Individualized 3D scanning and printing for non-melanoma skin cancer brachytherapy: a financial study for its integration into clinical workflow

Abstract

PurposeSkin cancer is the most common tumor in the population. There are different therapeutic modalities. Brachytherapy is one of the techniques used, in which it is necessary to build customized moulds for some patients. Currently, these moulds are made by hand using rudimentary techniques. We present a new procedure based on 3D printing and the analysis of the clinical workflow.Material and methodsMoulds can be made either by hand or by automated 3D printing. For making moulds by hand, a patient’s alginate negative is created and, from that, the gypsum cast and customized moulds are made by hand from the patient’s negative template. The new process is based on 3D printing. The first step is to take a 3D scan of the surface of the patient and then, 3D modelling software is used to obtain an accurate anatomical reconstruction of the treatment area. We present the clinical workflow using 3D scanning and printing technology, comparing its costs with the usual custom handmade mould protocol.ResultsThe time spent for the new process is 6.25 hours, in contrast to the time spent for the conventional process, which is 9.5 hours. We found a 34% reduction in time required to create a mould for brachytherapy treatment. The labor cost of the conventional process is 211.5 vs. 152.5 hours, so the reduction is 59 hours. There is also a 49.5% reduction in the financial costs, mostly due to lack of need of a computed tomography (CT) scan of the gypsum and the mould. 3D scanning and printing offers financial benefits and reduces the clinical workload.ConclusionsAs the present project demonstrates, through the application of 3D printing technologies, the costs and time spent during the process in the clinical workload in brachytherapy treatment are reduced. Overall, 3D printing is a promising technique for brachytherapy that might be well received in the community.

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

“…The finding of our cost analysis is in line with those of Arenas et al who demonstrated reduced labour and material costs for 3D printed bolus compared to traditional bolus . Similarly, a reduction in RT staff time of 4 hours was reported by Canter et al As the printer does not require active monitoring, staff can set the printer to run overnight or complete other tasks during the print time, thereby improving staff cost‐effectiveness.…”

“…In the case where a diagnostic CT is available for the patient prior to simulation, a 3D print could be generated from this CT and fit of the bolus confirmed with the planning CT rather than on the first day of treatment with kV or CBCT imaging. Optical surface scanning also provides an option for avoiding plaster bust acquisition for patients with significant claustrophobia; however, its use would not negate the need for a planning CT of the patient in a mask …”

“…Optical surface scanning also provides an option for avoiding plaster bust acquisition for patients with significant claustrophobia; however, its use would not negate the need for a planning CT of the patient in a mask. 17,18 The choice to 3D print the bolus as a shell with fill rather than as a whole piece was to reduce the time of printing and the exposure of staff to released particles in the air from the process of fused deposition modelling. There are no long-term health effect studies associated with 3D printer use in confined space.…”

Surface brachytherapy: Joint report of the AAPM and the GEC‐ESTRO Task Group No. 253

“…Potential attributes creating applicators via additive manufacturing are the timeline for incorporating patient imaging to guide the applicator design for radiation dose conformity, improved source: patient positioning accuracy, improved applicator geometric stability, and improved target dosimetry and dose conformity by creating HDR source channels located at positions not possible with off-the-shelf applicators built by manufacturers for widespread use. 101,102 While there remain challenges regarding hospital-specific fabrication and sterilization protocols, as well as identifying the best materials for certain circumstances, it is expected that 3D-printed applicators for surface brachytherapy will play a greater role in the future. Coordination of this new technology through user groups and open source approaches will be vital for its long-term success.…”

Inversely designed, 3D-printed personalized template-guided interstitial brachytherapy for vaginal tumors

“…concluded that 3D-printing applicators could be used for highly conformal superficial dose distributions by using preplanned catheter orientations [ 5 ]. Other authors reported molds for brachytherapy for skin cancers created using 3D scanner [ 6 ]. Another study showed two cases of interstitial brachytherapy for vagina tumors performed using 3D-printed custom-made cylinders [ 7 ].…”