Clinical implementation of 3D printing in the construction of patient specific bolus for electron beam radiotherapy for non-melanoma skin cancer

Canters, R.; Lips, Irene M.; Wendling, M.; Kusters, Martijn; Zeeland, Marianne van; Gerritsen, Rianne M. J. P.; Poortmans, Philip; Verhoef, C.

doi:10.1016/j.radonc.2016.07.011

Cited by 112 publications

(118 citation statements)

References 14 publications

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“…The 100% shells with water came closest to matching the reference RED of the VB, with in‐house studies post‐completion of this project demonstrating a PLA print with 93.5% solid construction equivalent to a RED of 1.0 . Dosimetric analyses in the literature agree with our findings . A comparison of commercial superflab to 3D printed bolus found no significant difference (<1%) when measured with gafchromic film …”

Section: Discussionsupporting

confidence: 90%

“…The finding of our cost analysis is in line with those of Arenas et al who demonstrated reduced labour and material costs for 3D printed bolus compared to traditional bolus . Similarly, a reduction in RT staff time of 4 hours was reported by Canter et al As the printer does not require active monitoring, staff can set the printer to run overnight or complete other tasks during the print time, thereby improving staff cost‐effectiveness. Where experienced traditional mould room skills are lacking in a department, 3D printing provides for excellence in a consistent product that can be achieved through very little real‐time training.…”

Section: Discussionsupporting

confidence: 89%

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Comparison of 3D printed nose bolus to traditional wax bolus for cost‐effectiveness, volumetric accuracy and dosimetric effect

Albantow

Hargrave

Brown

et al. 2020

J of Medical Radiation Sci

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Introduction Three‐dimensional printing technology has the potential to streamline custom bolus production in radiotherapy. This study evaluates the volumetric, dosimetric and cost differences between traditional wax and 3D printed versions of nose bolus. Method Nose plaster impressions from 24 volunteers were CT scanned and planned. Planned virtual bolus was manufactured in wax and created in 3D print (100% and 18% shell infill density) for comparison. To compare volume variations and dosimetry, each constructed bolus was CT scanned and a plan replicating the reference plan fields generated. Bolus manufacture time and material costs were analysed. Results Mean volume differences between the virtual bolus (VB) and wax, and the VB and 18% and 100% 3D shells were −3.05 ± 11.06 cm3, −1.03 ± 8.09 cm3 and 1.31 ± 2.63 cm3, respectively. While there was no significant difference for the point and mean doses between the 100% 3D shell filled with water and the VB plans (P> 0.05), the intraclass coefficients for these dose metrics for the 100% 3D shell filled with wax compared to VB doses (0.69–0.96) were higher than those for the 18% and 100% 3D shell filled with water and the wax (0.48–0.88). Average costs for staff time and materials were higher for the wax ($138.54 and $20.49, respectively) compared with the 3D shell prints ($10.58 and $13.87, respectively). Conclusion Three‐dimensional printed bolus replicated the VB geometry with less cost for manufacture than wax bolus. When shells are printed with 100% infill density, 3D bolus dosimetrically replicates the reference plan.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 89%

Comparison of 3D printed nose bolus to traditional wax bolus for cost‐effectiveness, volumetric accuracy and dosimetric effect

Albantow

Hargrave

Brown

et al. 2020

J of Medical Radiation Sci

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“…Both materials are nearly identical in price and printing speed, and both have similar radiological properties to water 1, 5, 10. However, ABS warps considerably more than PLA which makes it extremely difficult to use for large objects printed at 100% infill 5, 12. PLA was chosen primarily for its superior warping characteristics.…”

Section: Methodsmentioning

confidence: 99%

Preparation and fabrication of a full‐scale, sagittal‐sliced, 3D‐printed, patient‐specific radiotherapy phantom

Craft

Howell

2017

J Applied Clin Med Phys

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PurposePatient‐specific 3D‐printed phantoms have many potential applications, both research and clinical. However, they have been limited in size and complexity because of the small size of most commercially available 3D printers as well as material warping concerns. We aimed to overcome these limitations by developing and testing an effective 3D printing workflow to fabricate a large patient‐specific radiotherapy phantom with minimal warping errors. In doing so, we produced a full‐scale phantom of a real postmastectomy patient.MethodsWe converted a patient's clinical CT DICOM data into a 3D model and then sliced the model into eleven 2.5‐cm‐thick sagittal slices. The slices were printed with a readily available thermoplastic material representing all body tissues at 100% infill, but with air cavities left open. Each slice was printed on an inexpensive and commercially available 3D printer. Once the printing was completed, the slices were placed together for imaging and verification. The original patient CT scan and the assembled phantom CT scan were registered together to assess overall accuracy.ResultsThe materials for the completed phantom cost $524. The printed phantom agreed well with both its design and the actual patient. Individual slices differed from their designs by approximately 2%. Registered CT images of the assembled phantom and original patient showed excellent agreement.ConclusionsThree‐dimensional printing the patient‐specific phantom in sagittal slices allowed a large phantom to be fabricated with high accuracy. Our results demonstrate that our 3D printing workflow can be used to make large, accurate, patient‐specific phantoms at 100% infill with minimal material warping error.

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“…The proposed workflow allows for the production of aperture cut‐outs without dedicated foam cutting equipment and without dedicated foam material, both of which may represent a significant cost in terms of monetary or storage resources. Instead, a single, relatively inexpensive and versatile 3D printer with a single raw material can be used to create a wide range of patient‐specific treatment auxiliaries besides the molds for aperture cut‐out production, such as individualized bolus,11 dosimetry phantoms,12 and immobilization 13. In addition, the proposed workflow allows for introduction of a number of measures to enhance safety and quality in the aperture production process, including patient identification and accurate, error‐free alignment during casting.…”

Section: Discussionmentioning

confidence: 99%

“…An increasing number of radiation oncology centers have a 3D printer available on‐site, for instance to create individualized bolus,11 dosimetry phantoms12 and immobilization 13. 3D printing likewise allows to produce the molds for the production of patient‐specific aperture cut‐outs.…”

Section: Introductionmentioning

confidence: 99%

Production of patient‐specific electron beam aperture cut‐outs using a low‐cost, multi‐purpose 3D printer

Michiels

Mangelschots

Roover

et al. 2018

J Applied Clin Med Phys

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Electron beam collimators for non‐standard field sizes and shapes are typically fabricated using Styrofoam molds to cast the aperture cut‐out. These molds are often produced using a dedicated foam cutter, which may be expensive and only serves a single purpose. An increasing number of radiotherapy departments, however, has a 3D printer on‐site, to create a wide range of custom‐made treatment auxiliaries, such as bolus and dosimetry phantoms. The 3D printer can also be used to produce patient‐specific aperture cut‐outs, as elaborated in this note. Open‐source programming language was used to automatically generate the mold's shape in a generic digital file format readable by 3D printer software. The geometric mold model has the patient's identification number integrated and is to be mounted on a uniquely fitting, reusable positioning device, which can be 3D printed as well. This assembly likewise fits uniquely onto the applicator tray, ensuring correct and error‐free alignment of the mold during casting of the aperture. For dosimetric verification, two aperture cut‐outs were cast, one using a conventionally cut Styrofoam mold and one using a 3D printed mold. Using these cut‐outs, the clinical plan was delivered onto a phantom, for which the transversal dose distributions were measured at 2 cm depth using radiochromic film and compared using gamma‐index analysis. An agreement score of 99.9% between the measured 2D dose distributions was found in the (10%–80%) dose region, using 1% (local) dose‐difference and 1.0 mm distance‐to‐agreement acceptance criteria. The workflow using 3D printing has been clinically implemented and is in routine use at the author's institute for all patient‐specific electron beam aperture cut‐outs. It allows for a standardized, cost‐effective, and operator‐friendly workflow without the need for dedicated equipment. In addition, it offers possibilities to increase safety and quality of the process including patient identification and methods for accurate mold alignment.

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Clinical implementation of 3D printing in the construction of patient specific bolus for electron beam radiotherapy for non-melanoma skin cancer

Cited by 112 publications

References 14 publications

Comparison of 3D printed nose bolus to traditional wax bolus for cost‐effectiveness, volumetric accuracy and dosimetric effect

Comparison of 3D printed nose bolus to traditional wax bolus for cost‐effectiveness, volumetric accuracy and dosimetric effect

Preparation and fabrication of a full‐scale, sagittal‐sliced, 3D‐printed, patient‐specific radiotherapy phantom

Production of patient‐specific electron beam aperture cut‐outs using a low‐cost, multi‐purpose 3D printer

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