An evaluation of consumer smartphones for generating bolus and surface mould applicators for radiation oncology
Authors: Bridger Corey A. , Caraça Santos Alexandre M. , Reich Paul D. , Douglass Michael J. J. 
Published: May 2024

Background

The use of Computed Tomography (CT) imaging data to create 3D printable patient‐specific devices for radiation oncology purposes is already well established in the literature and has shown to have superior conformity than conventional methods. Using non‐ionizing radiation imaging techniques such as photogrammetry or laser scanners in‐lieu of a CT scanner presents many desirable benefits including reduced imaging dose and fabrication of the device can be completed prior to simulation. With recent advancements in smartphone‐based technology, photographic and LiDAR‐based technologies are more readily available than ever before and to a high level of quality. As a result, these non‐ionizing radiation imaging methods are now able to generate patient‐specific devices that can be acceptable for clinical use.

Purpose

In this work, we aim to determine if smartphones can be used by radiation oncologists or other radiation oncology staff to generate bolus or brachytherapy surface moulds instead of conventional CT with equivalent or comparable accuracy.

Methods

This work involved two separate studies: a phantom and participant study. For the phantom study, a RANDO anthropomorphic phantom (limited to the nose region) was used to generate 3D models based on three different imaging techniques: conventional CT, photogrammetry & LiDAR which were both acquired on a smartphone. Virtual boli were designed in Blender and 3D printed from PLA plastic material. The conformity of each printed boli was assessed by measuring the air gap volume and approximate thickness between the phantom & bolus acquired together on a CT. For the participant study, photographs, and a LiDAR scan of four volunteers were captured using an iPhone 13 Pro™ to assess their feasibility for generating human models. Each virtual 3D model was visually assessed to identify any issues in their reconstruction. The LiDAR models were registered to the photogrammetry models where a distance to agreement analysis was performed to assess their level of similarity. Additionally, a 3D virtual bolus was designed and printed using ABS material from all models to assess their conformity onto the participants skin surface using a verbal feedback method.

Results

The photogrammetry derived bolus showed comparable conformity to the CT derived bolus while the LiDAR derived bolus showed poorer conformity as shown by their respective air gap volume and thickness measurements. The reconstruction quality of both the photogrammetry and LiDAR models of the volunteers was inadequate in regions of facial hair and occlusion, which may lead to clinically unacceptable patient‐specific device that are created from these areas. All participants found the photogrammetry 3D printed bolus to conform to their nose region with minimal room to move while three of the four participants found the LiDAR was acceptable and could be positioned comfortably over their entire nose.

Conclusions

Smartphone‐based photogrammetry and LiDAR software show great potential for future use in generating 3D reference models for radiation oncology purposes. Further investigations into whether they can be used to fabricate clinically acceptable patient‐specific devices on a larger and more diverse cohort of participants and anatomical locations is required for a thorough validation of their clinical usefulness.