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Jablonska PA, Parent A, La Macchia N, Chan HH, Filleti M, Ramotar M, Cho YB, Braganza M, Badzynski A, Laperriere N, Conrad T, Tsang DS, Shultz D, Santiago A, Irish JC, Millar BA, Tadic T, Berlin A. A total inverse planning paradigm: Prospective clinical trial evaluating the performance of a novel MR-based 3D-printed head immobilization device. Clin Transl Radiat Oncol 2023; 42:100663. [PMID: 37587925 PMCID: PMC10425893 DOI: 10.1016/j.ctro.2023.100663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/25/2023] [Accepted: 07/20/2023] [Indexed: 08/18/2023] Open
Abstract
Background and purpose Brain radiotherapy (cnsRT) requires reproducible positioning and immobilization, attained through redundant dedicated imaging studies and a bespoke moulding session to create a thermoplastic mask (T-mask). Innovative approaches may improve the value of care. We prospectively deployed and assessed the performance of a patient-specific 3D-printed mask (3Dp-mask), generated solely from MR imaging, to replicate a reproducible positioning and tolerable immobilization for patients undergoing cnsRT. Material and methods Patients undergoing LINAC-based cnsRT (primary tumors or resected metastases) were enrolled into two arms: control (T-mask) and investigational (3Dp-mask). For the latter, an in-house designed 3Dp-mask was generated from MR images to recreate the head positioning during MR acquisition and allow coupling with the LINAC tabletop. Differences in inter-fraction motion were compared between both arms. Tolerability was assessed using patient-reported questionnaires at various time points. Results Between January 2020 - July 2022, forty patients were enrolled (20 per arm). All participants completed the prescribed cnsRT and study evaluations. Average 3Dp-mask design and printing completion time was 36 h:50 min (range 12 h:56 min - 42 h:01 min). Inter-fraction motion analyses showed three-axis displacements comparable to the acceptable tolerance for the current standard-of-care. No differences in patient-reported tolerability were seen at baseline. During the last week of cnsRT, 3Dp-mask resulted in significantly lower facial and cervical discomfort and patients subjectively reported less pressure and confinement sensation when compared to the T-mask. No adverse events were observed. Conclusion The proposed total inverse planning paradigm using a 3D-printed immobilization device is feasible and renders comparable inter-fraction performance while offering a better patient experience, potentially improving cnsRT workflows and its cost-effectiveness.
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Affiliation(s)
- Paola Anna Jablonska
- Department of Radiation Oncology, University of Toronto, 149 College Street, Unit 504, Toronto, Ontario M5T 1P5, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, Canada
- Department of Radiation Oncology, Clinica Universidad de Navarra, 31008 Pamplona, Spain
| | - Amy Parent
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, Canada
| | - Nancy La Macchia
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, Canada
| | - Harley H.L. Chan
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada
| | - Matthew Filleti
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, Canada
| | - Matthew Ramotar
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, Canada
| | - Young-Bin Cho
- Department of Radiation Oncology, University of Toronto, 149 College Street, Unit 504, Toronto, Ontario M5T 1P5, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, Canada
- Department of Radiation Oncology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Maria Braganza
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, Canada
| | - Adam Badzynski
- Cancer Digital Intelligence Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, Canada
| | - Normand Laperriere
- Department of Radiation Oncology, University of Toronto, 149 College Street, Unit 504, Toronto, Ontario M5T 1P5, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, Canada
| | - Tatiana Conrad
- Department of Radiation Oncology, University of Toronto, 149 College Street, Unit 504, Toronto, Ontario M5T 1P5, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, Canada
| | - Derek S. Tsang
- Department of Radiation Oncology, University of Toronto, 149 College Street, Unit 504, Toronto, Ontario M5T 1P5, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, Canada
| | - David Shultz
- Department of Radiation Oncology, University of Toronto, 149 College Street, Unit 504, Toronto, Ontario M5T 1P5, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, Canada
| | - Anna Santiago
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, Canada
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada
| | - Jonathan C. Irish
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada
- Department of Otolaryngology – Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada
| | - Barbara-Ann Millar
- Department of Radiation Oncology, University of Toronto, 149 College Street, Unit 504, Toronto, Ontario M5T 1P5, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, Canada
| | - Tony Tadic
- Department of Radiation Oncology, University of Toronto, 149 College Street, Unit 504, Toronto, Ontario M5T 1P5, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, Canada
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada
| | - Alejandro Berlin
- Department of Radiation Oncology, University of Toronto, 149 College Street, Unit 504, Toronto, Ontario M5T 1P5, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, Canada
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada
- Cancer Digital Intelligence Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, Canada
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Robar JL, Kammerzell B, Hulick K, Kaiser P, Young C, Verzwyvelt V, Cheng X, Shepherd M, Orbovic R, Fedullo S, Majcher C, DiMarco S, Stasiak J. Novel multi jet fusion 3D-printed patient immobilization for radiation therapy. J Appl Clin Med Phys 2022; 23:e13773. [PMID: 36052990 DOI: 10.1002/acm2.13773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/25/2022] [Accepted: 08/11/2022] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Thermoplastic immobilizers are used routinely in radiation therapy to achieve positioning accuracy. These devices are variable in quality as they are dependent on the skill of the human fabricator. We examine the potential multi jet fusion (MJF) 3D printing for the production immobilizers with a focus on the surface dosimetry of several MJF-printed PA12-based material candidates. Materials are compared with the goal of minimizing surface dose with comparison to standard thermoplastic. We introduce a novel metamaterial design for the shell of the immobilizer, with the aims of mechanical robustness and low-dose buildup. We demonstrate first examples of adult and pediatric cranial and head-and-neck immobilizers. METHODS Three different PA12 materials were examined and compared to fused deposition modeling-printed polylactic acid (PLA), PLA with density lowered by adding hollow glass microspheres, and to perforated or perforated/stretched and solid status quo thermoplastic samples. Build-up dose measurements were made using a parallel plate chamber. A metamaterial design was established based on a packed hexagonal geometry. Radiochromic film dosimetry was performed to determine the dependence of surface dose on the metamaterial design. Full cranial and head-and-neck prototype immobilizers were designed, printed, and assessed with regard to dimensional accuracy. RESULTS Build-up dose measurements demonstrated the superiority of the PA12 material with a light fusing agent, which yielded a ∼15% dose reduction compared to other MJF materials. Metamaterial samples provided dose reductions ranging from 11% to 40% compared to stretched thermoplastic. MJF-printed immobilizers were produced reliably, demonstrated the versatility of digital design, and showed dimensional accuracy with 97% of sampled points within ±2 mm. CONCLUSIONS MJF is a promising technology for an automated fabrication of patient immobilizers. Material selection and metamaterial design can be leveraged to yield surface dose reduction of up to 40%. Immobilizer design is highly customizable, and the first examples of MJF-printed immobilizers demonstrate excellent dimensional accuracy.
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Affiliation(s)
- James L Robar
- Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada.,Nova Scotia Health, Halifax, Nova Scotia, Canada.,Adaptiiv Medical Technologies, Halifax, Nova Scotia, Canada
| | | | - Kevin Hulick
- HP, Vancouver, Washington, USA.,HP, Corvallis, Oregon, USA
| | - Pierre Kaiser
- HP, Vancouver, Washington, USA.,HP, Corvallis, Oregon, USA
| | - Calvin Young
- HP, Vancouver, Washington, USA.,HP, Corvallis, Oregon, USA
| | | | - Xin Cheng
- HP, Vancouver, Washington, USA.,HP, Corvallis, Oregon, USA
| | | | | | - Sara Fedullo
- Adaptiiv Medical Technologies, Halifax, Nova Scotia, Canada
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Miron VM, Etzelstorfer T, Kleiser R, Raffelsberger T, Major Z, Geinitz H. Evaluation of novel 3D-printed and conventional thermoplastic stereotactic high-precision patient fixation masks for radiotherapy. Strahlenther Onkol 2022; 198:1032-1041. [PMID: 35697775 PMCID: PMC9581856 DOI: 10.1007/s00066-022-01963-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/15/2022] [Indexed: 11/30/2022]
Abstract
Purpose For stereotactic radiation therapy of intracranial malignancies, a patient’s head needs to be immobilized with high accuracy. Fixation devices such as invasive stereotactic head frames or non-invasive thermoplastic mask systems are often used. However, especially stereotactic high-precision masks often cause discomfort for patients due to a long manufacturing time during which the patient is required to lie still and because the face is covered, including the mouth, nose, eyes, and ears. To avoid these issues, the target was to develop a non-invasive 3D-printable mask system with at least the accuracy of the high-precision masks, for producing masks which can be manufactured in the absence of patients and which allow the eyes, mouth, and nose to be uncovered during therapy. Methods For four volunteers, a personalized 3D-printed mask based on magnetic resonance imaging (MRI) data was designed and manufactured using fused filament fabrication (FFF). Additionally, for each of the volunteers, a conventional thermoplastic stereotactic high-precision mask from Brainlab AG (Munich, Germany) was fabricated. The intra-fractional fixation accuracy for each mask and volunteer was evaluated using the motion-correction algorithm of functional MRI measurements with and without guided motion. Results The average values for the translations and rotations of the volunteers’ heads lie in the range between ±1 mm and ±1° for both masks. Interestingly, the standard deviations and the relative and absolute 3D displacements are lower for the 3D-printed masks compared to the Brainlab masks. Conclusion It could be shown that the intra-fractional fixation accuracy of the 3D-printed masks was higher than for the conventional stereotactic high-precision masks.
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Affiliation(s)
- Veronika M Miron
- Institute of Polymer Product Engineering, Johannes Kepler University, Altenberger Str. 69, 4040, Linz, Austria.
| | - Tanja Etzelstorfer
- Abteilung für Radioonkologie, Ordensklinikum Linz Barmherzige Schwestern, Seilerstätte 4, 4010, Linz, Austria
| | - Raimund Kleiser
- Department of Neuroradiology, Johannes Kepler University Clinic, Wagner-Jauregg-Weg 15, 4020, Linz, Austria
| | - Tobias Raffelsberger
- Department of Neuroradiology, Johannes Kepler University Clinic, Wagner-Jauregg-Weg 15, 4020, Linz, Austria
| | - Zoltan Major
- Institute of Polymer Product Engineering, Johannes Kepler University, Altenberger Str. 69, 4040, Linz, Austria
| | - Hans Geinitz
- Abteilung für Radioonkologie, Ordensklinikum Linz Barmherzige Schwestern, Seilerstätte 4, 4010, Linz, Austria
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4
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Asfia A, Deepak B, Novak JI, Rolfe B, Kron T. Multi-jet fusion for additive manufacturing of radiotherapy immobilization devices: Effects of color, thickness, and orientation on surface dose and tensile strength. J Appl Clin Med Phys 2022; 23:e13548. [PMID: 35212139 PMCID: PMC8992947 DOI: 10.1002/acm2.13548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 12/21/2021] [Accepted: 01/19/2022] [Indexed: 12/05/2022] Open
Abstract
Immobilization devices are used to obtain reproducible patient setup during radiotherapy treatment, improving accuracy, and reducing damage to surrounding healthy tissue. Additive manufacturing is emerging as a viable method for manufacturing and personalizing such devices. The goal of this study was to investigate the dosimetric and mechanical properties of a recent additive technology called multi‐jet fusion (MJF) for radiotherapy applications, including the ability for this process to produce full color parts. Skin dose testing included 50 samples with dimensions 100 mm × 100 mm with five different thicknesses (1 mm, 2 mm, 3 mm, 4 mm, and 5 mm) and grouped into colored (cyan, magenta, yellow, and black (CMYK) additives) and non‐colored (white) samples. Results using a 6 MV beam found that surface dose readings were predominantly independent of the colored additives. However, for an 18 MV beam, the additives affected the surface dose, with black recording significantly lower surface dose readings compare to other colors. The accompanying tensile testing of 175 samples designed to ASTM D638 type I standards found that the black agent resulted in the lowest ultimate tensile strength (UTS) for each thickness of 1–5 mm. It was also found that the print orientation had influence on the skin dose and mechanical properties of the samples. When all data were combined and analyzed using a multiple‐criteria decision‐making technique, magenta was found to offer the best balance between high UTS and low surface dose across different thicknesses and orientations, making it an optimal choice for immobilization devices. This is the first study to consider the use of color MJF for radiotherapy immobilization devices, and suggests that color additives can affect both dosimetry and mechanical performance. This is important as industrial additive technologies like MJF become increasingly adopted in the health and medical sectors.
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Affiliation(s)
- Amirhossein Asfia
- School of Engineering, Faculty of Science, Engineering and Built Environment, Deakin University, Victoria, Australia.,ARC Industrial Transformation Training Centre in Additive Bio-manufacturing, Queensland University of Technology, Queensland, Australia
| | - Basaula Deepak
- Department of Physical Science, Peter MacCallum Cancer Centre, Victoria, Australia
| | - James Ivan Novak
- School of Architecture, Faculty of Engineering, Architecture and Information Technology, The University of Queensland, Queensland, Australia.,Herston Biofabrication Institute, Metro North Hospital and Health Service, Level 12, Block 7, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Bernard Rolfe
- School of Engineering, Faculty of Science, Engineering and Built Environment, Deakin University, Victoria, Australia
| | - Tomas Kron
- ARC Industrial Transformation Training Centre in Additive Bio-manufacturing, Queensland University of Technology, Queensland, Australia.,Department of Physical Science, Peter MacCallum Cancer Centre, Victoria, Australia
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5
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Asfia A, Deepak B, Novak JI, Rolfe B, Kron T. Infill selection for 3D printed radiotherapy immobilisation devices. Biomed Phys Eng Express 2020; 6. [DOI: 10.1088/2057-1976/abb981] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/17/2020] [Indexed: 12/19/2022]
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Park JI, Lee S, Kim IH, Ye SJ. Artifact-free CT images for electron beam therapy using a patient-specific non metallic shield. Phys Med 2020; 75:92-99. [PMID: 32559651 DOI: 10.1016/j.ejmp.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 05/10/2020] [Accepted: 06/01/2020] [Indexed: 10/24/2022] Open
Abstract
Patient's CT images taken with metallic shields for radiotherapy suffer from artifacts. Furthermore, the treatment planning system (TPS) has a limitation on accurate dose calculations for high density materials. In this study, a Monte Carlo (MC)-based method was developed to accurately evaluate the dosimetric effect of the metallic shield. Two patients with a commercial tungsten shield of lens and two patients with a custom-made lead shield of lip were chosen to produce their non-metallic dummy shields using 3D scanner and printer. With these dummy shields, we generated artifact-free CT images. The maximum CT number allowed in TPS was assigned to metallic shields. MC simulations with real material information were carried out. In addition, clinically relevant dose-volumetric parameters were calculated for the comparison between MC and TPS. Relative dosimetry was performed using radiochromic films. The dose reductions below metallic structures were shown on MC dose distributions, but not evident on TPS dose distributions. The differences in dose-volumetric parameters of PTV between TPS and MC for eye shield cases were not clearly shown. However, the mean dose of lens from TPS and MC was different. The MC results were in superior agreement with measured data in relative dosimetry. The lens dose could be overestimated by TPS. The differences in dose-volumetric parameters of PTV between TPS and MC were generally larger in lip cases than in eye cases. The developed method is useful in predicting the realistic dose distributions around the organs blocked by the metallic shields.
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Affiliation(s)
- Jong In Park
- Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea.
| | - Sangmin Lee
- Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea
| | - Il Han Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, South Korea
| | - Sung-Joon Ye
- Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea; Department of Radiation Oncology, Seoul National University Hospital, Seoul, South Korea; Robotics Research Laboratory for Extreme Environment, Advanced Institutes of Convergence Technology, Seoul National University, Suwon, Gyeonggi-do, South Korea
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7
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Asfia A, Novak JI, Mohammed MI, Rolfe B, Kron T. A review of 3D printed patient specific immobilisation devices in radiotherapy. Phys Imaging Radiat Oncol 2020; 13:30-35. [PMID: 33458304 PMCID: PMC7807671 DOI: 10.1016/j.phro.2020.03.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE Radiotherapy is one of the most effective cancer treatment techniques, however, delivering the optimal radiation dosage is challenging due to movements of the patient during treatment. Immobilisation devices are typically used to minimise motion. This paper reviews published research investigating the use of 3D printing (additive manufacturing) to produce patient-specific immobilisation devices, and compares these to traditional devices. MATERIALS AND METHODS A systematic review was conducted across thirty-eight databases, with results limited to those published between January 2000 and January 2019. A total of eighteen papers suitably detailed the use of 3D printing to manufacture and test immobilisers, and were included in this review. This included ten journal papers, five posters, two conference papers and one thesis. RESULTS 61% of relevant studies featured human subjects, 22% focussed on animal subjects, 11% used phantoms, and one study utilised experimental test methods. Advantages of 3D printed immobilisers reported in literature included improved patient experience and comfort over traditional methods, as well as high levels of accuracy between immobiliser and patient, repeatable setup, and similar beam attenuation properties to thermoformed immobilisers. Disadvantages included the slow 3D printing process and the potential for inaccuracies in the digitisation of patient geometry. CONCLUSION It was found that a lack of technical knowledge, combined with disparate studies with small patient samples, required further research in order to validate claims supporting the benefits of 3D printing to improve patient comfort or treatment accuracy.
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Affiliation(s)
- Amirhossein Asfia
- School of Engineering, Faculty of Science, Engineering and Built Environment, Deakin University, Geelong, Victoria, Australia
- ARC Industrial Transformation Training Centre in Additive Bio-manufacturing, Brisbane, Queensland, Australia
| | - James I. Novak
- School of Engineering, Faculty of Science, Engineering and Built Environment, Deakin University, Geelong, Victoria, Australia
| | | | - Bernard Rolfe
- School of Engineering, Faculty of Science, Engineering and Built Environment, Deakin University, Geelong, Victoria, Australia
| | - Tomas Kron
- ARC Industrial Transformation Training Centre in Additive Bio-manufacturing, Brisbane, Queensland, Australia
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- School of Applied Sciences, RMIT University, Melbourne, Victoria, Australia
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Haefner MF, Giesel FL, Mattke M, Rath D, Wade M, Kuypers J, Preuss A, Kauczor HU, Schenk JP, Debus J, Sterzing F, Unterhinninghofen R. 3D-Printed masks as a new approach for immobilization in radiotherapy - a study of positioning accuracy. Oncotarget 2018; 9:6490-6498. [PMID: 29464087 PMCID: PMC5814227 DOI: 10.18632/oncotarget.24032] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 01/02/2018] [Indexed: 11/25/2022] Open
Abstract
We developed a new approach to produce individual immobilization devices for the head based on MRI data and 3D printing technologies. The purpose of this study was to determine positioning accuracy with healthy volunteers. 3D MRI data of the head were acquired for 8 volunteers. In-house developed software processed the image data to generate a surface mesh model of the immobilization mask. After adding an interface for the couch, the fixation setup was materialized using a 3D printer with acrylonitrile butadiene styrene (ABS). Repeated MRI datasets (n=10) were acquired for all volunteers wearing their masks thus simulating a setup for multiple fractions. Using automatic image-to-image registration, displacements of the head were calculated relative to the first dataset (6 degrees of freedom). The production process has been described in detail. The absolute lateral (x), vertical (y) and longitudinal (z) translations ranged between −0.7 and 0.5 mm, −1.8 and 1.4 mm, and −1.6 and 2.4 mm, respectively. The absolute rotations for pitch (x), yaw (y) and roll (z) ranged between −0.9 and 0.8°, −0.5 and 1.1°, and −0.6 and 0.8°, respectively. The mean 3D displacement was 0.9 mm with a standard deviation (SD) of the systematic and random error of 0.2 mm and 0.5 mm, respectively. In conclusion, an almost entirely automated production process of 3D printed immobilization masks for the head derived from MRI data was established. A high level of setup accuracy was demonstrated in a volunteer cohort. Future research will have to focus on workflow optimization and clinical evaluation.
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Affiliation(s)
- Matthias Felix Haefner
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany.,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), 69120 Heidelberg, Germany
| | - Frederik Lars Giesel
- Department of Nuclear Medicine, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Matthias Mattke
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany.,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), 69120 Heidelberg, Germany
| | - Daniel Rath
- Department of Nuclear Medicine, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Moritz Wade
- Department of Nuclear Medicine, Heidelberg University Hospital, 69120 Heidelberg, Germany.,Institute of Antropomatics and Robotics, Karlsruhe Institute of Technology (KIT), 76131 Karlsruhe, Germany
| | - Jacob Kuypers
- Department of Nuclear Medicine, Heidelberg University Hospital, 69120 Heidelberg, Germany.,Institute of Antropomatics and Robotics, Karlsruhe Institute of Technology (KIT), 76131 Karlsruhe, Germany
| | - Alan Preuss
- Department of Nuclear Medicine, Heidelberg University Hospital, 69120 Heidelberg, Germany.,Institute of Antropomatics and Robotics, Karlsruhe Institute of Technology (KIT), 76131 Karlsruhe, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Jens-Peter Schenk
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Juergen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany.,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), 69120 Heidelberg, Germany
| | - Florian Sterzing
- National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), 69120 Heidelberg, Germany.,Department of Radiation Oncology Kempten, 87439 Kempten, Germany
| | - Roland Unterhinninghofen
- Institute of Antropomatics and Robotics, Karlsruhe Institute of Technology (KIT), 76131 Karlsruhe, Germany.,Institute of Robotics and Mechatronics, German Aerospace Center, 82234 Oberpfaffenhofen-Weßling, Germany
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Ehler ED, Barney BM, Higgins PD, Dusenbery KE. Patient specific 3D printed phantom for IMRT quality assurance. Phys Med Biol 2014; 59:5763-73. [PMID: 25207965 DOI: 10.1088/0031-9155/59/19/5763] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The purpose of this study was to test the feasibility of a patient specific phantom for patient specific dosimetric verification.Using the head and neck region of an anthropomorphic phantom as a substitute for an actual patient, a soft-tissue equivalent model was constructed with the use of a 3D printer. Calculated and measured dose in the anthropomorphic phantom and the 3D printed phantom was compared for a parallel-opposed head and neck field geometry to establish tissue equivalence. A nine-field IMRT plan was constructed and dose verification measurements were performed for the 3D printed phantom as well as traditional standard phantoms.The maximum difference in calculated dose was 1.8% for the parallel-opposed configuration. Passing rates of various dosimetric parameters were compared for the IMRT plan measurements; the 3D printed phantom results showed greater disagreement at superficial depths than other methods.A custom phantom was created using a 3D printer. It was determined that the use of patient specific phantoms to perform dosimetric verification and estimate the dose in the patient is feasible. In addition, end-to-end testing on a per-patient basis was possible with the 3D printed phantom. Further refinement of the phantom construction process is needed for routine use.
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Affiliation(s)
- Eric D Ehler
- Department of Radiation Oncology, University of Minnesota, MMC494, 420 Delaware Street SE, Minneapolis, MN 55455, USA
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10
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Towards the production of radiotherapy treatment shells on 3D printers using data derived from DICOM CT and MRI: preclinical feasibility studies. JOURNAL OF RADIOTHERAPY IN PRACTICE 2014. [DOI: 10.1017/s1460396914000326] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:Immobilisation for patients undergoing brain or head and neck radiotherapy is achieved using perspex or thermoplastic devices that require direct moulding to patient anatomy. The mould room visit can be distressing for patients and the shells do not always fit perfectly. In addition the mould room process can be time consuming. With recent developments in three-dimensional (3D) printing technologies comes the potential to generate a treatment shell directly from a computer model of a patient. Typically, a patient requiring radiotherapy treatment will have had a computed tomography (CT) scan and if a computer model of a shell could be obtained directly from the CT data it would reduce patient distress, reduce visits, obtain a close fitting shell and possibly enable the patient to start their radiotherapy treatment more quickly.Purpose:This paper focuses on the first stage of generating the front part of the shell and investigates the dosimetric properties of the materials to show the feasibility of 3D printer materials for the production of a radiotherapy treatment shell.Materials and methods:Computer algorithms are used to segment the surface of the patient’s head from CT and MRI datasets. After segmentation approaches are used to construct a 3D model suitable for printing on a 3D printer. To ensure that 3D printing is feasible the properties of a set of 3D printing materials are tested.Conclusions:The majority of the possible candidate 3D printing materials tested result in very similar attenuation of a therapeutic radiotherapy beam as the Orfit soft-drape masks currently in use in many UK radiotherapy centres. The costs involved in 3D printing are reducing and the applications to medicine are becoming more widely adopted. In this paper we show that 3D printing of bespoke radiotherapy masks is feasible and warrants further investigation.
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Abstract
It has been generally accepted that tissue engineered constructs should closely resemble the in-vivo mechanical and structural properties of the tissues they are intended to replace. However, most scaffolds produced so far were isotropic porous scaffolds with non-characterized mechanical properties, different from those of the native healthy tissue. Tissues that are formed into these scaffolds are initially formed in the isotropic porous structure and since most tissues have significant anisotropic extracellular matrix components and concomitant mechanical properties, the formed tissues have no structural and functional relationships with the native tissues. The complete regeneration of tissues requires a second differentiation step after resorption of the isotropic scaffold. It is doubtful if the required plasticity for this remains present in already final differentiated tissue. It would be much more efficacious if the newly formed tissues in the scaffold could differentiate directly into the anisotropic organization of the native tissues. Therefore, anisotropic scaffolds that enable such a direct differentiation might be extremely helpful to realize this goal. Up to now, anisotropic scaffolds have been fabricated using modified conventional techniques, solid free-form fabrication techniques, and a few alternative methods. In this review we present the current status and discuss the procedures that are currently being used for anisotropic scaffold fabrication.
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Murray D, Edwards G, Mainprize J, Antonyshyn O. Advanced technology in the management of fibrous dysplasia. J Plast Reconstr Aesthet Surg 2008; 61:906-16. [DOI: 10.1016/j.bjps.2007.08.029] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2006] [Revised: 04/21/2007] [Accepted: 08/28/2007] [Indexed: 10/22/2022]
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Optimizing Craniofacial Osteotomies: Applications of Haptic and Rapid Prototyping Technology. J Oral Maxillofac Surg 2008; 66:1766-72. [DOI: 10.1016/j.joms.2007.08.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2007] [Accepted: 08/30/2007] [Indexed: 11/23/2022]
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McKernan B, Bydder SA, Deans T, Nixon MA, Joseph DJ. Surface laser scanning to routinely produce casts for patient immobilization during radiotherapy. ACTA ACUST UNITED AC 2007; 51:150-3. [PMID: 17419860 DOI: 10.1111/j.1440-1673.2007.01686.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Immobilization casts are used to reduce patient movement during the radiotherapy of head and neck and brain malignancies. Polyethylene-based casts are produced by first taking a Plaster of Paris 'negative' impression of the patient. A 'positive' mould is then made, which is used to vacuum form an immobilization cast. Taking the 'negative' cast can be messy, stressful for patients and labour intensive. Recently, lightweight hand-held laser surface scanners have become available. These allow an accurate 3-D representation of objects to be generated non-invasively. This technology has now been applied to the production of casts for radiotherapy. Each patient's face and head is digitized using the Polhemus FastSCAN (Polhemus, Colchester, VT, USA) scanner. The electronic data are transferred to a computer numerical controlled mill, where a positive impression is machined. The feasibility of the process was examined, the labour required and radiation therapists' satisfaction with aspects of the produced masks assessed. The scanner-based method of mask production was found to be simple, accurate and non-invasive. There was a reduction in radiation therapist labour required. Masks produced with the scanner-based method were reported to result in improved mask fitting, daily reproducibility, patient immobilization and patient comfort.
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Affiliation(s)
- B McKernan
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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Simpson RL, Wiria FE, Amis AA, Chua CK, Leong KF, Hansen UN, Chandrasekaran M, Lee MW. Development of a 95/5 poly(L-lactide-co-glycolide)/hydroxylapatite and β-tricalcium phosphate scaffold as bone replacement material via selective laser sintering. J Biomed Mater Res B Appl Biomater 2007; 84:17-25. [PMID: 17465027 DOI: 10.1002/jbm.b.30839] [Citation(s) in RCA: 138] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
95/5 Poly(L-lactide-co-glycolide) was investigated for the role of a porous scaffold, using the selective laser sintering (SLS) fabrication process, with powder sizes of 50-125 and 125-250 microm. SLS parameters of laser power, laser scan speed, and part bed temperature were altered and the degree of sintering was assessed by scanning electron microscope. Composites of the 125-250 microm polymer with either hydroxylapatite or hydroxylapatite/beta-tricalcium phosphate (CAMCERAM II were sintered, and SLS settings using 40 wt % CAMCERAM II were optimized for further tests. Polymer thermal degradation during processing led to a reduction in number and weight averaged molecular weight of 9% and 12%, respectively. Compression tests using the optimized composite sintering parameters gave a Young's modulus, yield strength, and strain at 1% strain offset of 0.13 +/- 0.03 GPa, 12.06 +/- 2.53 MPa, and 11.39 +/- 2.60%, respectively. Porosity was found to be 46.5 +/- 1.39%. CT data was used to create an SLS model of a human fourth middle phalanx and a block with designed porosity was fabricated to illustrate the process capabilities. The results have shown that this composite and fabrication method has potential in the fabrication of porous scaffolds for bone tissue engineering.
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Affiliation(s)
- Rebecca Louise Simpson
- Department of Mechanical Engineering, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
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