Three‐dimensional printing in radiation oncology: A systematic review of the literature

Abstract

Purpose/objectives: Three-dimensional (3D) printing is recognized as an effective clinical and educational tool in procedurally intensive specialties. However, it has a nascent role in radiation oncology. The goal of this investigation is to clarify the extent to which 3D printing applications are currently being used in radiation oncology through a systematic review of the literature. Materials/methods: A search protocol was defined according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Included articles were evaluated using parameters of interest including: year and country of publication, experimental design, sample size for clinical studies, radiation oncology topic, reported outcomes, and implementation barriers or safety concerns. Results: One hundred and three publications from 2012 to 2019 met inclusion criteria. The most commonly described 3D printing applications included quality assurance phantoms (26%), brachytherapy applicators (20%), bolus (17%), preclinical animal irradiation (10%), compensators (7%), and immobilization devices (5%). Most studies were preclinical feasibility studies (63%), with few clinical investigations such as case reports or series (13%) or cohort studies (11%). The most common applications evaluated within clinical settings included brachytherapy applicators (44%) and bolus (28%). Sample sizes for clinical investigations were small (median 10, range 1-42). A minority of articles described basic or translational research (11%) and workflow or cost evaluation studies (3%). The number of articles increased over time (P < 0.0001). While outcomes were heterogeneous, most studies reported successful implementation of accurate and cost-effective 3D printing methods. Conclusions: Three-dimensional printing is rapidly growing in radiation oncology and has been implemented effectively in a diverse array of applications. Although the number of 3D printing publications has steadily risen, the majority of current reports are preclinical in nature and the few clinical studies that do exist report on small sample sizes. Further dissemination of ongoing investigations describing the clinical application of developed 3D printing technologies in larger cohorts is warranted.

Technical report: 3D-printed patient-specific scalp shield for hair preservation in total skin electron beam therapy

“…Three-dimensional printing in radiation oncology is still in its infancy with potential applications undiscovered. The most common uses include creation of quality assurance phantoms and custom bolus [6] , with rare reports of custom shielding [11] , [12] , [13] . This report describes a novel technique for patient-specific scalp-shielding in TSEBT using 3D-printing which provided similar hair-preservation as would be expected for lead shielding, with the added benefit of customized shielding at the hairline.…”

“…Two patients have been treated with this technique thus far; one patient underwent shielding for the entire course with promising results. Application of 3D-printing in radiation oncology has been expanding since its introduction several years ago given the promise of patient-specific conformality, ease of production, and cost-effectiveness [6] ; however, it has not been studied in scalp shielding for total skin treatments.…”

COMP Report: An updated algorithm to estimate medical physics staffing levels for radiation oncology

“…This is explained by some centralization of mechanical support services to larger centers for the design/fabrication of specialized devices, with 70% of small centers in Ontario (<6 Linacs) reporting that they no longer have any in‐house mechanical engineering (or machinist) staff. The widespread adoption of IMRT and volumetric modulated arc therapy (VMAT) has greatly reduced the need for custom‐made devices, while the introduction of 3D printers has simplified the fabrication of selected custom‐made accessories 23 . Furthermore, modern Linacs have less requirements for complex mechanical procedures to access components during routine servicing (e.g., hoisting the Linac head).…”

“…The widespread adoption of IMRT and volumetric modulated arc therapy (VMAT) has greatly reduced the need for custom‐made devices, while the introduction of 3D printers has simplified the fabrication of selected custom‐made accessories. 23 Furthermore, modern Linacs have less requirements for complex mechanical procedures to access components during routine servicing (e.g., hoisting the Linac head). Indeed, many facilities have integrated the positions of mechanical and electronics engineering to a single classification of a service engineer, following the example set by Linac vendors.…”

Advances in 3D-Printed Surface-Modified Ca-Si Bioceramic Structures and Their Potential for Bone Tumor Therapy

“…Within cancer applications, recent advances include the use of 3D-printed template-assisted CT-guided radioactive seed for radiation therapy, where the printed template was personalized and supported more targeted radiation. However, these clinical studies utilizing 3D-printed platforms are still in their early stages, with a small number of patients, and might not be indicative of their long-term and wide-spread clinical performances [ 96 , 97 ]. In bone regeneration applications, large animal models had been studied with a 3D-printed bioceramic scaffold, implanted via surgical procedures.…”