VA’s 3D printed boluses revolutionizing radiation therapy for Veterans

VA is continuing to lead the way in providing new and innovative solutions for Veterans with cancer. One of the latest examples is the use of 3D-printing technology to change the way Veterans receive radiation therapy.

VA's Office of Advanced Manufacturing (OAM) is producing precise, patient-specific, FDA-cleared radiotherapy boluses (RTB) to help control the radiation dose.

These patient-matched boluses are transforming cancer care. Each bolus is customized for the patient's treatment needs and anatomy using a patient's CT scan to create a unique 3D-printed RTB. This advanced technology supports precise radiation, targeting tumors while sparing healthy tissue, improving cancer care for Veterans.

Traditional boluses often resemble sheets of paper, requiring providers to engage in a delicate procedure during application. The challenge lies in achieving a flat, bubble-free surface against the Veteran patient's skin. Providers must ensure no air pockets disrupt the uniformity of the bolus, a process that can be time-consuming and prone to imperfections.

A collaborative effort to treat cancer

VA engineers at OAM's Seattle site at Puget Sound VA worked with radiation oncology clinicians across the enterprise and an external 3D printing company, 3D Systems, to bring this solution to life.

The team conducted extensive interviews with subject matter experts and implemented a comprehensive, five-phase development process for the RTB to improve the experience and outcomes for Veterans undergoing radiation therapy.

"We had clinicians from Richmond VA and Cleveland VA who were meeting with us on a recurring basis giving feedback on how the project was progressing, feedback on the device itself and they functioned as those advisors throughout the development process," said Alex Hotz, product development engineer at Puget Sound VA.

Clinician feedback on Veteran impact

With 21 personalized boluses since April 2023, the RTB has already demonstrated its potential to enhance radiation therapy precision and improve outcomes for Veterans. Clinicians who have used the RTB for Veterans have reported impressive results.

A radiotherapy clinician from VISN 6 said the 3D-printed devices are working as planned and she is looking forward to new opportunities. "The CT scan of the piece fit nicely to the patient's external contour and it matched the planned structure almost perfectly."

Another clinician from VISN 20 echoed this sentiment. "Everything worked out wonderfully. The bolus fit like a glove and the cleave location was spot on. The smoothing of the contour gave us a nice, finished product, and the bolus on the patient and under the mask looks great."

The future of radiation therapy within VHA

The RTB has gained traction across VA largely due to expanded benefits through the PACT Act. VA has 41 radiation oncology sites, with more than half already capable of providing Veterans access to RTB and more planned to come onboard in the coming months.

"As an FDA-registered medical device manufacturer housed within VA, we provide accountability and seamless integration with our clinicians without the need for complex contracts or processes that come with using outside vendors," said Sam Mentzer, clinical engineer at Puget Sound VA.

The RTB can be turned around in just a matter of days from clinician request to delivery, ensuring Veterans receive timely and effective treatment.

"We hope to reduce the time Veterans spend in the treatment chair and improve the overall dose distribution," said Lorelei Gorr, product lead at OAM's Seattle site, Puget Sound VA. "This project aligns with our commitment to offering the soonest and best care to those who have served the Nation."

For more information on VHA's RTB and to begin the ordering process, visit OAM's website.

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