title: Introduction of novel 3D-printed superficial applicators for high-dose-rate skin brachytherapy.
abstract: 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.
  
  
  
  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.
  
  
  
  The treatment planning process, with the introduction of a pre-plan, allows for an "ideal" catheter arrangement within an applicator to be determined, 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.
  
  
  
  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.
authors.affiliation: Department of Medical Physics, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK. Electronic address: emma.jones@gstt.nhs.uk.
authors.forename: Emma-Louise
authors.initials: EL
authors.lastname: Jones
authors.affiliation: Department of Medical Physics, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Tonino Baldion
authors.affiliation: Department of Medical Physics, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Thomas
authors.affiliation: Department of Medical Physics, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Burrows
authors.affiliation: Department of Medical Physics, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK.
authors.forename: Nick
authors.initials: N
authors.lastname: Byrne
authors.affiliation: Department of Medical Physics, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK.
authors.forename: Victoria
authors.initials: V
authors.lastname: Newton
authors.affiliation: Department of Medical Physics, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Aldridge
mesh_terms: D001918:Brachytherapy / Q000295:instrumentation*; D004867:Equipment Design / Q000379:methods*; D006801:Humans; D058958:Organs at Risk; D066330:Printing, Three-Dimensional; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D012878:Skin Neoplasms / Q000532:radiotherapy*
keywords: 3D-printed; Applicators; Brachytherapy; HDR; High dose rate; Skin; Superficial