Clinical Implementation of 3D Printing in the Construction of Patient Specific Bolus for Photon Beam Radiotherapy for Mycosis Fungoides
Progress in Medical Physics 2017³â 28±Ç 1È£ p.33 ~ p.38
±è¼º¿ì(Kim Sung-Woo) - University of Ulsan College of Medicine Asan Medical Center Department of Radiation Oncology
°ûÁ¤¿ø(Kwak Jung-Won) - University of Ulsan College of Medicine Asan Medical Center Department of Radiation Oncology
Á¶º´Ã¶(Cho Byung-Chul) - University of Ulsan College of Medicine Asan Medical Center Department of Radiation Oncology
¼Û½Ã¿(Song Si-Yeol) - University of Ulsan College of Medicine Asan Medical Center Department of Radiation Oncology
ÀÌ»ó¿í(Lee Sang-Wook) - University of Ulsan College of Medicine Asan Medical Center Department of Radiation Oncology
Á¤Ä¡¿µ(Jeong Chi-Young) - University of Ulsan College of Medicine Asan Medical Center Department of Radiation Oncology
Abstract
Creating individualized build-up material for superficial photon beam radiation therapy at irregular surface is complex with rice or commonly used flat shape bolus. In this study, we implemented a workflow using 3D printed patient specific bolus and describe our clinical experience. To provide better fitted build-up to irregular surface, the 3D printing technique was used. The PolyLactic Acid (PLA) which processed with nontoxic plant component was used for 3D printer filament material for clinical usage. The 3D printed bolus was designed using virtual bolus structure delineated on patient CT images. Dose distributions were generated from treatment plan for bolus assigned uniform relative electron density and bolus using relative electron density from CT image and compared to evaluate the inhomogeneity effect of bolus material. Pretreatment QA is performed to verify the relative electron density applied to bolus structure by gamma analysis. As an in-vivo dosimetry, Optically Stimulated Luminescent Dosimeters (OSLD) are used to measure the skin dose. The plan comparison result shows that discrepancies between the virtual bolus plan and printed bolus plan are negligible. (0.3% maximum dose difference and 0.2% mean dose difference). The dose distribution is evaluated with gamma method (2%, 2 mm) at the center of GTV and the passing rate was 99.6%. The OSLD measurement shows 0.3% to 2.1% higher than expected dose at patient treatment lesion. In this study, we treated Mycosis fungoides patient with patient specific bolus using 3D printing technique. The accuracy of treatment plan was verified by pretreatment QA and in-vivo dosimetry. The QA results and 4 month follow up result shows the radiation treatment using 3D printing bolus is feasible to treat irregular patient skin.
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3D print, Bolus, Cutaneous lymphoma
KMID :
1038720170280010033
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À¯È¿¼º°á°ú(Recomendation)
The 3D printed bolus has the advantages of easy patient set-up, comfort of patient, function of build-up and immobilization.