Sci—Thur AM: YIS ‐ 07: Design and production of 3D printed bolus for electron radiation therapy

Abstract

This is a proof‐of‐concept study demonstrating the capacity for modulated electron radiation therapy (MERT) using 3D printed bolus. Previous reports have involved bolus design using an electron pencil beam model and fabrication using a milling machine. In this study, an in‐house algorithm is presented that optimizes the dose distribution with regard to dose coverage, conformity and homogeneity within planning target volume (PTV). The algorithm uses calculated result of a commercial electron Monte Carlo dose calculation as input. Distances along ray lines from distal side of 90% isodose to distal surface of PTV are used to estimate the bolus thickness. Inhomogeneities within the calculation volume are accounted for using coefficient of equivalent thickness method. Several regional modulation operators are applied to improve dose coverage and uniformity. The process is iterated (usually twice) until an acceptable MERT plan is realized, and the final bolus is printed using solid polylactic acid. The method is evaluated with regular geometric phantoms, anthropomorphic phantoms and a clinical rhabdomyosarcoma pediatric case. In all cases the dose conformity is improved compared to that with uniform bolus. The printed boluses conform well to the surface of complex anthropomorphic phantoms. For the rhabdomyosarcoma patient, the MERT plan yields a reduction of mean dose by 38.2% in left kidney relative to uniform bolus. MERT using 3D printed bolus appears to be a practical, low cost approach to generating optimized bolus for electron therapy. The method is effective in improving conformity of prescription isodose surface and in sparing immediately adjacent normal tissues.