Material matters: Analysis of density uncertainty in 3D printing and its consequences for radiation oncology

Purpose Using 3D printing to fabricate patient-specific devices such as tissue compensators, boluses, and phantoms is inexpensive and relatively simple. However, most 3D printing materials have not been well characterized, including their radiologic tissue equivalence. The purposes of this study were to (a) determine the variance in Hounsfield Units (HU) for printed objects, (b) determine if HU varies over time, and (c) calculate the clinical dose uncertainty caused by these material variations. Methods For a sample of 10 printed blocks each of PLA, NinjaFlex, ABS, and Cheetah, the average HU and physical density were tracked at initial printing and over the course of 5 weeks, a typical timeframe for a standard course of radiotherapy. After initial printing, half the blocks were stored in open boxes, the other half in sealed bags with desiccant. Variances in HU and density over time were evaluated for the four materials. Various clinical photon and electron beams were used to evaluate potential errors in clinical depth dose as a function of assumptions made during treatment planning. The clinical depth error was defined as the distance between the correctly calculated 90% isodose line and the 90% isodose line calculated using clinically reasonable, but simplified, assumptions. Results The average HU measurements of individual blocks of PLA, ABS, NinjaFlex, and Cheetah varied by as much as 121, 30, 178, and 30 HU, respectively. The HU variation over 5 weeks was much smaller for all materials. The magnitude of clinical depth errors depended strongly on the material, energy, and assumptions, but some were as large as 9.0 mm. Conclusions If proper quality assurance steps are taken, 3D printed objects can be used accurately and effectively in radiation therapy. It is critically important, however, that the properties of any material being used in patient care be well understood and accounted for.