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Towards the production of radiotherapy treatment shells on 3D printers using data derived from DICOM CT and MRI: preclinical feasibility studies

Published online by Cambridge University Press:  22 August 2014

S. D. Laycock*
School of Computing Sciences, University of East Anglia, Norwich, UK
M. Hulse
Department of Health Studies, University Campus Suffolk, Ipswich, UK
C. D. Scrase
Department of Clinical Oncology, Ipswich Hospital NHS Trust, Ipswich, UK
M. D. Tam
Department of Radiology, Southend University Hospital NHS Foundation Trust, Southend, UK Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, UK
S. Isherwood
Department of Clinical Oncology, Ipswich Hospital NHS Trust, Ipswich, UK
D. B. Mortimore
Newbourne Solutions Ltd, Newbourne, Woodbridge, UK
D. Emmens
Department of Clinical Oncology, Ipswich Hospital NHS Trust, Ipswich, UK
J. Patman
Department of Health Studies, University Campus Suffolk, Ipswich, UK
S. C. Short
Leeds Institute of Cancer Studies and Pathology, University of Leeds and St James’s Institute of Oncology, Leeds, UK
G. D. Bell
School of Computing Sciences, University of East Anglia, Norwich, UK East Anglian Experimental Radiography, Modelling and 3D Printing Group, School of Science, Technology and Health, University Campus Suffolk, Ipswich, UK
Correspondence to: Stephen D. Laycock, School of Computing Sciences, University of East Anglia, Norwich, NR4 7TJ, UK. Tel: +44(0)1603 593795; E-mail:



Immobilisation for patients undergoing brain or head and neck radiotherapy is achieved using perspex or thermoplastic devices that require direct moulding to patient anatomy. The mould room visit can be distressing for patients and the shells do not always fit perfectly. In addition the mould room process can be time consuming. With recent developments in three-dimensional (3D) printing technologies comes the potential to generate a treatment shell directly from a computer model of a patient. Typically, a patient requiring radiotherapy treatment will have had a computed tomography (CT) scan and if a computer model of a shell could be obtained directly from the CT data it would reduce patient distress, reduce visits, obtain a close fitting shell and possibly enable the patient to start their radiotherapy treatment more quickly.


This paper focuses on the first stage of generating the front part of the shell and investigates the dosimetric properties of the materials to show the feasibility of 3D printer materials for the production of a radiotherapy treatment shell.

Materials and methods:

Computer algorithms are used to segment the surface of the patient’s head from CT and MRI datasets. After segmentation approaches are used to construct a 3D model suitable for printing on a 3D printer. To ensure that 3D printing is feasible the properties of a set of 3D printing materials are tested.


The majority of the possible candidate 3D printing materials tested result in very similar attenuation of a therapeutic radiotherapy beam as the Orfit soft-drape masks currently in use in many UK radiotherapy centres. The costs involved in 3D printing are reducing and the applications to medicine are becoming more widely adopted. In this paper we show that 3D printing of bespoke radiotherapy masks is feasible and warrants further investigation.

Technical Note
© Cambridge University Press 2014 

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1.Devereux, C, Grundy, G, Littman, P. Plastic moulds for patient immobilisation. Int J Radiat Oncol Biol Phys 1976; 1: 553557.CrossRefGoogle Scholar
2.Gilbeau, L, Octave-Prignot, M, Loncol, T, Ranard, L, Gregoire, V. Comparison of setup accuracy of three different thermoplastic masks for the treatment of brain and head and neck tumours. Radiother Oncol 2001; 58: 155162.CrossRefGoogle Scholar
3.Hess, C F, Kortmann, R D, Jany, A, Hamberger, M. Accuracy of field alignment in radiotherapy of head and neck cancer utilizing individualized face mask immobilisation: a retrospective analysis of clinical practice. Radiother Oncol 1995; 34: 6972.CrossRefGoogle ScholarPubMed
4.Schulte, R W, Fargo, R A, Meinass, H J, Slater, J D, Slater, J M. Analysis of head motion prior to and during proton beam therapy. Int J Radiat Oncol Biol Phys 2000; 47: 11051110.CrossRefGoogle ScholarPubMed
5.Sharp, L, Lewin, F, Johansson, H, Payne, D, Gerhardsson, A, Rutqvist, L E. Randomized trial on two types of thermoplastic masks for patient immobilization during radiation therapy for head and neck cancer. Int J Radiat Oncol Biol Phys 2005; 61: 250256.CrossRefGoogle ScholarPubMed
6.McCloskey, T, Moore, P. Making a radiotherapy mask, Macmillan Cancer Support. Accessed 12 August 2014.Google Scholar
7.Tam, M D, Laycock, S, Bell, G D, Chojnowski, A. 3D printout of a DICOM to aid surgical planning in a 6 year old patient with a large scapular osteochondroma complicating congenital diaphyseal aclasia. J Radiol Case Rep 2012; 6 (1): 3137.Google Scholar
8.Laycock, S D, Bell, G D, Mortimore, D, Greco, M K, Corps, N, Finkle, I. Combining X-ray micro-CT technology and 3D printing for the digital preservation and study of a 19th century Cantonese Chess piece with intricate internal structures. J Comput Cult Herit 2013; 5 (4): 17.CrossRefGoogle Scholar
9.Esses, S J, Berman, P, Bloom, A I, Sosna, J. Clinical applications of physical 3D models derived from MDCT data and created by rapid prototyping. AJR Am J Roentgenol 2011; 196: W683W688.CrossRefGoogle ScholarPubMed
10.Sanghera, B, Amis, A, McGurk, M. Preliminary study of the potential for rapid prototype and surfaced scanned radiotherapy facemask production technique. J Med Eng Technol 2002; 26: 1621.CrossRefGoogle Scholar
11.McKernan, B, Bydder, S, Deans, T, Nixon, M A, Joseph, D J. Surface laser scanning to routinely produce casts for patient immobilization during radiotherapy. Australas Radiol 2007; 51 (2): 150153.CrossRefGoogle ScholarPubMed
12.Hulse, M, Isherwood, S, Scrase, C, Laycock, S, Bell, G D. 3D CT-aided modelling of treatment shells for use in radiotherapy. Presented at the National Cancer Research Institute (NCRI) Clinical and Translational Radiotherapy Research Working Group (CTRad) Clinical Trials Workshop, 27th February 2012, Leeds.Google Scholar
13.Zou, W, Fisher, T, Swann, Bet al. MO-H-19A-03: patient specific bolus with 3D printing technology for electron radiotherapy. Med Phys 2014; 41: 443.CrossRefGoogle Scholar
14.Kim, H, Park, Y-K, Ki, I H, Ye, S-J. Development of an optical-based image guidance system: technique detecting external markers behind a full mask. Med Phys 2011; 38: 30063012.CrossRefGoogle Scholar
15.Rotondo, R L, Sultanem, K, Lavoie, I, Skelly, J, Raymond, L. Comparison of repositioning accuracy of two commercially available immobilization systems for treatment of head-and-neck tumors using simulation computed tomography imaging. Int J Radiat Oncol Biol Phys 2008; 70 (5): 13891396.CrossRefGoogle ScholarPubMed
16.Kang, H, Lovelock, D M, Yorke, E D, Kriminski, S, Lee, N, Amols, H I. Accurate positioning for head and neck cancer patients using 2D and 3D image guidance. J Appl Clin Med Phys 2010; 12 (1): 8696.CrossRefGoogle ScholarPubMed