Abstract
Purpose: Integrating 3D technologies in the clinic allows new workflows to emerge and improve patient care. A specific workflow was developed to replace our handmade oral shields used in orthovoltage radiation therapy.
Materials and Methods: The new workflow requires the patient to have one additional appointment before his orthovoltage treatments to produce one or more dental impressions. Each impression is later digitally reconstructed using a 3D optical scanner. A custom oral shield is then designed from the reconstruction. The device is subsequently produced using a stereolithography 3D printer with a biocompatible resin. A 1-mm lead sheet is then shaped on the device and covered by a thin layer of the same biocompatible resin that is cured by UV light. The assembled device is finally sterilized in the autoclave. Attenuation and backscatter measurements were also conducted on a similar flat shield device before clinical implementation.
Results: The custom radiation oral shields fit well and protected the teeth and gums. Once in place, they didn’t move. Patient comfort was improved by wetting the custom shields before insertion in their mouth. The installation was fast and did not require any adjustment, which simplified the technologist’s task and reduced the patient's presence time. The custom radiation oral shield attenuated 99.5% of the incident beam and backscatter dose enhancement factor measurements showed an increase of only 0.1%.
Conclusions: We observed benefits to use 3D printed shields for patients receiving orthovoltage. Benefits include ease of installation, a custom shield with smooth edges that was easy to position, improved sanitary protocol, good attenuation properties and with very low backscatter contamination. Further advancement in orthovoltage will integrate optical 3D scanning and 3D printing to facilitate the making of patient-specific shields for different anatomical regions.
