Patient-Specific Quality Assurance Using a 3D-Printed Chest Phantom for Intraoperative Radiotherapy in Breast Cancer

Abstract

This study aims to confirm the usefulness of patient-specific quality assurance (PSQA) using three-dimensional (3D)-printed phantoms in ensuring the stability of IORT and the precision of the treatment administered. In this study, five patient-specific chest phantoms were fabricated using a 3D printer such that they were dosimetrically equivalent to the chests of actual patients in terms of organ density and shape around the given target, where a spherical applicator was inserted for breast IORT treatment via the INTRABEAM™ system. Models of lungs and soft tissue were fabricated by applying infill ratios corresponding to the mean Hounsfield unit (HU) values calculated from CT scans of the patients. The two models were then assembled into one. A 3D-printed water-equivalent phantom was also fabricated to verify the vendor-provided depth dose curve. Pieces of an EBT3 film were inserted into the 3D-printed customized phantoms to measure the doses. A 10 Gy prescription dose based on the surface of the spherical applicator was delivered and measured through EBT3 films parallel and perpendicular to the axis of the beam. The shapes of the phantoms, CT values, and absorbed doses were compared between the expected and printed ones. The morphological agreement among the five patient-specific 3D chest phantoms was assessed. The mean differences in terms of HU between the patients and the phantoms was 2.2 HU for soft tissue and −26.2 HU for the lungs. The dose irradiated on the surface of the spherical applicator yielded a percent error of −2.16% ± 3.91% between the measured and prescribed doses. In a depth dose comparison using a 3D-printed water phantom, the uncertainty in the measurements based on the EBT3 film decreased as the depth increased beyond 5 mm, and a good agreement in terms of the absolute dose was noted between the EBT3 film and the vendor data. These results demonstrate the applicability of the 3D-printed chest phantom for PSQA in breast IORT. This enhanced precision offers new opportunities for advancements in IORT.

3D and 4D Printing in the Fight against Breast Cancer

“…Three-dimensional-printed physical phantoms are employed to mimic the patient’s anatomy, both from the external and internal perspectives, allowing the evaluation and optimization of imaging techniques [ 76 , 77 ]. In addition, they can be useful to predict the dose distribution for safe and effective radiotherapy treatments [ 78 ]. Three-dimensional-printed models can additionally help surgeons to plan and make decisions, as well as be employed for training activities or to increase the efficacy of patient communication [ 79 ].…”

Reproduction of a conventional anthropomorphic female chest phantom by 3D‐printing: Comparison of image contrasts and absorbed doses in CT

“…1,2 This printing method is common for the production of phantoms for x-ray imaging and therapy. [3][4][5][6] By reducing the density of the interior area (infill density), printed objects can be used to mimic the physical properties of different tissues. [7][8][9] Despite the advantages mentioned, 3D-printing of body phantoms is still at the experimental level.…”

“…With professional equipment, the simultaneous processing of multiple materials to print different types of tissues is possible 1,2 . This printing method is common for the production of phantoms for x‐ray imaging and therapy 3–6 . By reducing the density of the interior area (infill density), printed objects can be used to mimic the physical properties of different tissues 7–9 .…”