Development of a semi-customized tongue displacement device using a 3D printer for head and neck IMRT
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RESEARCH
Open Access
Development of a semi-customized tongue displacement device using a 3D printer for head and neck IMRT Chae-Seon Hong1,2†, Dongryul Oh1†, Sang Gyu Ju1*, Yong Chan Ahn1,3, Cho Hee Na1,3, Dong Yeol Kwon1 and Cheol Chong Kim1
Abstract Purpose: To reduce radiation doses to the tongue, a patient-specific semi-customized tongue displacement device (SCTDD) was developed using a 3D printer (3DP) for head and neck (H&N) radiation therapy (RT). Dosimetric characteristics of the SCTDD were compared with those of a standard mouthpiece (SMP). Materials and methods: The SCTDD consists of three parts: a mouthpiece, connector with an immobilization mask, and tongue displacer, which can displace the tongue to the contralateral side of the planning target volume. Semi-customization was enabled by changing the thickness and length of the SCTDD. The instrument was printed using a 3DP with a biocompatible material. With the SCTDD and SMP, two sets of planning computed tomography (CT) and tomotherapy plans were obtained for seven H&N cancer patients. Dosimetric and geometric characteristics were compared. Results: Using the SCTDD, the tongue was effectively displaced from the planning target volume without significant tongue volume change compared to the SMP. The median tongue dose was significantly reduced (29.6 Gy vs. 34.3 Gy). The volumes of the tongue receiving a dose of 15 Gy, 30 Gy, 35 Gy, 45 Gy, and 60 Gy were significantly lower than using the SMP. Conclusion: The SCTDD significantly decreased the radiation dose to the tongue compared to the SMP, which may potentially reduce RT-related tongue toxicity. Keywords: Tongue displacement, 3D printing, Head and neck cancer, Tomotherapy
Introduction Radiation therapy (RT) has played an important role as a standard treatment for head and neck squamous cell carcinoma (HNSCC) [1–4] with surgery and chemotherapy. However, it is not an easy task to meet the aim of RT, which delivers a curable dose to a target volume while minimizing the dose to organs at risk (OARs) near the target volume because head and neck (H&N) tumors usually overlap or are adjacent to normal organs. There are many OARs of concern in the RT planning for H&N cancer, such as the brain, brainstem, optic apparatus, * Correspondence: [email protected] † Chae-Seon Hong and Dongryul Oh contributed equally as first authors 1 Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81 ,Gangnam-Gu, Seoul 06351, Republic of Korea Full list of author information is available at the end of the article
parotid gland, submandibular glands, pharyngeal muscles, laryngeal structures, and oral cavity (OC), including the tongue. Intensity modulated radiation therapy (IMRT) technique has made a significant contribution to reduce dose of these OARs [1, 2, 5–7], but reduction of OC dose to a meaningful level still remain a big challenge because it is close to target volume and immobilization is not an easy task in H&N RT. The tongue is a subsite of the OC and is no
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