Characterization of a novel 3D printed patient specific phantom for quality assurance in cranial stereotactic radiosurgery applications

• Published in: Physics in medicine & biology Vol. 64; no. 10; p. 105009
• Main Authors: Makris, D N, Pappas, E P, Zoros, E, Papanikolaou, N, Saenz, D L, Kalaitzakis, G, Zourari, K, Efstathopoulos, E, Maris, T G, Pappas, E
• Format: Journal Article
• Language: English
• Published: England IOP Publishing 10.05.2019
• Subjects: 3D printing; Algorithms; Brain Neoplasms - surgery; end-to-end QA; Film Dosimetry - instrumentation; head phantom; Humans; patient-specific QA; Phantoms, Imaging; Printing, Three-Dimensional - instrumentation; Quality Assurance, Health Care - standards; Radiometry - methods; Radiosurgery - methods; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted - methods; SRS; stereotactic radiosurgery; stereotactic radiotherapy; Tomography, X-Ray Computed
• DOI: 10.1088/1361-6560/ab1758
• ISSN: 0031-9155; 1361-6560

In single-isocenter stereotactic radiosurgery/radiotherapy (SRS/SRT) intracranial applications, multiple targets are being treated concurrently, often involving non-coplanar arcs, small photon beams and steep dose gradients. In search for more rigorous quality assurance protocols, this work presents and evaluates a novel methodology for patient-specific pre-treatment plan verification, utilizing 3D printing technology. In a patient's planning CT scan, the external contour and bone structures were segmented and 3D-printed using high-density bone-mimicking material. The resulting head phantom was filled with water while a film dosimetry insert was incorporated. Patient and phantom CT image series were fused and inspected for anatomical coherence. HUs and corresponding densities were compared in several anatomical regions within the head. Furthermore, the level of patient-to-phantom dosimetric equivalence was evaluated both computationally and experimentally. A single-isocenter multi-focal SRS treatment plan was prepared, while dose distributions were calculated on both CT image series, using identical calculation parameters. Phantom- and patient-derived dose distributions were compared in terms of isolines, DVHs, dose-volume metrics and 3D gamma index (GI) analysis. The phantom was treated as if the real patient and film measurements were compared against the patient-derived calculated dose distribution. Visual inspection of the fused CT images suggests excellent geometric similarity between phantom and patient, also confirmed using similarity indices. HUs and densities agreed within one standard deviation except for the skin (modeled as 'bone') and sinuses (water-filled). GI comparison between the calculated distributions resulted in passing rates better than 97% (1%/1 mm). DVHs and dose-volume metrics were also in satisfying agreement. In addition to serving as a feasibility proof-of-concept, experimental absolute film dosimetry verified the computational study results. GI passing rates were above 90%. Results of this work suggest that employing the presented methodology, patient-equivalent phantoms (except for the skin and sinuses areas) can be produced, enabling literally patient-specific pre-treatment plan verification in intracranial applications.