Customized 3D Printed Bolus for Breast Reconstruction for Modified Radical Mastectomy (MRM)

Jin-Suk Ha; Jae Hong Jung; Min-Joo Kim; Mi Jin Jeon; Won Suk Jang; Ik Jae Lee; Jun Won Kim; Tae Suk Suh

doi:10.14316/pmp.2016.27.4.196

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Ha, Jung, Kim, Jeon, Jang, Lee, Kim, and Suh: Customized 3D Printed Bolus for Breast Reconstruction for Modified Radical Mastectomy (MRM)

Original Article

Progress in Medical Physics 2016;27(4):196-202.

Published online: 17 December 2016

DOI: https://doi.org/10.14316/pmp.2016.27.4.196

Customized 3D Printed Bolus for Breast Reconstruction for Modified Radical Mastectomy (MRM)

Jin-Suk Ha^∗,^†, Jae Hong Jung^†,^‡, Min-Joo Kim^†, Mi Jin Jeon^∗, Won Suk Jang^∗, Ik Jae Lee^∗, Jun Won Kim^∗, Tae Suk Suh^†,

^∗Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

^†Department of Radiation Oncology, College of Medicine, Soonchunhyang University, Bucheon, Korea

^‡Department of Biomedical Engineering and Research Institute of Biomedical Engineering, The Catholic University of Korea, Seoul, Korea

Correspondence: Tae Suk Suh (suhsanta@catholic.ac.kr) Tel: 82-2-2258-7232, Fax: 82-2-2258-7506

Received 10 November 201619 December 2016 Accepted 20 December 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 aim to develop the breast bolus by using a 3D printer to minimize the air-gap, and compare it to commercial bolus used for patients undergoing reconstruction in breast cancer. The bolus-shaped region of interests (ROIs) were contoured at the surface of the intensity-modulated radiation therapy (IMRT) thorax phantom with 5 mm thickness, after which the digital imaging and communications in mdicine (DICOM)-RT structure file was acquired. The intensity-modulated radiation therapy (Tomo-IMRT) and direct mode (Tomo-Direct) using the Tomotherapy were established. The 13 point doses were measured by optically stimulated luminescence (OSLD) dosimetry. The measurement data was analyzed to quantitatively evaluate the applicability of 3D bolus. The percentage change of mean measured dose between the commercial bolus and 3D-bolus was 2.3% and 0.7% for the Tomo-direct and Tomo-IMRT, respectively. For air-gap, range of the commercial bolus was from 0.8 cm to 1.5 cm at the periphery of the right breast. In contrast, the 3D-bolus have occurred the air-gap (i.e., 0 cm). The 3D-bolus for radiation therapy reduces the air-gap on irregular body surface that believed to help in accurate and precise radiation therapy due to better property of adhesion.

Keywords: Modified radical mastectomy, Breast radiation treatment, 3D printing, Bolus

REFERENCES

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Fig. 1.

3D-bolus file converted output type by using KISSlice program.

Fig. 2.

Air-gap measurement of distance and volume.

Fig. 3.

The IMRT thorax phantom with OSLDs (a) and total of 13 points in horizontal, vertical and central location in breast phantom (b) (L: Lateral, M: Medial, C: Center, S: Superior, I: Inferior).

Fig. 4.

MVCT image after applying (a) commercialized-bolus and the (b) 3D-bolus.

Fig. 5.

DVH of (a) IMRT and (b) Direct applied for commercialized-bolus and 3D printed bolus.

Table 1.

OSLD measurement at 13 points for Tomo-IMRT treatment planning.

Point		Commercialized-bolus				3D-bolus
Point		Planning (cGy)	Measure (cGy)	Difference (%)	Planning (cGy)	Measure (cGy)	Difference (%)
Lateral	L1	171.0	167.8	−1.9	181.0	190.0	5.0
	L2	163.0	168.3	3.3	176.0	167.5	−4.9
	L3	179.0	175.2	−2.1	182.0	191.7	5.4
Medial	M1	171.0	173.4	1.4	181.0	174.6	−3.6
	M2	166.0	177.5	6.9	178.0	171.0	−3.9
	M3	174.0	171.0	−1.7	185.0	186.8	1.0
Center	C	186.0	195.3	5.0	183.0	185.1	1.1
Superior	S1	171.0	166.4	−2.7	157.0	155.0	−1.3
	S2	181.0	191.7	5.9	182.0	177.8	−2.3
	S3	182.0	178.4	−2.0	181.0	186.3	3.0
Inferior	I1	177.0	174.7	−1.3	181.0	185.8	2.7
	I2	172.0	171.8	−0.1	182.0	191.8	5.4
	I3	163.0	157.2	−3.6	153.0	160.0	4.6
Mean±SD		173.5±7.2	174.5±10.0		177.0±10.0	178.7±12.2

Table 2.

OSLD measurement at 13 points for Tomo-Direct treatment planning.

Point		Commercialized-bolus			3D-bolus
Point		Planning (cGy)	Measure (cGy)	Difference (%)	Planning (cGy)	Measure (cGy)	Difference (%)
Lateral	L1	140.0	135.3	−3.4	139.0	145.0	4.3
	L2	169.0	175.1	3.6	171.0	168.2	−1.6
	L3	173.0	170.3	−1.6	171.0	170.8	−0.1
Medial	M1	162.0	166.7	2.9	177.0	183.3	3.6
	M2	167.0	168.7	1.0	170.0	183.1	7.7
	M3	113.0	110.0	−2.7	109.0	105.0	−3.7
Center	C	169.0	155.8	−7.8	160.0	141.7	−11.4
Superior	S1	164.0	158.2	−3.6	159.0	155.0	−2.5
	S2	179.0	182.4	1.9	183.0	175.8	−3.9
	S3	173.0	172.7	−0.2	171.0	165.2	−3.4
Inferior	I1	169.0	164.7	−2.5	176.0	159.5	−9.4
	I2	173.0	167.0	−3.5	186.0	189.0	1.6
	I3	155.0	157.3	1.5	150.0	157.3	4.8
Mean±SD		162.0±17.7	160.3±18.9		163.2±20.8	161.4±22.3

L: Lateral, M: Medial, C: Center, S: Superior, I: Inferior.

Table 3.

Evaluation treatment planning of comparison between commercialized- and 3D-bolus with 5 mm thickness for rightlung.

Measurement (Gy)
Mode	Commercialized-bolus				3D-bolus
	Max	Min	Mean±SD	Max	Min	Mean±SD
Tomo-IMRT	37.0	0.4	10.0±7.6	41.4	0.4	8.7±7.3
Tomo-Direct	47.2	0.1	3.0±7.6	48.8	0.1	2.7±7.0

Max: maximum value, Min: minimum value, SD: standard deviation.

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