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Herpel C, Schwindling FS, Held T, Christ L, Lang K, Schwindling M, Moratin J, Zaoui K, Moutsis T, Plinkert P, Herfarth K, Freudlsperger C, Rammelsberg P, Debus J, Adeberg S. Individualized 3D-Printed Tissue Retraction Devices for Head and Neck Radiotherapy. Front Oncol 2021; 11:628743. [PMID: 33833988 PMCID: PMC8021903 DOI: 10.3389/fonc.2021.628743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/11/2021] [Indexed: 11/25/2022] Open
Abstract
Background Radiotherapy for head and neck cancer may cause various oral sequelae, such as radiation-induced mucositis. To protect healthy tissue from irradiation, intraoral devices can be used. Current tissue retraction devices (TRDs) have to be either individually manufactured at considerable cost and time expenditure or they are limited in their variability. In this context, a 3D-printed, tooth-borne TRD might further facilitate clinical use. Methods A novel approach for the manufacturing of TRDs is described and its clinical application is analysed retrospectively. The devices were virtually designed for fabrication by 3D-printing technology, enabling—in only a single printing design—caudal or bi-lateral tongue displacement, as well as stabilization of a tongue-out position. For a total of 10 patients undergoing radiotherapy of head and neck tumors, the devices were individually adapted after pre-fabrication. Technical and clinical feasibility was assessed along with patient adherence. Tissue spacing was calculated by volumetric analysis of tongue retraction. In one exemplary case, radiotherapy treatment plans before and after tissue displacement were generated and compared. The reproducibility of maxillomandibular relation at device re-positioning was quantified by repeated intraoral optical scanning in a voluntary participant. Results 3D-printing was useful for the simplification of TRD manufacture, resulting in a total patient treatment time of less than 30 min. The devices were tolerated well by all tested patients over the entire radiation treatment period. No technical complications occurred with the devices. The TRDs caused an effective spacing of the healthy adjacent tissue, e.g., the tongue. Position changes of maxillomandibular relation were limited to a mean value of 98.1 µm ± 29.4 µm root mean square deviation between initial reference and follow-up positions. Conclusions The presented method allows a resource-efficient fabrication of individualized, tooth-bourne TRDs. A high reproducibility of maxillomandibular relation was found and the first clinical experiences underline the high potential of such devices for radiotherapy in the head and neck area.
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Affiliation(s)
- Christopher Herpel
- Department of Prosthetic Dentistry, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Thomas Held
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Leo Christ
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Kristin Lang
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | | | - Julius Moratin
- Department of Oral and Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Karim Zaoui
- Department of Otorhinolaryngology, University of Heidelberg, Heidelberg, Germany
| | - Tracy Moutsis
- Department of Otorhinolaryngology, University of Heidelberg, Heidelberg, Germany
| | - Peter Plinkert
- Department of Otorhinolaryngology, University of Heidelberg, Heidelberg, Germany
| | - Klaus Herfarth
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center (HIT), University Hospital Heidelberg, Heidelberg, Germany
| | - Christian Freudlsperger
- Department of Oral and Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Peter Rammelsberg
- Department of Prosthetic Dentistry, Heidelberg University Hospital, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center (HIT), University Hospital Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), partner site Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sebastian Adeberg
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center (HIT), University Hospital Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), partner site Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Iltis PW, Frahm J, Voit D, Joseph AA, Schoonderwaldt E, Altenmüller E. High-speed real-time magnetic resonance imaging of fast tongue movements in elite horn players. Quant Imaging Med Surg 2015; 5:374-81. [PMID: 26029640 DOI: 10.3978/j.issn.2223-4292.2015.03.02] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 02/27/2015] [Indexed: 12/23/2022]
Abstract
This paper describes the use of high-speed real-time (RT) magnetic resonance imaging (MRI) in quantifying very rapid motor function within the oropharyngeal cavity of six elite horn players. Based on simultaneous sound recordings, the efficacy of RT-MRI films at 30 and 100 frames per second (fps) was assessed for tongue movements associated with double tonguing performance. Serial images with a nominal temporal resolution of 10.0 and 33.3 ms were obtained by highly undersampled radial fast low-angle shot (FLASH) sequences (5 and 17 spokes, respectively) using complementary sets of spokes for successive acquisitions (extending over 9 and 5 frames, respectively). Reconstructions of high-speed images were obtained by temporally regularized nonlinear inversion (NLINV) as previously described. A customized MATLAB toolkit was developed for the extraction of line profiles from MRI films to quantify temporal phenomena associated with task performance. The analyses reveal that for the present setting, which required the use of a temporal median filter to optimize image quality, acquisition rates of 30 fps are inadequate to accurately detect tongue movements during double tonguing, but that rates of 100 fps do allow for a precise quantification of movement. These data for the first time demonstrate the extreme performance of elite horn players. High-speed RT-MRI offers so far unavailable opportunities to study the oropharyngeal movements during brass playing with future potential for teaching and the treatment of patients suffering from dystonia.
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Affiliation(s)
- Peter W Iltis
- 1 Department of Kinesiology, Gordon College, Wenham, MA, USA ; 2 University of Music, Drama and Media, Hannover, Germany ; 3 Biomedizinische NMR Forschungs GmbH am Max-Planck-Institut für biophysikalische Chemie, Göttingen, Germany
| | - Jens Frahm
- 1 Department of Kinesiology, Gordon College, Wenham, MA, USA ; 2 University of Music, Drama and Media, Hannover, Germany ; 3 Biomedizinische NMR Forschungs GmbH am Max-Planck-Institut für biophysikalische Chemie, Göttingen, Germany
| | - Dirk Voit
- 1 Department of Kinesiology, Gordon College, Wenham, MA, USA ; 2 University of Music, Drama and Media, Hannover, Germany ; 3 Biomedizinische NMR Forschungs GmbH am Max-Planck-Institut für biophysikalische Chemie, Göttingen, Germany
| | - Arun A Joseph
- 1 Department of Kinesiology, Gordon College, Wenham, MA, USA ; 2 University of Music, Drama and Media, Hannover, Germany ; 3 Biomedizinische NMR Forschungs GmbH am Max-Planck-Institut für biophysikalische Chemie, Göttingen, Germany
| | - Erwin Schoonderwaldt
- 1 Department of Kinesiology, Gordon College, Wenham, MA, USA ; 2 University of Music, Drama and Media, Hannover, Germany ; 3 Biomedizinische NMR Forschungs GmbH am Max-Planck-Institut für biophysikalische Chemie, Göttingen, Germany
| | - Eckart Altenmüller
- 1 Department of Kinesiology, Gordon College, Wenham, MA, USA ; 2 University of Music, Drama and Media, Hannover, Germany ; 3 Biomedizinische NMR Forschungs GmbH am Max-Planck-Institut für biophysikalische Chemie, Göttingen, Germany
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