TedFisher1,MichaelBligh1,TonyLaurel1,KarlRasmussen2

(1)MemorialMedicalCenter,Modesto,CA,(2)EastCarolinaUniversity,Greenville,NC

Introduction Procedure and results Conclusions

The creation of patient specific custom bolus is
advantageous for the treatment of certain skin
lesions in order to compensate for an irregular
surface. Specifically, if a skin lesions is on the tip
or bridge of a nose, a custom bolus can be
employed for a more acceptable dose distribution.
The patient sits in a chair in front of the camera, and slowly The system is straightforward to setup and
rotates their head from side to side. The Kinect Fusion software relatively inexpensive. $1000-$2000 printer +
acquires the data at ~30 fps, and integrates the data over time in $2000 computer + $250 Kinect.
order to reconstruct a high quality triangulated mesh of the
patient surface. Printing material (ABS or PLA) is inexpensive,
around $40/kg. Typical models cost ~$5.

We have utilized a novel method of creating a Model acquisition is fast. We are able to obtain
digital model of the patients face with a Microsoft a model in less than 10 seconds. We usually
Kinect camera. After some digital manipulation, perform the scan at the time of physician
we are able to use a 3D printer to create a physical consult. Our acquisition PC is on a mobile cart
copy of the model, or to print the bolus directly. and can easily be wheeled into an exam room.

The low cost coupled with the relative ease of The nose block can then be printed. We have been printing the Patient discomfort is decreased as compared to
implementation make this a viable low cost solution blocks with a low infill of 5-10% in a honeycomb pattern. previous methods of making a physical mold of
for any clinic requiring the ability to fabricate Molten wax is injected into the honeycombs to create a solid their face.
custom bolus for electron treatments. bolus. Air gaps are minimized by using a large stainless steel
syringe to fill the honeycombs. Time requirement for physics staff is decreased
Once this model is acquired, the patient is free to go. The 3D as compared to previous methods of making a
mesh is then manipulated, cleaned, and a region of interest is physical mold of the patients face.
formed. In order to print the object, the mesh needs to be a solid
Materials object without degenerate or self-intersecting faces.
Patients typically think the process is quite neat
The acquisition system consists of a Microsoft
and leave enthusiastic about the technology.
Kinect camera connected to a typical higher end PC
Most have heard about 3D printing in the news,
(Intel i7 3770 CPU, 16GB DDR3 RAM, nVidia 680
and this is usually the 1st time they have seen it
GTX GPU). Kinect Fusion acquisition software
in person. We have had lots of positive
examples written in C++ and C# are provided by
feedback.
Microsoft in their Developer Toolkit. These
examples programs can easily be modified
depending on your site specifications (we have Kinect acquired mesh is of higher quality than
increased the sample density), or used directly. available from a typical CT. The example nose
File copyright Colin Parrington. You
block has >80,000 distinct points on the
Open source and/or freely available software such
may use for
surface). making
We have your
found CT sliceposter,
thicknessof
to
be the main
course, but cause
pleaseof lower resolution
do not models
plagiarize,
as Meshlab, Netfab Studio Basic, and OpenScad are
obtained from TPS contours.
used to refine the acquired mesh and to obtain a adapt, or put on your own site. Also, do
volume of interest.
notBolus
upload this
material file, conformal
is highly even if modified,
to the to
patients anatomy.
third-party We have been
file-sharing using
sites sucha thinas
The face model can then be printed directly, and the bolus can be layer of ultrasound coupling gel between the
constructed by making a dam using modeling clay and pouring doctoc.com.
patient and theIfbolus
youtohave insatiable
minimize any air gaps.need
molten wax onto the face.
to post a template onto your own site,
search
Typicalthe
print time for the
internet fornose block is on the
a different
order of 2.5 hours. This will vary considerably
template to steal.
with the size File piece,
of the printed downloaded
layer from
http://colinpurrington.com/tips/academi
thickness, and infill percentage.
c/posterdesign.
The small physical foot print of the printer and
acquisition system allow for desktop printing.
A CT can be taken to verify that the air gaps are minimized in the
bolus and that the correct minimum thickness is maintained.

The print material is either acrylonitrile butadiene styrene (ABS)

The bolus can constructed by two methods with a
3D extrusion printer. The 1st method is to print out
a 1:1 scale model of the patients nose, and
construct the bolus by pouring molten wax on the
face model. The 2nd method is to create a digital
model of the bolus material to the specifications of
the physician (depth, size). This bolus can either be
printed solid, or with a low infill percentage and
filled with wax to save print time.
Both a Makerbot Replicator, and a Printrbot+ have
been used to print the face models and nose blocks
with success.
or polylactic acid (PLA) plastic. We have found that the PLA has Further information
a more pleasant smell when printing in the office. It also seems
to have less problems with warping than the ABS. When
This method works well if the lesion is positioned such that eye Details, questions, comments, or want to set up
printing a 100% infill test piece, the PLA has a mean Hounsfield
shields are needed. The eye shields can be set atop the model, your own system? Please contact Ted Fisher at
number of 5215HU, and the ABS is -7814HU. This could
and the wax poured on top. ted.gfish@gmail.com.
vary by plastic manufacturer, or by printer. Some variation is
noted in the CT image.
The second method is to take the digital face model and perform
some Boolean operations with it and a rectangular block:
block [block face]
The block needs to be positioned so that the correct minimum
thickness of the bolus is maintained. We use scripts in OpenScad
for this purpose.