Introduction of novel 3D-printed superficial applicators for high-dose-rate skin brachytherapy

PURPOSE: Custom-made surface mold applicators often allow more flexibility when carrying out skin brachytherapy, particularly for small treatment areas with high surface obliquity. They can, however, be difficult to manufacture, particularly if there is a lack of experience in superficial high-dose-rate brachytherapy techniques or with limited resources. METHODS AND MATERIALS: We present a novel method of manufacturing superficial brachytherapy applicators utilizing three-dimensional (3D) printing techniques. We describe the treatment planning process and the process of applicator manufacture. RESULTS: The treatment planning process, with the introduction of a pre-plan, allows for an ideal catheter arrangement within an applicator to be deteriulned, exploiting varying catheter orientations, heights, and curvatures if required. The pre-plan arrangement is then 3D printed to the exact specifications of the pre-plan applicator design. This results in improved target volume coverage and improved sparing of organs at risk. CONCLUSIONS: Using a pre-plan technique for ideal catheter placement followed by automated 3D-printed applicator manufacture has greatly improved the entire process of superficial high-dose-rate brachytherapy treatment. We are able to design and manufacture flexible, well-fitting, superior quality applicators resulting in a more efficient and improved patient pathway and patient experience. (C) 2016 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.