Clinical implementation of 3D printing in the construction of patient specific bolus for electron beam radiotherapy for non-melanoma skin cancer

Radiother Oncol. 2016 Oct;121(1):148-153. doi: 10.1016/j.radonc.2016.07.011. Epub 2016 Jul 27.


Background and purpose: Creating an individualized tissue equivalent material build-up (i.e. bolus) for electron beam radiation therapy is complex and highly labour-intensive. We implemented a new clinical workflow in which 3D printing technology is used to create the bolus.

Material and methods: A patient-specific bolus is designed in the treatment planning system (TPS) and a shell around it is created in the TPS. The shell is printed and subsequently filled with silicone rubber to make the bolus. Before clinical implementation we performed a planning study with 11 patients to evaluate the difference in tumour coverage between the designed 3D-print bolus and the clinically delivered plan with manually created bolus. For the first 15 clinical patients a second CT scan with the 3D-print bolus was performed to verify the geometrical accuracy.

Results: The planning study showed that the V85% of the CTV was on average 97% (3D-print) vs 88% (conventional). Geometric comparison of the 3D-print bolus to the originally contoured bolus showed a high similarity (DSC=0.89). The dose distributions on the second CT scan with the 3D print bolus in position showed only small differences in comparison to the original planning CT scan.

Conclusions: The implemented workflow is feasible, patient friendly, safe, and results in high quality dose distributions. This new technique increases time efficiency.

Keywords: 3D printing; Bolus; Clinical application; Electron beam radiotherapy; Non-melanoma skin cancer; Workflow.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Electrons / therapeutic use
  • Female
  • Humans
  • Male
  • Middle Aged
  • Models, Anatomic
  • Printing, Three-Dimensional*
  • Radiotherapy Dosage
  • Radiotherapy Planning, Computer-Assisted / instrumentation
  • Radiotherapy Planning, Computer-Assisted / methods*
  • Skin Neoplasms / radiotherapy*
  • Tomography, X-Ray Computed