Individual 3D-printed fixation masks for radiotherapy: first clinical experiences

Mattke, Matthias; Rath, Daniel; Häfner, Matthias; Unterhinninghofen, Roland; Sterzing, Florian; Debus, Jürgen; Giesel, Frederik L.

doi:10.1007/s11548-021-02393-2

Cited by 9 publications

(9 citation statements)

References 22 publications

(31 reference statements)

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“…However, to date there are very few reports on the use of this method in the clinical medicine, especially in radiotherapy. Mattke et al [16] explored the feasibility of 3D-printed fixation masks for whole brain radiation therapy in a clinical setting and performed a first comparison to an established thermoplastic mask system. Six patients were irradiated with whole brain radiotherapy using individually 3D-printed masks.…”

Section: Discussionmentioning

confidence: 99%

Study on the application of 3D printing head film fixation technology in cranial radiotherapy

Guo¹,

Wang²,

Zhang³

et al. 2023

J. Cancer

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Objective: To investigate the use of 3D printing technology to customize individualized precise radiotherapy head masks for cranial radiotherapy patients. Through the comparison with thermoplastic head film, evaluate the effect of this material on deep dose attenuation and body surface dose, and evaluate its positioning accuracy and repeatability for clinical application. Methods: Thirty patients with head and neck radiotherapy were divided into the control group and the experimental group. The control group used the traditional thermoplastic head film fixation technique for body position fixation, and the experimental group used the 3D printing head film fixation technique. The patient setup was verified by kV-CBCT scanning to obtain the translational setup error and rotational setup error in the X, Y, and Z directions. Results: At a depth of 5 cm, both materials have a radiation attenuation rate of <1%. At the surface location, the body surface dose of control group increased by approximately 27%. With a 3D printing head film, the body surface dose increased by approximately 18%. The positioning of two groups of patients was verified by the kV-CBCT, and a total of 232 data sets were obtained. The average translation positioning errors in the X, Y, and Z direction of control group and experimental group were 1.29 mm, 1.42 mm, 1.38 mm and 1.16 mm, 1.24 mm, 1.16 mm, respectively. The average rotation positioning error in the X, Y, and Z direction of control group and experimental group were 1.29°, 1.02°, 1.01° and 1.08°, 0.96°, 1.00°, respectively. The translational setup errors in the Y and Z directions and rotational setup errors in the X direction significantly differed between the control and experimental groups (all p＜0.05), but no statistical significance was found in the other directions (all p>0. 05). Conclusion: Compared to the traditional thermoplastic head membranes, 3D printing head membranes has shown a reliable and reproducible interactional positioning accuracy. Of course, further investigations are needed before the new technology can be used on a regular basis.

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Section: Discussionmentioning

confidence: 99%

Study on the application of 3D printing head film fixation technology in cranial radiotherapy

Guo¹,

Wang²,

Zhang³

et al. 2023

J. Cancer

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“…M. Mattke et al. ( 8 ) also found the fixation accuracy of 3D-printed cephalic masks is lower than that of conventional cephalic fixation. Nonetheless, the fixation accuracy of 3D-printed cephalic masks is within the allowable error range.…”

Section: Introductionmentioning

confidence: 99%

“…Ghazal Shafai-Erfani et al (7) found systematic errors of 1.1, 2.0, and 2.3 mm in the left-right, head-foot, and anterior-posterior directions, respectively, for the headrest plus mask fixation technique. M. Mattke et al (8) found mean positional errors of 0.9, 2.28, and 1.9 mm in the left-right, head-foot, and anteriorposterior directions, respectively, for patients undergoing wholebrain radiotherapy using headrest plus mask fixation. These findings indicate that the accuracy of standard headrest and mask fixation should be improved.…”

Section: Introductionmentioning

confidence: 99%

“…Veronika M. Miron et al (9) fabricated a new comfortable positioning head mask via a 3D printing technique with higher fixation accuracy. M. Mattke et al (8) also found the fixation accuracy of 3D-printed cephalic masks is lower than that of conventional cephalic fixation. Nonetheless, the fixation accuracy of 3D-printed cephalic masks is within the allowable error range.…”

Section: Introductionmentioning

confidence: 99%

“…M. Mattke et al. ( 8 ) found mean positional errors of 0.9, 2.28, and 1.9 mm in the left-right, head-foot, and anterior-posterior directions, respectively, for patients undergoing whole-brain radiotherapy using headrest plus mask fixation. These findings indicate that the accuracy of standard headrest and mask fixation should be improved.…”

Section: Introductionmentioning

confidence: 99%

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Clinical value of styrofoam fixation in intracranial tumor radiotherapy

Bai

et al. 2023

Front. Oncol.

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ObjectiveTo analyze the application value of two postural fixation techniques.(styrofoam combined with head mask and fixed headrest combined with head mask) in intracranial tumor radiotherapy via cone beam computed tomography (CBCT).MethodsThis study included 104 patients with intracranial tumors undergoing radiotherapy. The patients were divided into two groups: Group A (54 cases with styrofoam fixation) and Group B (50 cases with fixed headrest fixation). The positional deviation in 3D space between the two groups was compared using CBCT. The set-up errors were expressed as median (25th percentile, 75th percentile)or M(p25, p75) since the set-up errors in all directions were not normally distributed,The Mann-Whitney U test was performed.ResultsThe age and gender of patients in the two groups were not significantly different. The set-up errors of A in lateral (X), longitudinal (Y), vertical (Z), and yaw(Rtn) axes were 1.0 (0,1) mm, 1.0 (0,1) mm, 1.0 (0,2) mm, and 0.4 (0.1, 0.8) degrees, respectively while the set-up errors of B were 1.0 (0,1) mm, 1.0 (1,2) mm, 1.0 (0,2) mm, and 0.5 (0.15,0.9) degrees, respectively. Moreover, patients in the styrofoam group had significantly smaller set-up errors in the Y-axis than patients in the headrest group (p=0.001). However, set-up errors in the X, Z, and Rtn axes were not significantly different between the two groups. The expansion boundaries of the target area in the X, Y, and Z directions were 1.77 mm, 2.45 mm, and 2.47 mm, respectively. The outer expansion boundaries of the headrest group were 2.03 mm, 3.88 mm, and 2.57 mm in X, Y, and Z directions, respectively. The set-up times of groups A and B were (32.71 ± 5.21) seconds and (46.57 ± 6.68) seconds, respectively (p=0.014). Patients in group A had significantly better comfort satisfaction than patients in group B (p=0.001).ConclusionStyrofoam plus head thermoplastic mask body fixation technique has a higher positional accuracy in intracranial tumor radiotherapy than headrest plus head thermoplastic mask fixation. Besides, styrofoam plus head thermoplastic mask body fixation technique is associated with improved positioning efficiency, and better comfort than headrest plus head thermoplastic mask fixation, and thus can be effectively applied for intracranial tumor radiotherapy positioning.

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Comprehensive clinical implementation, workflow, and FMEA of bespoke silicone bolus cast from 3D printed molds using open‐source resources

Hobbis,

Armstrong,

Patel

et al. 2024

J Applied Clin Med Phys

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BackgroundBolus materials have been used for decades in radiotherapy. Most frequently, these materials are utilized to bring dose closer to the skin surface to cover superficial targets optimally. While cavity filling, such as nasal cavities, is desirable, traditional commercial bolus is lacking, requiring other solutions. Recently, investigators have worked on utilizing 3D printing technology, including commercially available solutions, which can overcome some challenges with traditional bolus.PurposeTo utilize failure modes and effects analysis (FMEA) to successfully implement a comprehensive 3D printed bolus solution to replace commercial bolus in our clinic using a series of open‐source (or free) software products.Methods3D printed molds for bespoke bolus were created by exporting the DICOM structures of the bolus designed in the treatment planning system and manipulated to create a multipart mold for 3D printing. A silicone (Ecoflex 00–30) mixture is poured into the mold and cured to form the bolus. Molds for sheet bolus of five thicknesses were also created. A comprehensive FMEA was performed to guide workflow adjustments and QA steps.ResultsThe process map identified 39 and 30 distinct steps for the bespoke and flat sheet bolus workflows, respectively. The corresponding FMEA highlighted 119 and 86 failure modes, with 69 shared between the processes. Misunderstanding of plan intent was a potential cause for most of the highest‐scoring failure modes, indicating that physics and dosimetry involvement early in the process is paramount.ConclusionFMEA informed the design and implementation of QA steps to guarantee a safe and high‐quality comprehensive implementation of silicone bolus from 3D printed molds. This approach allows for greater adaptability not afforded by traditional bolus, as well as potential dissemination to other clinics due to the open‐source nature of the workflow.

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Individual 3D-printed fixation masks for radiotherapy: first clinical experiences

Cited by 9 publications

References 22 publications

Study on the application of 3D printing head film fixation technology in cranial radiotherapy

Study on the application of 3D printing head film fixation technology in cranial radiotherapy

Clinical value of styrofoam fixation in intracranial tumor radiotherapy

Comprehensive clinical implementation, workflow, and FMEA of bespoke silicone bolus cast from 3D printed molds using open‐source resources

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