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. 2019 Jan 1:18:1533033819870208.
doi: 10.1177/1533033819870208.

A Systematic Review on 3D-Printed Imaging and Dosimetry Phantoms in Radiation Therapy

Rance Tino  1   2   3 , Adam Yeo  3 , Martin Leary  1   2 , Milan Brandt  1   2 , Tomas Kron  2   3
Affiliations

A Systematic Review on 3D-Printed Imaging and Dosimetry Phantoms in Radiation Therapy

Rance Tino et al. Technol Cancer Res Treat. .

Abstract

Introduction: Additive manufacturing or 3-dimensional printing has become a widespread technology with many applications in medicine. We have conducted a systematic review of its application in radiation oncology with a particular emphasis on the creation of phantoms for image quality assessment and radiation dosimetry. Traditionally used phantoms for quality assurance in radiotherapy are often constraint by simplified geometry and homogenous nature to perform imaging analysis or pretreatment dosimetric verification. Such phantoms are limited due to their ability in only representing the average human body, not only in proportion and radiation properties but also do not accommodate pathological features. These limiting factors restrict the patient-specific quality assurance process to verify image-guided positioning accuracy and/or dose accuracy in "water-like" condition.

Methods and results: English speaking manuscripts published since 2008 were searched in 5 databases (Google Scholar, Scopus, PubMed, IEEE Xplore, and Web of Science). A significant increase in publications over the 10 years was observed with imaging and dosimetry phantoms about the same total number (52 vs 50). Key features of additive manufacturing are the customization with creation of realistic pathology as well as the ability to vary density and as such contrast. Commonly used printing materials, such as polylactic acid, acrylonitrile butadiene styrene, high-impact polystyrene and many more, are utilized to achieve a wide range of achievable X-ray attenuation values from -1000 HU to 500 HU and higher. Not surprisingly, multimaterial printing using the polymer jetting technology is emerging as an important printing process with its ability to create heterogeneous phantoms for dosimetry in radiotherapy.

Conclusion: Given the flexibility and increasing availability and low cost of additive manufacturing, it can be expected that its applications for radiation medicine will continue to increase.

Keywords: additive manufacturing; dosimetry; heterogeneity; imaging; radiation; radiopacity.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Types of radiation dosimetry phantoms for quality assurance applications.
Figure 2.
Figure 2.
Applications for imaging and dosimetry phantoms within the radiotherapy treatment pathway: (1) the use of various imaging modalities, (2) utilizing available treatment planning software systems, (3) irradiation—fractionation, and (4) comparison of planned dose to actual dose.
Figure 3.
Figure 3.
Current trend of AM applications for radiation therapy as of 2018. AM indicates additive manufacturing.
Figure 4.
Figure 4.
Number of publications for AM of imaging and dosimetry radiation therapy phantoms. The ascending arrow indicates an observed linear trend for both imaging and dosimetry applications of manufactured radiotherapy phantoms using AM. AM indicates additive manufacturing.
Figure 5.
Figure 5.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart process for paper selection.
Figure 6.
Figure 6.
Different fused deposition AM materials, their achievable hounsfield units, and their corresponding references. * indicates materials with 100% infilling and + indicates materials with greater than 1000 hounsfield units (Tables 1 and 2). AM indicates additive manufacturing.
Figure 7.
Figure 7.
Additive Manufacturing materials manufactured with other AM technologies [Polymer Jetting technology (PJT), Digital Laser printing (DLP), Selective laser sintering (SLS), Stererolithography (SLA), Multijet Printing (MJP)], their achievable hounsfield units, and their corresponding references. * indicates materials with 100% infilling (Tables 1 and 2). SLA indicates stereolithography; SLS, Selective Laser Sintering.
Figure 8.
Figure 8.
The standard manufacturing workflow for manufacturing patient-specific AM-RPs. AM-RPs indicates additive manufacturing-radiotherapy phantoms.
Figure 9.
Figure 9.
Types of additively manufactured radiotherapy phantoms.
See this image and copyright information in PMC

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