Nov 17, 2017 | By David
We've reported before on the advances that are being made in the treatment of cancer and other serious health conditions with the help of 3D printing. Medical professionals are able to use the technology to cheaply and quickly design and prototype innovative solutions for more and more specific problems. The latest breakthrough in this area is happening at Dalhousie University in Canada, where radiation therapist Dr James Robar and his team have pioneered a new way to make oncology treatment more efficient, more comfortable, and less time-consuming.
Radiation therapy is one of the most effective ways of fighting cancer, but the process isn't a straightforward one for patients or for health practitioners. Dosage control is one crucial aspect that can be tricky to manage. In order to optimize the radiation dosage that is administered to a particular cancer patient, a special device known as a bolus is often used by radiation therapists. This functions like an extra layer of tissue, and is placed on the patient's skin in order to control the amount of radiation that is absorbed.
To make the bolus, a product called SuperFlab is used, and this rubbery material has been the industry standard for decades. The problem with this SuperFlab material is that it can often be difficult to get it to conform to the patient's skin properly, which can cause problems when the radiation is administered. This can lead to significantly more work for medical staff, as they turn to all kinds of different methods and more basic materials like wax, linens and tape in order to get the bolus to fit.
"If you tour a clinic...you'll see rooms that look like arts and crafts studios, where radiation therapists are trying to be sculptors essentially and build things for the patients," says Dr. Robar. "There are a few consequences of that approach. It has limited accuracy in many cases, and can take a lot of time. It's not only a time-sink for the patient, but also for the radiation therapists and other staff.''
To improve the situation, Robar and his team decided to make use of 3D printing technology in order to create customized bolus devices that would be perfectly tailored to a patient's anatomy. They started work back in 2012, purchasing a 3D printer and working with CT scans converted into 3D digital models. Four different types of devices were designed, according to the specific type of treatment. One type of bolus is intended for electron beam therapy, another for photon beam therapy, a third is specifically intended for breast cancer treatment, and the fourth is for brachy therapy.
For electron beam therapy, which treats tumours close to the surface of the patient's skin, Robar's team developed novel algorithms that produce a 3-D printed bolus that will modulate the energy of the electron beam. One of his students in the Dal Medical Physics Graduate Program, Shiqin Su, was responsible for developing the algorithm. "For this application, we need to produce a dose distribution that conforms to the tumor, by varying the depth of the bolus over the tumour, depending on the depth of the tumour below the surface," says Dr. Robar. "As a result, we produce a dose distribution that matches the shape of the tumor, and much of the healthy tissue is spared."
The team also was successful with 3D printing devices for photon beam therapy. "One of my favorite uses of photon bolus was for a patient who had a tumor on his nasal septum," says Robar. "He had undergone surgery but the tumor recurred, so we wanted to treat him using photon radiotherapy. The patient hadn't been to our clinic before but he had a previous CT imaging for diagnoses and follow-up with his surgery...We put topical anesthetic on it, and it fit his nose perfectly... We could verify that because he had to have a CT scan that day. It worked really well. He had 30 treatments with this device and by the end of his treatment course, he would hop on the treatment bed, grab his 3-D printed nose bolus, insert it himself, snap it together and he was ready to go."
As for breast cancer treatment, what was needed was an immobilization device. This is a bolus that acts like a shell, made from very stiff 3D printing materials. This keeps the mobile breast tissue fixed in place while the radiation is administered, improving efficiency and limiting toxicity.
Brachy therapy usually requires an accessory known as a 'Freiburg flap', a beaded sheet-like device, similar to a bolus but allowing catheters to pass through. 3D printing enabled this device to be tailored to a patient's anatomy, improving the often awkward fit. Dal Medical Physics Graduate student Scott Clarke played a major role in developing the technology for this particular device.
After successful testing, the team created a start-up company called 3D Bolus to develop their research project into a commercial product, which includes standardized design software and a bundled 3D printer. Versions of the technology have already been deployed in clinics in Dublin, Ireland and Tel-Aviv, with research versions in Chicago, San Francisco and Halifax. Once FDA clearance is granted in early 2018, 3D Bolus will be able to start sales across the U.S.
Posted in 3D Printing Application
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I manage a prototyping and development lab at UC Davis, (TEAM), and we’ve actually been doing this for about a year and a half now (different 3d printed materials)
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