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Efficacy and Accuracy of Patient Specific Customize Bolus Using a 3-Dimensional Printer for Electron Beam Therapy
Korean Journal of Medical Physics 2016;27(2):64-71
Published online June 30, 2016
© 2016 Korean Society of Medical Physics.

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 ofMedicine, Department of Radiation Oncology, Kangbuk Samsung Hospital, Sungkyunkwan UniversitySchool of Medicine, Seoul, Department of Medical Physics, Kyonggi University, Suwon, Korea
Received May 23, 2016; Revised May 25, 2016; Accepted May 26, 2016.
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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