Three dimensional printed electron beam modifier for total skin electron treatments.

Total Skin Electron Beam (TSEB) treatment, despite its proven effectiveness in skin malignancies, is a rather exhausting irradiation method, especially for feeble patients. In an effort to reduce treatment time by creating a clinically acceptable single TSEB field, various beam modifiers of different materials and shapes were tested. Using the TSEB immobilization device of our department and 3D printing technology, aluminum and thermoplastic modifiers were designed and constructed, according to the resulting profiles at treatment distance. Electron beam characteristics were measured and calculated both at SSD = 100 cm and at treatment level. Aluminum scatterers of the same thickness caused different modification according to the area of blocking. Aluminum modifiers reduced significantly central dose deposition for the same amount of MUs and therefore they expanded treatment time in undesirable levels. Plastic modifiers offer a good combination of field dimensions and treatment time. The final 3D printed modifier shaped the electron beam as desired resulting to a clinically acceptable 6 MeV field of 176 × 70 cm field with 10% inhomogeneity in vertical and 3% in the lateral dimension with adequate skin coverage at SSD = 400 cm. This modification offered approximately a two-minute treatment time reduction compared to the current technique. Underdosed areas appear near the edge of the field, but in regions that are far from the torso of the patient. Bremsstrahlung radiation was kept at clinically accepted levels (< 5%). This modification of the original six dual-field technique of our hospital could probably benefit fragile patients who could not easily tolerate a twenty-minute standing position without compromising the quality of their treatment.