Workload implications for clinic workflow with implementation of three-dimensional printed customized bolus for radiation therapy: A pilot study
Workload implications for clinic workflow with implementation of three-dimensional printed customized bolus for radiation therapy: A pilot study
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DOI：
10.1371/journal.pone.0204944
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发表时间：
2018-10-01
期刊：
影响因子：
3.7
通讯作者：
Lawrence, Jessica
中科院分区：
文献类型：
--
作者：
Ehler, Eric;Sterling, David;Lawrence, Jessica
Bolus通常用于放射治疗，以改善放射剂量在靶体积上的分布，但市售产品并不总是与患者表面很好地吻合。肿瘤控制可能会受到损害，特别是对于浅表肿瘤，如果丸剂不符合，患者表面和丸剂之间存在气隙。三维（3D）打印技术允许创建高度详细的，可变形状的物体，使其成为一个有吸引力的和负担得起的选择，定制，针对患者的丸剂创建。3D打印在临床环境中的应用仍然有限。因此，本研究的目的是评估使用3D打印定制丸的工作流程对接受放射治疗的自发性肿瘤伴侣动物的时间和临床契合度的影响。本研究的主要目的是评估创建临床3D打印丸剂所需的时间。次要目的是评估该丸的临床适宜性和验证皮肤表面剂量。记录了分割时间和3D打印时间，同时评估了丸剂与治疗计划中创建的丸剂的临床契合度。3D打印丸从分割到生成的平均时间为6.15 h，中位数时间为5.25 h。3D打印丸剂与常规丸剂相比，与计划丸剂的偏差明显更小（p = 0.0078），在88%的测量中，丸剂下的测量剂量与预期剂量的一致性在5%以内。在一个工作日内成功制作出临床可接受的3D打印定制丸剂进行治疗。对时间影响最大的是3D打印本身，因此对人员和人员配备的影响最小。在放射治疗诊所实施3D打印工作流程时，建议采取质量保证步骤。
Bolus is commonly used in radiation therapy to improve radiation dose distribution to the target volume, but commercially available products do not always conform well to the patient surface. Tumor control may be compromised, particularly for superficial tumors, if bolus does not conform well and air gaps exist between the patient surface and the bolus. Three-dimensional (3D) printing technology allows the creation of highly detailed, variable shaped objects, making it an attractive and affordable option for customized, patient-specific bolus creation. The use of 3D printing in the clinical setting remains limited. Therefore, the objective of this study was to assess the implications on time and clinical fit using a workflow for 3D printing of customized bolus in companion animals with spontaneous tumors treated with radiation therapy. The primary aim of this study was to evaluate the time required to create a clinical 3D printed bolus. The secondary aims were to evaluate the clinical fit of the bolus and to verify the skin surface dose. Time to segmentation and 3D printing were documented, while the clinical fit of the bolus was assessed in comparison to the bolus created in the treatment planner. The mean and median time from segmentation to generation of 3D printed boluses was 6.15 h and 5.25 h, respectively. The 3D printed bolus was significantly less deviated from the planned bolus compared to the conventional bolus (p = 0.0078) with measured dose under the bolus within 5% agreement of expected dose in 88% of the measurements. Clinically acceptable 3D printed customized bolus was successfully created for treatment within one working day. The most significant impact on time is the 3D printing itself, which therefore has minimal implications on personnel and staffing. Quality assurance steps are recommended when implementing a 3D printing workflow to the radiotherapy clinic.