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Research Papers

A Three-Dimensional-Printed Patient-Specific Phantom for External Beam Radiation Therapy of Prostate Cancer

[+] Author and Article Information
Christopher L. Lee

Mem. ASME
Franklin W. Olin College of Engineering,
1000 Olin Way,
Needham, MA 02492
e-mail: christopher.lee@olin.edu

Max C. Dietrich, Uma G. Desai, Ankur Das

Franklin W. Olin College of Engineering,
1000 Olin Way,
Needham, MA 02492

Suhong Yu, Hong F. Xiang, Ariel E. Hirsch

Department of Radiation Oncology,
Boston Medical Center & Boston University
School of Medicine,
820 Harrison Avenue,
Boston, MA 02118

C. Carl Jaffe

Department of Radiology,
Boston Medical Center & Boston University
School of Medicine,
820 Harrison Avenue,
Boston 02118, MA

B. Nicolas Bloch

Department of Radiology,
Boston Medical Center & Boston University
School of Medicine
820 Harrison Avenue,
Boston, MA 02118

1Corresponding author.

2Present address: LIM Innovations, San Francisco, CA 94103.

3Present address: Department of Radiation Oncology, Penn Medicine/Lancaster General Health and University of Pennsylvania School of Medicine, Lancaster, PA 17601.

Manuscript received February 13, 2018; final manuscript received July 5, 2018; published online August 6, 2018. Assoc. Editor: Lijie Grace Zhang.

ASME J of Medical Diagnostics 1(4), 041004 (Aug 06, 2018) (12 pages) Paper No: JESMDT-18-1008; doi: 10.1115/1.4040817 History: Received February 13, 2018; Revised July 05, 2018

This paper presents the design evolution, fabrication, and testing of a novel patient and organ-specific, three-dimensional (3D)-printed phantom for external beam radiation therapy (EBRT) of prostate cancer. In contrast to those found in current practice, this phantom can be used to plan and validate treatment tailored to an individual patient. It contains a model of the prostate gland with a dominant intraprostatic lesion (DIL), seminal vesicles, urethra, ejaculatory duct, neurovascular bundles, rectal wall, and penile bulb generated from a series of combined T2-weighted/dynamic contrast-enhanced magnetic resonance (MR) images. The iterative process for designing the phantom based on user interaction and evaluation is described. Using the CyberKnife System at Boston Medical Center, a treatment plan was successfully created and delivered. Dosage delivery results were validated through gamma index calculations based on radiochromic film measurements which yielded a 99.8% passing rate. This phantom is a demonstration of a methodology for incorporating high-contrast MR imaging into computed-tomography-based radiotherapy treatment planning; moreover, it can be used to perform quality assurance (QA).

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Figures

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Fig. 1

Process workflow diagram for creating 3D CAD and printed models based on a patient's MR images. Seven commercial and open source software programs are involved: Seg3D, 3D Slicer, Blender, Meshmixer, Fusion 360, SOLIDWORKS, and MakerBot Desktop.

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Fig. 2

CAD render of assembled model: prostate gland (clear), DIL, seminal vesicles and ejaculatory duct, urethra and neurovascular bundles, and rectal wall and penile bulb

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Fig. 3

Anthropomorphic pelvis base with cylindrical passagedrilled out for the pelvis-base cartridge. The radiodensity of the clear, thermoplastic acrylic is equivalent to that of soft tissue.

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Fig. 4

CAD renders of the pelvis-base cartridge, version 1 film holder: axial (left) and coronal-sagittal (right)

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Fig. 5

Printed prototype of pelvis-base cartridge, version 1, axial orientation. The outer diameter and length of the main body are 6.35 cm and 15.874 cm, respectively. The length of the adjustable end cap as shown is 8.25 cm.

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Fig. 6

Printed prototype of pelvis-base cartridge, version 1, coronal-sagittal orientation

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Fig. 7

CAD renders of pelvis-base cartridge, version 2, coronal-sagittal orientation

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Fig. 8

Printed prototypes of pelvis-base cartridge, version 2, coronal-sagittal orientation. The outer diameter and length are 6.35 cm and 11.75 cm, respectively.

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Fig. 9

CAD render (left) and printed prototype (right) of the pelvis-base cartridge, version 3. The outer diameter and length of the insert are 5.1 cm and 11.75 cm, respectively.

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Fig. 10

CAD renders (left) and printed prototypes (right) of thecoronal-sagittal combined imaging-model and film holder, version 3

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Fig. 11

CAD image (left, right) and printed prototype (center) of the universal canister, version 4. The O-ring is only supported at one location by the backbone of the film holder (right).

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Fig. 12

Printed prototype of the axial film holder, version 4. The overall length of the holder is 11.43 cm. The outer diameter of the circular frames is 6.0 cm.

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Fig. 13

CAD image (left) and printed prototype (right) of the coronal-sagittal film holder, version 4. The overall height of the holder is 12.54 cm. The diameter of the circular frames is 6.0 cm.

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Fig. 14

CAD render (left) and printed prototype (right) of the imaging-model, version 4

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Fig. 15

CAD image (left) and printed prototype (right) of the universal canister, version 5. The outer diameter, wall thickness, and length of the canister body are 6.45 cm, 0.375 cm, and 12.85 cm, respectively. It weighs 106.8 g (100% infill) and takes 7 h and 45 min to print (alone) on a MakerBot 2×.

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Fig. 16

Printed prototype of the universal canister cap, version 5 with O-ring (left). The height of the cap is 2.5 cm. It weighs 66.3 g (100% infill) and takes 4 h 27 min to print (alone) on a MakerBot 2×. CAD image of the bottom of the canister showing the three alignment pegs (right).

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Fig. 17

CAD renders (left) and printed prototypes (right) of iterations of axial film holder, version 5. The outer diameter and length of the holder are 5.7 cm and 11.4 cm, respectively.

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Fig. 18

CAD renders and printed prototypes of iterations of coronal-sagittal film holder, version 5. The outer diameter and length of the holder are 5.7 cm and 11.7 cm, respectively. The film is 4.44 cm × 10.16 cm.

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Fig. 19

Printed prototype of the imaging model, version 5 which prints as one object. The outer diameter and length are 5.5 cm and 11.4 cm, respectively.

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Fig. 20

Printed prototype of the imaging model, version 5 which prints as separate parts and must be assembled with its frame

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Fig. 21

Printed prototype of the imaging model and film holder, version 6 with coronal slots. The middle slot passes through the centroid of the DIL. The printing time (100% fill) is 7 h and 47 min.

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Fig. 22

Three iterations of printed prototypes of the support frame for the imaging-model and film holder, version 6

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Fig. 23

Final iteration of the support frame (right). Posterior view of rectal wall part with the three square mounting pegs (left).

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Fig. 24

CAD render of pelvis-base cartridge assembly (right). Printed prototypes of coronal, axial, and sagittal-orientation imaging/film holders, version 6 mounted on support frames (left). The holders and their frames weigh 114.6 g, 115.6 g, and 95.0 g, respectively.

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Fig. 25

Pelvic phantom on the robotic treatment couch of the CyberKnife System at Boston Medical Center

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Fig. 26

CT images (left to right: axial, sagittal, and coronal view) with contours of the PTV, seminal vesicles, urethra, prostate gland, and DIL

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Fig. 27

Cumulative dose volume histogram. The dose bin width is 10 cGy.

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Fig. 28

Example isodose lines in axial (top right), coronal (bottom right), and sagittal (bottom left) planes. The prostate gland is filled in.

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Fig. 29

Beam paths calculated for the treatment plan

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Fig. 30

Isodose map of the film portion within the prostate gland. The delivered and planned dosages correspond to the thick and thin lines, respectively. The contour lines are 500.0, 539.4, 578.7, 618.1, 657.4, 696.8, and 726.1 cGy.

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Fig. 31

The planned (solid) and delivered (dashed) dose profiles (right) along a diagonal line from the top left corner to the bottom right corner of the film slice (left). The rectangle (dashed) is the outline of the film section corresponding to the isodose map in Fig. 30.

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Fig. 32

The planned (solid) and delivered (dashed) dose profiles along the horizontal (left) and vertical (right) lines passing through the center of the isodose map in Fig. 30

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