Intrapatient study comparing 3D printed bolus versus standard vinyl gel sheet bolus for postmastectomy chest wall radiation therapy

Robar, James L.; Moran, Kathryn; Allan, James; Clancey, James; Joseph, Tami; Chytyk-Praznik, Krista; MacDonald, R. Lee; Lincoln, John; Sadeghi, Parisa; Rutledge, Robert

doi:10.1016/j.prro.2017.12.008

Cited by 52 publications

(56 citation statements)

References 30 publications

(36 reference statements)

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“…This methodology is easily applicable to photon beam therapy, with and without immobilization masks. In photon beam radiotherapy the bolus thickness can often be decided before the CT scan [ 3 ] and a 5 mm thick bolus is generally sufficient to obtain a good coverage of superficial target using intensity modulated treatments. In fact, targets in these irradiation techniques are generally cropped at 5 mm under the skin surface to prevent dosimetric optimization problems, as discussed by Verbakel et al [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…With the arrival and still maturing technology of three-dimensional printing, some studies have already tested and applied the concept of 3D-printed boluses [ 2 , 3 ], to optimize treatment preparation time and reduce overall costs [ 2 ]. Applications of patient-specific 3D-printed bolus are also investigated for range shifter air gap reduction in intensity-modulated proton therapy [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Improving 3D-printing of megavoltage X-rays radiotherapy bolus with surface-scanner

et al. 2018

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BackgroundComputed tomography (CT) data used for patient radiotherapy planning can nowadays be used to create 3D-printed boluses. Nevertheless, this methodology requires a second CT scan and planning process when immobilization masks are used in order to fit the bolus under it for treatment.This study investigates the use of a high-grade surface-scanner to produce, prior to the planning CT scan, a 3D-printed bolus in order to increase the workflow efficiency, improve treatment quality and avoid extra radiation dose to the patient.MethodsThe scanner capabilities were tested on a phantom and on volunteers. A phantom was used to produce boluses in the orbital region either from CT data (resolution ≈1 mm), or from surface-scanner images (resolution 0.05 mm). Several 3D-printing techniques and materials were tested. To quantify which boluses fit best, they were placed on the phantom and scanned by CT. Hounsfield Unit (HU) profiles were traced perpendicular to the phantom’s surface. The minimum HU in the profiles was compared to the HU values for calibrated air-gaps. Boluses were then created from surface images of volunteers to verify the feasibility of surface-scanner use in-vivo.ResultsPhantom based tests showed a better fit of boluses modeled from surface-scanner than from CT data. Maximum bolus-to-skin air gaps were 1-2 mm using CT models and always < 0.6 mm using surface-scanner models. Tests on volunteers showed good and comfortable fit of boluses produced from surface-scanner images acquired in 0.6 to 7 min. Even in complex surface regions of the body such as ears and fingers, the high-resolution surface-scanner was able to acquire good models. A breast bolus model generated from images acquired in deep inspiration breath hold was also successful. None of the 3D-printed bolus using surface-scanner models required enlarging or shrinking of the initial model acquired in-vivo.ConclusionsRegardless of the material or printing technique, 3D-printed boluses created from high-resolution surface-scanner images proved to be superior in fitting compared to boluses created from CT data. Tests on volunteers were promising, indicating the possibility to improve overall radiotherapy treatments, primarily for megavoltage X-rays, using bolus modeled from a high-resolution surface-scanner even in regions of complex surface anatomy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Improving 3D-printing of megavoltage X-rays radiotherapy bolus with surface-scanner

et al. 2018

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“…There is a growing interest in the application of three-dimensional (3D) printing to the RT process. The majority of studies focus on the creation of boluses [8,9], masks [10,11], and phantoms for quality assurance [12,13]. Their clinical use in HNC RT is still under investigation.…”

Section: Introductionmentioning

confidence: 99%

Three-Dimensional Printed Silicone Bite Blocks for Radiotherapy of Head and Neck Cancer—A Preliminary Study

et al. 2020

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Conventional methods that have been developed to immobilize the mouth and tongue for radiotherapy (RT) in head and neck cancer (HNC) treatment have been unsatisfactory. We, therefore, developed three-dimensional (3D), customizable, silicone bite blocks and examined their clinical feasibility. For HNC patients, before RT, the 3D printed bite blocks were fabricated based on primary computed tomography (CT) simulation images. The placement of the 3D bite blocks was followed by a secondary CT simulation before RT planning was finalized. Dosimetric parameters and positioning verification achieved with the propose bite blocks were compared with conventional universal oral corks. The 3D printed bite blocks were conformal to the occlusal surface, ensuring immobilization of the tongue without eliciting a gag reflex, and an elastic and firm texture that supports opening of the mouth, with a smooth surface with tolerable intraoral tactility. The dosimetry of patients using the proposed bite blocks showed better coverage of the planning target volume and surface of a tumour bed along with reduction in normal tissue doses. Good concordance of positioning by 3D printed bite blocks during the RT course was verified. The 3D printed bite blocks with silicone might be a customizable, safe, and practical advanced technology in RT for HNC.

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“…In the literature this technology has been used to fabricate compensators for TBI, brachytherapy applicators, range compensators for proton therapy, and phantoms for quality assurance . Various investigators have utilized 3D printing for bolus fabrication for megavoltage photon and electron treatments as well, but only a few describe a full case series …”

Section: Introductionmentioning

confidence: 99%

A modern mold room: Meshing 3D surface scanning, digital design, and 3D printing with bolus fabrication

Sasaki

McGeachy²,

Aviles

et al. 2019

J Applied Clin Med Phys

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Purpose This case series represents an initial experience with implementing 3‐dimensional (3D) surface scanning, digital design, and 3D printing for bolus fabrication for patients with complex surface anatomy where traditional approaches are challenging. Methods and Materials For 10 patients requiring bolus in regions with complex contours, bolus was designed digitally from 3D surface scanning data or computed tomography (CT) images using either a treatment planning system or mesh editing software. Boluses were printed using a fused deposition modeling printer with polylactic acid. Quality assurance tests were performed for each printed bolus to verify density and shape. Results For 9 of 10 patients, digitally designed boluses were used for treatment with no issues. In 1 case, the bolus was not used because dosimetric requirements were met without the bolus. QA tests revealed that the bulk density was within 3% of the reference value for 9 of 12 prints, and with more judicious selection of print settings this could be increased. For these 9 prints, density uniformity was as good as or better than our traditional sheet bolus material. The average shape error of the pieces was less than 0.5 mm, and no issues with fit or comfort were encountered during use. Conclusions This study demonstrates that new technologies such as 3D surface scanning, digital design and 3D printing can be safely and effectively used to modernize bolus fabrication.

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Intrapatient study comparing 3D printed bolus versus standard vinyl gel sheet bolus for postmastectomy chest wall radiation therapy

Cited by 52 publications

References 30 publications

Improving 3D-printing of megavoltage X-rays radiotherapy bolus with surface-scanner

Improving 3D-printing of megavoltage X-rays radiotherapy bolus with surface-scanner

Three-Dimensional Printed Silicone Bite Blocks for Radiotherapy of Head and Neck Cancer—A Preliminary Study

A modern mold room: Meshing 3D surface scanning, digital design, and 3D printing with bolus fabrication

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