Development and validation of a 3D‐printed bolus cap for total scalp irradiation

  • Garrett C. Baltz
    Department of Radiation Physics The University of Texas MD Anderson Cancer Center Houston TX USA
  • Pai‐Chun Melinda Chi
    Department of Radiation Physics The University of Texas MD Anderson Cancer Center Houston TX USA
  • Pei‐Fong Wong
    Department of Radiation Physics The University of Texas MD Anderson Cancer Center Houston TX USA
  • Congjun Wang
    Department of Radiation Physics The University of Texas MD Anderson Cancer Center Houston TX USA
  • Daniel F. Craft
    Department of Radiation Physics The University of Texas MD Anderson Cancer Center Houston TX USA
  • Stephen F. Kry
    Department of Radiation Physics The University of Texas MD Anderson Cancer Center Houston TX USA
  • Stacy Sydney Hsinyi Lin
    Department of Radiation Physics The University of Texas MD Anderson Cancer Center Houston TX USA
  • Adam S. Garden
    Department of Radiation Oncology The University of Texas MD Anderson Cancer Center Houston TX USA
  • Susan A. Smith
    Department of Radiation Physics The University of Texas MD Anderson Cancer Center Houston TX USA
  • Rebecca M. Howell
    Department of Radiation Physics The University of Texas MD Anderson Cancer Center Houston TX USA

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<jats:title>Abstract</jats:title><jats:sec><jats:title>Purpose</jats:title><jats:p>The goal of total scalp irradiation (<jats:styled-content style="fixed-case">TSI</jats:styled-content>) is to deliver a uniform dose to the scalp, which requires the use of a bolus cap. Most current methods for fabricating bolus caps are laborious, yet still result in nonconformity and low reproducibility, which can lead to nonuniform irradiation of the scalp. We developed and validated patient‐specific bolus caps for <jats:styled-content style="fixed-case">TSI</jats:styled-content> using three‐dimensional (3D) printing.</jats:p></jats:sec><jats:sec><jats:title>Methods and materials</jats:title><jats:p>3D‐printing materials were radiologically analyzed to identify a material with properties suitable for use as a bolus cap. A Python script was developed within a commercial treatment planning system to automate the creation of a ready‐to‐print, patient‐specific 3D bolus cap model. A bolus cap was printed for an anthropomorphic head phantom using a commercial vendor and a computed tomography simulation of the anthropomorphic head phantom and bolus cap was used to create a volumetric‐modulated arc therapy <jats:styled-content style="fixed-case">TSI</jats:styled-content> treatment plan. The planned treatment was delivered to the head phantom and dosimetric validation was performed using thermoluminescent dosimeters (<jats:styled-content style="fixed-case">TLD</jats:styled-content>). The developed procedure was used to create a bolus cap for a clinical <jats:styled-content style="fixed-case">TSI</jats:styled-content> patient, and <jats:italic>in vivo </jats:italic><jats:styled-content style="fixed-case">TLD</jats:styled-content> measurements were acquired for several fractions.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Agilus‐60 was validated as a new 3D‐printing material suitable for use as bolus. A 3D‐printed Agilus‐60 bolus cap had excellent conformality to the phantom scalp, with a maximum air gap of 4 mm. <jats:styled-content style="fixed-case">TLD</jats:styled-content> measurements showed that the bolus cap generated a uniform dose to the scalp within a 2.7% standard deviation, and the delivered doses agreed with calculated doses to within 2.4% on average. The patient bolus was conformal and the average difference between <jats:styled-content style="fixed-case">TLD</jats:styled-content> measured and planned doses was 5.3%.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>We have developed a workflow to 3D‐print highly conformal bolus caps for <jats:styled-content style="fixed-case">TSI</jats:styled-content> and demonstrated these caps can reproducibly generate a uniform dose to the scalp.</jats:p></jats:sec>

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