FAQ

Uniform Thickness Bolus

Can a uniform thickness bolus be created to treat a patient with their breast still intact?

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

How accurate is 3D printed uniform thickness 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.

How does the custom-fit bolus compare to other traditional materials such as moulding wax or jelly-based materials such as Superflab?

Boluses designed using our software use 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.

How does the uniform thickness bolus module differ from a conventional STL conversion?

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.

How much benefit does the reduction of air gaps really have on treatment?

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.

What are the benefits of a custom 3D printed uniform thickness bolus?

– Patient-specific fit eliminates air gaps and resultant surface dose uncertainty, improving treatment accuracy.
– Optimized fabrication process through in-house 3D printing.
– Centers can allocate resources more efficiently.

Modulated Electron Bolus

Couldn’t we simply contour our bolus accordingly in the TPS and then export for printing?

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 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.

How do adjustments or modifications occur to the bolus design using Adaptiiv software?

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

If I am able to achieve acceptable dosimetry using wax bolus, then what is the value of using Adaptiiv software?

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.

What are the advantages of using Adaptiiv software to create modulated electron bolus?

– Direct integration with the TPS to allow the import and export of optimized bolus structures via DICOM exchange.
– Algorithms lower the presence of hot spots and provide a homogeneous dose distribution.
– Generates the custom bolus design in under 2 minutes allowing users to optimize their planning process.
– Improved comfort for the patient.

What are the benefits of a 3D printed modulated electron bolus?

– Optimized bolus design allows for tailoring of the dose distribution while maintaining conformal fit to the patient’s anatomy.
– Conforms the high dose area to the tumor volume while sparing healthy tissues.
– Optimized fabrication process through in-house 3D printing.
– Centers can allocate resources more efficiently.

Brachytherapy Applicator

Can Adaptiiv software create intracavitary brachytherapy applicators?

We are currently collaborating with centers to create new features and modules for both intracavitary and interstitial brachytherapy applicators.

How does Adaptiiv’s software account for the density of PLA in Brachytherapy TPS?

Brachytherapy source energies are governed by the Inverse Square Law, so density is not paramount. In fact, you can even print in infill less than 100% (e.g. 20%). Our workflow includes printing the applicator, scanning the applicator with patient, and planning from this.

In the case of smaller lesions that would be primarily treated using a Valencia applicator, how would Adaptiiv applicators compare in terms of treatment effectiveness?

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.

What are the advantages of using Adaptiiv software to create patient-specific brachytherapy applicators?

– Our software enables user to create customizable catheter trajectories that are specific to the patient’s anatomy and treatment plan.
– Replaces the need for expensive applicators.
– Our 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 TPS to recalculate dose (if required).

Software & Hardware

How does Adaptiiv integrate with existing systems?

Our software integrates directly with the clinically commissioned TPS to produce a patient-specific bolus design based on CT scan data. The structure is then exported as an STL file which can be 3D printed.

In the case of a patient’s contours or size changing during treatment, what is the process of adjusting the accessory to meet the new contours?

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.

What are the capabilities of the smoothing tool within Adaptiiv’s software without going back to the TPS to manually edit the problem areas?

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

What type of materials are used?

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

Where will Adaptiiv software be installed in my Center?

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.