HJAR Nov/Dec 2020

56 NOV / DEC 2020 I  HEALTHCARE JOURNAL OF ARKANSAS DIALOGUE COLUMN ONCOLOGY TODAY, more and more forward-thinking ra- diation therapy departments are incorporat- ing 3-D printing into their practice because of the benefits it has in both the mapping and delivery of the therapy and the positive impact it can have on a patient’s quality of life and overall prognosis. As with many other healthcare special- ties, radiation therapy is all about precision. From the radiation oncologists and medical physicists to the dosimetrists and therapists, we all work with one mission—to ensure that each individual patient’s treatment plan is personalized in such a way that the proper dose is delivered with pinpoint accuracy to the tumor only, sparing the healthy tissues and organs that surround it. While we have come a long way in our abilities to model, map and stabilize the patient throughout their treatments, there have still been cer- tain limitations within our field. One such limitation has been the use of a bolus. A bolus is a treatment device that is placed on the skin surface during radia- tion treatment to reduce or alter the dose delivered in the patient’s tissues. It helps the oncologist deliver a uniform therapeutic dose to the treatment area, especially for irregu- lar surface contours, including around the bridge of the nose, the ear and some chest wall reconstructions. Historically, boluses were created using preformed pieces of material of uniform thickness that were fitted to the patient or by custom-sculpting the bolus by hand. While both options have their advantages, they also have their shortcomings, includ- ing a significant effort on behalf of the care team to mold and adapt this material to the patients’ specific anatomy. Traditional sheet bolus used on curved surfaces, such as a breast, can result in poor conformity and result in air gaps. Addition- al pieces (including plaster, thermoplastics and wax) were sometimes needed to get the bolus as near to perfect as possible. Then, if the patient’s anatomy changed throughout their oftenmulti-week course of therapy (due to tumor regression, edema or weight-loss) the team and the patient might have to go through the entire process again to create a new bolus that fit the patient’s changing body. Today, with the advancements of 3-D printing, radiation teams are able to utilize While 3-D printing has been an effective tool in both educational and clinical specialties that are primarily procedural based, its relevance to radiation oncology has been limited. Until now. The Use of 3-D Printing in Radiation Therapy Christopher H. Pope, MD Radiation Oncologist CARTI, Inc.