medical Physics, Radiation Oncology, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
| | - Alexandre M Caraça Santos
- School of Physical Sciences, The University of Adelaide, North Terrace, Adelaide, SA, 5005, Australia.,Department of Medical Physics, Radiation Oncology, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
| | - Michael J J Douglass
- School of Physical Sciences, The University of Adelaide, North Terrace, Adelaide, SA, 5005, Australia.,Department of Medical Physics, Radiation Oncology, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
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29
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Pereira DD, Cardoso SC, da Rosa LA, de Souza FM, de Sousa JV, Batista DV, Boiset GR, Wolff W, Gonçalves OD. Validation of polylactic acid polymer as soft tissue substitutive in radiotherapy. Radiat Phys Chem Oxf Engl 1993 2021. [DOI: 10.1016/j.radphyschem.2021.109726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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30
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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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31
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Biele¸da G, Marach A, Boehlke M, Zwierzchowski G, Malicki J. 3D-printed surface applicators for brachytherapy: a phantom study. J Contemp Brachytherapy 2021; 13:549-562. [PMID: 34759980 PMCID: PMC8565625 DOI: 10.5114/jcb.2021.110304] [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: 02/10/2021] [Accepted: 08/03/2021] [Indexed: 12/02/2022] Open
Abstract
PURPOSE Brachytherapy is a great alternative for restrictive surgical procedures in facial cancers. Moreover, dose distribution is more beneficial compared with teleradiotherapy during treatment of lesions located on anatomical curves. However, repetitiveness of application is the main issue associated with using commercial applicators. The risk of its displacement is very unfavorable due to large dose gradients in brachytherapy. The aim of this study was to develop a process of preparation of applicators using 3D printing technology. MATERIAL AND METHODS In planning system, circular volumes near the nose, eye, and ear were determined on transverse layers of an anthropomorphic phantom. Next, boluses with a thickness of 5 mm and 10 mm were designed for each of the layers. Channels in the 10 mm bolus were designed in such a way to place the catheters into the layers. Prepared applicators were printed using polylactic acid (PLA) filament. Plans to irradiate the films for their calibration and plans for treatment prepared in the treatment planning system were conducted. A special phantom was created to calibrate the radiochromic films. Dose distribution around the designed applicators was measured in an anthropomorphic phantom using films within the layers of phantom. Comparison of doses was performed with two-dimensional gamma analysis using OmniPro I'mRT software. RESULTS The obtained results confirmed compliance of the planned and measured doses in 92%; the analysis of gamma parameter showed 1%/1 mm for acceptability level of 95%. Moreover, the initial dosimetric analysis for gamma criteria with 2%/2 mm showed compliance at 99%. CONCLUSIONS The results of the present study confirm potential clinical usefulness of the applicators obtained with the use of 3D printing for brachytherapy.
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Affiliation(s)
- Grzegorz Biele¸da
- Electroradiology Department, Poznan University of Medical Sciences, Poznan´, Poland
- Medical Physics Department, Greater Poland Cancer Centre, Poznan´, Poland
| | - Anna Marach
- Medical Physics Department, Greater Poland Cancer Centre, Poznan´, Poland
| | - Marek Boehlke
- Medical Physics Department, West Pomeranian Oncology Center, Strzałowska, Szczecin, Poland
| | - Grzegorz Zwierzchowski
- Electroradiology Department, Poznan University of Medical Sciences, Poznan´, Poland
- Medical Physics Department, Greater Poland Cancer Centre, Poznan´, Poland
| | - Julian Malicki
- Electroradiology Department, Poznan University of Medical Sciences, Poznan´, Poland
- Medical Physics Department, Greater Poland Cancer Centre, Poznan´, Poland
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32
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Kairn T, Talkhani S, Charles PH, Chua B, Lin CY, Livingstone AG, Maxwell SK, Poroa T, Simpson-Page E, Spelleken E, Vo M, Crowe SB. Determining tolerance levels for quality assurance of 3D printed bolus for modulated arc radiotherapy of the nose. Phys Eng Sci Med 2021; 44:1187-1199. [PMID: 34529247 DOI: 10.1007/s13246-021-01054-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Abstract
Given the existing literature on the subject, there is obviously a need for specific advice on quality assurance (QA) tolerances for departments using or implementing 3D printed bolus for radiotherapy treatments. With a view to providing initial suggested QA tolerances for 3D printed bolus, this study evaluated the dosimetric effects of changes in bolus geometry and density, for a particularly common and challenging clinical situation: specifically, volumetric modulated arc therapy (VMAT) treatment of the nose. Film-based dose verification measurements demonstrated that both the AAA and the AXB algorithms used by the Varian Eclipse treatment planning system (Varian Medical Systems, Palo Alto, USA) were capable of providing sufficiently accurate dose calculations to allow this planning system to be used to evaluate the effects of bolus errors on dose distributions from VMAT treatments of the nose. Thereafter, the AAA and AXB algorithms were used to calculate the dosimetric effects of applying a range of simulated errors to the design of a virtual bolus, to identify QA tolerances that could be used to avoid clinically significant effects from common printing errors. Results were generally consistent, whether the treatment target was superficial and treated with counter-rotating coplanar arcs or more-penetrating and treated with noncoplanar arcs, and whether the dose was calculated using the AAA algorithm or the AXB algorithm. The results of this study suggest the following QA tolerances are advisable, when 3D printed bolus is fabricated for use in photon VMAT treatments of the nose: bolus relative electron density variation within [Formula: see text] (although an action level at [Formula: see text] may be permissible); bolus thickness variation within [Formula: see text] mm (or 0.5 mm variation on opposite sides); and air gap between bolus and skin [Formula: see text] mm. These tolerances should be investigated for validity with respect to other treatment modalities and anatomical sites. This study provides a set of baselines for future comparisons and a useful method for identifying additional or alternative 3D printed bolus QA tolerances.
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Affiliation(s)
- T Kairn
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia. .,Herston Biofabrication Institute, Metro North Hospital and Health Service, Brisbane, QLD, Australia. .,School of Information Technology and Electrical Engineering, University of Queensland, Brisbane, QLD, Australia. .,School of Chemistry and Physics, Queensland University of Technology, Brisbane, QLD, Australia.
| | - S Talkhani
- School of Chemistry and Physics, Queensland University of Technology, Brisbane, QLD, Australia
| | - P H Charles
- Herston Biofabrication Institute, Metro North Hospital and Health Service, Brisbane, QLD, Australia.,School of Information Technology and Electrical Engineering, University of Queensland, Brisbane, QLD, Australia.,School of Chemistry and Physics, Queensland University of Technology, Brisbane, QLD, Australia
| | - B Chua
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - C Y Lin
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - A G Livingstone
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - S K Maxwell
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - T Poroa
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - E Simpson-Page
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - E Spelleken
- GenesisCare Rockhampton, Rockhampton Hospital, Rockhampton, QLD, Australia
| | - M Vo
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - S B Crowe
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Herston Biofabrication Institute, Metro North Hospital and Health Service, Brisbane, QLD, Australia.,School of Information Technology and Electrical Engineering, University of Queensland, Brisbane, QLD, Australia.,School of Chemistry and Physics, Queensland University of Technology, Brisbane, QLD, Australia
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33
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Wakabayashi K, Monzen H, Tamura M, Takei Y, Okuhata K, Anami S, Doi H, Nishimura Y. A novel real-time shapeable soft rubber bolus for clinical use in electron radiotherapy. Phys Med Biol 2021; 66. [PMID: 34438390 DOI: 10.1088/1361-6560/ac215b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 08/26/2021] [Indexed: 11/12/2022]
Abstract
We have developed soft rubber (SR) bolus that can be shaped in real-time by heating flexibly and repeatedly. This study investigated whether the SR bolus could be used as an ideal bolus, such as not changing of the beam characteristics and homogeneity through the bolus and high plasticity to adhere a patient in addition to real-time shapeable and reusability, in electron radiotherapy. Percentage depth doses (PDDs) and lateral dose profiles (LDPs) were obtained for 4, 6, and 9 MeV electron beams and were compared between the SR and conventional gel boluses. For the LDP at depth of 90% dose, the penumbra as lateral distance between the 80% and 20% isodose lines (P80-20) and the width of 90% dose level (r90) were compared. To evaluate adhesion, the air gap volume between the boluses and nose of a head phantom was evaluated on CT image. The dose profiles along the center axis for the 6 MeV electron beam with SR, gel, and virtual boluses (thickness = 5 mm) on the head phantom were also calculated for the irradiation of 200 monitor unit with a treatment planning system and the depth of the maximum dose (dmax) and maximum dose (Dmax) were compared. The PDDs,P80-20, andr90between the SR and gel boluses corresponded well (within 2%, 0.4 mm, and 0.7 mm, respectively). The air gap volumes of the SR and gel boluses were 3.14 and 50.35 cm3, respectively. Thedmaxwith SR, gel and virtual boluses were 8.0, 6.0, and 7.0 mm (no bolus: 12.0 mm), and theDmaxvalues were 186.4, 170.6, and 186.8 cGy, respectively. The SR bolus had the equivalent electron beam characteristics and homogeneity to the gel bolus and achieved excellent adhesion to a body surface, which can be used in electron radiotherapy as an ideal bolus.
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Affiliation(s)
- Kazuki Wakabayashi
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511, Japan.,Department of Central Radiology, Wakayama Medical University Hospital, 811-1 Kimiidera, Wakayama, Wakayama, 641-8510, Japan
| | - Hajime Monzen
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Mikoto Tamura
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Yoshiki Takei
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511, Japan.,Department of Radiology, Kindai University Nara Hospital, 1248-1 Otoda-cho, Ikoma, Nara 630-0293, Japan
| | - Katsuya Okuhata
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Shimpei Anami
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-8510, Japan
| | - Hiroshi Doi
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, 377-2 Ohno-higashi, Osaka-Sayama, Osaka 589-8511, Japan
| | - Yasumasa Nishimura
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, 377-2 Ohno-higashi, Osaka-Sayama, Osaka 589-8511, Japan
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Pera O, Membrive I, Lambisto D, Quera J, Fernandez-Velilla E, Foro P, Reig A, Rodríguez N, Sanz J, Algara V, Algara M. Validation of 3D printing materials for high dose-rate brachytherapy using ionisation chamber and custom phantom. Phys Med Biol 2021; 66. [PMID: 34464938 DOI: 10.1088/1361-6560/ac226b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/31/2021] [Indexed: 11/12/2022]
Abstract
Methods.Measurements were taken with the Exradin A20 (Standard Imaging) ionisation chamber, and the 'homemade' MARM phantom was made with the 3D Ultimaker 2+ printer using PLA material. The material used for validation was ABS Medical from Smart Materials 3D. The irradiation was undertaken with a192Ir source by means of Varian's GammaMed Plus iX HDR equipment. EBT3 films were used to run additional tests. We compared different measurements for PLA, ABS Medical, and water. Additional validation methods, described in the bibliography, were also compared.Results.The measurements with the ionisation chamber that we obtained using the MARM phantom with PLA and ABS within the clinically relevant range (0.5-1.5 cm) differ with respect to the measures in the water reference, by 2.3% and 0.94%, respectively.Discussion.The literature describes highly heterogeneous validation methods, complicating the performance of systematic reviews and comparisons between materials. Thus, creating a phantom represents a single effort that will quickly pay off. This system enables comparisons, ensuring that geometric conditions remain stable-something that is not always possible with radiochromic films. The use of a calibrated ionisation chamber in the corresponding energy range, combined with the 'homemade' MARM phantom applied according to the proposed methodology, allows a differentiation between the attenuation of the material itself and the drop in the dose due to distance.Conclusion.The validation method for 3D printing materials, using an ionisation chamber and the MARM PLA phantom, represents an accessible, standardisable solution for manufacturing brachytherapy applicators.
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Affiliation(s)
- Oscar Pera
- Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, Passeig Marítim 25 E-08003 Barcelona, Spain.,Institut Hospital del Mar d'Investigacions Mèdiques. Barcelona, Spain.,Pompeu Fabra University. Barcelona, Spain
| | - Ismael Membrive
- Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, Passeig Marítim 25 E-08003 Barcelona, Spain.,Institut Hospital del Mar d'Investigacions Mèdiques. Barcelona, Spain
| | - Daniel Lambisto
- Medical Physics and Radiation Protection, Institut Català d'Oncologia Girona, Spain Hospital Josep Trueta. Sant Ponç, Avinguda de França 0, E-17007 Girona, Spain
| | - Jaume Quera
- Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, Passeig Marítim 25 E-08003 Barcelona, Spain.,Institut Hospital del Mar d'Investigacions Mèdiques. Barcelona, Spain.,Pompeu Fabra University. Barcelona, Spain
| | - Enric Fernandez-Velilla
- Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, Passeig Marítim 25 E-08003 Barcelona, Spain.,Institut Hospital del Mar d'Investigacions Mèdiques. Barcelona, Spain
| | - Palmira Foro
- Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, Passeig Marítim 25 E-08003 Barcelona, Spain.,Institut Hospital del Mar d'Investigacions Mèdiques. Barcelona, Spain.,Pompeu Fabra University. Barcelona, Spain
| | - Ana Reig
- Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, Passeig Marítim 25 E-08003 Barcelona, Spain.,Institut Hospital del Mar d'Investigacions Mèdiques. Barcelona, Spain
| | - Nuria Rodríguez
- Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, Passeig Marítim 25 E-08003 Barcelona, Spain.,Institut Hospital del Mar d'Investigacions Mèdiques. Barcelona, Spain.,Pompeu Fabra University. Barcelona, Spain
| | - Javier Sanz
- Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, Passeig Marítim 25 E-08003 Barcelona, Spain.,Institut Hospital del Mar d'Investigacions Mèdiques. Barcelona, Spain.,Pompeu Fabra University. Barcelona, Spain
| | | | - Manuel Algara
- Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, Passeig Marítim 25 E-08003 Barcelona, Spain.,Institut Hospital del Mar d'Investigacions Mèdiques. Barcelona, Spain.,Autonomous University of Barcelona, Spain
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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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Membrive Conejo I, Pera Cegarra O, Foro Arnalot P, Reig Castillejo A, Rodríguez de Dios N, Sanz Latiesas X, Pujol Vallverdú RM, Quera Jordana J, Fernandez-Velilla Cepria E, Algara Muñoz V, Algara López M. Custom 3D-printed applicators for high dose-rate brachytherapy in skin cancer. Brachytherapy 2021; 20:1257-1264. [PMID: 34384694 DOI: 10.1016/j.brachy.2021.05.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 05/20/2021] [Accepted: 05/27/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE This paper describes the protocol for the development of 3D-printed custom applicators in treating skin carcinoma, the evaluation of the materials used, and the methods for segmentation and rendering of the applicators. MATERIAL AND METHODS The segmentation and rendering process for the applicator had six phases: (i) determination of the volume of the lesion using a computed tomography (CT) scan; (ii) delineation of the patient surface, using the same CT images; (iii) creation of the applicator in the planner and segmentation of the mold; (iv) preliminary dosimetry and establishment of the route of the catheter from the brachytherapy unit; (v) creation of the 3D applicator using specialized software; and (vi) applicator printing. Following this process, the patient returned for a second CT to undergo the definitive dosimetry with the applicator in place. Radiation therapy was then administered. RESULTS We made a total of 16 applicators. Only three applicators had to be remade, two due to an error in the infill and the other due to incorrect catheter geometry. In all cases, correct coverage of the planning target volume was achieved with the prescribed isodose. CONCLUSIONS The creation of custom molds in plesiotherapy for skin cancer with 3D printing is feasible. Compared to manual methods, 3D printing increases precision in applicator geometry and optimization of the dosimetry.
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Affiliation(s)
- Ismael Membrive Conejo
- Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques Barcelona, Spain.
| | - Oscar Pera Cegarra
- Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques Barcelona, Spain
| | - Palmira Foro Arnalot
- Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques Barcelona, Spain; Pompeu Fabra University, Barcelona, Spain
| | - Ana Reig Castillejo
- Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques Barcelona, Spain
| | - Nuria Rodríguez de Dios
- Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques Barcelona, Spain; Pompeu Fabra University, Barcelona, Spain
| | - Xavier Sanz Latiesas
- Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques Barcelona, Spain; Pompeu Fabra University, Barcelona, Spain
| | - Ramón M Pujol Vallverdú
- Institut Hospital del Mar d'Investigacions Mèdiques Barcelona, Spain; Dermatology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Universitat Autónoma de Barcelona Barcelona, Spain
| | - Jaume Quera Jordana
- Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques Barcelona, Spain; Pompeu Fabra University, Barcelona, Spain
| | - Enric Fernandez-Velilla Cepria
- Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques Barcelona, Spain
| | | | - Manuel Algara López
- Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques Barcelona, Spain; Universitat Autónoma de Barcelona Barcelona, Spain
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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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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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Bridger CA, Douglass MJJ, Reich PD, Santos AMC. Evaluation of camera settings for photogrammetric reconstruction of humanoid phantoms for EBRT bolus and HDR surface brachytherapy applications. Phys Eng Sci Med 2021; 44:457-471. [PMID: 33844156 DOI: 10.1007/s13246-021-00994-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 03/18/2021] [Indexed: 11/25/2022]
Abstract
The fabrication of brachytherapy surface moulds is considered laborious and time consuming that often result in repeated attempts due to incorrect catheter positioning or the presence of air gaps. 3-dimensional printing using low-cost and reliable materials has allowed the rapid creation of patient-specific surface mould applicators to be achieved using patient imaging data obtained via CT scan. In this study we investigate whether an alternative approach using photogrammetry techniques can improve this process and how camera settings and object texture affect the reconstructions. Two humanoid phantoms, an anthropomorphic RANDO phantom and a Laerdal Little Anne CPR training manikin were used in this study. Both were imaged using a Nikon D5600 DSLR and Nokia 3.1 smartphone camera and reconstructed using Agisoft Metashape software. CT scans of both phantoms were taken as references for comparing the photogrammetry reconstructions. Models were reconstructed from different photo sets and assessed by distance to agreement with the CT models. Both phantoms were effectively reconstructed for most experiments. Increasing the number of photos used produced the better reconstructions while in general, reconstructions using video data were poor. The two phantoms were reconstructed at a similar quality. Background light that caused undesirable reflections significantly reduced reconstruction quality. Applying a non-reflective tape to the affected regions provided a suitable method for reducing their effects. Photogrammetry techniques were effectively able to reconstruct 3-dimensional models of both phantom. The camera settings and lighting did have a profound effect on the reconstruction quality and should be chosen appropriately depending on the scene.
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Affiliation(s)
- Corey A Bridger
- School of Physical Sciences, The University of Adelaide, North Terrace, Adelaide, South Australia, 5005, Australia.
| | - Michael J J Douglass
- School of Physical Sciences, The University of Adelaide, North Terrace, Adelaide, South Australia, 5005, Australia
- Department of Medical Physics, Royal Adelaide Hospital, Port Road, Adelaide, 5000, South Australia, Australia
| | - Paul D Reich
- School of Physical Sciences, The University of Adelaide, North Terrace, Adelaide, South Australia, 5005, Australia
- Department of Medical Physics, Royal Adelaide Hospital, Port Road, Adelaide, 5000, South Australia, Australia
| | - Alexandre M Caraça Santos
- School of Physical Sciences, The University of Adelaide, North Terrace, Adelaide, South Australia, 5005, Australia
- Department of Medical Physics, Royal Adelaide Hospital, Port Road, Adelaide, 5000, South Australia, Australia
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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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Wochnik A, Stolarczyk L, Ambrožová I, Davídková M, De Saint-Hubert M, Domański S, Domingo C, Knežević Ž, Kopeć R, Kuć M, Majer M, Mojżeszek N, Mares V, Martínez-Rovira I, Caballero-Pacheco MÁ, Pyszka E, Swakoń J, Trinkl S, Tisi M, Harrison R, Olko P. Out-of-field doses for scanning proton radiotherapy of shallowly located paediatric tumours-a comparison of range shifter and 3D printed compensator. Phys Med Biol 2021; 66:035012. [PMID: 33202399 DOI: 10.1088/1361-6560/abcb1f] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The lowest possible energy of proton scanning beam in cyclotron proton therapy facilities is typically between 60 and 100 MeV. Treatment of superficial lesions requires a pre-absorber to deliver doses to shallower volumes. In most of the cases a range shifter (RS) is used, but as an alternative solution, a patient-specific 3D printed proton beam compensator (BC) can be applied. A BC enables further reduction of the air gap and consequently reduction of beam scattering. Such pre-absorbers are additional sources of secondary radiation. The aim of this work was the comparison of RS and BC with respect to out-of-field doses for a simulated treatment of superficial paediatric brain tumours. EURADOS WG9 performed comparative measurements of scattered radiation in the Proteus C-235 IBA facility (Cyclotron Centre Bronowice at the Institute of Nuclear Physics, CCB IFJ PAN, Kraków, Poland) using two anthropomorphic phantoms-5 and 10 yr old-for a superficial target in the brain. Both active detectors located inside the therapy room, and passive detectors placed inside the phantoms were used. Measurements were supplemented by Monte Carlo simulation of the radiation transport. For the applied 3D printed pre-absorbers, out-of-field doses from both secondary photons and neutrons were lower than for RS. Measurements with active environmental dosimeters at five positions inside the therapy room indicated that the RS/BC ratio of the out-of-field dose was also higher than one, with a maximum of 1.7. Photon dose inside phantoms leads to higher out-of-field doses for RS than BC to almost all organs with the highest RS/BC ratio 12.5 and 13.2 for breasts for 5 and 10 yr old phantoms, respectively. For organs closest to the isocentre such as the thyroid, neutron doses were lower for BC than RS due to neutrons moderation in the target volume, but for more distant organs like bladder-conversely-lower doses for RS than BC were observed. The use of 3D printed BC as the pre-absorber placed in the near vicinity of patient in the treatment of superficial tumours does not result in the increase of secondary radiation compared to the treatment with RS, placed far from the patient.
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Affiliation(s)
- A Wochnik
- Institute of Nuclear Physics PAN, Radzikowskiego 152, Krakow 31-342, Poland
| | - L Stolarczyk
- Institute of Nuclear Physics PAN, Radzikowskiego 152, Krakow 31-342, Poland.,Skandionkliniken, von Kraemers Allé 26, Uppsala 752 37, Sweden.,Dansk Center for Partikelterapi, Palle Juul-Jensens Boulevard 25, 8200 Aarhus N, Denmark
| | - I Ambrožová
- Department of Radiation Dosimetry, Nuclear Physics Institute Czech Academy of Sciences, Prague CZ-250 68 Řež, Czech Republic
| | - M Davídková
- Department of Radiation Dosimetry, Nuclear Physics Institute Czech Academy of Sciences, Prague CZ-250 68 Řež, Czech Republic
| | - M De Saint-Hubert
- Belgium Nuclear Research Centre (SCK CEN), Boeretang 200, Mol BE-2400, Belgium
| | - S Domański
- National Centre for Nuclear Research, Otwock-Świerk 05-400, Poland
| | - C Domingo
- Departament de Física, Universitat Autònoma de Barcelona (UAB), Bellaterra E-08193, Spain
| | - Ž Knežević
- Ruđer Bošković Institute, Bijenička c. 54, Zagreb 10000, Croatia
| | - R Kopeć
- Institute of Nuclear Physics PAN, Radzikowskiego 152, Krakow 31-342, Poland
| | - M Kuć
- National Centre for Nuclear Research, Otwock-Świerk 05-400, Poland
| | - M Majer
- Ruđer Bošković Institute, Bijenička c. 54, Zagreb 10000, Croatia
| | - N Mojżeszek
- Institute of Nuclear Physics PAN, Radzikowskiego 152, Krakow 31-342, Poland
| | - V Mares
- Helmholtz Zentrum München, Institute of Radiation Medicine, Ingolstädter Landstraße 1, Neuherberg 85764, Germany
| | - I Martínez-Rovira
- Departament de Física, Universitat Autònoma de Barcelona (UAB), Bellaterra E-08193, Spain
| | - M Á Caballero-Pacheco
- Departament de Física, Universitat Autònoma de Barcelona (UAB), Bellaterra E-08193, Spain
| | - E Pyszka
- Institute of Nuclear Physics PAN, Radzikowskiego 152, Krakow 31-342, Poland
| | - J Swakoń
- Institute of Nuclear Physics PAN, Radzikowskiego 152, Krakow 31-342, Poland
| | - S Trinkl
- Helmholtz Zentrum München, Institute of Radiation Medicine, Ingolstädter Landstraße 1, Neuherberg 85764, Germany.,Technische Universität München, Physik-Department, Garching 85748, Germany
| | - M Tisi
- Helmholtz Zentrum München, Institute of Radiation Medicine, Ingolstädter Landstraße 1, Neuherberg 85764, Germany
| | - R Harrison
- University of Newcastle upon Tyne, Tyne and Wear, Newcastle upon Tyne NE1 7RU, United Kingdom
| | - P Olko
- Institute of Nuclear Physics PAN, Radzikowskiego 152, Krakow 31-342, Poland
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Muramatsu N, Ito S, Hanmura M, Nishimura T. Development of a transparent and flexible patient-specific bolus for total scalp irradiation. Radiol Phys Technol 2021; 14:82-92. [PMID: 33484400 DOI: 10.1007/s12194-021-00606-6] [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: 02/17/2020] [Revised: 12/28/2020] [Accepted: 01/03/2021] [Indexed: 11/30/2022]
Abstract
A commercially available flat bolus (commercial bolus) would not fully fit the irregular surfaces of the scalp. We developed a transparent and flexible material with good fitting properties, analyzed its physical characteristics, and evaluated the clinical feasibility of the bolus fabricated using a three-dimensional (3D) printer (3D bolus). To evaluate the physical characteristics of the new material, treatment plans with virtual, 3D, and commercial boluses were created for water-equivalent phantoms using a radiation treatment planning system (RTPS). Using a head phantom and the dose volume histogram calculated with RTPS, dose distributions for total scalp irradiation were compared between the three treatment plans. To evaluate the clinical feasibility, the fitness and reproducibility of the 3D bolus were compared with the head phantom and clinical cases using dice similarity coefficient (DSC) measurements. A good agreement was observed between the percentage depth dose (PDD) curves for the virtual, 3D, and commercial boluses. The homogeneity indexes of the planning target volume (PTV) for the 3D and commercial boluses were 0.083 and 0.153, respectively, proving that the former achieved a better dose uniformity of PTV than the latter. Good fitness and reproducibility with the 3D bolus were observed in both the head phantom and two clinical cases, with mean DSC values of 0.854, 0.829, and 0.843, respectively. These results successfully demonstrated and verified the utility of the 3D bolus for total scalp irradiation.
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Affiliation(s)
- Noriaki Muramatsu
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
| | - Satoshi Ito
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Masahiro Hanmura
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Tetsuo Nishimura
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
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Ade N, du Plessis F. Feasibility of using a single transmission factor for the Integral Quality Monitor ® on dynamic 15 MV photon beams. Radiat Phys Chem Oxf Engl 1993 2020. [DOI: 10.1016/j.radphyschem.2020.109199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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Evaluation of a 3-Dimensional-Printed Head Simulation Technique for Teaching Flexible Nasopharyngoscopy to Radiation Oncology Residents. Int J Radiat Oncol Biol Phys 2020; 109:317-323. [PMID: 32891794 PMCID: PMC7471799 DOI: 10.1016/j.ijrobp.2020.08.063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/27/2020] [Accepted: 08/31/2020] [Indexed: 12/25/2022]
Abstract
Purpose Simulation-based medical education is an effective tool for medical teaching, but simulation-based medical education deployment in radiation oncology (RO) is limited. Flexible nasopharyngoscopy (FNP), an essential skill for RO residents, requires practice that typically occurs on volunteer patients, introducing the potential for stress and discomfort. We sought to develop a high-fidelity simulator and intervention that provides RO residents the opportunity to develop FNP skills in a low-pressure environment. Methods and Materials Computed tomography images were used to create an anatomically accurate 3-dimensional–printed model of the head and neck region. An intervention incorporating didactic instruction, multimedia content, and FNP practice on the model was designed and administered to RO residents attending the Anatomy and Radiology Contouring Bootcamp. Participants completed pre- and postintervention evaluations of the training session and model fidelity, and self-assessments of FNP skill and confidence performing FNP. Participants were video recorded performing FNP pre- and postintervention. Videos were scored by a blinded observer on a predefined rubric. Changes in scores were evaluated using the Wilcoxon signed-rank test. Results Twenty-four participants from 17 institutions and 4 countries completed the intervention, 50% were women, and most were senior residents. Postintervention, FNP confidence and FNP performance improved significantly (mean ± standard deviation on a 10-point scale: 1.8 ± 1.8, P < .001; 2.2 ± 2.0, P < .001, respectively). Participants felt the model was helpful (mean ± standard deviation on a 5-point scale: 4.2 ± 0.6), anatomically correct (4.1 ± 0.9), and aided in spatial comprehension (4.3 ± 0.8). Overall satisfaction for the intervention was high (4.3 ± 0.8). Participants strongly agreed the intervention should be integrated into RO training programs (4.3 ± 0.8). Conclusions A 3-dimensional–printed model and associated intervention were effective at improving FNP performance and the teaching method was rated highly by participants. RO residents may benefit from broader dissemination of this technique to improve trainee performance.
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Zoljalali Moghaddam SH, Baghani HR, Mahdavi SR. Construction and performance evaluation of a buildup bolus for breast intraoperative electron radiotherapy. Radiat Phys Chem Oxf Engl 1993 2020. [DOI: 10.1016/j.radphyschem.2020.108952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Low JM, Lee NJ, Sprow G, Chlebik A, Olch A, Darrow K, Bowlin K, Wong KK. Scalp and Cranium Radiation Therapy Using Modulation (SCRUM) and Bolus. Adv Radiat Oncol 2020; 5:936-942. [PMID: 33083656 PMCID: PMC7557138 DOI: 10.1016/j.adro.2020.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/31/2020] [Accepted: 03/09/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose A bolus is usually required to ensure radiation dose coverage of extensive superficial tumors of the scalp or skull. Oftentimes, these boluses are challenging to make and are nonreproducible, so an easier method was sought. Methods and Materials Thermoplastic sheets are widely available in radiation oncology clinics and can serve as bolus. Two template cutouts were designed for anterior and posterior halves to encompass the cranium of children and adults. Results The created bolus was imaged using computed tomography, which demonstrated good conformity and minimal air gaps. Conclusions Although making a bolus for treating superficial tumors of the scalp or head and neck is challenging, the presented technique enables thermoplastic to be used as a bolus and is quick, easy, and reproducible.
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Affiliation(s)
- Justin M. Low
- Long School of Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Nicole J.H. Lee
- Touro University California College of Osteopathic Medicine, Vallejo, California
| | - Grant Sprow
- Albert Einstein College of Medicine, Bronx, New York
| | - Alisha Chlebik
- Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, California
| | - Arthur Olch
- Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, California
- Department of Radiation Oncology, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Kaleb Darrow
- University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee
| | - Kristine Bowlin
- Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, California
| | - Kenneth K. Wong
- Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, California
- Department of Radiation Oncology, Keck School of Medicine of the University of Southern California, Los Angeles, California
- Corresponding author: Kenneth K. Wong, MD
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48
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Improvement of flattenability using particle swarm optimizer for surface unfolding in bolus shaping. SN APPLIED SCIENCES 2020. [DOI: 10.1007/s42452-020-03330-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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49
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Koutsouvelis N, Rouzaud M, Dubouloz A, Nouet P, Jaccard M, Garibotto V, Tournier BB, Zilli T, Dipasquale G. 3D printing for dosimetric optimization and quality assurance in small animal irradiations using megavoltage X-rays. Z Med Phys 2020; 30:227-235. [DOI: 10.1016/j.zemedi.2020.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/17/2020] [Accepted: 03/30/2020] [Indexed: 11/29/2022]
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50
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Baltz GC, Briere T, Luo D, Howell RM, Krafft S, Han EY. 3D-printed headrest for frameless Gamma Knife radiosurgery: Design and validation. J Appl Clin Med Phys 2020; 21:6-15. [PMID: 32603542 PMCID: PMC7497935 DOI: 10.1002/acm2.12956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/18/2020] [Accepted: 05/20/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose Frameless Gamma Knife stereotactic radiosurgery (SRS) uses a moldable headrest with a thermoplastic mask for patient immobilization. An efficacious headrest is time consuming and difficult to fabricate due to the expertise required to mold the headrest within machine geometrical limitations. The purpose of this study was to design and validate a three‐dimensional (3D)‐printed headrest for frameless Gamma Knife SRS that can overcome these difficulties. Materials and methods A headrest 3D model designed to fit within the frameless adapter was 3D printed. Dosimetric properties of the 3D‐printed headrest and a standard‐of‐care moldable headrest were compared by delivering a Gamma Knife treatment to an anthropomorphic head phantom fitted with an ionization chamber and radiochromic film. Ionization measurements were compared to assess headrest attenuation and a gamma index was calculated to compare the film dose distributions. A volunteer study was conducted to assess the immobilization efficacy of the 3D‐printed headrest compared to the moldable headrest. Five volunteers had their head motion tracked by a surface tracking system while immobilized in each headrest for 20 min. The recorded motion data were used to calculate the average volunteer movement and a paired t‐test was performed. Results The ionization chamber readings were within 0.55% for the 3D‐printed and moldable headrests, and the calculated gamma index showed 98.6% of points within dose difference of 2% and 2 mm distance to agreement for the film measurement. These results demonstrate that the headrests were dosimetrically equivalent within the experimental uncertainties. Average motion (±standard deviation) of the volunteers while immobilized was 1.41 ± 0.43 mm and 1.36 ± 0.51 mm for the 3D‐printed and moldable headrests, respectively. The average observed volunteer motion between headrests was not statistically different, based on a P‐value of 0.466. Conclusions We designed and validated a 3D‐printed headrest for immobilizing patients undergoing frameless Gamma Knife SRS.
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Affiliation(s)
- Garrett C Baltz
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tina Briere
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dershan Luo
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rebecca M Howell
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shane Krafft
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eun Young Han
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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