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

Albantow, Christine; Hargrave, Catriona; Brown, Amy; Halsall, Christopher

doi:10.1002/jmrs.378

Cited by 15 publications

(17 citation statements)

References 17 publications

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“…The nose is a common site for non-melanomatous skin cancer. However, there are few studies investigating the application of 3D printing in radiation treatments of nasal cutaneous cancers [ 12 , 13 , 18 , 19 ]. In the present study, we highlight our applications of the optic scanner and 3D printers to create the custom nose block bolus and the clinical outcomes from this novel treatment.…”

Section: Discussionmentioning

confidence: 99%

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Optical scan and 3D printing guided radiation therapy – an application and provincial experience in cutaneous nasal carcinoma

et al. 2022

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Background Single field Orthovoltage radiation is an acceptable modality used for the treatment of nasal cutaneous cancer. However, this technique has dosimetric pitfalls and unnecessary excessive exposure of radiation to organs at risk (OAR). We present the clinical outcome of a case series of cutaneous nasal tumours using a novel technique incorporating an optical scanner and a 3-dimensional (3D) printer to deliver treatments using parallel opposed (POP) fields. Materials and methods The POP delivery method was validated using ion chamber and phantom measurements before implementation. A retrospective chart review of 26 patients treated with this technique between 2015 and 2019 was conducted. Patients’ demographics and treatment outcomes were gathered and tabulated. These patients first underwent an optical scan of their faces to collect topographical data. The data were then transcribed into 3D printing algorithms, and positive impressions of the faces were printed. Custom nose block bolus was made with wax encased in an acrylic shell; 4 cm thick using the printed face models. Custom lead shielding was also generated. Treatments were delivered using 250 KeV photons POP arrangement with 4 cm diameter circle applicator cone and prescribed to the midplane. Dose and fractionation were as per physician discretion. Results Phantom measurements at mid-plane were found to match the prescribed dose within ±0.5%. For the 26 cases in this review, the median age was 78.5 years, with 15 females and 11 males. 85% of cases had Basal cell carcinoma (BCC); 1 had squamous cell carcinoma (SCC), one had synchronous BCC + SCC, and 1 had Merkel cell carcinoma. Twenty-one cases had T1N0 disease, 4 had T2N0, and 1 had T3N0. Dose and fractionation delivered were 40Gy in 10 fractions for the majority of cases. The complete response rate at a median follow-up of 6 months was 88%; 1 patient had a refractory tumour, and one patient had a recurrence. Toxicities were minor with 81% with no reported side effects. Three patients experienced grade 3 skin toxicity. Conclusions Utilization of optic scanner and 3D printing technology, with the innovative approach of using POP orthovoltage beams, allows an effective and efficient way of treatment carcinomas of the nose with a high control rate and low toxicity profiles.

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Section: Discussionmentioning

confidence: 99%

“…The nose is a common site for non-melanomatous skin cancer. However, few studies are investigating the application of 3D printing in radiation treatments of nasal cutaneous cancers [ 12 , 13 , 18 , 19 ]. Furthermore, of the studies available, none used the optical scanners or provided insights on the clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

Optical scan and 3D printing guided radiation therapy – an application and provincial experience in cutaneous nasal carcinoma

et al. 2022

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“…Based on this, Christine Albantow et al compared 24 cases of a 3D-printed nose bolus made of paraffin and PLA. The time cost and average material cost of the paraffin bolus were $138.54 and $20.49, respectively, while the 3D printing bolus costs were only $10.58 and $13.87, respectively, indicating that the 3D-printed bolus was more cost-effective ( 22 ). Although a 3D-printed bolus could significantly reduce labor and material costs, there are still significant differences between different materials and labor ( 20 , 29 , 41 , 44 , 54 ).…”

Section: Clinical Evidencementioning

confidence: 99%

“…The 3D-printed bolus is one of many research advances in 3D printing technology, broadening its prospects (10,20,21). In comparison with the traditional bolus, individualized 3D-printed boluses have many advantages: Firstly, the more uniform thickness reduces ray scattering and avoids hot and cold spots (20,(22)(23)(24). Secondly, the area covered by the 3D-printed bolus is more accurate; reducing unnecessary dose increases to distant organs.…”

Section: Introductionmentioning

confidence: 99%

The Clinical Application of 3D-Printed Boluses in Superficial Tumor Radiotherapy

Wang

Zeng

et al. 2021

Front. Oncol.

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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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“…The image data obtained can then be manipulated to create a 3D virtual model of the region scanned and converted into a format suitable for 3D printing. Research on using a CT scanner to generate 3D printable surface applicators and EBRT bolus has already been extensively studied [1][2][3][4][5][6][7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

A dosimetric comparison of CT- and photogrammetry- generated 3D printed HDR brachytherapy surface applicators

et al. 2022

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In this study, we investigate whether an acceptable dosimetric plan can be obtained for a surface applicator designed using photogrammetry and compare the plan quality to a CT-derived applicator. The nose region of a RANDO anthropomorphic phantom was selected as the treatment site due to its high curvature. Photographs were captured using a Nikon D5600 DSLR camera and reconstructed using Agisoft Metashape while CT data was obtained using a Canon Aquillion scanner. Virtual surface applicators were designed in Blender and printed with ABS plastic. Treatment plans with a prescription dose of 3.85 Gy x 10 fractions with 100 % dose to PTV on the bridge of the nose at 2 mm depth were generated separately using AcurosBV in the Varian BrachyVision TPS. PTV D 98% , D 90% and V 100% , and OAR D 0.1cc , D 2cc and V 50% dose metrics and dwell times were evaluated, with the applicator t assessed by air-gap volume measurements. Both types of surface applicators were printed with minimal defects and visually tted well to the target area. The measured air-gap volume between the photogrammetry applicator and phantom surface was 44 % larger than the CT-designed applicator, with a mean air gap thickness of 3.24 and 2.88 mm, respectively. The largest difference in the dose metric observed for the PTV and OAR was the PTV V 100% of -1.27 % and skin D 0.1cc of -0.28 %. PTV D 98% and D 90% and OAR D 2cc and V 50% for the photogrammetry based plan were all within 0.5 % of the CT based plan. Total dwell times were also within 5 %. A 3D printed surface applicator for the nose was successfully constructed using photogrammetry techniques. Although it produced a larger air gap between the surface applicator and phantom surface, a clinically acceptable dose plan was created with similar PTV and OAR dose metrics to the CT-designed applicator. Additional future work is required to comprehensively evaluate its suitability in a clinically environment.

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

Cited by 15 publications

References 17 publications

Optical scan and 3D printing guided radiation therapy – an application and provincial experience in cutaneous nasal carcinoma

Optical scan and 3D printing guided radiation therapy – an application and provincial experience in cutaneous nasal carcinoma

The Clinical Application of 3D-Printed Boluses in Superficial Tumor Radiotherapy

A dosimetric comparison of CT- and photogrammetry- generated 3D printed HDR brachytherapy surface applicators

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