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Title: TU-H-BRC-08: Use and Validation of Flexible 3D Printed Tissue Compensators for Post-Mastectomy Radiation Therapy

Abstract

Purpose: Patient-specific tissue equivalent compensators can be used for post-mastectomy radiation therapy (PMRT) to achieve homogenous dose distributions with single-field treatments. However, current fabrication methods are time consuming and expensive. 3D-printing technology could overcome these limitations. The purposes of this study were to [1] evaluate materials for 3D-printed compensators [2] design and print a compensator to achieve a uniform thickness to a clinical target volume (CTV), and [3] demonstrate that a single-field electron compensator plan is a clinically feasible treatment option for PMRT. Methods: Blocks were printed with three materials; print accuracy, density, Hounsfield units (HU), and percent depth doses (PDD) were evaluated. For a CT scan of an anthropomorphic phantom, we used a ray-tracing method to design a compensator that achieved uniform thickness from compensator surface to CTV. The compensator was printed with flexible tissue equivalent material whose physical and radiological properties were most similar to soft tissue. A single-field electron compensator plan was designed and compared with two standard-of-care techniques. The compensator plan was validated with thermoluminescent dosimeter (TLD) measurements. Results: We identified an appropriate material for 3D-printed compensators that had high print accuracy (99.6%) and was similar to soft tissue; density was 1.04, HU was - 45more » ± 43, and PDD curves agreed with clinical curves within 3 mm. We designed and printed a compensator that conformed well to the phantom surface and created a uniform thickness to the CTV. In-house fabrication was simple and inexpensive (<$75). Compared with the two standard plans, the compensator plan resulted in overall more homogeneous dose distributions and performed similarly in terms of lung/heart doses and 90% isodose coverage of the CTV. TLD measurements agreed well with planned doses (within 5 %). Conclusions: We have demonstrated that 3D-printed compensators make single-field electron therapy a clinically feasible treatment option for PMRT.« less

Authors:
; ; ;  [1];  [2];  [3];  [2];  [4]
  1. Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX (United States)
  2. (United States)
  3. The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX (United States)
  4. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (United States)
Publication Date:
OSTI Identifier:
22654022
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 43; Journal Issue: 6; Other Information: (c) 2016 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
60 APPLIED LIFE SCIENCES; 61 RADIATION PROTECTION AND DOSIMETRY; ANIMAL TISSUES; COMPUTERIZED TOMOGRAPHY; DEPTH DOSE DISTRIBUTIONS; IMAGE PROCESSING; PATIENTS; PLANT TISSUES; RADIOTHERAPY; THERMOLUMINESCENT DOSEMETERS; THICKNESS

Citation Formats

Craft, D, Kry, S, Salehpour, M, Howell, R, The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX, Woodward, W, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, and Kanke, J. TU-H-BRC-08: Use and Validation of Flexible 3D Printed Tissue Compensators for Post-Mastectomy Radiation Therapy. United States: N. p., 2016. Web. doi:10.1118/1.4957615.
Craft, D, Kry, S, Salehpour, M, Howell, R, The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX, Woodward, W, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, & Kanke, J. TU-H-BRC-08: Use and Validation of Flexible 3D Printed Tissue Compensators for Post-Mastectomy Radiation Therapy. United States. doi:10.1118/1.4957615.
Craft, D, Kry, S, Salehpour, M, Howell, R, The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX, Woodward, W, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, and Kanke, J. Wed . "TU-H-BRC-08: Use and Validation of Flexible 3D Printed Tissue Compensators for Post-Mastectomy Radiation Therapy". United States. doi:10.1118/1.4957615.
@article{osti_22654022,
title = {TU-H-BRC-08: Use and Validation of Flexible 3D Printed Tissue Compensators for Post-Mastectomy Radiation Therapy},
author = {Craft, D and Kry, S and Salehpour, M and Howell, R and The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX and Woodward, W and Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX and Kanke, J},
abstractNote = {Purpose: Patient-specific tissue equivalent compensators can be used for post-mastectomy radiation therapy (PMRT) to achieve homogenous dose distributions with single-field treatments. However, current fabrication methods are time consuming and expensive. 3D-printing technology could overcome these limitations. The purposes of this study were to [1] evaluate materials for 3D-printed compensators [2] design and print a compensator to achieve a uniform thickness to a clinical target volume (CTV), and [3] demonstrate that a single-field electron compensator plan is a clinically feasible treatment option for PMRT. Methods: Blocks were printed with three materials; print accuracy, density, Hounsfield units (HU), and percent depth doses (PDD) were evaluated. For a CT scan of an anthropomorphic phantom, we used a ray-tracing method to design a compensator that achieved uniform thickness from compensator surface to CTV. The compensator was printed with flexible tissue equivalent material whose physical and radiological properties were most similar to soft tissue. A single-field electron compensator plan was designed and compared with two standard-of-care techniques. The compensator plan was validated with thermoluminescent dosimeter (TLD) measurements. Results: We identified an appropriate material for 3D-printed compensators that had high print accuracy (99.6%) and was similar to soft tissue; density was 1.04, HU was - 45 ± 43, and PDD curves agreed with clinical curves within 3 mm. We designed and printed a compensator that conformed well to the phantom surface and created a uniform thickness to the CTV. In-house fabrication was simple and inexpensive (<$75). Compared with the two standard plans, the compensator plan resulted in overall more homogeneous dose distributions and performed similarly in terms of lung/heart doses and 90% isodose coverage of the CTV. TLD measurements agreed well with planned doses (within 5 %). Conclusions: We have demonstrated that 3D-printed compensators make single-field electron therapy a clinically feasible treatment option for PMRT.},
doi = {10.1118/1.4957615},
journal = {Medical Physics},
number = 6,
volume = 43,
place = {United States},
year = {Wed Jun 15 00:00:00 EDT 2016},
month = {Wed Jun 15 00:00:00 EDT 2016}
}
  • Purpose: To validate Computed Tomography Fractional Flow Reserve (CT-FFR) measurements with accurate 3D printed coronary phantoms. Methods: DICOM data from four phases in two patients imaged with a standard 320 × 0.5mm coronary CT acquisition (70–80% cardiac cycle) underwent semi-automated segmentation using a research workstation. Both patients had a >50% stenosis from the clinical image interpretation. Each volume was saved as a Stereo Lithographic (STL) file with 250 micron resolution. The 3D geometries were qualitatively assessed; the best of the four phases was 3D printed using a Stratasys Eden260V printer in Tango+, a rubber-like material that roughly emulates mechanical propertiesmore » of human vasculature. We connected the model to a programmable pump and measured the pressure drop using pressure sensors embedded proximal and distal to the arterial stenosis. Next, the STL files used for the 3D printed models were uploaded in the ANSYS meshing tool (ICEM CFD 16.1). A standard meshing process was applied and the meshed geometry was directly imported in the ANSYS Fluent for Computational Flow Dynamics simulations. The CFD simulations were used to calculate the CT-FFR and compared to the bench top FFR measured in the 3D printed phantoms. Results: FFR-CT measurements and phantoms were completed in within an hour after the segmentation. Patient 1 had a 60% stenosis that resulted in a CT-FFR of 0.68. The second case had a 50% stenosis and a CT-FFR of 0.75. The average bench top FFR measurements were 0.72 and 0.80, respectively. Conclusion: This pilot investigation demonstrated the use of a bench-top coronary model for CT-FFR validation. The measurements and the CFD simulations agreed within 6%. Project supported by Support: Toshiba America Medical Systems Corp.and NIH grant R01-EB002873. Project supported by Toshiba America Medical Systems Corp.and partial support from NIH grant R01-EB002873.« less
  • Purpose: The study has the goal to demonstrate that breast and soft tissue-equivalent phantoms for dosimetry applications in the diagnostic energy range can be fabricated using common 3D printing methods. Methods: 3D printing provides the opportunity to rapidly prototype uniquely designed objects from a variety of materials. Common 3D printers are usually limited to printing objects based on thermoplastic materials such as PLA, or ABS. The most commonly available plastic is PLA, which has a density significantly greater than soft tissue. We utilized a popular 3D printer to demonstrate that tissue specific phantom materials can be generated through the carefulmore » selection of 3D printing parameters. A series of stepwedges were designed and printed using a Makerbot Replicator2 3D printing system. The print file provides custom adjustment of the infill density, orientation and position of the object on the printer stage, selection of infill patterns, and other control parameters. The x-ray attenuation and uniformity of fabricated phantoms were evaluated and compared to common tissue-equivalent phantom materials, acrylic and BR12. X-ray exposure measurements were made using narrow beam geometry on a clinical mammography unit at 28 kVp on the series of phantoms. The 3D printed phantoms were imaged at 28 kVp to visualize the internal structure and uniformity in different planes of the phantoms. Results: By utilizing specific in-fill density and patterns we are able to produce a phantom closely matching the attenuation characteristics of BR12 at 28 kVp. The in-fill patterns used are heterogeneous, so a judicious selection of fill pattern and the orientation of the fill pattern must be made in order to obtain homogenous attenuation along the intended direction of beam propagation. Conclusions: By careful manipulation of the printing parameters, breast and soft tissue-equivalent phantoms appropriate for use at imaging energies can be fabricated using 3D printing techniques.« less
  • Purpose: To describe the design and characteristics of a novel linac-based MRI guided radiation therapy system that addresses RF and magnetic field interference and that can be housed in conventional radiotherapy vaults. Methods: The MR-IGRT system will provide simultaneous MR imaging combined with both simple (3D) and complex (IMRT, SBRT, SRS) techniques. The system is a combination of a) double-donut split solenoidal superconducting 0.345T MRI; and b) a 90 cm isocenter ring-gantry mounted 6MV, flattening filter-free linac coupled with a stacked doubly-focused multileaf collimator with 4 mm resolution. A novel RF shielding and absorption technology was developed to isolate themore » beam generating RF emissions from the MR, while a novel magnetic shielding sleeve system was developed to place the magnetic field-sensitive components in low-magnetic field regions. The system design produces high spatial resolution radiation beams with state-of-the art radiation dose characteristics and simultaneous MR imaging. Results: Prototype testing with a spectrum analyzer has demonstrated complete elimination of linac RF inside the treatment room. The magnetic field inside of the magnetic shielding was well below the specification, allowing the linear accelerator to operate normally. A novel on-gantry shimming system maintained < 25 ppm magnetic field homogeneity over a 45 cm spherical field of view for all gantry angles. Conclusion: The system design demonstrates the feasibility coupling a state-of-the art linac system with a 0.345T MRI, enabling highly conformal radiation therapy with simultaneous MR image guidance. S. Mutic’s employer (Washington University) has grant with ViewRay; D. Low is former ViewRay scientific advisory board member (ended October 2015); T. Chmielewski, G. Fought, M. Hernandez, I. Kawrakow, A. Sharma, S. Shvartsman, J. Dempsey are employees of ViewRay with stock options (Dempsey has leadership role and Dempsey/Kawrakow have stock).« less
  • Purpose: Three-dimensional printing has been implemented at our institution to create customized treatment accessories including shielding and bolus. In order to effectively use 3D printing, the topography of the patient must first be acquired. To this end, we have evaluated a low-cost structured-light 3D scanner in order to assess the clinical viability of this technology. Methods: For ease of use, the scanner (3D Systems, Sense 3D Scanner) was mounted in a simple gantry that guided its motion and maintained an optimum distance between the scanner and the object. To characterise the spatial accuracy of the scanner, we used a geometricmore » phantom and an anthropomorphic head phantom. The geometric phantom was machined from plastic and had overall dimensions of 24 cm by 15 cm and included a hemispherical and a tetrahedron protrusion roughly the dimensions of an average forehead and nose respectively. Meshes acquired by the optical scanner were compared to meshes generated from high-resolution CT images. Results: Scans were acquired in under one minute. Most of the optical scans contained noticeable artefacts although in most instances these were considered minor. Using an algorithm that calculated distances between the two meshes, we found most of the optical scanner measurements agreed with those from CT to within about 1 mm for the geometric phantom and to within about 2 mm for the head phantom. Conclusion: In summary, we deemed this scanner to be clinically acceptable and it has been used to design treatment accessories for several skin cancer patients.« less
  • Purpose: Using secondary skin collimation (SSC) to protect the critical organ surrounding the tumors is always desirable for electron and/or ortho-voltage treatments. However, the time-consuming and labor-intensive fabrication processes of current method (manually fabricate the lead mask) restrict the general use of SSC. The aim of this study is to develop a new SSC fabrication method using 3D scanning and 3D printing technologies in order to largely decrease the human labor involvement and fabrication time, also improve the fabrication accuracy. Methods: First, the patient surface was scanned with a 3D scanner (Structure Sensor, Occipital, CO). The raw scan data wasmore » subsequently transferred to a 3D modeling software (Rhinoceros, Ver. 5.0, McNeel North America, Seattle, WA). The tumor contour was then digitized and shielding region was determined by clinicians in the same software. The corresponding SCC conformed to the skin surface was then automatically generated by the software with the proper shielding thickness. The shell of the SCC (with hollow inside) was consequently printed by a 3D printer (Lulzbot TAZ, Aleph Objects, CO) using plastic material. Finally, the hollow mold of SCC was filled up with a melted cerrobend alloy. Once the cerrobend alloy cooled down, the fabrication of SCC was accomplished. Results: The results indicated the proposed method can achieve a much shorter time on making a SCC compared with tradition fabrication method. The processes of making a skin contour model for patients have been eliminated with the new method. SCC created by the new method possessed better accuracy and better conformality to patient’s skin contours. Conclusion: In this study, we have demonstrated a new method for the SCC fabrication. It is anticipated that our method can be an alternative way to replace conventional manual-based methods for electron and/or ortho-voltage SCC fabrication. This research was supported by the Global Ph.D. Fellowship Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (Grant No. 2015H1A2A1034071), Republic of Korea.« less