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3D Printing in Radiation Therapy provides practical and comprehensive guidance for the implementation, quality management, maintenance and safe use of a clinical 3D printing programme in the radiation therapy context. Radiation therapy is a safe and effective treatment that can benefit half of all cancer patients, and the introduction of an appropriately planned, managed, and resourced 3D printing programme can increase that benefit in terms of the radiation therapy patient experience, staff engagement, treatment accuracy and improved treatment outcomes, in addition to monetary savings. This book provides the guidance needed to:
Select suitable 3D printing modalities, materials and software;
Develop processes for efficiently and accurately designing, printing and post-processing phantoms, jigs and attachments as well as radiation treatment equipment such as bolus, immobilisation devices, radiation shields and brachytherapy applicators;
Achieve comprehensive quality management of the 3D printing service, including documented risk assessments, commissioning methods, 3D printer maintenance, 3D print quality control, reviews, audits and staff training; and
Understand the potential costs and benefits of the 3D printing service in terms of time, money, space, patient and staff safety, and waste management.
This book is a resource for medical physicists, engineers and technicians, radiation therapists and technologists, dosimetrists, nurses, radiation oncologists, administrators and schedulers, as well as workshop and mould room staff, i.e., all radiation therapy staff who are planning, setting up, managing, researching, auditing or working within a clinical 3D printing service.
Prof Tanya Kairn PhD is the Director of Medical Physics for Cancer Care Services at the Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia. Prof Kairn has over 150 papers in refereed journals, including 20 papers on applications of 3D printing in radiation therapy. The use of novel 3D printing techniques for the benefit of cancer patients remains an important focus of Prof Kairn's research.
Prof Scott B. Crowe PhD is the Senior Research Medical Physicist at the Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia. Prof Crowe is the Clinical Lead for the Herston Biofabrication Institute Cancer Care Services research programme, and oversaw the process by which the Royal Brisbane and Women's Hospital (Metro North Hospital and Health Service) became the first hospital in Australia to be listed on the Australian Register of Therapeutic Goods as a point-of-care manufacturer of 3D printed radiation therapy bolus.
Prof Tomas Kron OAM PhD FACPSEM is the Managing Director of the Department of Medical Physics at the Peter MacCallum Cancer Centre, Melbourne, Australia, with responsibility for overseeing a programme that has produced nearly 2000 patient-matched 3D printed radiation therapy devices. Prof Kron has over 600 publications, many of which demonstrate his ongoing interest in developing bespoke phantoms and dosimetry systems, including eight papers on 3D printing topics in the last three years and an early paper on 3D printed phantom materials in 2015.
Preface
Acknowledgements
Editor biographies
List of contributors
Contributor biographies
1 Introduction
Tomas Kron and Tanya Kairn
References
2 3D printing
Rance Tino and Martin Leary
2.1 Introduction
2.2 Vat photopolymerisation
2.2.1 Stereolithography
2.2.2 Digital light processing
2.2.3 Continuous direct light processing
2.2.4 State-of-the-art vat photopolymerisation-based techniques
2.3 Material extrusion
2.4 Powder bed fusion
2.4.1 Multi jet fusion
2.4.2 Selective laser sintering
2.4.3 Direct metal laser sintering and selective laser melting
2.4.4 Electron beam melting
2.5 Directed energy deposition
2.5.1 Laser engineering net shape
2.5.2 Electron beam additive manufacturing
2.6 Sheet lamination
2.7 Material jetting
2.7.1 Polymer multi-jet printing
2.7.2 Nanoparticle jetting
2.7.3 Drop-on-demand
2.8 Binder jetting
2.9 Key points
3 Materials
Amirhossein Asfia, Giorgio Andrew Katsifis, James I Novak and Scott B Crowe
3.1 Introduction
3.2 3D-printed plastics
3.3 3D-printed composites
3.4 3D-printed metals
3.5 Other materials
3.6 Key points
4 Design
Rance Tino, Martin Leary, Gorgio Andrew Katsifis, James I Novak and Scott B Crowe
4.1 Introduction
4.2 Medical imaging
4.3 3D optical scanning
4.4 Design software
4.5 Key points
5 Processing
Rance Tino, Amirhossein Asfia, Giorgio Andrew Katsifis, James I Novak and Scott B Crowe
5.1 Introduction
5.2 Preparation
5.2.1 Slicing
5.2.2 Nozzle temperature
5.2.3 Build plate temperature
5.2.4 Printing speed
5.2.5 Layer height
5.2.6 Infill density and pattern
5.2.7 Build orientation and support
5.2.8 Variable print parameters
5.3 Printing
5.4 Post-processing
5.5 Key points
6 Costs
Tanya Kairn, Rance Tino, Martin Leary and Adam Unjin Yeo
6.1 Introduction
6.2 Money
6.3 Time
6.4 Health
6.5 Space
6.6 Waste
6.7 Key points
7 Quality management
Emily Simpson-Page, Deepak Basaula and Scott B Crowe
7.1 Introduction
7.2 Quality management systems
7.3 Risk management
7.4 Documentation requirements
7.5 Resource management
7.5.1 Human resources
7.5.2 Infrastructure
7.6 Product realisation
7.6.1 Request and specification
7.6.2 Modelling and design
7.6.3 Fabrication
7.6.4 Post-processing
7.6.5 Quality assurance
7.7 Ongoing responsibilities
7.8 Key points
8 Quality assurance
Adam Unjin Yeo and Tanya Kairn
8.1 Introduction
8.2 Defects and consequences
8.2.1 Irregular surface
8.2.2 Geometric error
8.2.3 Density variation
8.2.4 Unsuitable doping
8.2.5 Bulk deformation and clearance
8.2.6 Print failure
8.2.7 Consistency and reproducibility
8.3 Commissioning
8.3.1 Risk assessment and overview
8.3.2 Familiarisation with existing documentation
8.3.3 Optimisation of the 3D-printing parameters
8.3.4 Evaluation of geometric accuracy
8.3.5 Characterising the physical properties of materials
8.3.6 Characterising the density properties of materials
8.3.7 Testing challenging geometries and long print jobs
8.3.8 Evaluating 3D-print reproducibility and consistency
8.3.9 Completion of end-to-end testing
8.3.10 Development of a 3D-print sanitisation process
8.3.11 Planning of routine maintenance for a 3D printer
8.3.12 Development of quality control processes
8.3.13 Preparation of a commissioning report
8.3.14 Provision of written instructions
8.3.15 Creating logs
8.3.16 Provision of staff training
8.3.17 Repetition of commissioning for new equipment
8.4 3D-printer maintenance
8.5 3D-print quality control
8.6 Key points
9 Patient treatments
Tanya Kairn, Rachael Wilks and Samuel C Peet
9.1 Introduction
9.2 Patient safety
9.2.1 Regulatory and quality management context
9.2.2 External use
9.2.3 Internal use
9.2.4 Cleaning and sterilisation
9.3 Bolus, compensators, and range shifters
9.3.1 Clinical context
9.3.2 Photon radiation therapy
9.3.3 Electron radiation therapy
9.3.4 Proton radiation therapy
9.4 Custom shielding
9.4.1 Clinical context
9.4.2 Shields
9.4.3 Apertures
9.4.4 Positives
9.5 Immobilisation
9.5.1 Clinical context
9.5.2 Mechanical safety
9.5.3 Patient supports
9.5.4 Immobilisation masks
9.5.5 Displacement stabilisation
9.6 Brachytherapy
9.6.1 Clinical context
9.6.2 Superficial applicators
9.6.3 Interstitial templates
9.6.4 Intracavitary moulds
9.6.5 Dose calculation considerations
9.7 Key points
10 Treatment verification
Deepak Basaula, Emily Simpson-Page, Scott B Crowe and Tanya Kairn
10.1 Introduction
10.2 Dosimeter augmentation
10.2.1 Dosimetry jigs 1
10.2.2 Adaptors, attachments, and inserts
10.3 Geometrically simple phantoms
10.3.1 Hidden targets
10.3.2 Simple imaging phantoms
10.3.3 Simple dosimetry phantoms
10.4 Anthropomorphic phantoms
10.4.1 Summary of requirements
10.4.2 Geometric properties
10.4.3 Material properties
10.4.4 Functional properties
10.5 Key points
11 Beyond radiation therapy
Mathilde R Desselle and Natalka Suchowerska
11.1 Introduction
11.2 Patient-matched anatomical models
11.3 Templates for clinical intervention
11.4 Surgical guides
11.5 Customised prostheses and orthoses
11.6 Regenerative medicine
11.7 Bioprinting
11.8 Key points
12 Conclusions
Tanya Kairn, Scott B Crowe and Tomas Kron
List of acronyms/initialisms
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