Yes. Adaptiiv’s software is compatible with all 3D printers on the market that accept STL files.

Printer maintenance is quite minimal in comparison to traditional fabrication methods. These tasks include, but not limited to: lubricating the print rods, exchanging the nozzles, and cleaning/replacing the glass bed.

Features within Adaptiiv’s software increase the probability of print success. For example, using the cropping feature in Adaptiiv software ensures that the print will lie flush on the print bed, improving print success. In addition, Adaptiiv provides settings for validated filaments used with printers that improve the probability of success.

• Ease of use
• Large print volume
• Can print over 40 types of filaments through the extruder
• Reliability
• Durability

There are 5 main factors that contribute to the print time:

1. Printer model/settings
2. Nozzle extruder size
3. Filament type
4. Infill density
5. Size of accessory

Smaller bolus for noses and cheeks take ~1-2 hours to print, while large chest walls could take 15 hours. Since brachytherapy applicators can be printed at <100% infill (as low as 20%), the print time decreases accordingly. Any accessories that take longer to print can be left to print overnight (or when the facility has downtime), ensuring the accessory will be ready for use during planned treatment.

Our software uses DICOM data exported from a TPS and modifies the accessory using that data. The modified data needs to be imported back to the TPS for proper dose verification. Our software is typically installed on a separate workstation from the TPS, but it’s possible to be installed on the same server as the TPS, if hardware and software requirements are met.

3D printed bolus are created with durable, tissue-equivalent materials that hold their shape and do not degrade during treatment. Patients typically use the same 3D printed bolus for the duration of their treatment, reducing the risk of infection.

Any object entered into our software goes through a global smoothing operator to ensure minimal discrete stepping.

Our software accepts DICOM information as input. As a result, daily (or new) CBCT information can be used to create a new bolus structure if a patient’s anatomy changes.

Our software converts patient DICOM data into a digital model which can be 3D printed, no matter the size or complexity. RT accessories designed in our software can be validated in the TPS ensuring that the designed accessory matches the prescribed treatment plan prior to printing.

Unlike general flat-surfaced Valencia applicators, our devices are tailored to the individual patient for more consistent placement over both small and large areas—no matter how complex.

Adaptiiv software automatically identifies which part of each trajectory has a minimum bend-radius less than a commissioned threshold which can be set by a user (e.g. 13mm), further minimizing the risk of a source being stuck. The software highlights those potentially problematic areas in red color where users can simply click on a specific trajectory node and drag it until the curvature radius is changed, reflecting the safety of a chosen threshold value (those areas then turn from red to yellow).

Yes. In Adaptiiv software, a user can export a DICOM RT structure containing the brachy applicator with tunnels back into the TPS. When imported into the TPS, a user would need to recreate source trajectories based on the generated tunnel RT structures. Another solution is to scan the 3D-printed applicator with X-ray markers without a patient, import it
back into the TPS and co-register it with original patient CT images, and then re-create the source trajectories according to markers.

We are currently researching the possibility of exporting the source trajectory coordinates via the DICOM RT plan, upon rendering the 3D brachy-tunnels in our software. Stay tuned – more to come on this.

Applicators for surface brachytherapy can be printed in various percentages of infill (up to 100% which density is then close to being water-equivalent). Since the dose fall-off for surface brachytherapy applications is governed mainly by the Inverse Square Law, you can even print in infill less than 100% (e.g. 30%) to save time, depending on the radiological backscattering properties of the applicator which need to be achieved.

• Adaptiiv’s software enables users to create customizable catheter trajectories that are specific to the patient’s anatomy and treatment plan (e.g. user-selectable stand-off and separation distances, number and orientation of trajectories, tunnel radius etc.).
• We incorporated safety features not present in any other brachytherapy software like controlling the minimum bend-radius of curvature.
• Replaces the need for expensive applicators.
• Adaptiiv’s software optimization eliminates the need for labor intensive fabrication methods.
• Custom fit provides better patient comfort.
• Users can import the new applicator design back into the treatment planning system for QA purposes (if required).

• The MEB algorithm produces a modulated shape of the bolus which conforms the prescribed dose to the distal part of a target volume while sparing the underlying healthy tissue.
• The hotspot correction algorithm lowers the presence of hotspots, thus providing a homogeneous dose distribution while maintaining the dose conformity to a target volume.
• An optimal balance between dose homogeneity and dose conformity to a target volume can be achieved.
• Seamless integration with a TPS allows establishing QA processes through DICOM file exchange.
• MEB design is generated under 2 minutes allowing users to optimize their planning process.
• Leads to improved quality of electron RT treatment plans that would otherwise be unfeasible or clinically unacceptable, ensuring patients receive the optimal cancer treatment modality.

• Improved fit and comfort due to the patient-specific shape of the bolus.
• Automated design through Adaptiiv’s software.
• No need for special skills in design and fabrication involving RT staff.
• Automated fabrication through 3D printing.
• Minimal time invested in fabrication (3D printers do the job for you!)
• Centers can allocate resources more efficiently.

Wax bolus generally take longer to fabricate and don’t allow the users to communicate back and forth with the TPS to evaluate and recalculate dose. This process would involve the user having to place the accessory on the patient and scan for positioning which adds time to the setup process. Our software processes all key patient information from the TPS and optimizes a new bolus structure in a matter of minutes.

Our software’s algorithms generate a custom bolus structure based on patient DICOM information imported from the TPS. No manual alterations are required.

In a recent business case, a leading cancer center developed a modulated bolus using Eclipse software. The therapist had to adjust the bolus slice by slice to ensure that the bolus thickness aligned with the PTV. It took a total of 32 hours.

In comparison, when using our software, it took only 2 minutes to render the same design. You can even import the model back into the TPS to be reviewed and verified prior to 3D printing.

Air gaps beneath conventional sheet bolus (i.e. Superflab) may cause substantial inaccuracies in delivered surface dose to the patient. Using patient-specific 3D printed bolus minimizes the risk of delivering inadequate RT treatment.

Post-production modifications such as cropping and smoothing functions were added for a better fit and patient experience. Adaptiiv also allows the user to add a printable ID tag directly to the bolus. We are continually investing in new features, such as vivo dosimetry and the ability to print bolus in multiple pieces for larger or hard-to-fit areas, like the skull.

Bolus designed using our software uses the patient’s exact measurements and can be previewed before printing. Our software offers smoothing and cropping functions to ensure that the device is not only the best fit, but that it also has no air gaps, completely eliminating the need for additional bolus.

In a recent study where a standard sheet bolus and 3D printed bolus were fitted to the chest wall, the occurrence of air gaps were reduced from 30% to 13% and the average maximum air gap dimension diminished from 0.5 +/− 0.3 mm to 0.3 +/− 0.3 mm. Surface dosage was within 3% for both standard sheet bolus and 3D printed bolus.

Source: Robar et al – Intrapatient study comparing 3D printed bolus versus standard vinyl gel sheet bolus for postmastectomy chest wall radiation therapy.

Yes. 3D printed bolus created using our software incorporates all contours and shapes of the treatment area, including breast tissue.