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Technical Note: Development of 3D?printed breast phantoms for end?to?end testing of whole breast volumetric arc radiotherapy

ABSTRACT: Abstract End?to?end testing of a new breast radiotherapy technique preferably requires realistic phantom geometries, which is challenging to achieve using currently commercially available solutions. We have developed a series of three?dimensional (3D)?printed breast phantoms, with ionization chamber and radiochromic film inserts, which can be attached to a commercial anthropomorphic thorax phantom. A contoured left breast from a patient’s planning CT was mapped onto a CT of the CIRS E2E thorax phantom (CIRS Inc.) and cropped to fit the surface. Four versions of the breast were 3D printed, containing a cavity for an ionization chamber and slits for radiochromic film insertion in the three cardinal planes, respectively. The phantoms were fully compatible with surface scanning technology used for setup. The phantoms were validated using a whole?breast volumetric modulated arc therapy protocol with a simultaneous integrated boost to the tumor bed (VMAT?SIB). Six patient plans and one original plan on the breast phantom were verified with planar portal imaging, point dose, and film measurements in the MultiCube phantom and planar ??analysis using ArcCHECK diode array. Six patient plans were recalculated on the breast phantom (hybrid plans) and delivered with point dose and film measurements with 3% (local)/2 mm ??analysis. One complete end?to?end test on the breast phantom was performed. All plan quality verifications had point dose differences below 2.4% from the calculated dose and ??agreement scores (?AS) > 87.3% for film measurements in the MultiCube, portal dosimetry, and ArcCHECK. Point dose differences in the 3D?printed phantoms were below 2.6% (median ?1.4%, range ?2.6%; 0.3%). Median ?AS was 96.4% (range 80.1%–99.7%) for all film inserts. The proposed 3D?printed attachable breast dosimetry phantoms have been shown to be a valuable tool for end?to?end testing of a new radiotherapy protocol. The workflow described in this report can aid users to create their own phantom?specific breast 3D?printed phantoms.

SUBMITTER: Delombaerde L

PROVIDER: S-EPMC7484846 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Project description:PurposeInterventional fluorescence imaging is increasingly being utilized to quantify cancer biomarkers in both clinical and preclinical models, yet absolute quantification is complicated by many factors. The use of optical phantoms has been suggested by multiple professional organizations for quantitative performance assessment of fluorescence guidance imaging systems. This concept can be further extended to provide standardized tools to compare and assess image analysis metrics.Procedures3D-printed fluorescence phantoms based on solid tumor models were developed with representative bio-mimicking optical properties. Phantoms were produced with discrete tumors embedded with an NIR fluorophore of fixed concentration and either zero or 3% non-specific fluorophore in the surrounding material. These phantoms were first imaged by two fluorescence imaging systems using two methods of image segmentation, and four assessment metrics were calculated to demonstrate variability in the quantitative assessment of system performance. The same analysis techniques were then applied to one tumor model with decreasing tumor fluorophore concentrations.ResultsThese anatomical phantom models demonstrate the ability to use 3D printing to manufacture anthropomorphic shapes with a wide range of reduced scattering (μs': 0.24-1.06 mm-1) and absorption (μa: 0.005-0.14 mm-1) properties. The phantom imaging and analysis highlight variability in the measured sensitivity metrics associated with tumor visualization.Conclusions3D printing techniques provide a platform for demonstrating complex biological models that introduce real-world complexities for quantifying fluorescence image data. Controlled iterative development of these phantom designs can be used as a tool to advance the field and provide context for consensus-building beyond performance assessment of fluorescence imaging platforms, and extend support for standardizing how quantitative metrics are extracted from imaging data and reported in literature.

Project description:IntroductionAdditive manufacturing or 3-dimensional printing has become a widespread technology with many applications in medicine. We have conducted a systematic review of its application in radiation oncology with a particular emphasis on the creation of phantoms for image quality assessment and radiation dosimetry. Traditionally used phantoms for quality assurance in radiotherapy are often constraint by simplified geometry and homogenous nature to perform imaging analysis or pretreatment dosimetric verification. Such phantoms are limited due to their ability in only representing the average human body, not only in proportion and radiation properties but also do not accommodate pathological features. These limiting factors restrict the patient-specific quality assurance process to verify image-guided positioning accuracy and/or dose accuracy in "water-like" condition.Methods and resultsEnglish speaking manuscripts published since 2008 were searched in 5 databases (Google Scholar, Scopus, PubMed, IEEE Xplore, and Web of Science). A significant increase in publications over the 10 years was observed with imaging and dosimetry phantoms about the same total number (52 vs 50). Key features of additive manufacturing are the customization with creation of realistic pathology as well as the ability to vary density and as such contrast. Commonly used printing materials, such as polylactic acid, acrylonitrile butadiene styrene, high-impact polystyrene and many more, are utilized to achieve a wide range of achievable X-ray attenuation values from -1000 HU to 500 HU and higher. Not surprisingly, multimaterial printing using the polymer jetting technology is emerging as an important printing process with its ability to create heterogeneous phantoms for dosimetry in radiotherapy.ConclusionGiven the flexibility and increasing availability and low cost of additive manufacturing, it can be expected that its applications for radiation medicine will continue to increase.

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Technical Note: Development of 3D?printed breast phantoms for end?to?end testing of whole breast volumetric arc radiotherapy

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