3D-printed surface mould applicator for high-dose-rate brachytherapy

Schumacher, Mark; Lassó, András; Cumming, I.; Rankin, Adam; Falkson, Conrad; Schreiner, L J; Joshi, Chandra P.; Fichtinger, Gabor

doi:10.1117/12.2082543

Cited by 6 publications

(5 citation statements)

References 3 publications

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“…It is not restricted to the size of the target. While competing strategies reported the use of 3D printable applicators for smaller targets, 8,14 this study showed that 3D printable applicator holders can be used for large areas such as for the treatment of cutaneous T-cell lymphoma of the calf or the scalp. However, the 3D-AH cannot be used to treat closed surfaces, for example, a whole leg or head, with a single applicator.…”

Section: Discussionmentioning

confidence: 88%

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Development and clinical implementation of semi‐automated treatment planning including 3D printable applicator holders in complex skin brachytherapy

et al. 2020

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Purpose High‐dose‐rate brachytherapy (HDR‐BT) is a treatment option for malignant skin diseases compared to external beam radiation therapy, HDR‐BT provides improved target coverage, better organ sparing, and has comparable treatment times. This is especially true for large clinical targets with complex topologies. To standardize and improve the quality and efficacy of the treatments, a novel streamlined treatment approach in complex skin HDR‐BT was developed and implemented. This approach consists of auto generated treatment plans and a 3D printable applicator holder (3D‐AH). Materials and methods The in‐house developed planning system automatically segments computed tomography simulation images (a), optimizes a treatment plan (b), and generates a model of the 3D‐AH (c). The 3D‐AH is used as an immobilization device for the flexible Freiburg flap applicator used to deliver treatment. The developed, automated planning is compared against the standard clinical plan generation process for a flat 10 × 10 cm2 field, curved fields with radii of 4, 6, and 8 cm, and a representative clinical case. The quality of the 3D print is verified via an additional CT of the flap applicator latched into the holder, followed by an automated rigid registration with the original planning CT. Finally, the methodology is implemented and tested clinically under an IRB approval. Results All automatically generated plans were reviewed and accepted for clinical use. For the clinical workflow, the coverage achieved at a prescription depth for the flat 4, 6, and 8 cm applicator was (100.0 ± 4.9)%, (100.0 ± 4.9)%, (96.0 ± 0.3)%, and (98.4 ± 0.3)%, respectively. For auto planning, the coverage was (99.9 ± 0.3)%, (100.0 ± 0.2)%, (100.0 ± 0.3)%, and (100.1 ± 0.2)%. For the clinical test case, the D90 for the clinical workflow and auto planning was found to be 93.5% and 100.29% of the prescribed dose, respectively. Processing of the patient's CT to generate trajectories and positions as well as the 3D model of the applicator took <5 min. Conclusion This workflow automates time intensive catheter digitizing and treatment planning. Compared to printing full applicators, the use of 3D‐AH reduces the complexity of the 3D prints, the amount of the material to be used, the time of 3D printing, and amount of quality assurance required. The proposed methodology improves the overall treatment plan quality in complex HDR‐BT and impact patient treatment outcomes potentially.

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Section: Discussionmentioning

confidence: 88%

“…However recent studies restrict 3D printable applicators to smaller lesions on the face. 8,14 For larger lesions their use is still to be evaluated. Extended printing times (several days for large applicators) and the necessity of an additional CT scan might make clinical implementation complicated.…”

Section: Introductionmentioning

confidence: 99%

Development and clinical implementation of semi‐automated treatment planning including 3D printable applicator holders in complex skin brachytherapy

et al. 2020

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“…After including additional abbreviated keywords, 28 publications were found for AM in superficial skin BT, which formed the basis of this review. These included 8 clinical case studies [30][31][32][33][34][35][36][37], 7 physical and dosimetric evaluations [38][39][40][41][42][43][44], 6 proof-of-concept cases [45][46][47][48][49][50], 6 design process assessments [51][52][53][54][55][56], and 1 economic feasibility study [57]. All these articles, except for one, were published since 2015.…”

Section: Current Literature Profile Of Additive Manufacturing In Superficial Brachytherapymentioning

confidence: 99%

Additive manufacturing (3D printing) in superficial brachytherapy

Bellis¹,

Rembielak²,

Barnes³

et al. 2021

jcb

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The aim of this work is to provide an overview of the current state of additive manufacturing (AM), commonly known as 3D printing, within superficial brachytherapy (BT). Several comprehensive database searches were performed to find publications linked to AM in superficial BT. Twenty-eight core publications were found, which can be grouped under general categories of clinical cases, physical and dosimetric evaluations, proof-of-concept cases, design process assessments, and economic feasibility studies. Each study demonstrated a success regarding AM implementation and collectively, they provided benefits over traditional applicator fabrication techniques. Publications of AM in superficial BT have increased significantly in the last 5 years. This is likely due to associated efficiency and consistency benefits; though, more evidences are needed to determine the true extent of these benefits.

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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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3D-printed surface mould applicator for high-dose-rate brachytherapy

Cited by 6 publications

References 3 publications

Development and clinical implementation of semi‐automated treatment planning including 3D printable applicator holders in complex skin brachytherapy

Development and clinical implementation of semi‐automated treatment planning including 3D printable applicator holders in complex skin brachytherapy

Additive manufacturing (3D printing) in superficial brachytherapy

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

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