Development of a customisable 3D-printed intra-oral stent for head-and-neck radiotherapy.

Intra-oral stents (including mouth-pieces and bite blocks) can be used to displace adjacent non-involved oral tissue and reduce radiation side effects from radiotherapy treatments for head-and-neck cancer. In this study, a modular and customisable 3D printed intra-oral stent was designed, fabricated and evaluated, to utilise the advantages of the 3D printing process without the interruption of clinical workflow associated with printing time. The stent design used a central mouth-opening and tongue-depressing main piece, with optional cheek displacement pieces in three different sizes, plus an anchor point for moulding silicone to fit individual patients' teeth. A magnetic resonance imaging (MRI) study of one healthy participant demonstrated the tissue displacement effects of the stent, while providing a best-case indication of its comfort.

Dosimetric evaluation of a patient-specific 3D-printed oral positioning stent for head-and-neck radiotherapy.

As head-and-neck radiotherapy treatments become more complex and sophisticated, and the need to control and stabilise the positioning of intra-oral anatomy becomes more important, leading the increasing use of oral positioning stents during head-and-neck radiotherapy simulation and delivery. As an alternative to the established practice of creating oral positioning stents using wax, this study investigated the use of a 3D printing technique. An Ender 5 3D printer (Creality 3D, Shenzhen, China) was used, with PLA+ "food-safe" polylactic acid filament (3D Fillies, Dandenong South, Australia), to produce a low-density 3D printed duplicate of a conventional wax stent. The physical and dosimetric effects of the two stents were evaluated using radiochromic film in a solid head phantom that was modified to include flexible parts. The Varian Eclipse treatment planning system (Varian Medical Systems, Palo Alto, USA) was used to calculate the dose from two different head-and-neck treatment plans for the phantom with each of the two stents. Examination of the resulting four dose distributions showed that both stents effectively pushed sensitive oral tissues away from the treatment targets, even though most of the phantom was solid. Film measurements confirmed the accuracy of the dose calculations from the treatment planning system, despite the steep density gradients in the treated volume, and demonstrated that the 3D print could be a suitable replacement for the wax stent. This study demonstrated a useful method for dosimetrically testing novel oral positioning stents. We recommend the development of flexible phantoms for future studies.

Characterisation of radiological properties of a brachytherapy moulding material.

The use of a non-water-equivalent personalised mould for gynaecological brachytherapy treatments can result in a substantial dose reduction at the treatment site, compared to calculated dose, in lieu of a dose calculation algorithm capable of modelling non-water-equivalent materials. This study describes the characterisation of the radiological properties of a brachytherapy applicator moulding material. Simple line source correction factors for an 192Ir source are obtained through Monte Carlo simulations and verified by film measurements. The dwell position corrections are used to estimate aggregate correction factors for dose deliveries that involve multiple dwell positions, in terms of treatment length, applicator radii and depth of reference dose. For the Fricotan moulding material used locally, the dose reductions varied from 1% for an applicator radius of 0.5 cm to > 4% for radii exceeding 2 cm. The method described in this paper could be used to develop correction factors for other non-water-equivalent moulding materials, in a TG-43UI dose calculation environment.

A unique approach to high-dose-rate vaginal mold brachytherapy of gynecologic malignancies.

PURPOSE: Patients with cervical and vaginal cancer sometimes have a less straightforward approach for choice of brachytherapy treatment owing to the tumor's location and clinical presentation. The staff at Royal Brisbane & Women's Hospital in Queensland, Australia, is trying to solve this problem by the use of an old technique in a new approach called vaginal molds. With a patient-specific vaginal mold, the appearance of the applicator and the dose distribution can be customized to provide an optimal treatment for each patient. METHODS AND MATERIALS: The technique used at the Royal Brisbane & Women's Hospital uses a flexible two-part putty, moulded to the shape of the vagina, in which standard catheters (flexible implant tubes) are incorporated, in a pattern designed to permit a dose distribution more conformal to the target volume. RESULTS: The presented technique is efficient and improves the accuracy of a homogeneous target cover and sparing of organs at risk for vaginal mold brachytherapy treatments at our institution. CONCLUSION: This technique offers a customizable option when traditional cylindrical- or dome-type applicators cannot be used, or provide inadequate dose coverage. Molds to match the patient anatomy can be created quickly, while allowing flexibility in positioning of catheters to achieve the desired dose distribution.