Efficacy and Accuracy of Patient Specific Customize Bolus Using a 3-Dimensional Printer for Electron Beam Therapy

Woo Keun Choi; Jun Chul Chun; Sang Gyu Ju; Byung Jun Min; Su Yeon Park; Hee Rim Nam; Chae-Seon Hong; MinKyu Kim; Bum Yong Koo; Do Hoon Lim

doi:10.14316/pmp.2106.27.2.64

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Choi, Chun, Ju, Min, Park, Nam, Hong, Kim, Koo, and Lim: Efficacy and Accuracy of Patient Specific Customize Bolus Using a 3-Dimensional Printer for Electron Beam Therapy

Original Article

Progress in Medical Physics 2106;27(2):64-71.

Published online: 20 June 2106

DOI: https://doi.org/10.14316/pmp.2106.27.2.64

Efficacy and Accuracy of Patient Specific Customize Bolus Using a 3-Dimensional Printer for Electron Beam Therapy

Woo Keun Choi^∗,^‡, Jun Chul Chun^‡, Sang Gyu Ju^∗, Byung Jun Min^†, Su Yeon Park^∗, Hee Rim Nam^†, Chae-Seon Hong^∗, MinKyu Kim^∗, Bum Yong Koo^∗, Do Hoon Lim^∗

^∗Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Suwon, Korea

^†Department of Radiation Oncology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea

^‡Department of Medical Physics, Kyonggi University, Suwon, Korea

Correspondence: Sang Gyu Ju (sg.ju@samsung.com) Tel: 82-2-3410-2612, Fax: 82-2-3410-2619

Received 23 May 2016 Revised 25 May 2016 Accepted 26 May 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We develop a manufacture procedure for the production of a patient specific customized bolus (PSCB) using a 3D printer (3DP). The dosimetric accuracy of the 3D-PSCB is evaluated for electron beam therapy. In order to cover the required planning target volume (PTV), we select the proper electron beam energy and the field size through initial dose calculation using a treatment planning system. The PSCB is delineated based on the initial dose distribution. The dose calculation is repeated after applying the PSCB. We iteratively fine-tune the PSCB shape until the plan quality is sufficient to meet the required clinical criteria. Then the contour data of the PSCB is transferred to an in-house conversion software through the DICOMRT protocol. This contour data is converted into the 3DP data format, STereoLithography data format and then printed using a 3DP. Two virtual patients, having concave and convex shapes, were generated with a virtual PTV and an organ at risk (OAR). Then, two corresponding electron treatment plans with and without a PSCB were generated to evaluate the dosimetric effect of the PSCB. The dosimetric characteristics and dose volume histograms for the PTV and OAR are compared in both plans. Film dosimetry is performed to verify the dosimetric accuracy of the 3D-PSCB. The calculated planar dose distribution is compared to that measured using film dosimetry taken from the beam central axis. We compare the percent depth dose curve and gamma analysis (the dose difference is 3%, and the distance to agreement is 3 mm) results. No significant difference in the PTV dose is observed in the plan with the PSCB compared to that without the PSCB. The maximum, minimum, and mean doses of the OAR in the plan with the PSCB were significantly reduced by 9.7%, 36.6%, and 28.3%, respectively, compared to those in the plan without the PSCB. By applying the PSCB, the OAR volumes receiving 90% and 80% of the prescribed dose were reduced from 14.40 cm³ to 0.1 cm³ and from 42.6 cm³ to 3.7 cm³, respectively, in comparison to that without using the PSCB. The gamma pass rates of the concave and convex plans were 95% and 98%, respectively. A new procedure of the fabrication of a PSCB is developed using a 3DP. We confirm the usefulness and dosimetric accuracy of the 3D-PSCB for the clinical use. Thus, rapidly advancing 3DP technology is able to ease and expand clinical implementation of the PSCB.

Keywords: Customized bolus, 3D printer, electron beam therapy

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Fig. 1.

Work flow diagram for the manufacture of a patient-specific customized bolus using a three-dimensional printer.

Fig. 2.

Two types of patient-specific customized bolus produced by three-dimensional printer for virtual patients (concave and convex shape, physical density=1.5±1 g/cm³).

Fig. 3.

Comparison of dose distribution of with- and without concave shaped PSCB (a) and convex shaped PSCB (b).

Fig. 4.

Comparison of DVHs for OAR and PTV of with- and without concave shaped PSCB (a) and convex shaped PSCB (b).

Fig. 5.

Comparison of percent depth dose (a) and (c) at central axis of the beam and Gamma analysis (b) and (d) through film dosimetry. (a) and (b) represent PDD and Gamma analysis result for a virtual patient with a concave shaped PSCB respectively. (c) and (d) represent PDD and Gamma analysis result for a virtual patient with a convex shaped PSCB respectively.

Table 1.

Comparison of the dosimetric characteristic for treatment plan and quality assurance with- and without PSCB.

		PTV					^OAR				Gamma
	Volume (cm³)	Max Dose (Gy)	Min Dose (Gy)	Mean Dose (Gy)	Volume (cm³)	Max Dose (Gy)	Min Dose (Gy)	e Mean Dose (Gy)	V_90%	V_80%	Pass Rate (3%/3 mm)
Concave WO/B	16.15	3.35	2.86	3.04±0.05	15.05	2.86	1.28	2.14±0.36	5.04	28.28	0.95
W/B		3.24	2.64	3.1±0.08		2.77	0.81	1.68±0.45	0.15	6.50
Convex WO/B	10.07	3.34	2.88	3.07±0.04	15.05	2.99	1.45	2.43±0.32	23.83	57.05	0.98
W/B		3.25	2.56	3.04±0.14		2.51	0.92	1.59±0.37	0.00	1.07
Average WO/B		3.35	2.87	3.06		2.93	1.37	2.28	14.44	42.67	0.97
W/B		3.25	2.60	3.08		2.64	0.87	1.64	0.08	3.79
Ratio		−2.99%	−9.41%	0.65%		−9.74%	−36.63%	−28.29% −	−99.48%	−91.13%

V₉₀: volume received 90% of the prescribed dose, V₈₀: volume received 90% of the prescribed dose, WO/B: without bolus, W/B: with bolus, Ratio: (W/B-WO/B)/WOB)×100%.

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