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Jung KH, Han DH, Lee KY, Kim JO, Ahn WS, Baek CH. Evaluating the performance of thermoplastic 3D bolus used in radiation therapy. Appl Radiat Isot 2024; 209:111329. [PMID: 38701594 DOI: 10.1016/j.apradiso.2024.111329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 04/05/2024] [Accepted: 04/20/2024] [Indexed: 05/05/2024]
Abstract
A 3D-printed bolus is being developed to deliver accurate doses to superficial cancers. In this study, flexible thermoplastic filaments, specifically PLA, TPU, PETG, and HIPS, were fabricated into boluses and then compared to commercial bolus for the variation of the dose elevation region of photon beams. The experimental results indicate that the maximum dose depth is similar, and the consistent trend of the percentage depth dose confirms the potential usage as a build-up bolus.
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Affiliation(s)
- Kyung Hwan Jung
- Department of Health Medical Science, Kangwon National University, South Korea
| | - Dong Hee Han
- Department of Health Medical Science, Kangwon National University, South Korea
| | - Ki Yoon Lee
- Department of Health Medical Science, Kangwon National University, South Korea
| | - Jang Oh Kim
- Department of Radiological Science, Kangwon National University, South Korea
| | - Woo Sang Ahn
- Department of Radiation Oncology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, South Korea
| | - Cheol Ha Baek
- Department of Radiological Science, Kangwon National University, South Korea.
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2
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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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Kadiri S, Jakupi K, Dukovski V, Hodolli G. Optimizing 3D-printed workpieces for radiotherapy application: modelling the CT number and print time. Biomed Phys Eng Express 2024; 10:025009. [PMID: 38198717 DOI: 10.1088/2057-1976/ad1d0b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/08/2024] [Indexed: 01/12/2024]
Abstract
This study aims to analyze the influence of specific printing parameters, including infilling, print speed, and layer height, on the CT numbers and printing time of 3D-printed workpieces fabricated from Polylactic Acid (PLA). The primary objective is to optimize these parameters to attain desired CT numbers and print time for radiotherapy applications. To achieve this objective, we employed the Taguchi experimental design and regression analysis methodologies. A series of experiments were conducted to systematically assess the effects of varying infilling, print speed, and layer height values on the CT numbers and printing time of the PLA workpieces. The resulting data were then used to create mathematical models for predicting optimal parameter settings. Our investigations revealed that specific adjustments to infilling and layer height significantly influence the CT numbers and printing time of 3D-printed workpieces. By leveraging the developed mathematical models, precise predictions can be made to optimize independent parameters for the desired CT numbers and printing times, enhancing the efficacy of 3D-printed workpieces for radiotherapy applications. This research contributes to the advancement of 3D-printed workpieces utilized in radiotherapy, offering a pathway to enhance the accuracy and efficiency of treatment delivery. The optimization of printing parameters outlined in this study provides a valuable tool for clinicians and researchers in the field, ultimately benefiting patients undergoing radiotherapy treatments.
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Affiliation(s)
- Sehad Kadiri
- Faculty of Radiology, AAB College, 10000 Pristina, Kosovo
| | - Kaltrine Jakupi
- Faculty of Mechanical Engineering, University of Pristina 'Hasan Prishtina', 10000 Pristina, Kosovo
- Faculty of Mechanical Engineering, 'Ss. Cyril and Methodius' University in Skopje, 1001 Skopje, North Macedonia
| | - Vladimir Dukovski
- Faculty of Mechanical Engineering, 'Ss. Cyril and Methodius' University in Skopje, 1001 Skopje, North Macedonia
| | - Gezim Hodolli
- Faculty of Veterinary and Agriculture, University of Pristina 'Hasan Prishtina', 10000 Pristina, Kosovo
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Tian L, Mao R, Li D, Guo W, Li B, Lou Z, Guo L. Superficial Dosimetry Study of the Frequency of Bolus Using in Volumetric Modulated Arc Therapy after Modified Radical Mastectomy. Technol Cancer Res Treat 2024; 23:15330338241264848. [PMID: 39129335 PMCID: PMC11322943 DOI: 10.1177/15330338241264848] [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] [Indexed: 08/13/2024] Open
Abstract
OBJECTIVE To investigate the effect of various frequencies of bolus use on the superficial dose of volumetric modulated arc therapy after modified radical mastectomy for breast cancer. METHODS Based on the computed tomography images of a female anthropomorphic breast phantom, a 0.5 cm silicone-based 3D-printed bolus was created. Nine points evenly distributed on the breast skin were selected for assessing the skin dose, and a volume of subcutaneous lymphatic drainage of the breast (noted as ROI2-3) was delineated for assessing the chest wall dose. The treatment plans with and without bolus (plan_wb and plan_nb) were separately designed using the prescription of 50 Gy in 25 fractions following the standard dose constraints of the adjacent organ at risk. To characterize the accuracy of treatment planning system (TPS) dose calculations, the doses of the nine points were measured five times by thermoluminescence dosimeters (TLDs) and then were compared with the TPS calculated dose. RESULTS Compared with Plan_nb (144.46 ± 10.32 cGy), the breast skin dose for plan_wb (208.75 ± 4.55 cGy) was significantly increased (t = -18.56, P < 0.001). The deviation of skin dose was smaller for Plan_wb, and the uniformity was significantly improved. The calculated value of TPS was in good agreement with the measured value of TLD, and the maximum deviation was within 5%. Skin and ROI2-3 doses were significantly increased with increasing frequencies of bolus applications. The mean dose of the breast skin and ROI2-3 for 15 and 23 times bolus applications were 45.33 Gy, 50.88 Gy and 50.36 Gy, 52.39 Gy, respectively. CONCLUSION 3D printing bolus can improve the radiation dose and the accuracy of the planned dose. Setting Plan_wb to 15 times for T1-3N+ breast cancer patients and 23 times for T4N+ breast cancer patients can meet the clinical need. Quantitative analysis of the bolus application frequency for different tumor stages can provide a reference for clinical practice.
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Affiliation(s)
- Lingling Tian
- Department of Radiation, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Ronghu Mao
- Department of Radiation, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Dingjie Li
- Department of Radiation, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Wei Guo
- Department of Radiation, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Bing Li
- Department of Radiation, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Zhaoyang Lou
- Department of Radiation, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Leiming Guo
- Department of Radiation, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
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Wang J, Xiang ZZ, Tan CF, Zeng YY, Yang T, Wei XY, Yu ST, Dai ZL, Xu NY, Liu L. Individualized 3D-printed bolus promotes precise postmastectomy radiotherapy in patients receiving breast reconstruction. Front Oncol 2023; 13:1239636. [PMID: 38152364 PMCID: PMC10751906 DOI: 10.3389/fonc.2023.1239636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 11/29/2023] [Indexed: 12/29/2023] Open
Abstract
Purpose To evaluate the efficacy and safety of 3D-printed tissue compensations in breast cancer patients receiving breast reconstruction and postmastectomy radiotherapy (PMRT). Methods and materials We enrolled patients with breast cancer receiving breast reconstruction and PMRT. The dose distribution of target and skin, conformability, and dose limit of organs at risk (OARs) were collected to evaluate the efficacy of the 3D-printed bolus. Radiation Therapy Oncology Group (RTOG) radiation injury classification was used to evaluated the skin toxicities. Results A total of 30 patients diagnosed between October 2019 to July 2021 were included for analysis. Among all the patients, the 3D-printed bolus could ensure the dose coverage of planning target volume (PTV) [homogeneity index (HI) 0.12 (range: 0.08-0.18)], and the mean doses of D99%, D98%, D95%, D50%, D2% and Dmean were 4606.29cGy, 4797.04cGy, 4943.32cGy, 5216.07cGy, 5236.10cGy, 5440.28cGy and 5462.10cGy, respectively. The bolus demonstrated an excellent conformability, and the mean air gaps between the bolus and the chest wall in five quadrants were 0.04cm, 0.18cm, 0.04cm, 0.04cm and 0.07cm, respectively. In addition, the bolus had acceptable dosage limit of OARs [ipsilateral lung: Dmean 1198.68 cGy, V5 46.10%, V20 21.66%, V30 16.31%); heart: Dmean 395.40 cGy, V30 1.02%, V40 0.22%; spinal cord planning risk volume (PRV): Dmax 1634 cGy] and skin toxicity (grade 1, 76.0%; grade 2, 21.0%; grade 3, 3.3%). Conclusion The 3D-printed bolus offers advantages in terms of dose uniformity and controllable skin toxicities in patients receiving breast reconstruction and PMRT. Further research is needed to comprehensively evaluate the effectiveness of the 3Dprinted bolus in this patient subset.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Lei Liu
- Division of Head & Neck Tumor Multimodality Treatment, Cancer Center, West, China Hospital, Sichuan University, Chengdu, Sichuan, China
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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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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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Miéville FA, Pitteloud N, Achard V, Lamanna G, Pisaturo O, Tercier PA, Allal AS. Post-mastectomy radiotherapy: Impact of bolus thickness and irradiation technique on skin dose. Z Med Phys 2023:S0939-3889(23)00041-7. [PMID: 37150728 DOI: 10.1016/j.zemedi.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/27/2023] [Accepted: 03/08/2023] [Indexed: 05/09/2023]
Abstract
PURPOSE To determine 10 MV IMRT and VMAT based protocols with a daily bolus targeting a skin dose of 45 Gy in order to replace the 6 MV tangential fields with a 5 mm thick bolus on alternate days method for post-mastectomy radiotherapy. METHOD We measured the mean surface dose along the chest wall PTV as a function of different bolus thicknesses for sliding window IMRT and VMAT plans. We analyzed surface dose profiles and dose homogeneities and compared them to our standard 6 MV strategy. All measurements were performed on a thorax phantom with Gafchromic films while dosimetric plans were computed using the Acuros XB algorithm (Varian). RESULTS We obtained the best compromise between measured surface dose (mean dose and homogeneity) and skin toxicity threshold obtained from the literature using a daily 3 mm thick bolus. Mean surface doses were 91.4 ± 2.8% [85.7% - 95.4%] and 92.2 ± 2.3% [85.6% - 95.2%] of the prescribed dose with IMRT and VMAT techniques, respectively. Our standard 6 MV alternate days 5 mm thick bolus leads to 89.0 ± 3.7% [83.6% - 95.5%]. Mean dose differences between measured and TPS results were < 3.2% for depths as low as 2 mm depth. CONCLUSION 10 MV IMRT-based protocols with a daily 3 mm thick bolus produce a surface dose comparable to the standard 6 MV 5 mm thick bolus on alternate days method but with an improved surface dose homogeneity. This allows for a better control of skin toxicity and target volume coverage.
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Affiliation(s)
- Frédéric A Miéville
- Department of Radiation Oncology, Hôpital Fribourgeois, 2-6 Chemin des Pensionnats, 1752 Villars-sur-Glâne, Fribourg, Switzerland.
| | - Nicolas Pitteloud
- Department of Radiation Oncology, Hôpital Fribourgeois, 2-6 Chemin des Pensionnats, 1752 Villars-sur-Glâne, Fribourg, Switzerland
| | - Vérane Achard
- Department of Radiation Oncology, Hôpital Fribourgeois, 2-6 Chemin des Pensionnats, 1752 Villars-sur-Glâne, Fribourg, Switzerland
| | - Giorgio Lamanna
- Department of Radiation Oncology, Hôpital Fribourgeois, 2-6 Chemin des Pensionnats, 1752 Villars-sur-Glâne, Fribourg, Switzerland
| | - Olivier Pisaturo
- Department of Radiation Oncology, Hôpital Fribourgeois, 2-6 Chemin des Pensionnats, 1752 Villars-sur-Glâne, Fribourg, Switzerland
| | - Pierre-Alain Tercier
- Department of Radiation Oncology, Hôpital Fribourgeois, 2-6 Chemin des Pensionnats, 1752 Villars-sur-Glâne, Fribourg, Switzerland
| | - Abdelkarim S Allal
- Department of Radiation Oncology, Hôpital Fribourgeois, 2-6 Chemin des Pensionnats, 1752 Villars-sur-Glâne, Fribourg, Switzerland
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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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10
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Arribas EM, Kelil T, Santiago L, Ali A, Chadalavada SC, Chepelev L, Ghodadra A, Ionita CN, Lee J, Ravi P, Ryan JR, Sheikh AM, Rybicki FJ, Ballard DH. Radiological Society of North America (RSNA) 3D Printing Special Interest Group (SIG) clinical situations for which 3D printing is considered an appropriate representation or extension of data contained in a medical imaging examination: breast conditions. 3D Print Med 2023; 9:8. [PMID: 36952139 PMCID: PMC10037829 DOI: 10.1186/s41205-023-00171-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 03/07/2023] [Indexed: 03/24/2023] Open
Abstract
The use of medical 3D printing has expanded dramatically for breast diseases. A writing group composed of the Radiological Society of North America (RSNA) Special Interest Group on 3D Printing (SIG) provides updated appropriateness criteria for breast 3D printing in various clinical scenarios. Evidence-based appropriateness criteria are provided for the following clinical scenarios: benign breast lesions and high-risk breast lesions, breast cancer, breast reconstruction, and breast radiation (treatment planning and radiation delivery).
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Affiliation(s)
- Elsa M Arribas
- Division of Diagnostic Imaging, Department of Breast Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
| | - Tatiana Kelil
- Department of Radiology, University of California, 1600 Divisadero St, C250, Box 1667, San Francisco, CA, 94115, USA
| | - Lumarie Santiago
- Division of Diagnostic Imaging, Department of Breast Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Arafat Ali
- Diagnostic Radiology, Henry Ford Medical Group, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA
| | | | - Leonid Chepelev
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Anish Ghodadra
- UPMC Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Ciprian N Ionita
- Department of Biomedical Engineering, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, University at Buffalo School of Engineering and Applied Sciences, 8052 Clinical Translational Research Center, 875 Ellicott Street, Buffalo, NY, 14203, USA
| | - Joonhyuk Lee
- University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
| | - Prashanth Ravi
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Justin R Ryan
- 3D Innovations Lab, Rady Children's Hospital, San Diego, CA, USA
| | - Adnan M Sheikh
- Department of Medical Imaging, Ottawa Hospital Research Institute (OHRI), The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, K1H 8L6, Canada
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University, St Louis, MO, USA
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11
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Hosseini FS, Baghani HR, Robatjazi M, Mowlavi AA, Porouhan P. Performance evaluation of buildup bolus during external radiotherapy of mastectomy patients: treatment planning and film dosimetry. Med Biol Eng Comput 2023; 61:435-444. [PMID: 36460872 DOI: 10.1007/s11517-022-02721-x] [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: 06/10/2021] [Accepted: 11/19/2022] [Indexed: 12/04/2022]
Abstract
A buildup bolus is used during the post-mastectomy radiotherapy (PMRT) to overcome under-dosage issues in the chest wall. The current study is aimed at evaluating the performance of a bolus in dose enhancement through both film dosimetry and treatment planning approaches. Twenty patients were enrolled in current research. The received dose by the skin at the lateral and medial regions of the chest wall in the presence and absence bolus was evaluated. Film dosimetry results showed that the presence of the bolus can averagely increase the skin dose by about 80% (P value < 0.001) and 92% (P value < 0.001) in lateral and medial regions, respectively. No significant difference was observed between the measured and treatment planning system (TPS)-calculated dose values in the presence of bolus. The presence of the bolus can considerably increase the absorbed dose by superficial chest wall regions. The TPS shows a favorable performance in superficial dose calculations in the presence of the buildup bolus. Hosseini et al.: demonstration of implemented research in the current study.
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Affiliation(s)
| | | | - Mostafa Robatjazi
- Medical Physics and Radiological Sciences Department, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | | | - Pejman Porouhan
- Radiation Oncology Department, Sabzevar University of Medical Sciences, Sabzevar, Iran
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12
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Gong P, Dai G, Wu X, Wang X, Xie L, Xu S, Zhong R. Application of thermoplastic elastomer (TPE) bolus in postmastectomy radiotherapy. Breast 2022; 66:317-323. [PMID: 36463642 PMCID: PMC9719108 DOI: 10.1016/j.breast.2022.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/10/2022] [Accepted: 11/27/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To assess the planned dose, in vivo dosimetry, acute skin toxicity, pain, and distress using Thermoplastic Elastomer (TPE) bolus for postmastectomy radiotherapy (PMRT). MATERIAL AND METHODS Thirty-two PMRT patients with TPE bolus (17 patients for 25 fractions, 15 patients for the first 20 fractions) were selected for the study. The acute skin toxicity, pain, and psychological distress were assessed from the first treatment week to the fourth week after the end of treatment. At the first treatment, the MOSFET was used in vivo dosimetry measurement. RESULTS In vivo dosimetry with the bolus, the dose deviation ranged from -6.22% to -1.56% for 5 points. The presence of grade 1 and 2 skin toxicity reached its peak (70.0% and 13.3%) in the sixth week. Two patients (6.6%) with 25 fractions bolus experienced moist desquamation in the fifth and seventh week, with pain score 2 and 3, and interruptions of 3 and 5 days, respectively. The incidence of pain score 1, 2, and 3 peaked in the fifth (33.3%), fourth (33.3%), and seventh (10.0%) week. No patients experienced grade 3 skin toxicity and severe pain. One patient had significant anxiety, and two patients had significant depression. CONCLUSION The TPE bolus can accurately fit skin and improve the surface dose to more than 90%. Twenty fractions with TPE bolus had similar skin toxicity and pain to those without bolus and did not increase patients' distress and clinical workload, compared with the literature's data, which is an alternative to the 3D printing bolus for PMRT.
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Affiliation(s)
- Pan Gong
- Radiotherapy Physics and Technology Center, Cancer Center, West China School of Medicine, West China Hospital of Sichuan University, Chengdu, 610041, PR China
| | - Guyu Dai
- Radiotherapy Physics and Technology Center, Cancer Center, West China School of Medicine, West China Hospital of Sichuan University, Chengdu, 610041, PR China
| | - Xiaoyu Wu
- Department of Respiratory Critical Care Medicine/Thoracic Surgery, West China School of Medicine, West China Hospital of Sichuan University, Chengdu, 610041, PR China
| | - Xuetao Wang
- Radiotherapy Physics and Technology Center, Cancer Center, West China School of Medicine, West China Hospital of Sichuan University, Chengdu, 610041, PR China
| | - Li Xie
- Department of Radiotherapy/Department of Head and Neck Oncology, West China School of Medicine, West China Hospital of Sichuan University, Chengdu, 610041, PR China
| | - Shuni Xu
- Radiotherapy Physics and Technology Center, Cancer Center, West China School of Medicine, West China Hospital of Sichuan University, Chengdu, 610041, PR China
| | - Renming Zhong
- Radiotherapy Physics and Technology Center, Cancer Center, West China School of Medicine, West China Hospital of Sichuan University, Chengdu, 610041, PR China.
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13
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Teuwen J, Gouw ZA, Sonke JJ. Artificial Intelligence for Image Registration in Radiation Oncology. Semin Radiat Oncol 2022; 32:330-342. [DOI: 10.1016/j.semradonc.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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14
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Wang X, Zhao J, Xiang Z, Wang X, Zeng Y, Luo T, Yan X, Zhang Z, Wang F, Liu L. 3D-printed bolus ensures the precise postmastectomy chest wall radiation therapy for breast cancer. Front Oncol 2022; 12:964455. [PMID: 36119487 PMCID: PMC9478602 DOI: 10.3389/fonc.2022.964455] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To investigate the values of a 3D-printed bolus ensuring the precise postmastectomy chest wall radiation therapy for breast cancer. Methods and materials In the preclinical study on the anthropomorphic phantom, the 3D-printed bolus was used for dosimetry and fitness evaluation. The dosimetric parameters of planning target volume (PTV) were assessed, including Dmin, Dmax, Dmean, D95%, homogeneity index (HI), conformity index (CI), and organs at risk (OARs). The absolute percentage differences (|%diff|) between the theory and fact skin dose were also estimated, and the follow-up was conducted for potential skin side effects. Results In preclinical studies, a 3D-printed bolus can better ensure the radiation coverage of PTV (HI 0.05, CI 99.91%), the dose accuracy (|%diff| 0.99%), and skin fitness (mean air gap 1.01 mm). Of the 27 eligible patients, we evaluated the radiation dose parameter (median(min–max): Dmin 4967(4789–5099) cGy, Dmax 5447(5369–5589) cGy, Dmean 5236(5171–5323) cGy, D95% 5053(4936–5156) cGy, HI 0.07 (0.06–0.17), and CI 99.94% (97.41%–100%)) and assessed the dose of OARs (ipsilateral lung: Dmean 1341(1208–1385) cGy, V5 48.06%(39.75%–48.97%), V20 24.55%(21.58%–26.93%), V30 18.40%(15.96%–19.16%); heart: Dmean 339(138–640) cGy, V30 1.10%(0%–6.14%), V40 0.38%(0%–4.39%); spinal cord PRV: Dmax 639(389–898) cGy). The skin doses in vivo were Dtheory 208.85(203.16–212.53) cGy, Dfact 209.53(204.14–214.42) cGy, and |%diff| 1.77% (0.89–2.94%). Of the 360 patients enrolled in the skin side effect follow-up study (including the above 27 patients), grade 1 was the most common toxicity (321, 89.2%), some of which progressing to grade 2 or grade 3 (32, 8.9% or 7, 1.9%); the radiotherapy interruption rate was 1.1%. Conclusion A 3D-printed bolus can guarantee the precise radiation dose on skin surface, good fitness to skin, and controllable acute skin toxicity, which possesses a great clinical application value in postmastectomy chest call radiation therapy for breast cancer.
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Affiliation(s)
- Xiran Wang
- Department of Head and Neck and Mammary Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Jianling Zhao
- Department of Radiotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Zhongzheng Xiang
- Department of Head and Neck and Mammary Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Xuetao Wang
- Department of Radiotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Yuanyuan Zeng
- Department of Head and Neck and Mammary Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Ting Luo
- Department of Head and Neck and Mammary Oncology, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu, China
| | - Xi Yan
- Department of Head and Neck and Mammary Oncology, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu, China
| | - Zhuang Zhang
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Feng Wang
- Department of Head and Neck and Mammary Oncology, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Liu
- Department of Head and Neck and Mammary Oncology, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Lei Liu,
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Dilson L, Challapalli S, Sourjya B, Athiyamaan MS, Ramamoorthy R, Johan S, Abhishek K. Estimation of Surface Dose in the Presence of Unwanted Air Gaps under the Bolus in Postmastectomy Radiation Therapy: A Phantom Dosimetric Study. Asian Pac J Cancer Prev 2022; 23:2973-2981. [PMID: 36172659 PMCID: PMC9810302 DOI: 10.31557/apjcp.2022.23.9.2973] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND The aim of this study is to design and fabricate a thorax phantom with irregularly shaped trapezoidal slots across the left side of the chest wall, allowing for the creation of unwanted air gaps under the bolus. METHOD Surface dose (Dsurf) measurements were made with Gaf Chromic EBT3 films at air gaps (0.0, 5.0, 10.0 and 15.0 mm) under gel bolus of thickness (5.0 mm & 10.0 mm), for 3DCRT technique (2 and 3 field) with clinical 6 MV photon beam under uniform and non-uniform air gap condition. The obtained values were compared with TPS estimated ones. RESULTS In the presence of 15.0 mm uniform air gap, the mean estimated and measured Dsurf values with two and three field techniques decreased by 14.0 % to 15.2% and 14.7% to 17.4% under 5.0 mm and 10.0 mm bolus applications respectively. In presence of non-uniform air gap condition, the effect on Dsurf was minimal (3 to 3.5%) compared with the uniform air gap condition. CONCLUSIONS Based on the study's findings, it is recommended that when using bolus in clinical radiotherapy applications, special care be taken to avoid unwanted air gaps under the bolus in order to achieve a uniform surface dose across the treatment region, where a customized 3D printed bolus may be a better option.
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16
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Pollmann S, Toussaint A, Flentje M, Wegener S, Lewitzki V. Dosimetric Evaluation of Commercially Available Flat vs. Self-Produced 3D-Conformal Silicone Boluses for the Head and Neck Region. Front Oncol 2022; 12:881439. [PMID: 36033533 PMCID: PMC9399510 DOI: 10.3389/fonc.2022.881439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background Boluses are routinely used in radiotherapy to modify surface doses. Nevertheless, considerable dose discrepancies may occur in some cases due to fit inaccuracy of commercially available standard flat boluses. Moreover, due to the simple geometric design of conventional boluses, also surrounding healthy skin areas may be unintentionally covered, resulting in the unwanted dose buildup. With the fused deposition modeling (FDM) technique, there is a simple and possibly cost-effective way to solve these problems in routine clinical practice. This paper presents a procedure of self-manufacturing bespoke patient-specific silicone boluses and the evaluation of buildup and fit accuracy in comparison to standard rectangular commercially available silicone boluses. Methods 3D-conformal silicone boluses were custom-built to cover the surgical scar region of 25 patients who received adjuvant radiotherapy of head and neck cancer at the University Hospital Würzburg. During a standard CT-based planning procedure, a 5-mm-thick 3D bolus contour was generated to cover the radiopaque marked surgical scar with an additional safety margin. From these digital contours, molds were 3D printed and poured with silicone. Dose measurements for both types of boluses were performed with radiochromic films (EBT3) at three points per patient—at least one aimed to be in the high-dose area (scar) and one in the lower-dose area (spared healthy skin). Surface–bolus distance, which ideally should not be present, was determined from cone-beam CT performed for positioning control. The dosimetric influence of surface–bolus distance was also determined on slab phantom for different field sizes. The trial was performed with hardware that may be routinely available in every radiotherapy department, with the exception of the 3D printer. The required number of patients was determined based on the results of preparatory measurements with the help of the statistical consultancy of the University of Würzburg. The number of measuring points represents the total number of patients. Results In the high-dose area of the scar, there was a significantly better intended dose buildup of 2.45% (95%CI 0.0014–0.0477, p = 0.038, N = 30) in favor of a 3D-conformal bolus. Median distances between the body surface and bolus differed significantly between 3D-conformal and commercially available boluses (3.5 vs. 7.9 mm, p = 0.001). The surface dose at the slab phantom did not differ between commercially available and 3D-conformal boluses. Increasing the surface–bolus distance from 5 to 10 mm decreased the surface dose by approximately 2% and 11% in the 6 × 6- and 3 × 3-cm2 fields, respectively. In comparison to the commercially available bolus, an unintended dose buildup in the healthy skin areas was reduced by 25.9% (95%CI 19.5–32.3, p < 0.01, N = 37) using the 3D-conformal bolus limited to the region surrounding the surgical scar. Conclusions Using 3D-conformal boluses allows a comparison to the commercially available boluses’ dose buildup in the covered areas. Smaller field size is prone to a larger surface–bolus distance effect. Higher conformity of 3D-conformal boluses reduces this effect. This may be especially relevant for volumetric modulated arc therapy (VMAT) and intensity-modulated radiotherapy (IMRT) techniques with a huge number of smaller fields. High conformity of 3D-conformal boluses reduces an unintended dose buildup in healthy skin. The limiting factor in the conformity of 3D-conformal boluses in our setting was the immobilization mask, which was produced primarily for the 3D boluses. The mask itself limited tight contact of subsequently produced 3D-conformal boluses to the mask-covered body areas. In this respect, bolus adjustment before mask fabrication will be done in the future setting.
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17
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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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18
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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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Zhang Y, Huang Y, Ding S, Liang J, Kuang J, Mao Q, Ying W, Shu Y, Li J, Jiang C. A clinical trial to compare a 3D-printed bolus with a conventional bolus with the aim of reducing cardiopulmonary exposure in postmastectomy patients with volumetric modulated arc therapy. Cancer Med 2021; 11:1037-1047. [PMID: 34939343 PMCID: PMC8855922 DOI: 10.1002/cam4.4496] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/13/2021] [Accepted: 12/03/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND We compared the dosimetry, application, and acute toxicity of a 3D-printed and a conventional bolus for postmastectomy radiotherapy (PMRT) with volumetric modulated arc therapy (VMAT). Materials and Methods Eligible patients (n = 75) with PMRT breast cancer were randomly selected to receive VMAT with a conventional bolus or a 3D-printed bolus. The primary endpoint was a 10% decrease in the mean heart dose to left-sided breast cancer patients. The secondary endpoint was a 5% decrease in the mean ipsilateral lung dose to all patients. A comparative analysis was carried out of the dosimetry, normal tissue complication probability (NTCP), acute skin toxicity, and radiation pneumonitis. RESULTS Compared to a conventional bolus, the mean heart dose in left-sided breast cancer was reduced by an average of 0.8 Gy (5.5 ± 1.3 Gy vs. 4.7 ± 0.8 Gy, p = 0.035) and the mean dose to the ipsilateral lung was also reduced by an average of 0.8 Gy (12.4 ± 1.0 Gy vs. 11.6 ± 0.8 Gy, p < 0.001). The values for V50Gy of the PTV of the chest wall for the 3D-printed and conventional boluses were 95.4 ± 0.6% and 94.8 ± 0.8% (p = 0.026) and the values for the CI of the entire PTV were 0.83 ± 0.02 and 0.80 ± 0.03 (p < 0.001), respectively. The NTCP for the 3D-printed bolus was also reduced to an average of 0.14% (0.32 ± 0.19% vs. 0.18 ± 0.11%, p = 0.017) for the heart and 0.45% (3.70 ± 0.67% vs. 3.25 ± 0.18%, p < 0.001) for the ipsilateral lung. Grade 2 and Grade 1 radiation pneumonitis were 0.0% versus 7.5% and 14.3% versus 20.0%, respectively (p = 0.184). CONCLUSIONS The 3D-printed bolus may reduce cardiopulmonary exposure in postmastectomy patients with volumetric modulated arc therapy.
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Affiliation(s)
- Yun Zhang
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, PR China
| | - Yuling Huang
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, PR China
| | - Shenggou Ding
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, PR China
| | - Jinghui Liang
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, PR China
| | - Jie Kuang
- School of Public Health, Nanchang University, Nanchang, PR China
| | - Qingfeng Mao
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, PR China
| | - Weiliang Ying
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, PR China
| | - Yuxian Shu
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, PR China
| | - Jingao Li
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, PR China.,Key Laboratory of Personalized Diagnosis and Treatment of Nasopharyngeal Carcinoma Nanchang, Nanchang, PR China.,Medical College of Nanchang University, Nanchang, PR China
| | - Chunling Jiang
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, PR China.,Key Laboratory of Personalized Diagnosis and Treatment of Nasopharyngeal Carcinoma Nanchang, Nanchang, PR China.,Medical College of Nanchang University, Nanchang, PR China
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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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Lu Y, Wang F, Shi Q, Zhang J, Xiang Z, Li N, Huang X, Song J. Three-Dimensional Printing Chitosan-Based Bolus Used for Radiotherapy. ACS APPLIED BIO MATERIALS 2021; 4:7094-7102. [PMID: 35006941 DOI: 10.1021/acsabm.1c00701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A bolus is a kind of tissue equivalent material used in radiotherapy for treating superficial lesions. Despite the availability of various commercial boluses, it is hard for them to form full contact with the irregular surface of patients' skin, such as the scalp, nose, and ear, resulting in air gaps and leading to a discrepancy between the delivered dose and planned dose. To solve this problem, we provided a photocurable bioink created from chitosan (CHI) for digital light processing (DLP) three-dimensional (3D) printing the bolus in radiotherapy application. The chitosan-based bioink (CHI-MA) was obtained by a methacrylation process using methacrylic anhydride (MA). Photosensitive crosslinkers with different molecular weights were introduced into the bioink. The photocuring efficiency and mechanical properties of CHI-MA hydrogels can be well modulated by varying the crosslinkers. This CHI-MA bioink allowed us to create complex structures with reliable biocompatibility, good flexibility, and excellent structural stability. Furthermore, the nose bolus processed by 3D printing this bioink proved to be a good fit for the nose model and showed a desirable radiotherapy effect. This suggests that DLP 3D printing of the CHI-MA bioink would be a promising approach to obtain the customized bolus in the application of radiotherapy.
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Affiliation(s)
- Ying Lu
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Taiyuan 030032, Shanxi Province, China
| | - Fan Wang
- Laboratory of Biomaterial Surface and Interface, School of Materials Science and Engineering, Taiyuan University of Technology, Taiyuan 030024, Shanxi Province, P.R. China
| | - Qinying Shi
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Taiyuan 030032, Shanxi Province, China
| | - Jianan Zhang
- Laboratory of Biomaterial Surface and Interface, School of Materials Science and Engineering, Taiyuan University of Technology, Taiyuan 030024, Shanxi Province, P.R. China
| | - Zuojia Xiang
- Laboratory of Biomaterial Surface and Interface, School of Materials Science and Engineering, Taiyuan University of Technology, Taiyuan 030024, Shanxi Province, P.R. China
| | - Ning Li
- Laboratory of Biomaterial Surface and Interface, School of Materials Science and Engineering, Taiyuan University of Technology, Taiyuan 030024, Shanxi Province, P.R. China
| | - Xiaobo Huang
- Laboratory of Biomaterial Surface and Interface, School of Materials Science and Engineering, Taiyuan University of Technology, Taiyuan 030024, Shanxi Province, P.R. China
| | - Jianbo Song
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Taiyuan 030032, Shanxi Province, China
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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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23
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Lee CY, Kaza E, Devlin PM, Cormack RA, Buzurovic I. Feasibility of magnetic resonance-only high-dose-rate surface brachytherapy for clinical application. Med Phys 2021; 48:7313-7322. [PMID: 34519360 DOI: 10.1002/mp.15224] [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: 04/02/2021] [Revised: 08/19/2021] [Accepted: 08/30/2021] [Indexed: 11/12/2022] Open
Abstract
PURPOSE In this article, we investigate the feasibility of magnetic resonance (MR)-only imaging for high-dose-rate (HDR) surface brachytherapy (SABT). We examined whether a standard CT-based planning can be replaced with an MR-only planning. For this purpose, the MRI digitization and plan quality check processes were compared against the standard CT-based processes. A prospective clinical implementation of the MR-only planning was evaluated on a clinical data set. METHODS A pointwise encoding time reduction with radial acquisition (PETRA) sequence was optimized for visualization of Freiburg flap (FF) on MR images. MR and conventional CT images were acquired with a FF applicator (Elekta, Stockholm, Sweden) placed on the following phantoms: (1) flat styrofoam (FST), FF locked-in placed with supporting structure; (2) cast-made facemask, and (3) porcine leg (PL). Catheters were digitized and activated with 10 mm step size on Oncentra Brachy 4.5.3 Treatment Planning System. The CT-only and MR-only treatment plans were generated by optimizing the dose to the target defined as volume at 3 mm skin depth. To compare the plans, the MRI-to-CT alignment was performed via rigid registration. Positional displacements of dwell positions between CT and MR plans were compared on the FST phantom and the relative percent dose difference in 2210 different points from CT or MR-only plans was compared. For all three phantoms, the comparabilities between CT and MR-only plans were assessed by calculating dice similarity coefficient (DSC) for volumes enclosing 150%, 125%, 100%, 95%, 90%, 80%, and 65% isodose lines (V150 -V65 ). The MR images of FF placed on the forearm of a healthy subject were acquired with this optimized PETRA sequence and used for treatment planning. The relative percent dose was calculated on 140 representative points placed at 3 mm skin depth to evaluate the dose to the skin. RESULTS Using the optimized PETRA sequence, MRTP digitization accuracy was < 1 mm in each dimension and on three-dimensional (3D) displacement for the FST phantom. In each phantom and clinical data set, it was possible to generate MR-only treatment plans with the 3 mm skin depth prescription. In the FST phantom, the mean relative dose at the points was not significantly different (< 0.1% difference) for CT or MR-based plans. The assessment of similarities in dose profiles between CT and MR-only plans' provided DSC values greater than 0.96, 0.92, and 0.73 for all volumes enclosing up to 100%, 125%, and 150% isodose lines, respectively. CONCLUSION The feasibility of generating a HDR treatment plan with FF using MR-only has been evaluated in phantoms with varying geometry and for a clinical data set. The optimization of a standard MRI sequence-PETRA-implemented in this study showed that FF-based catheters can be digitized and a plan can be generated using only MRI. The resulting MR-only plans were comparable to the conventional CT-based plans, suggesting that MRI alone can generate clinically acceptable plans for FF in phantoms and on a clinical data set. Reliable MR-only treatment planning could improve treatment prescription through more accurate characterization of soft tissue targets.
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Affiliation(s)
- Casey Y Lee
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Evangelia Kaza
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Phillip M Devlin
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert A Cormack
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ivan Buzurovic
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
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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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25
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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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26
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Zhang C, Hu W, Zhou Q, He J, Wang H, Qiu K, Wang L, Li X. The possibility of developing customized 3D-printed silicone hydrogel bolus for post-mastectomy radiotherapy. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2021. [DOI: 10.1080/16878507.2021.1962629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Caixun Zhang
- Department of Radiotherapy, Renmin Hospital of Wuhan University, Wuhan, P .R. China
| | - Weiguo Hu
- Department of Oncology Center, Renmin Hospital of Wuhan University, Wuhan, P .R. China
| | - Qing Zhou
- Department of Ultrasound, Renmin Hospital of Wuhan University, Wuhan, P .R. China
| | - Junxiang He
- Department of Radiotherapy, Renmin Hospital of Wuhan University, Wuhan, P .R. China
| | - Hao Wang
- Department of Ultrasound, Renmin Hospital of Wuhan University, Wuhan, P .R. China
| | - Kehu Qiu
- Department of Oncology Center, Renmin Hospital of Wuhan University, Wuhan, P .R. China
| | - Luzhou Wang
- Department of Radiotherapy, Renmin Hospital of Wuhan University, Wuhan, P .R. China
| | - Xiangpan Li
- Department of Radiotherapy, Renmin Hospital of Wuhan University, Wuhan, P .R. China
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27
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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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29
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Baek S, Ahn S, Ju E, Jung NH. Customized 3D Bolus Applied to the Oral Cavity and Supraclavicular Area for Head and Neck Cancer. In Vivo 2021; 35:579-584. [PMID: 33402512 DOI: 10.21873/invivo.12294] [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: 10/21/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND/AIM In this study, a new method to create a customized three-dimensional (3D) bolus by accurately considering the anatomy of an individual patient is demonstrated. PATIENTS AND METHODS A 3D bolus structure was created from an extended planning target volume (PTV) to reduce an inevitable skin reaction. In addition, during computed tomography simulation in patients with oral cavity cancers, a balloon was inserted into the mouth of a patient to secure space, and then the area surrounding the balloon was designed into a 3D bolus structure. RESULTS For patients with head and neck cancers, a customized 3D bolus can reduce the unnecessary skin dose by 14.4% compared to a commercial bolus. For patients with oral cavity cancer, the PTV and tongue doses were 93.8% and 8% of the prescribed dose, respectively. CONCLUSION The customized 3D bolus enables effective skin sparing and full coverage of the target area.
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Affiliation(s)
- Seunghyeop Baek
- Department of Radiological Science, Yonsei University, Wonju, Republic of Korea
| | - Sohyun Ahn
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea;
| | - Eunbin Ju
- Department of Radiation Oncology, Kangwon National University Hospital, Kangwon, Republic of Korea.,Department of Bio-medical Science, Graduate School of Korea University, Sejong, Republic of Korea
| | - Nuri Hyun Jung
- Department of Radiation Oncology, Kangwon National University Hospital, Kangwon, Republic of Korea
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30
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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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34
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S A, M K, A R M, M O. A Novel Adjustable Anthropomorphic Head Phantom for Verifying the Dose of Radiation Therapy. J Biomed Phys Eng 2020; 10:663-668. [PMID: 33134227 PMCID: PMC7557469 DOI: 10.31661/jbpe.v0i0.2003-1082] [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: 03/11/2020] [Accepted: 04/12/2020] [Indexed: 06/11/2023]
Abstract
This study aims to make a phantom to verify dose distribution and compare two techniques of radiation therapy, including 3D conventional radiotherapy (3D-CRT) and modulated photon radiotherapy (IMRT). For treatment of brain cancer, physicians have to prescribe radiation therapy to involved patients so that organs at risk receive unwanted dose causing them to be damaged. To know precise dose delivered into them and evaluate treatment-planning system (TPs), it is necessary to do dosimetry in the phantom owing to difficulties of dosimetry in human. It is important to make a phantom with characteristics similar to humans and ability to compute dose and dose distribution in desired organs and tissue. Thus, there is possibility to compute dose in different parts, including doses delivered in ears, eyes, stem brain and optic nerve. Furthermore, this phantom has to provide this opportunity to investigate whether some techniques of radiation therapy such as 3D-CRT or IMRT depend on the size or location of tumors. To this end, a low workload, easy-to-set-up, lightweight, and transportable phantom was designed, and made from Polylactic acid (PLA) in dimensions 23×24×32 cm3. The phantom consists of brain, tumors in different dimeters, including 2, 4, 6 cm and also parts for eyes and ears to locate TLDs. Head, brain and tumors are able to open so that they can be filled with polymer gel dosimetry making possible record dose distribution in three-dimensions (3D) and sharp dose gradients.
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Affiliation(s)
- Abbasi S
- MSc student, Department of Medical Physics and Engineering, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Khosravi M
- MSc, Department of Medical Physics and Engineering, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdizadeh A R
- PhD, Department of Medical Physics and Engineering, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ostovari M
- PhD, Department of Medical Physics and Engineering, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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35
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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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36
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Rooney MK, Rosenberg DM, Braunstein S, Cunha A, Damato AL, Ehler E, Pawlicki T, Robar J, Tatebe K, Golden DW. Three-dimensional printing in radiation oncology: A systematic review of the literature. J Appl Clin Med Phys 2020; 21:15-26. [PMID: 32459059 PMCID: PMC7484837 DOI: 10.1002/acm2.12907] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/16/2020] [Accepted: 04/23/2020] [Indexed: 12/21/2022] Open
Abstract
Purpose/objectives Three‐dimensional (3D) printing is recognized as an effective clinical and educational tool in procedurally intensive specialties. However, it has a nascent role in radiation oncology. The goal of this investigation is to clarify the extent to which 3D printing applications are currently being used in radiation oncology through a systematic review of the literature. Materials/methods A search protocol was defined according to preferred reporting items for systematic reviews and meta‐analyses (PRISMA) guidelines. Included articles were evaluated using parameters of interest including: year and country of publication, experimental design, sample size for clinical studies, radiation oncology topic, reported outcomes, and implementation barriers or safety concerns. Results One hundred and three publications from 2012 to 2019 met inclusion criteria. The most commonly described 3D printing applications included quality assurance phantoms (26%), brachytherapy applicators (20%), bolus (17%), preclinical animal irradiation (10%), compensators (7%), and immobilization devices (5%). Most studies were preclinical feasibility studies (63%), with few clinical investigations such as case reports or series (13%) or cohort studies (11%). The most common applications evaluated within clinical settings included brachytherapy applicators (44%) and bolus (28%). Sample sizes for clinical investigations were small (median 10, range 1–42). A minority of articles described basic or translational research (11%) and workflow or cost evaluation studies (3%). The number of articles increased over time (P < 0.0001). While outcomes were heterogeneous, most studies reported successful implementation of accurate and cost‐effective 3D printing methods. Conclusions Three‐dimensional printing is rapidly growing in radiation oncology and has been implemented effectively in a diverse array of applications. Although the number of 3D printing publications has steadily risen, the majority of current reports are preclinical in nature and the few clinical studies that do exist report on small sample sizes. Further dissemination of ongoing investigations describing the clinical application of developed 3D printing technologies in larger cohorts is warranted.
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Affiliation(s)
- Michael K Rooney
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - David M Rosenberg
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Steve Braunstein
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - Adam Cunha
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - Antonio L Damato
- Department Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eric Ehler
- Department of Radiation Oncology, University of Minnesota, Minneapolis, MN, USA
| | - Todd Pawlicki
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, CA, USA
| | - James Robar
- Department of Radiation Oncology, Dalhousie University, Halifax, Canada.,Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Canada.,Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Ken Tatebe
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
| | - Daniel W Golden
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
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Cho JD, Son J, Sung J, Choi CH, Kim JS, Wu HG, Park JM, Kim JI. Flexible film dosimeter for in vivo dosimetry. Med Phys 2020; 47:3204-3213. [PMID: 32248523 DOI: 10.1002/mp.14162] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/20/2020] [Accepted: 03/23/2020] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The aims of this study were to develop a flexible film dosimeter applicable to the irregular surface of a patient for in vivo dosimetry and to evaluate the device's dosimetric characteristics. METHODS A flexible film dosimeter with active layers consisting of radiochromic-sensitive films and flexible silicone materials was constructed. The dose-response, sensitivity, scanning orientation dependence, energy dependence, and dose rate dependence of the flexible film dosimeter were tested. Irradiated dosimeters were scanned 24 h post-irradiation, and the region of interest was 5 mm × 5 mm. Biological stability tests ensured the safety of application of the flexible film dosimeter for patients. A preliminary clinical study with the flexible film dosimeter was implemented on four patients. RESULTS The red channel demonstrated the highest sensitivity among all channels, and the response sensitivity of the dosimeter decreased with the applied dose, which were the same as the characteristics of GAFCHROMIC EBT3 radiochromic films. The flexible film dosimeter showed no significant energy dependence for photon beams of 6 MV, 6 MV flattening filter-free (FFF), 10 MV, and 15 MV. The flexible film dosimeter showed no substantial dose rate dependence with 6 or 6 MV FFF. In terms of biological stability, the flexible film dosimeter demonstrated no cytotoxicity, no irritation, and no skin sensitization. In the preliminary clinical study, the dose differences between the measurements with the flexible film dosimeter and calculations with the treatment planning system ranged from -0.1% to 1.2% for all patients. CONCLUSIONS The dosimeter developed in this study is a flexible film capable of attachment to a curved skin surface. The biological test results indicate the stability of the flexible film dosimeter. The preliminary clinical study showed that the flexible film dosimeter can be successfully applied as an in vivo dosimeter.
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Affiliation(s)
- Jin Dong Cho
- 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.,Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Jaeman Son
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, 03080, Republic of Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, 03080, Republic of Korea
| | - Jiwon Sung
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, 03080, Republic of Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, 03080, Republic of Korea
| | - Chang Heon Choi
- 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
| | - Jin Sung Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Hong-Gyun Wu
- 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 Radiation Oncology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Jong Min Park
- 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.,Robotics Research Laboratory for Extreme Environments, Advanced Institute of Convergence Technology, Suwon, 16229, Republic of Korea
| | - Jung-In Kim
- 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
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Maxwell SK, Charles PH, Cassim N, Kairn T, Crowe SB. Assessing the fit of 3D printed bolus from CT, optical scanner and photogrammetry methods. Phys Eng Sci Med 2020; 43:601-607. [PMID: 32524442 DOI: 10.1007/s13246-020-00861-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 03/17/2020] [Indexed: 11/30/2022]
Abstract
Bolus plays an important role in the radiation therapy of superficial lesions and the application of 3D printing to its design can improve fit and dosimetry. This study quantitatively compares the fits of boluses designed from different imaging modalities. A head phantom was imaged using three systems: a CT simulator, a 3D optical scanner, and an interchangeable lens camera. Nose boluses were designed and 3D printed from each modality. A 3D printed phantom with air gaps of known thicknesses was used to calibrate mean HU to measure air gaps of unknown thickness and assess the fit of each bolus on the head phantom. The bolus created from the optical scanner data resulted in the best fit, with a mean air gap of 0.16 mm. Smoothing of the CT bolus resulted in a more clinically suitable model, comparable to that from the optical scanner method. The bolus produced from the photogrammetry method resulted in air gaps larger than 1 mm in thickness. The use of optical scanner and photogrammetry models have many advantages over the conventional bolus-from-CT method, however workflow should be refined to ensure accuracy if implemented clinically.
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Affiliation(s)
- S K Maxwell
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
| | - P H Charles
- Herston Biofabrication Institute, Brisbane, QLD, Australia.,Queensland University of Technology, Brisbane, QLD, Australia
| | - N Cassim
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - T Kairn
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Queensland University of Technology, Brisbane, QLD, Australia
| | - S B Crowe
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Queensland University of Technology, Brisbane, QLD, Australia
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3D printer-based novel intensity-modulated vaginal brachytherapy applicator: feasibility study. J Contemp Brachytherapy 2020; 12:17-26. [PMID: 32190066 PMCID: PMC7073342 DOI: 10.5114/jcb.2020.92407] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 12/18/2019] [Indexed: 12/14/2022] Open
Abstract
Purpose To design a novel high-dose-rate intracavitary applicator which may lead to enhanced dose modulation in the brachytherapy of gynecological cancers. Material and methods A novel brachytherapy applicator, auxiliary equipment and quality control phantom were modeled in SketchUp Pro 2017 modeling software and printed out from a MakerBot Replicator Z18 three-dimensional printer. As a printing material polylactic acid (PLA) filament was used and compensator materials including aluminum, stainless-steel and Cerrobend alloy were selected according to their radiation attenuation properties. To evaluate the feasibility of the novel applicator, two sets of measurements were performed in a Varian GammaMed iX Plus high-dose rate iridium-192 (192Ir) brachytherapy unit and all of the treatment plans were calculated in Varian BrachyVision treatment planning system v.8.9 with TG43-based formalism. In the first step, catheter and source-dwell positioning accuracy, reproducibility of catheter and source positions, linearity of relative dose with changing dwell times and compensator materials were tested to evaluate the mechanical stability of the designed applicator. In the second step, to validate the dosimetric accuracy of the novel applicator measured point dose and two-dimensional dose distributions in homogeneous medium were compared with calculated data in the treatment planning system using PTW VeriSoft v.5.1 software. Results In mechanical quality control tests source-dwell positioning accuracy and linearity of the designed applicator were measured as ≤ 0.5 mm and ≤ 1.5%, respectively. Reproducibility of the treatment planning was ≥ 97.7% for gamma evaluation criteria of 1 mm distance to agreement and 1% dose difference of local dose. In dosimetric quality control tests, maximum difference between measured and calculated point dose was found as 3.8% in homogeneous medium. In two-dimensional analysis, the number of passing points was greater than 90% for all measurements using gamma evaluation criteria of 3 mm distance to agreement and 3% dose difference of local dose. Conclusions The novel brachytherapy applicator met the necessary requirements in quality control tests.
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He C, Zhang S, Shi L. Three-Dimensionally-Precise Breast Conformal Device for IMRT in Breast Cancer Patients Treated With Breast-Conserving Surgery-A Pilot Randomized Controlled Trial. Technol Cancer Res Treat 2020; 19:1533033820971563. [PMID: 33174525 PMCID: PMC7672753 DOI: 10.1177/1533033820971563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/05/2020] [Accepted: 09/30/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To examine the accuracy and efficiency of breast radiotherapy after breast-conserving surgery of a novel 3-dimensional (3D) printing tissue compensator technology, the 3D-precise breast conformer, compared with a usual compensator and an unstructured compensator. METHODS This novel device is patented in China (patent No.: ZL2015 2 0259472.9). Thirty patients with breast cancer after breast-conserving surgery were randomly divided into 2 control groups (no compensator, NST group, and usual compensator, ST group) and 1 study group (3D-precise breast conformer, 3D-BCT group) (n = 10/group). Before radiotherapy, all patients were scanned in the same CT positioning conditions to prepare the treatment plans. RESULTS The 3D-BCT showed the best homogeneity index (HI) (0.08 ± 0.03) and conformity index (CI) (0.95 ± 0.03), while the NST group showed the worst HI (0.34 ± 0.07) and CI (0.78 ± 0.06), with the ST group between the 2 (HI: 0.15 ± 0.05; CI: 0.87 ± 0.04) (all P < 0.01). The common tissue compensation membrane could lead to 95-100% of the prescription dose covering 85-95% of the target volume, and the uniformity and conformability of the target dose were improved overall compared with the NST group. In the 3D-BCT group, 100% of the prescription dose covered the target volume of 95-100%. CONCLUSION The 3D-precision breast conformal device had the highest individualization, uniformity, and conformity. The V95, V98, CI, and HI of PTV were optimal in the 3D-BCT group, and an ideal isodose curve distribution of the breast and clavicle upper and lower target areas was achieved. This device could improve the surface dose and the efficacy of radiotherapy after breast-conserving surgery.
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Affiliation(s)
- Chunbo He
- Department of Radiation Oncology, The Fourth Hospital, Harbin Medical University, Harbin, China
| | - Shilin Zhang
- Department of Radiation Oncology, The Fourth Hospital, Harbin Medical University, Harbin, China
| | - Lei Shi
- Department of Radiation Oncology, The Fourth Hospital, Harbin Medical University, Harbin, China
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PLA as a suitable 3D printing thermoplastic for use in external beam radiotherapy. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2019; 42:1165-1176. [DOI: 10.1007/s13246-019-00818-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 11/05/2019] [Indexed: 11/26/2022]
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Ryu D, Kim JI, Lee S, Ye SJ, Park JM. Remote afterloading patient-specific brachytherapy with liquid radioisotope for irradiation of extensive scalp lesions: A Monte Carlo study. Med Phys 2019; 46:3227-3234. [PMID: 31049969 DOI: 10.1002/mp.13561] [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: 11/25/2018] [Revised: 03/15/2019] [Accepted: 04/25/2019] [Indexed: 11/11/2022] Open
Abstract
PURPOSE The aim of this study is to propose a remote afterloading patient-specific brachytherapy technique for total scalp irradiation by utilizing liquid radioisotope as well as a three-dimensional (3D) printer and to find an optimal radioisotope for the suggested technique. METHODS We designed a brachytherapy device composed of liquid radioisotope tank, tube, patient-specific applicator, and a thin flexible pouch. The liquid radioisotope tank, tube, and the flexible pouch are interconnected one another to constitute a closed loop system. The pouch is located inside the solid patient-specific applicator; therefore, when the liquid radioisotope is injected into the pouch, the pouch is inflated and fills the space inside the applicator. The 3D-printed patient-specific applicator keeps the uniform thickness of the liquid radioisotope conforming patient's contour. To investigate an optimum condition for the suggested system, we performed Monte Carlo simulation with the GEANT4 simulation toolkit. To find the optimal radioisotope, percent depth doses (PDDs) of P-32, Sr-89, Y-90, and I-125 solutions were acquired in a rectangular parallelepiped phantom. For the selected radiation source, PDDs as well as dose rates in spherical phantoms with radii of 7.7 cm (infant head size) and 9.1 cm (adult head size) were acquired. RESULTS To deliver prescription doses at 4-mm depth regions (scalp region), 1-mm-thick Y-90 and 5-mm-thick I-125 in liquid form were found to be feasible for the suggested technique. For both spherical phantoms with radii of 7.7 and 9.1 cm, when delivering 2 Gy at the 4-mm depth region with the 1-mm-thick Y-90 and 5-mm-thick I-125 sources, 53.3 and 3.8 Gy were delivered at the surface regions, respectively (delivery time = 111.1 and 3.5 min with 1 GBq/ml solutions). The PDDs of Y-90 and I-125 became less than 1% at depths greater than 8 and 50 mm, respectively. CONCLUSIONS The remote afterloading patient-patient specific brachytherapy with I-125 or Y-90 in liquid form seems feasible for total scalp irradiation.
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Affiliation(s)
- Dongmin Ryu
- Program in Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Seoul National University Graduate School of Convergence Science and Technology, Seoul, 16229, Republic of Korea
| | - Jung-In Kim
- 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
| | - Sangmin Lee
- Program in Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Seoul National University Graduate School of Convergence Science and Technology, Seoul, 16229, Republic of Korea
| | - Sung-Joon Ye
- Program in Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Seoul National University Graduate School of Convergence Science and Technology, Seoul, 16229, Republic of Korea
| | - Jong Min Park
- 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.,Robotics Research Laboratory for Extreme Environments, Advanced Institutes of Convergence Technology, Suwon, 16229, Republic of Korea
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Park JM, Son J, An HJ, Kim JH, Wu HG, Kim JI. Bio-compatible patient-specific elastic bolus for clinical implementation. ACTA ACUST UNITED AC 2019; 64:105006. [DOI: 10.1088/1361-6560/ab1c93] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kong Y, Yan T, Sun Y, Qian J, Zhou G, Cai S, Tian Y. A dosimetric study on the use of 3D-printed customized boluses in photon therapy: A hydrogel and silica gel study. J Appl Clin Med Phys 2019; 20:348-355. [PMID: 30402935 PMCID: PMC6333182 DOI: 10.1002/acm2.12489] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/29/2018] [Accepted: 09/24/2018] [Indexed: 12/26/2022] Open
Abstract
PURPOSE The aim of the study was to compare the dose differences between two kinds of materials (silica gel and hydrogel) used to prepare boluses based on three-dimensional (3D) printing technologies and commercial bolus in head phantoms simulating nose, ear, and parotid gland radiotherapy. METHODS AND MATERIALS We used 3D printing technology to make silica gel and hydrogel boluses. To evaluate the clinical feasibility, intensity modulated radiation therapy (IMRT) plans were created for head phantoms that were bolus-free or had a commercial bolus, a silica gel bolus, or a hydrogel bolus. Dosimetry differences were compared in simulating nose, ear, and parotid gland radiotherapy separately. RESULTS The air gaps were smaller in the silica gel and hydrogel bolus than the commercial one. In nose plans, it was shown that the V95% (relative volume that is covered by at least 95% of the prescription dose) of the silica gel (99.86%) and hydrogel (99.95%) bolus were better than the commercial one (98.39%) and bolus-free (87.52%). Similarly, the homogeneity index (HI) and conformity index (CI) of the silica gel (0.06; 0.79) and hydrogel (0.058; 0.80) bolus were better than the commercial one (0.094; 0.72) and bolus-free (0.59; 0.53). The parameters of results (HI, CI, V95% ) were also better in 3D printing boluses than in the commercial bolus or without bolus in ear and parotid plans. CONCLUSIONS Silica gel and hydrogel boluses were not only good for fit and a high level of comfort and repeatability, but also had better parameters in IMRT plans. They could replace the commercial bolus for clinical use.
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Affiliation(s)
- Yuehong Kong
- Department of Radiotherapy and OncologyThe Second Affiliated Hospital of Soochow UniversitySuzhouChina
- Institute of Radiotherapy and OncologySoochow UniversitySuzhouChina
| | - Tengfei Yan
- Department of Radiotherapy and OncologyThe Second Affiliated Hospital of Soochow UniversitySuzhouChina
- Institute of Radiotherapy and OncologySoochow UniversitySuzhouChina
| | - Yanze Sun
- Department of Radiotherapy and OncologyThe Second Affiliated Hospital of Soochow UniversitySuzhouChina
- Institute of Radiotherapy and OncologySoochow UniversitySuzhouChina
| | - Jianjun Qian
- Department of Radiotherapy and OncologyThe Second Affiliated Hospital of Soochow UniversitySuzhouChina
- Institute of Radiotherapy and OncologySoochow UniversitySuzhouChina
| | - Gang Zhou
- Department of Radiotherapy and OncologyThe Second Affiliated Hospital of Soochow UniversitySuzhouChina
- Institute of Radiotherapy and OncologySoochow UniversitySuzhouChina
| | - Shang Cai
- Department of Radiotherapy and OncologyThe Second Affiliated Hospital of Soochow UniversitySuzhouChina
- Institute of Radiotherapy and OncologySoochow UniversitySuzhouChina
| | - Ye Tian
- Department of Radiotherapy and OncologyThe Second Affiliated Hospital of Soochow UniversitySuzhouChina
- Institute of Radiotherapy and OncologySoochow UniversitySuzhouChina
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An HJ, Kim MS, Kim J, Son J, Choi CH, Park JM, Kim JI. Geometric Evaluation of Patient-Specific 3D Bolus from 3D Printed Mold and Casting Method for Radiation Therapy. ACTA ACUST UNITED AC 2019. [DOI: 10.14316/pmp.2019.30.1.32] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Hyun Joon An
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Myeong Soo Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Jiseong Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Jaeman Son
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Chang Heon Choi
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Jong Min Park
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
- Robotics Research Laboratory for Extreme Environments, Advanced Institutes of Convergence Technology, Suwon, Korea
| | - Jung-in Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
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Park SY, Kang S, Park JM, An HJ, Oh DH, Kim JI. Development and dosimetric assessment of a patient-specific elastic skin applicator for high-dose-rate brachytherapy. Brachytherapy 2018; 18:224-232. [PMID: 30528742 DOI: 10.1016/j.brachy.2018.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/01/2018] [Accepted: 11/05/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE The purpose of this study was to develop a patient-specific elastic skin applicator and to evaluate its dosimetric characteristics for high-dose-rate (HDR) brachytherapy. METHODS AND MATERIALS We simulated the treatment of a nonmelanoma skin cancer on the nose. An elastic skin applicator was manufactured by pouring the Dragon Skin (Smooth-On Inc., Easton, PA) with a shore hardness of 10A into an applicator mold. The rigid skin applicator was printed using high-impact polystyrene with a shore hardness of 73D. HDR plans were generated using a Freiburg Flap (FF) applicator and patient-specific rigid and elastic applicators. For dosimetric assessment, dose-volumetric parameters for target volume and normal organs were evaluated. Global gamma evaluations were performed, comparing film measurements and treatment planning system calculations with various gamma criteria. The 10% low-dose threshold was applied. RESULTS The V120% values of the target volume were 56.9%, 70.3%, and 70.2% for HDR plans using FF, rigid, and elastic applicators, respectively. The maximum doses of the right eyeball were 21.7 Gy, 20.5 Gy, and 20.5 Gy for the HDR plans using FF, rigid, and elastic applicators, respectively. The average gamma passing rates were 82.5% ± 1.5%, 91.6% ± 0.8%, and 94.8% ± 0.2% for FF, rigid, and elastic applicators, respectively, with 3%/3 mm criterion. CONCLUSIONS Patient-specific elastic skin applicator showed better adhesion to irregular or curved body surfaces, resulting in better agreement between planned and delivered dose distributions. The applicator suggested in this study can be effectively implemented clinically.
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Affiliation(s)
- So-Yeon Park
- Department of Radiation Oncology, Veterans Health Service Medical Center, Seoul, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Seonghee Kang
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Jong Min Park
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea; Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea; Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; Center for Convergence Research on Robotics, Advance Institutes of Convergence Technology, Suwon, Republic of Korea
| | - Hyun Joon An
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Do Hoon Oh
- Department of Radiation Oncology, Myongji Hospital, Goyang, Republic of Korea
| | - Jung-In Kim
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea; Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea; Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Chepelev L, Wake N, Ryan J, Althobaity W, Gupta A, Arribas E, Santiago L, Ballard DH, Wang KC, Weadock W, Ionita CN, Mitsouras D, Morris J, Matsumoto J, Christensen A, Liacouras P, Rybicki FJ, Sheikh A. Radiological Society of North America (RSNA) 3D printing Special Interest Group (SIG): guidelines for medical 3D printing and appropriateness for clinical scenarios. 3D Print Med 2018; 4:11. [PMID: 30649688 PMCID: PMC6251945 DOI: 10.1186/s41205-018-0030-y] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 09/19/2018] [Indexed: 02/08/2023] Open
Abstract
Medical three-dimensional (3D) printing has expanded dramatically over the past three decades with growth in both facility adoption and the variety of medical applications. Consideration for each step required to create accurate 3D printed models from medical imaging data impacts patient care and management. In this paper, a writing group representing the Radiological Society of North America Special Interest Group on 3D Printing (SIG) provides recommendations that have been vetted and voted on by the SIG active membership. This body of work includes appropriate clinical use of anatomic models 3D printed for diagnostic use in the care of patients with specific medical conditions. The recommendations provide guidance for approaches and tools in medical 3D printing, from image acquisition, segmentation of the desired anatomy intended for 3D printing, creation of a 3D-printable model, and post-processing of 3D printed anatomic models for patient care.
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Affiliation(s)
- Leonid Chepelev
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Nicole Wake
- Center for Advanced Imaging Innovation and Research (CAI2R), Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU School of Medicine, New York, NY USA
- Sackler Institute of Graduate Biomedical Sciences, NYU School of Medicine, New York, NY USA
| | | | - Waleed Althobaity
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Ashish Gupta
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Elsa Arribas
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Lumarie Santiago
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO USA
| | - Kenneth C Wang
- Baltimore VA Medical Center, University of Maryland Medical Center, Baltimore, MD USA
| | - William Weadock
- Department of Radiology and Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI USA
| | - Ciprian N Ionita
- Department of Neurosurgery, State University of New York Buffalo, Buffalo, NY USA
| | - Dimitrios Mitsouras
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | | | | | - Andy Christensen
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Peter Liacouras
- 3D Medical Applications Center, Walter Reed National Military Medical Center, Washington, DC, USA
| | - Frank J Rybicki
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Adnan Sheikh
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
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Diamantopoulos S, Kantemiris I, Patatoukas G, Dilvoi M, Efstathopoulos E, Kouloulias V, Platoni K. Theoretical and experimental determination of scaling factors in electron dosimetry for 3D-printed polylactic acid. Med Phys 2018; 45:1708-1714. [DOI: 10.1002/mp.12790] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 12/28/2017] [Accepted: 01/16/2018] [Indexed: 11/11/2022] Open
Affiliation(s)
- Stefanos Diamantopoulos
- 2nd Department of Radiology; University General Hospital “Attikon”; National and Kapodistrian University of Athens; 1 Rimini Street 12462 Chaidari Greece
- Medical Physics Department; Metropolitan Hospital; 9 Ethnarchou Makariou & 1 E. Venizelou Streets 18547 Neo Faliro Greece
| | - Ioannis Kantemiris
- Medical Physics Department; Metropolitan Hospital; 9 Ethnarchou Makariou & 1 E. Venizelou Streets 18547 Neo Faliro Greece
| | - Georgios Patatoukas
- 2nd Department of Radiology; University General Hospital “Attikon”; National and Kapodistrian University of Athens; 1 Rimini Street 12462 Chaidari Greece
| | - Maria Dilvoi
- 2nd Department of Radiology; University General Hospital “Attikon”; National and Kapodistrian University of Athens; 1 Rimini Street 12462 Chaidari Greece
| | - Efstathios Efstathopoulos
- 2nd Department of Radiology; University General Hospital “Attikon”; National and Kapodistrian University of Athens; 1 Rimini Street 12462 Chaidari Greece
| | - Vassilis Kouloulias
- 2nd Department of Radiology; University General Hospital “Attikon”; National and Kapodistrian University of Athens; 1 Rimini Street 12462 Chaidari Greece
| | - Kalliopi Platoni
- 2nd Department of Radiology; University General Hospital “Attikon”; National and Kapodistrian University of Athens; 1 Rimini Street 12462 Chaidari Greece
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Robar JL, Moran K, Allan J, Clancey J, Joseph T, Chytyk-Praznik K, MacDonald RL, Lincoln J, Sadeghi P, Rutledge R. Intrapatient study comparing 3D printed bolus versus standard vinyl gel sheet bolus for postmastectomy chest wall radiation therapy. Pract Radiat Oncol 2017; 8:221-229. [PMID: 29452866 DOI: 10.1016/j.prro.2017.12.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/11/2017] [Accepted: 12/20/2017] [Indexed: 11/16/2022]
Abstract
PURPOSE This patient study evaluated the use of 3-dimensional (3D) printed bolus for chest wall radiation therapy compared with standard sheet bolus with regard to accuracy of fit, surface dose measured in vivo, and efficiency of patient setup. By alternating bolus type over the course of therapy, each patient served as her own control. METHODS AND MATERIALS For 16 patients undergoing chest wall radiation therapy, a custom 5.0 mm thick bolus was designed based on the treatment planning computed tomography scan and 3D printed using polylactic acid. Cone beam computed tomography scanning was used to image and quantify the accuracy of fit of the 2 bolus types with regard to air gaps between the bolus and skin. As a quality assurance measure for the 3D printed bolus, optically stimulated luminescent dosimetry provided in vivo comparison of surface dose at 7 points on the chest wall. Durations of patient setup and image guidance were recorded and compared. RESULTS In 13 of 16 patients, the bolus was printed without user intervention, and the median print time was 12.6 hours. The accuracy of fit of the bolus to the chest wall was improved significantly relative to standard sheet bolus, with the frequency of air gaps 5 mm or greater reduced from 30% to 13% (P < .001) and maximum air gap dimension diminished from 0.5 ± 0.3 to 0.3 ± 0.3 mm on average. Surface dose was within 3% for both standard sheet and 3D printed bolus. On average, the use of 3D printed bolus reduced the setup time from 104 to 76 seconds. CONCLUSIONS This study demonstrates 3D printed bolus in postmastectomy radiation therapy improves fit of the bolus and reduces patient setup time marginally compared with standard vinyl gel sheet bolus. The time savings on patient setup must be weighed against the considerable time needed for the 3D printing process.
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Affiliation(s)
- James L Robar
- Department of Radiation Oncology, Dalhousie University, Halifax, Canada; Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Canada; Nova Scotia Health Authority, Halifax, Canada.
| | | | - James Allan
- Nova Scotia Health Authority, Halifax, Canada
| | | | - Tami Joseph
- Nova Scotia Health Authority, Halifax, Canada
| | - Krista Chytyk-Praznik
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Canada; Nova Scotia Health Authority, Halifax, Canada
| | - R Lee MacDonald
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Canada
| | - John Lincoln
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Canada
| | - Parisa Sadeghi
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Canada
| | - Robert Rutledge
- Department of Radiation Oncology, Dalhousie University, Halifax, Canada; Nova Scotia Health Authority, Halifax, Canada
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Ricotti R, Ciardo D, Pansini F, Bazani A, Comi S, Spoto R, Noris S, Cattani F, Baroni G, Orecchia R, Vavassori A, Jereczek-Fossa BA. Dosimetric characterization of 3D printed bolus at different infill percentage for external photon beam radiotherapy. Phys Med 2017; 39:25-32. [PMID: 28711185 DOI: 10.1016/j.ejmp.2017.06.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/09/2017] [Accepted: 06/09/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE 3D printing is rapidly evolving and further assessment of materials and technique is required for clinical applications. We evaluated 3D printed boluses with acrylonitrile butadiene styrene (ABS) and polylactide (PLA) at different infill percentage. MATERIAL AND METHODS A low-cost 3D printer was used. The influence of the air inclusion within the 3D printed boluses was assessed thoroughly both with treatment planning system (TPS) and with physical measurements. For each bolus, two treatment plans were calculated with Monte Carlo algorithm, considering the computed tomography (CT) scan of the 3D printed bolus or modelling the 3D printed bolus as a virtual bolus structure with a homogeneous density. Depth dose measurements were performed with Gafchromic films. RESULTS High infill percentage corresponds to high density and high homogeneity within bolus material. The approximation of the bolus in the TPS as a homogeneous material is satisfying for infill percentages greater than 20%. Measurements performed with PLA boluses are more comparable to the TPS calculated profiles. For boluses printed at 40% and 60% infill, the discrepancies between calculated and measured dose distribution are within 5%. CONCLUSIONS 3D printing technology allows modulating the shift of the build-up region by tuning the infill percentage of the 3D printed bolus in order to improve superficial target coverage.
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Affiliation(s)
- Rosalinda Ricotti
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Delia Ciardo
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy.
| | - Floriana Pansini
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Alessia Bazani
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Stefania Comi
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Ruggero Spoto
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Samuele Noris
- Corso di Laurea in Tecniche di radiologia medica, per immagini e radioterapia, University of Milan, Milan, Italy
| | - Federica Cattani
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Guido Baroni
- Dipartimento di Elettronica Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy; Bioengineering Unit, Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | - Roberto Orecchia
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Department of Medical Imaging and Radiation Sciences, European Institute of Oncology, Milan, Italy
| | - Andrea Vavassori
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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