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Hobson MA, Hu Y, Caldwell B, Cohen GN, Glide-Hurst C, Huang L, Jackson PD, Jang S, Langner U, Lee HJ, Levesque IR, Narayanan S, Park JC, Steffen J, Wu QJ, Zhou Y. AAPM Task Group 334: A guidance document to using radiotherapy immobilization devices and accessories in an MR environment. Med Phys 2024; 51:3822-3849. [PMID: 38648857 DOI: 10.1002/mp.17061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/13/2023] [Accepted: 03/28/2024] [Indexed: 04/25/2024] Open
Abstract
Use of magnetic resonance (MR) imaging in radiation therapy has increased substantially in recent years as more radiotherapy centers are having MR simulators installed, requesting more time on clinical diagnostic MR systems, or even treating with combination MR linear accelerator (MR-linac) systems. With this increased use, to ensure the most accurate integration of images into radiotherapy (RT), RT immobilization devices and accessories must be able to be used safely in the MR environment and produce minimal perturbations. The determination of the safety profile and considerations often falls to the medical physicist or other support staff members who at a minimum should be a Level 2 personnel as per the ACR. The purpose of this guidance document will be to help guide the user in making determinations on MR Safety labeling (i.e., MR Safe, Conditional, or Unsafe) including standard testing, and verification of image quality, when using RT immobilization devices and accessories in an MR environment.
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Affiliation(s)
- Maritza A Hobson
- Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Yanle Hu
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Barrett Caldwell
- School of Industrial Engineering, Purdue University, West Lafayette, Indiana, USA
- School of Aeronautics and Astronautics, Purdue University, West Lafayette, Indiana, USA
| | - Gil'ad N Cohen
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Carri Glide-Hurst
- Department of Human Oncology, University of Wisconsin--Madison, Madison, Wisconsin, USA
- Department of Medical Physics, University of Wisconsin--Madison, Madison, Wisconsin, USA
| | - Long Huang
- Department of Radiation Oncology, University of Utah, Salt Lake City, Utah, USA
| | - Paul D Jackson
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan, USA
| | - Sunyoung Jang
- Department of Radiation Oncology, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Ulrich Langner
- Department of Radiation Oncology, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Hannah J Lee
- Corewell Health William Beaumont University Hospital, Royal Oak, Michigan, USA
| | - Ives R Levesque
- Gerald Bronfman Department of Oncology and Medical Physics Unit, McGill University, Montreal, QC, Canada
- Department of Medical Physics, McGill University Health Centre, Cedars Cancer Centre, Montreal, QC, Canada
| | - Sreeram Narayanan
- Department of Radiation Oncology, Virginia Mason Cancer Institute, Seattle, Washington, USA
| | - Justin C Park
- Division of Medical Physics, Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Q Jackie Wu
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina, USA
| | - Yong Zhou
- Department of Radiology Services, Corewell Health, Grand Rapids, Michigan, USA
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Lee M, Noh S, Shin JB, Kwak J, Jeong C. Evaluation of Fused Deposition Modeling Materials for 3D-Printed Container of Dosimetric Polymer Gel. Gels 2024; 10:146. [PMID: 38391476 PMCID: PMC10888196 DOI: 10.3390/gels10020146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/01/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
Accurate dosimetric verification is becoming increasingly important in radiotherapy. Although polymer gel dosimetry may be useful for verifying complex 3D dose distributions, it has limitations for clinical application due to its strong reactivity with oxygen and other contaminants. Therefore, it is important that the material of the gel storage container blocks reaction with external contaminants. In this study, we tested the effect of air and the chemical permeability of various polymer-based 3D printing materials that can be used as gel containers. A methacrylic acid, gelatin, and tetrakis (hydroxymethyl) phosphonium chloride gel was used. Five types of printing materials that can be applied to the fused deposition modeling (FDM)-type 3D printer were compared: acrylonitrile butadiene styrene (ABS), co-polyester (CPE), polycarbonate (PC), polylactic acid (PLA), and polypropylene (PP) (reference: glass vial). The map of R2 (1/T2) relaxation rates for each material, obtained from magnetic resonance imaging scans, was analyzed. Additionally, response histograms and dose calibration curves from the R2 map were evaluated. The R2 distribution showed that CPE had sharper boundaries than the other materials, and the profile gradient of CPE was also closest to the reference vial. Histograms and dose calibration showed that CPE provided the most homogeneous and the highest relative response of 83.5%, with 8.6% root mean square error, compared with the reference vial. These results indicate that CPE is a reasonable material for the FDM-type 3D printing gel container.
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Affiliation(s)
- Minsik Lee
- Department of Radiation Oncology, Kangwon National University Hospital, 157 Baengnyeong-ro, Chuncheon-si 24290, Republic of Korea
| | - Seonyeong Noh
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Jun-Bong Shin
- Department of Radiation Oncology, Kangwon National University Hospital, 157 Baengnyeong-ro, Chuncheon-si 24290, Republic of Korea
| | - Jungwon Kwak
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Chiyoung Jeong
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
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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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Stengl C, Arbes E, Thai LYJ, Echner G, Vedelago J, Jansen J, Jäkel O, Seco J. Development and characterization of a versatile mini-beam collimator for pre-clinical photon beam irradiation. Med Phys 2023; 50:5222-5237. [PMID: 37145971 DOI: 10.1002/mp.16432] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Interest in spatial fractionation radiotherapy has exponentially increased over the last decade as a significant reduction of healthy tissue toxicity was observed by mini-beam irradiation. Published studies, however, mostly use rigid mini-beam collimators dedicated to their exact experimental arrangement such that changing the setup or testing new mini-beam collimator configurations becomes challenging and expensive. PURPOSE In this work, a versatile, low-cost mini-beam collimator was designed and manufactured for pre-clinical applications with X-ray beams. The mini-beam collimator enables variability of the full width at half maximum (FWHM), the center-to-center distance (ctc), the peak-to-valley dose ratio (PVDR), and the source-to-collimator distance (SCD). METHODS The mini-beam collimator is an in-house development, which was constructed of 10 × 40 mm2 tungsten or brass plates. These metal plates were combined with 3D-printed plastic plates that can be stacked together in the desired order. A standard X-ray source was used for the dosimetric characterization of four different configurations of the collimator, including a combination of plastic plates of 0.5, 1, or 2 mm width, assembled with 1 or 2 mm thick metal plates. Irradiations were done at three different SCDs for characterizing the performance of the collimator. For the SCDs closer to the radiation source, the plastic plates were 3D-printed with a dedicated angle to compensate for the X-ray beam divergence, making it possible to study ultra-high dose rates of around 40 Gy/s. All dosimetric quantifications were performed using EBT-XD films. Additionally, in vitro studies with H460 cells were carried out. RESULTS Characteristic mini-beam dose distributions were obtained with the developed collimator using a conventional X-ray source. With the exchangeable 3D-printed plates, FWHM and ctc from 0.52 to 2.11 mm, and from 1.77 to 4.61 mm were achieved, with uncertainties ranging from 0.01% to 8.98%, respectively. The FWHM and ctc obtained with the EBT-XD films are in agreement with the design of each mini-beam collimator configuration. For dose rates in the order of several Gy/min, the highest PVDR of 10.09 ± 1.08 was achieved with a collimator configuration of 0.5 mm thick plastic plates and 2 mm thick metal plates. Exchanging the tungsten plates with the lower-density metal brass reduced the PVDR by approximately 50%. Also, increasing the dose rate to ultra-high dose rates was feasible with the mini-beam collimator, where a PVDR of 24.26 ± 2.10 was achieved. Finally, it was possible to deliver and quantify mini-beam dose distribution patterns in vitro. CONCLUSIONS With the developed collimator, we achieved various mini-beam dose distributions that can be adjusted according to the needs of the user in regards to FWHM, ctc, PVDR and SCD, while accounting for beam divergence. Therefore, the designed mini-beam collimator may enable low-cost and versatile pre-clinical research on mini-beam irradiation.
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Affiliation(s)
- Christina Stengl
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
| | - Eric Arbes
- Biomedical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department for Physics and Astronomy, University of Heidelberg, Heidelberg, Germany
| | - Long-Yang Jan Thai
- Biomedical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department for Physics and Astronomy, University of Heidelberg, Heidelberg, Germany
| | - Gernot Echner
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
| | - José Vedelago
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
| | - Jeannette Jansen
- Biomedical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Oliver Jäkel
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
- Heidelberg Ion Beam Therapy Center (HIT), Heidelberg University Hospital, Heidelberg, Germany
| | - Joao Seco
- Biomedical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department for Physics and Astronomy, University of Heidelberg, Heidelberg, Germany
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Ehler ED. Clinical experience in the use of 3D printing as a rapid replacement of traditional radiation therapy immobilization materials. J Appl Clin Med Phys 2023:e14008. [PMID: 37128743 PMCID: PMC10402670 DOI: 10.1002/acm2.14008] [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: 01/17/2023] [Revised: 03/10/2023] [Accepted: 04/12/2023] [Indexed: 05/03/2023] Open
Abstract
PURPOSE Patient positioning and immobilization devices are commonly employed in radiation therapy. Unfortunately, cases can arise where the devices need to be reconstructed or improved. This work describes clinical processes to use a planning CT, to design and 3D print immobilization devices for reproducible patient positioning within a clinically feasible time frame when traditional methods can no longer be used or are insufficient. MATERIALS/METHODS Three clinical cases required rapid 3D printing of an immobilization device mid-treatment due to the following: (1) a lost headrest cushion, (2) needed improvement in lumbar spine positioning, and (3) a partially deflated vacuum immobilization mattress. RESULTS In the three cases, the 3D printed immobilization devices were clinically implemented successfully; two of the devices were fully designed and printed in 1 day. The 3D printed immobilization devices achieved a positioning accuracy sufficient to avoid the necessity to repeat the simulation and planning process. CONCLUSION If traditional immobilization devices fail or are misplaced, it is feasible to have a 3D printed replacement within the time span of 1 day. The design and fabrication methods, as well as the experiences gained, are described in detail to assist clinicians to implement 3D printing for similar situations.
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Affiliation(s)
- Eric D Ehler
- Department of Radiation Oncology, University of Minnesota, Minneapolis, Minnesota, USA
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Moon HC, Chung HT, Min BJ, Dho YS. Optimal mask fixation method for frameless radiosurgery with Leksell Gamma Knife Icon TM. J Appl Clin Med Phys 2023; 24:e13892. [PMID: 36610006 PMCID: PMC10113692 DOI: 10.1002/acm2.13892] [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: 08/17/2022] [Revised: 12/08/2022] [Accepted: 12/15/2022] [Indexed: 01/09/2023] Open
Abstract
The Leksell Gamma Knife (LGK) IconTM is used for mask-based and frame-based fixation. The mask fixation provides a noninvasive method. However, an optimal mask fixation method is yet to be established. We evaluated the characteristics of three mask fixation methods (Plain, Folded, and Wide) for the LGK IconTM . Force-sensitive resistor sensors were attached to the forehead, supraorbital, zygoma, mandible, and occipital bone of the phantom, and digital humidity and temperature sensors were attached to both temporal lobes. Cone-beam computed tomography (CBCT) and high-definition motion management (HDMM) for each mask fixation method were used to evaluate the phantom motion during the initial application. Subsequently, the mask was removed and reapplied on the second (1st reapplication) and third days (2nd reapplication). In the initial application, forces acting on most portions of the phantom were stabilized within 1.5 h. The largest force acted on the occipital bone for the Plain and Wide methods and on the mandible for the Folded method. The temperature rapidly approaches the initial temperature, whereas the humidity gradually approached the initial humidity in all fixation methods. The Folded method exhibited a significantly lower translation along the Y-axis of the Leksell coordinate system, and rotations along all axes were under 0.5°. The HDMM values remained at 0.1 mm for all fixation methods. In the reapplications, the force acting on the occipital bone was significantly greater than that during the initial application for all mask fixation methods; the temperature and humidity remained unchanged. All mask fixation methods in the 1st reapplication were not significantly different from those in the 2nd reapplication. The Folded method is recommended as an optimal mask fixation for patients who require tight fixation; the Wide method can be considered if patient comfort is a priority.
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Affiliation(s)
- Hyeong Cheol Moon
- Department of Neurosurgery, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Hyun-Tai Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Medical Device Development, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Byung Jun Min
- Department of Radiation Oncology, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Yun-Sik Dho
- Department of Neurosurgery, Chungbuk National University Hospital, Cheongju, Republic of Korea.,Department of Neurosurgery, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
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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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Duarte J, Loja MAR, Portal R, Vieira L. 3D Printing of Abdominal Immobilization Masks for Therapeutics: Dosimetric, Mechanical and Financial Analysis. Bioengineering (Basel) 2022; 9:bioengineering9020055. [PMID: 35200408 PMCID: PMC8869160 DOI: 10.3390/bioengineering9020055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/18/2022] [Accepted: 01/21/2022] [Indexed: 12/03/2022] Open
Abstract
Molding immobilization masks is a time-consuming process, strongly dependent on the healthcare professional, and potentially uncomfortable for the patient. Thus, an alternative sustainable automated production process is proposed for abdominal masks, using fused deposition modelling (FDM) 3D printing with polylactic acid (PLA). Radiological properties of PLA were evaluated by submitting a set of PLA plates to photon beam radiation, while estimations of their mechanical characteristics were assessed through numerical simulation. Based on the obtained results, the abdominal mask was 3D printed and process costs and times were analyzed. The plates revealed dose transmissions similar to the conventional mask at all energies, and mechanical deformation guarantees the required immobilization, with a 66% final cost reduction. PLA proved to be an excellent material for this purpose. Despite the increase in labour costs, a significant reduction in material costs is observed with the proposed process. However, the time results are not favorable, mainly due to the printing technique used in this study.
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Affiliation(s)
- Jessica Duarte
- ISEL—Instituto Superior de Engenharia de Lisboa, ESTeSL–Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, 1549-020 Lisboa, Portugal;
| | - Maria Amélia Ramos Loja
- CIMOSM-Centro de Investigação em Modelação e Otimização de Sistemas Multifuncionais, ISEL-Instituto Superior de Engenharia de Lisboa, Instituto Politécnico de Lisboa, 1549-020 Lisboa, Portugal; (M.A.R.L.); (R.P.)
- IDMEC, IST-Instituto Superior Técnico, 1049-001 Lisboa, Portugal
| | - Ricardo Portal
- CIMOSM-Centro de Investigação em Modelação e Otimização de Sistemas Multifuncionais, ISEL-Instituto Superior de Engenharia de Lisboa, Instituto Politécnico de Lisboa, 1549-020 Lisboa, Portugal; (M.A.R.L.); (R.P.)
| | - Lina Vieira
- CIMOSM-Centro de Investigação em Modelação e Otimização de Sistemas Multifuncionais, ISEL-Instituto Superior de Engenharia de Lisboa, Instituto Politécnico de Lisboa, 1549-020 Lisboa, Portugal; (M.A.R.L.); (R.P.)
- H&TRC—Health & Technology Research Center, ESTeSL-Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, 1990-096 Lisboa, Portugal
- Correspondence:
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Development of a new poly-ε-caprolactone with low melting point for creating a thermoset mask used in radiation therapy. Sci Rep 2021; 11:20409. [PMID: 34650081 PMCID: PMC8516973 DOI: 10.1038/s41598-021-00005-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/01/2021] [Indexed: 12/03/2022] Open
Abstract
This study aimed to develop a poly-ε-caprolactone (PCL) material that has a low melting point while maintaining the deformation ability. The new PCL (abbreviated as 4b45/2b20) was fabricated by mixing two types of PCL with different molecular weights, numbers of branches, and physical properties. To investigate the melting point, crystallization temperature, elastic modulus, and elongation at break for 4b45/2b20 and three commercially available masks, differential scanning calorimetry and tensile tests were performed. The melting point of 4b45/2b20 was 46.0 °C, and that of the commercially available masks was approximately 56.0 °C (55.7 °C–56.5 °C). The elastic modulus at 60 °C of 4b45/2b20 was significantly lower than the commercially available masks (1.1 ± 0.3 MPa and 46.3 ± 5.4 MPa, p = 0.0357). In addition, the elongation at break of 4b45/2b20 were significantly larger than the commercially available masks (275.2 ± 25.0% and 216.0 ± 15.2%, p = 0.0347). The crystallization temperature of 4b45/2b20 (22.1 °C) was clinically acceptable and no significant difference was found in the elastic modulus at 23 °C (253.7 ± 24.3 MPa and 282.0 ± 44.3 MPa, p = 0.4). As a shape memory-based thermoset material, 4b45/2b20 has a low melting point and large deformation ability. In addition, the crystallization temperature and strength are within the clinically acceptable standards. Because masks made using the new PCL material are formed with less pressure on the face than commercially available masks, it is a promising material for making a radiotherapy mask that can reduce the burden on patients.
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Individual 3D-printed fixation masks for radiotherapy: first clinical experiences. Int J Comput Assist Radiol Surg 2021; 16:1043-1049. [PMID: 34021859 PMCID: PMC8166668 DOI: 10.1007/s11548-021-02393-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/27/2021] [Indexed: 11/13/2022]
Abstract
Purpose To show the feasibility of 3D-printed fixation masks for whole brain radiation therapy in a clinical setting and perform a first comparison to an established thermoplastic mask system. Methods Six patients were irradiated with whole brain radiotherapy using individually 3D-printed masks. Daily image guidance and position correction were performed prior to each irradiation fraction. The vectors of the daily position correction were compared to two collectives of patients, who were irradiated using the standard thermoplastic mask system (one cohort with head masks; one cohort with head and neck masks). Results The mean systematic errors in the experimental cohort ranged between 0.59 and 2.10 mm which is in a comparable range to the control groups (0.18 mm–0.68 mm and 0.34 mm–2.96 mm, respectively). The 3D-printed masks seem to be an alternative to the established thermoplastic mask systems. Nevertheless, further investigation will need to be performed. Conclusion The prevailing study showed a reliable and reproducible interfractional positioning accuracy using individually 3D-printed masks for whole brain irradiation in a clinical routine. Further investigations, especially concerning smaller target volumes or other areas of the body, need to be performed before using the system on a larger basis.
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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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Baltz GC, Briere T, Luo D, Howell RM, Krafft S, Han EY. 3D-printed headrest for frameless Gamma Knife radiosurgery: Design and validation. J Appl Clin Med Phys 2020; 21:6-15. [PMID: 32603542 PMCID: PMC7497935 DOI: 10.1002/acm2.12956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/18/2020] [Accepted: 05/20/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose Frameless Gamma Knife stereotactic radiosurgery (SRS) uses a moldable headrest with a thermoplastic mask for patient immobilization. An efficacious headrest is time consuming and difficult to fabricate due to the expertise required to mold the headrest within machine geometrical limitations. The purpose of this study was to design and validate a three‐dimensional (3D)‐printed headrest for frameless Gamma Knife SRS that can overcome these difficulties. Materials and methods A headrest 3D model designed to fit within the frameless adapter was 3D printed. Dosimetric properties of the 3D‐printed headrest and a standard‐of‐care moldable headrest were compared by delivering a Gamma Knife treatment to an anthropomorphic head phantom fitted with an ionization chamber and radiochromic film. Ionization measurements were compared to assess headrest attenuation and a gamma index was calculated to compare the film dose distributions. A volunteer study was conducted to assess the immobilization efficacy of the 3D‐printed headrest compared to the moldable headrest. Five volunteers had their head motion tracked by a surface tracking system while immobilized in each headrest for 20 min. The recorded motion data were used to calculate the average volunteer movement and a paired t‐test was performed. Results The ionization chamber readings were within 0.55% for the 3D‐printed and moldable headrests, and the calculated gamma index showed 98.6% of points within dose difference of 2% and 2 mm distance to agreement for the film measurement. These results demonstrate that the headrests were dosimetrically equivalent within the experimental uncertainties. Average motion (±standard deviation) of the volunteers while immobilized was 1.41 ± 0.43 mm and 1.36 ± 0.51 mm for the 3D‐printed and moldable headrests, respectively. The average observed volunteer motion between headrests was not statistically different, based on a P‐value of 0.466. Conclusions We designed and validated a 3D‐printed headrest for immobilizing patients undergoing frameless Gamma Knife SRS.
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Affiliation(s)
- Garrett C Baltz
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tina Briere
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dershan Luo
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rebecca M Howell
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shane Krafft
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eun Young Han
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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13
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Rooney MK, Rosenberg DM, Braunstein S, Cunha A, Damato AL, Ehler E, Pawlicki T, Robar J, Tatebe K, Golden DW. Three-dimensional printing in radiation oncology: A systematic review of the literature. J Appl Clin Med Phys 2020; 21:15-26. [PMID: 32459059 PMCID: PMC7484837 DOI: 10.1002/acm2.12907] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/16/2020] [Accepted: 04/23/2020] [Indexed: 12/21/2022] Open
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.
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Affiliation(s)
- Michael K Rooney
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - David M Rosenberg
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Steve Braunstein
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - Adam Cunha
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - Antonio L Damato
- Department Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eric Ehler
- Department of Radiation Oncology, University of Minnesota, Minneapolis, MN, USA
| | - Todd Pawlicki
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, CA, USA
| | - James Robar
- Department of Radiation Oncology, Dalhousie University, Halifax, Canada.,Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Canada.,Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Ken Tatebe
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
| | - Daniel W Golden
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
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Three-Dimensional Printed Silicone Bite Blocks for Radiotherapy of Head and Neck Cancer—A Preliminary Study. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10051688] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Conventional methods that have been developed to immobilize the mouth and tongue for radiotherapy (RT) in head and neck cancer (HNC) treatment have been unsatisfactory. We, therefore, developed three-dimensional (3D), customizable, silicone bite blocks and examined their clinical feasibility. For HNC patients, before RT, the 3D printed bite blocks were fabricated based on primary computed tomography (CT) simulation images. The placement of the 3D bite blocks was followed by a secondary CT simulation before RT planning was finalized. Dosimetric parameters and positioning verification achieved with the propose bite blocks were compared with conventional universal oral corks. The 3D printed bite blocks were conformal to the occlusal surface, ensuring immobilization of the tongue without eliciting a gag reflex, and an elastic and firm texture that supports opening of the mouth, with a smooth surface with tolerable intraoral tactility. The dosimetry of patients using the proposed bite blocks showed better coverage of the planning target volume and surface of a tumour bed along with reduction in normal tissue doses. Good concordance of positioning by 3D printed bite blocks during the RT course was verified. The 3D printed bite blocks with silicone might be a customizable, safe, and practical advanced technology in RT for HNC.
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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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Nowak LJ, Pawlowska E. Technical Note: an algorithm and software for conversion of radiotherapy contour‐sequence data to ready‐to‐print 3D structures. Med Phys 2019; 46:1829-1832. [DOI: 10.1002/mp.13452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 02/11/2019] [Accepted: 02/11/2019] [Indexed: 11/09/2022] Open
Affiliation(s)
- Lukasz J. Nowak
- Biomedical Photonic Imaging Group University of Twente Drienerlolaan 5 Enschede 7522 NB the Netherlands
| | - Ewa Pawlowska
- Department of Oncology and Radiotherapy Medical University of Gdansk Gdansk Poland
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Ehler E, Craft D, Rong Y. 3D printing technology will eventually eliminate the need of purchasing commercial phantoms for clinical medical physics QA procedures. J Appl Clin Med Phys 2018; 19:8-12. [PMID: 29943910 PMCID: PMC6036387 DOI: 10.1002/acm2.12392] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 06/01/2018] [Accepted: 06/04/2018] [Indexed: 11/07/2022] Open
Affiliation(s)
- Eric Ehler
- Department of Radiation OncologyUniversity of MinnesotaMinneapolisMN55455USA
| | - Daniel Craft
- Department of Radiation PhysicsUniversity of Texas MD Anderson Cancer CenterHoustonTX77030USA
| | - Yi Rong
- Department of Radiation OncologyUniversity of California Davis Comprehensive Cancer CenterSacramentoCA95817USA
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