A total inverse planning paradigm: Prospective clinical trial evaluating the performance of a novel MR-based 3D-printed head immobilization device
Background and purpose: Brain radiotherapy (cnsRT) requires reproducible positioning and immobilization, attained through redundant dedicated imaging studies and a bespoke moulding session to create a thermoplastic mask (T-mask). Innovative approaches may improve the value of care. We prospectively...
| Main Authors: | , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-09-01
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| Series: | Clinical and Translational Radiation Oncology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405630823000885 |
| _version_ | 1827855531172167680 |
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| author | Paola Anna Jablonska Amy Parent Nancy La Macchia Harley H.L. Chan Matthew Filleti Matthew Ramotar Young-Bin Cho Maria Braganza Adam Badzynski Normand Laperriere Tatiana Conrad Derek S. Tsang David Shultz Anna Santiago Jonathan C. Irish Barbara-Ann Millar Tony Tadic Alejandro Berlin |
| author_facet | Paola Anna Jablonska Amy Parent Nancy La Macchia Harley H.L. Chan Matthew Filleti Matthew Ramotar Young-Bin Cho Maria Braganza Adam Badzynski Normand Laperriere Tatiana Conrad Derek S. Tsang David Shultz Anna Santiago Jonathan C. Irish Barbara-Ann Millar Tony Tadic Alejandro Berlin |
| author_sort | Paola Anna Jablonska |
| collection | DOAJ |
| description | Background and purpose: Brain radiotherapy (cnsRT) requires reproducible positioning and immobilization, attained through redundant dedicated imaging studies and a bespoke moulding session to create a thermoplastic mask (T-mask). Innovative approaches may improve the value of care. We prospectively deployed and assessed the performance of a patient-specific 3D-printed mask (3Dp-mask), generated solely from MR imaging, to replicate a reproducible positioning and tolerable immobilization for patients undergoing cnsRT. Material and methods: Patients undergoing LINAC-based cnsRT (primary tumors or resected metastases) were enrolled into two arms: control (T-mask) and investigational (3Dp-mask). For the latter, an in-house designed 3Dp-mask was generated from MR images to recreate the head positioning during MR acquisition and allow coupling with the LINAC tabletop. Differences in inter-fraction motion were compared between both arms. Tolerability was assessed using patient-reported questionnaires at various time points. Results: Between January 2020 - July 2022, forty patients were enrolled (20 per arm). All participants completed the prescribed cnsRT and study evaluations. Average 3Dp-mask design and printing completion time was 36 h:50 min (range 12 h:56 min − 42 h:01 min). Inter-fraction motion analyses showed three-axis displacements comparable to the acceptable tolerance for the current standard-of-care. No differences in patient-reported tolerability were seen at baseline. During the last week of cnsRT, 3Dp-mask resulted in significantly lower facial and cervical discomfort and patients subjectively reported less pressure and confinement sensation when compared to the T-mask. No adverse events were observed. Conclusion: The proposed total inverse planning paradigm using a 3D-printed immobilization device is feasible and renders comparable inter-fraction performance while offering a better patient experience, potentially improving cnsRT workflows and its cost-effectiveness. |
| first_indexed | 2024-03-12T11:52:55Z |
| format | Article |
| id | doaj.art-498037506a1d424d8a2929a14910f341 |
| institution | Directory Open Access Journal |
| issn | 2405-6308 |
| language | English |
| last_indexed | 2024-03-12T11:52:55Z |
| publishDate | 2023-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Clinical and Translational Radiation Oncology |
| spelling | doaj.art-498037506a1d424d8a2929a14910f3412023-08-31T05:03:23ZengElsevierClinical and Translational Radiation Oncology2405-63082023-09-0142100663A total inverse planning paradigm: Prospective clinical trial evaluating the performance of a novel MR-based 3D-printed head immobilization devicePaola Anna Jablonska0Amy Parent1Nancy La Macchia2Harley H.L. Chan3Matthew Filleti4Matthew Ramotar5Young-Bin Cho6Maria Braganza7Adam Badzynski8Normand Laperriere9Tatiana Conrad10Derek S. Tsang11David Shultz12Anna Santiago13Jonathan C. Irish14Barbara-Ann Millar15Tony Tadic16Alejandro Berlin17Department of Radiation Oncology, University of Toronto, 149 College Street, Unit 504, Toronto, Ontario M5T 1P5, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, Canada; Department of Radiation Oncology, Clinica Universidad de Navarra, 31008 Pamplona, SpainRadiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, CanadaRadiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, CanadaGuided Therapeutics (GTx) Program, Techna Institute, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, CanadaRadiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, CanadaRadiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, CanadaDepartment of Radiation Oncology, University of Toronto, 149 College Street, Unit 504, Toronto, Ontario M5T 1P5, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, Canada; Department of Radiation Oncology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USARadiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, CanadaCancer Digital Intelligence Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, CanadaDepartment of Radiation Oncology, University of Toronto, 149 College Street, Unit 504, Toronto, Ontario M5T 1P5, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, CanadaDepartment of Radiation Oncology, University of Toronto, 149 College Street, Unit 504, Toronto, Ontario M5T 1P5, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, CanadaDepartment of Radiation Oncology, University of Toronto, 149 College Street, Unit 504, Toronto, Ontario M5T 1P5, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, CanadaDepartment of Radiation Oncology, University of Toronto, 149 College Street, Unit 504, Toronto, Ontario M5T 1P5, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, CanadaRadiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, Canada; Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, Ontario M5G 2M9, CanadaGuided Therapeutics (GTx) Program, Techna Institute, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada; Department of Otolaryngology – Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, 610 University Avenue, Toronto, Ontario M5G 2M9, CanadaDepartment of Radiation Oncology, University of Toronto, 149 College Street, Unit 504, Toronto, Ontario M5T 1P5, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, CanadaDepartment of Radiation Oncology, University of Toronto, 149 College Street, Unit 504, Toronto, Ontario M5T 1P5, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, Canada; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, CanadaDepartment of Radiation Oncology, University of Toronto, 149 College Street, Unit 504, Toronto, Ontario M5T 1P5, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, Canada; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada; Cancer Digital Intelligence Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, Canada; Corresponding author at: Department of Radiation Oncology, University of Toronto, 149 College Street, Unit 504, Toronto, Ontario M5T 1P5, Canada.Background and purpose: Brain radiotherapy (cnsRT) requires reproducible positioning and immobilization, attained through redundant dedicated imaging studies and a bespoke moulding session to create a thermoplastic mask (T-mask). Innovative approaches may improve the value of care. We prospectively deployed and assessed the performance of a patient-specific 3D-printed mask (3Dp-mask), generated solely from MR imaging, to replicate a reproducible positioning and tolerable immobilization for patients undergoing cnsRT. Material and methods: Patients undergoing LINAC-based cnsRT (primary tumors or resected metastases) were enrolled into two arms: control (T-mask) and investigational (3Dp-mask). For the latter, an in-house designed 3Dp-mask was generated from MR images to recreate the head positioning during MR acquisition and allow coupling with the LINAC tabletop. Differences in inter-fraction motion were compared between both arms. Tolerability was assessed using patient-reported questionnaires at various time points. Results: Between January 2020 - July 2022, forty patients were enrolled (20 per arm). All participants completed the prescribed cnsRT and study evaluations. Average 3Dp-mask design and printing completion time was 36 h:50 min (range 12 h:56 min − 42 h:01 min). Inter-fraction motion analyses showed three-axis displacements comparable to the acceptable tolerance for the current standard-of-care. No differences in patient-reported tolerability were seen at baseline. During the last week of cnsRT, 3Dp-mask resulted in significantly lower facial and cervical discomfort and patients subjectively reported less pressure and confinement sensation when compared to the T-mask. No adverse events were observed. Conclusion: The proposed total inverse planning paradigm using a 3D-printed immobilization device is feasible and renders comparable inter-fraction performance while offering a better patient experience, potentially improving cnsRT workflows and its cost-effectiveness.http://www.sciencedirect.com/science/article/pii/S24056308230008853D printingRadiotherapyMR-guidanceMaskImmobilization device |
| spellingShingle | Paola Anna Jablonska Amy Parent Nancy La Macchia Harley H.L. Chan Matthew Filleti Matthew Ramotar Young-Bin Cho Maria Braganza Adam Badzynski Normand Laperriere Tatiana Conrad Derek S. Tsang David Shultz Anna Santiago Jonathan C. Irish Barbara-Ann Millar Tony Tadic Alejandro Berlin A total inverse planning paradigm: Prospective clinical trial evaluating the performance of a novel MR-based 3D-printed head immobilization device Clinical and Translational Radiation Oncology 3D printing Radiotherapy MR-guidance Mask Immobilization device |
| title | A total inverse planning paradigm: Prospective clinical trial evaluating the performance of a novel MR-based 3D-printed head immobilization device |
| title_full | A total inverse planning paradigm: Prospective clinical trial evaluating the performance of a novel MR-based 3D-printed head immobilization device |
| title_fullStr | A total inverse planning paradigm: Prospective clinical trial evaluating the performance of a novel MR-based 3D-printed head immobilization device |
| title_full_unstemmed | A total inverse planning paradigm: Prospective clinical trial evaluating the performance of a novel MR-based 3D-printed head immobilization device |
| title_short | A total inverse planning paradigm: Prospective clinical trial evaluating the performance of a novel MR-based 3D-printed head immobilization device |
| title_sort | total inverse planning paradigm prospective clinical trial evaluating the performance of a novel mr based 3d printed head immobilization device |
| topic | 3D printing Radiotherapy MR-guidance Mask Immobilization device |
| url | http://www.sciencedirect.com/science/article/pii/S2405630823000885 |
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