Potential of 3D printing technologies for fabrication of electron bolus and proton compensators

Zou, W.; Fisher, Ted; Zhang, Miao; Kim, Leonard; Chen, Ting; Narra, Venkat; Swann, Beth; Singh, Rachana; Siderit, Richard; Yin, Lingshu; Teo, Boon-Keng; McKenna, Michael G.; McDonough, James E.; Ning, Yue J.

doi:10.1120/jacmp.v16i3.4959

Cited by 74 publications

(81 citation statements)

References 24 publications

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“…This has been demonstrated through the use of 3D‐printers in the fabrication of bolus, compensators, and patient‐specific phantoms . Thus far, most 3D‐printed boluses have been used for small and/or relatively flat treatment sites, such as the nose, ear, eye canthi, and foot surface . Additionally, most 3D‐printed bolus has used standard, rigid thermoplastic materials, including polylactic acid and acrylonitrile butadiene styrene.…”

Section: Introductionmentioning

confidence: 99%

Development and validation of a 3D‐printed bolus cap for total scalp irradiation

Baltz

Melinda

Wong

et al. 2019

J Applied Clin Med Phys

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Purpose The goal of total scalp irradiation (TSI) is to deliver a uniform dose to the scalp, which requires the use of a bolus cap. Most current methods for fabricating bolus caps are laborious, yet still result in nonconformity and low reproducibility, which can lead to nonuniform irradiation of the scalp. We developed and validated patient‐specific bolus caps for TSI using three‐dimensional (3D) printing. Methods and materials 3D‐printing materials were radiologically analyzed to identify a material with properties suitable for use as a bolus cap. A Python script was developed within a commercial treatment planning system to automate the creation of a ready‐to‐print, patient‐specific 3D bolus cap model. A bolus cap was printed for an anthropomorphic head phantom using a commercial vendor and a computed tomography simulation of the anthropomorphic head phantom and bolus cap was used to create a volumetric‐modulated arc therapy TSI treatment plan. The planned treatment was delivered to the head phantom and dosimetric validation was performed using thermoluminescent dosimeters (TLD). The developed procedure was used to create a bolus cap for a clinical TSI patient, and in vivo TLD measurements were acquired for several fractions. Results Agilus‐60 was validated as a new 3D‐printing material suitable for use as bolus. A 3D‐printed Agilus‐60 bolus cap had excellent conformality to the phantom scalp, with a maximum air gap of 4 mm. TLD measurements showed that the bolus cap generated a uniform dose to the scalp within a 2.7% standard deviation, and the delivered doses agreed with calculated doses to within 2.4% on average. The patient bolus was conformal and the average difference between TLD measured and planned doses was 5.3%. Conclusions We have developed a workflow to 3D‐print highly conformal bolus caps for TSI and demonstrated these caps can reproducibly generate a uniform dose to the scalp.

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Section: Introductionmentioning

confidence: 99%

Development and validation of a 3D‐printed bolus cap for total scalp irradiation

Baltz

Melinda

Wong

et al. 2019

J Applied Clin Med Phys

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“…Several studies have confirmed the advantages of electron conformal therapy performed using customized 3D-printed electron boluses and compensators over that performed with conventional ones [7, 8, 11, 12]. However, since these studies used the 3D-printed boluses only on phantoms and did not provide details of the procedures used, there remained a lack of information regarding their use with actual patients.…”

Section: Methodsmentioning

confidence: 99%

“…Moreover, Zou et al [8] reported that 3D printers have the ability to fabricate compensators with much finer patterns. As this trends, Park et al [9] used the 3D-printed bolus for Kimura's disease as a case report.…”

Section: Introductionmentioning

confidence: 99%

Clinical application of 3D-printed-step-bolus in post-total-mastectomy electron conformal therapy

Park

Jeon

et al. 2016

Oncotarget

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The 3D-printed boluses were used during the radiation therapy of the chest wall in six patients with breast cancer after modified radical mastectomy (MRM). We measured the in-vivo skin doses while both conventional and 3D-printed boluses were placed on the chest wall and compared the mean doses delivered to the ipsilateral lung and the heart. The homogeneity and conformity of the dose distribution in the chest wall for both types of boluses were also evaluated. The uniformity index on the chest skin was improved when the 3D-printed boluses were used, with the overall average skin dose being closer to the prescribed one in the former case (-0.47% versus -4.43%). On comparing the dose-volume histogram (DVH), it was found that the 3D-printed boluses resulted in a reduction in the mean dose to the ipsilateral lung by up to 20%. The precision of dose delivery was improved by 3% with the 3D-printed boluses; in contrast, the conventional step bolus resulted in a precision level of 5%. In conclusion, the use of the 3D-printed boluses resulted in better dose homogeneity and conformity to the chest wall as well as the sparing of the normal organs, especially the lung. This suggested that their routine use on the chest wall as a therapeutic approach during post-mastectomy radiation therapy offers numerous advantages over conventional step boluses.

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“…The bolus substance must be odorless, non-sticky, and harmless to the skin. In this study, thus, the polylactic acid (PLA) was adopted as a bolus material [16, 17]. We printed a patient-specific breast bolus for an anthropomorphic phantom and simulated a real patient treatment.…”

Section: Introductionmentioning

confidence: 99%

A Patient-Specific Polylactic Acid Bolus Made by a 3D Printer for Breast Cancer Radiation Therapy

Park¹,

Choi²,

Park³

et al. 2016

PLoS ONE

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PurposeThe aim of this study was to assess the feasibility and advantages of a patient-specific breast bolus made using a 3D printer technique.MethodsWe used the anthropomorphic female phantom with breast attachments, which volumes are 200, 300, 400, 500 and 650 cc. We simulated the treatment for a right breast patient using parallel opposed tangential fields. Treatment plans were used to investigate the effect of unwanted air gaps under bolus on the dose distribution of the whole breast. The commercial Super-Flex bolus and 3D-printed polylactic acid (PLA) bolus were applied to investigate the skin dose of the breast with the MOSFET measurement. Two boluses of 3 and 5 mm thicknesses were selected.ResultsThere was a good agreement between the dose distribution for a virtual bolus generated by the TPS and PLA bolus. The difference in dose distribution between the virtual bolus and Super-Flex bolus was significant within the bolus and breast due to unwanted air gaps. The average differences between calculated and measured doses in a 200 and 300 cc with PLA bolus were not significant, which were -0.7% and -0.6% for 3mm, and -1.1% and -1.1% for 5 mm, respectively. With the Super-Flex bolus, however, significant dose differences were observed (-5.1% and -3.2% for 3mm, and -6.3% and -4.2% for 5 mm).ConclusionThe 3D-printed solid bolus can reduce the uncertainty of the daily setup and help to overcome the dose discrepancy by unwanted air gaps in the breast cancer radiation therapy.

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Potential of 3D printing technologies for fabrication of electron bolus and proton compensators

Cited by 74 publications

References 24 publications

Development and validation of a 3D‐printed bolus cap for total scalp irradiation

Development and validation of a 3D‐printed bolus cap for total scalp irradiation

Clinical application of 3D-printed-step-bolus in post-total-mastectomy electron conformal therapy

A Patient-Specific Polylactic Acid Bolus Made by a 3D Printer for Breast Cancer Radiation Therapy

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