Abstract
This study aims to confirm the usefulness of patient-specific quality assurance (PSQA) using three-dimensional (3D)-printed phantoms in ensuring the stability of IORT and the precision of the treatment administered. In this study, five patient-specific chest phantoms were fabricated using a 3D printer such that they were dosimetrically equivalent to the chests of actual patients in terms of organ density and shape around the given target, where a spherical applicator was inserted for breast IORT treatment via the INTRABEAM™ system. Models of lungs and soft tissue were fabricated by applying infill ratios corresponding to the mean Hounsfield unit (HU) values calculated from CT scans of the patients. The two models were then assembled into one. A 3D-printed water-equivalent phantom was also fabricated to verify the vendor-provided depth dose curve. Pieces of an EBT3 film were inserted into the 3D-printed customized phantoms to measure the doses. A 10 Gy prescription dose based on the surface of the spherical applicator was delivered and measured through EBT3 films parallel and perpendicular to the axis of the beam. The shapes of the phantoms, CT values, and absorbed doses were compared between the expected and printed ones. The morphological agreement among the five patient-specific 3D chest phantoms was assessed. The mean differences in terms of HU between the patients and the phantoms was 2.2 HU for soft tissue and −26.2 HU for the lungs. The dose irradiated on the surface of the spherical applicator yielded a percent error of −2.16% ± 3.91% between the measured and prescribed doses. In a depth dose comparison using a 3D-printed water phantom, the uncertainty in the measurements based on the EBT3 film decreased as the depth increased beyond 5 mm, and a good agreement in terms of the absolute dose was noted between the EBT3 film and the vendor data. These results demonstrate the applicability of the 3D-printed chest phantom for PSQA in breast IORT. This enhanced precision offers new opportunities for advancements in IORT.
Highlights
Intraoperative radiation therapy (IORT) is a treatment modality that entails accelerated partial breast irradiation for early-stage breast cancer patients [1, 2]
Compared with conventional whole-breast irradiation (WBI) over 5 to 5.5 weeks followed by tumor-bed boost or hypofractionated WBI over 3 weeks with a boost, IORT is completed in one day, and intraoperative irradiation allows for the immediate treatment of the surgical bed in 30 min to avoid a delay between surgery and external beam radiotherapy
This study investigates the feasibility of verifying IORT dosimetry using a 3D-printed water-equivalent phantom as well as patient-specific 3D chest phantoms fabricated by simulating the actual structure of the body of the patient around the target
Summary
Intraoperative radiation therapy (IORT) is a treatment modality that entails accelerated partial breast irradiation for early-stage breast cancer patients [1, 2]. Compared with conventional whole-breast irradiation (WBI) over 5 to 5.5 weeks followed by tumor-bed boost or hypofractionated WBI over 3 weeks with a boost, IORT is completed in one day, and intraoperative irradiation allows for the immediate treatment of the surgical bed in 30 min to avoid a delay between surgery and external beam radiotherapy. This is convenient for the patient and helps reduce cost. Treating a smaller volume of normal tissue instead of performing WBI enables the reduction of potential lung and cardiac toxicities arising from radiation treatment and enhances tumor control [5,6,7]
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