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Barcena AJR, Ravi P, Kundu S, Tappa K. Emerging Biomedical and Clinical Applications of 3D-Printed Poly(Lactic Acid)-Based Devices and Delivery Systems. Bioengineering (Basel) 2024; 11:705. [PMID: 39061787 PMCID: PMC11273440 DOI: 10.3390/bioengineering11070705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 07/06/2024] [Accepted: 07/07/2024] [Indexed: 07/28/2024] Open
Abstract
Poly(lactic acid) (PLA) is widely used in the field of medicine due to its biocompatibility, versatility, and cost-effectiveness. Three-dimensional (3D) printing or the systematic deposition of PLA in layers has enabled the fabrication of customized scaffolds for various biomedical and clinical applications. In tissue engineering and regenerative medicine, 3D-printed PLA has been mostly used to generate bone tissue scaffolds, typically in combination with different polymers and ceramics. PLA's versatility has also allowed the development of drug-eluting constructs for the controlled release of various agents, such as antibiotics, antivirals, anti-hypertensives, chemotherapeutics, hormones, and vitamins. Additionally, 3D-printed PLA has recently been used to develop diagnostic electrodes, prostheses, orthoses, surgical instruments, and radiotherapy devices. PLA has provided a cost-effective, accessible, and safer means of improving patient care through surgical and dosimetry guides, as well as enhancing medical education through training models and simulators. Overall, the widespread use of 3D-printed PLA in biomedical and clinical settings is expected to persistently stimulate biomedical innovation and revolutionize patient care and healthcare delivery.
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Affiliation(s)
- Allan John R. Barcena
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
- College of Medicine, University of the Philippines Manila, Manila 1000, Philippines
| | - Prashanth Ravi
- Department of Radiology, University of Cincinnati, Cincinnati, OH 45219, USA;
| | - Suprateek Kundu
- Department of Biostatistics, Division of Basic Science Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Karthik Tappa
- Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Ahmed AMM, Buschmann M, Breyer L, Kuntner C, Homolka P. Tailoring the Mass Density of 3D Printing Materials for Accurate X-ray Imaging Simulation by Controlled Underfilling for Radiographic Phantoms. Polymers (Basel) 2024; 16:1116. [PMID: 38675035 PMCID: PMC11053449 DOI: 10.3390/polym16081116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/26/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Additive manufacturing and 3D printing allow for the design and rapid production of radiographic phantoms for X-ray imaging, including CT. These are used for numerous purposes, such as patient simulation, optimization of imaging procedures and dose levels, system evaluation and quality assurance. However, standard 3D printing polymers do not mimic X-ray attenuation properties of tissues like soft, adipose, lung or bone tissue, and standard materials like liquid water. The mass density of printing polymers-especially important in CT-is often inappropriate, i.e., mostly too high. Different methods can be applied to reduce mass density. This work examines reducing density by controlled underfilling either realized by using 3D printing materials expanded through foaming during heating in the printing process, or reducing polymer flow to introduce microscopic air-filled voids. The achievable density reduction depends on the base polymer used. When using foaming materials, density is controlled by the extrusion temperature, and ranges from 33 to 47% of the base polymer used, corresponding to a range of -650 to -394 HU in CT with 120 kV. Standard filaments (Nylon, modified PLA and modified ABS) allowed density reductions by 20 to 25%, covering HU values in CT from -260 to 77 (Nylon), -230 to -20 (ABS) and -81 to 143 (PLA). A standard chalk-filled PLA filament allowed reproduction of bone tissue in a wide range of bone mineral content resulting in CT numbers from 57 to 460 HU. Controlled underfilling allowed the production of radiographic phantom materials with continuously adjustable attenuation in a limited but appropriate range, allowing for the reproduction of X-ray attenuation properties of water, adipose, soft, lung, and bone tissue in an accurate, predictable and reproducible manner.
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Affiliation(s)
| | - Martin Buschmann
- Division of Medical Radiation Physics, Department of Radiation Oncology, Medical University of Vienna, and University Hospital Vienna, 1090 Vienna, Austria;
| | - Lara Breyer
- Department of Biomedical Imaging and Image-Guided Therapy, Medical Imaging Cluster (MIC), Medical University of Vienna, 1090 Vienna, Austria; (L.B.); (C.K.)
| | - Claudia Kuntner
- Department of Biomedical Imaging and Image-Guided Therapy, Medical Imaging Cluster (MIC), Medical University of Vienna, 1090 Vienna, Austria; (L.B.); (C.K.)
| | - Peter Homolka
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, 1090 Vienna, Austria
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Ashenafi M, Jeong S, Wancura JN, Gou L, Webster MJ, Zheng D. A quick guide on implementing and quality assuring 3D printing in radiation oncology. J Appl Clin Med Phys 2023; 24:e14102. [PMID: 37501315 PMCID: PMC10647979 DOI: 10.1002/acm2.14102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/23/2023] [Accepted: 07/08/2023] [Indexed: 07/29/2023] Open
Abstract
As three-dimensional (3D) printing becomes increasingly common in radiation oncology, proper implementation, usage, and ongoing quality assurance (QA) are essential. While there have been many reports on various clinical investigations and several review articles, there is a lack of literature on the general considerations of implementing 3D printing in radiation oncology departments, including comprehensive process establishment and proper ongoing QA. This review aims to guide radiation oncology departments in effectively using 3D printing technology for routine clinical applications and future developments. We attempt to provide recommendations on 3D printing equipment, software, workflow, and QA, based on existing literature and our experience. Specifically, we focus on three main applications: patient-specific bolus, high-dose-rate (HDR) surface brachytherapy applicators, and phantoms. Additionally, cost considerations are briefly discussed. This review focuses on point-of-care (POC) printing in house, and briefly touches on outsourcing printing via mail-order services.
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Affiliation(s)
- Michael Ashenafi
- Department of Radiation OncologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Seungkyo Jeong
- Department of Applied MathematicsUniversity of RochesterRochesterNew YorkUSA
| | - Joshua N. Wancura
- Department of Radiation OncologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Lang Gou
- Department of Radiation OncologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Matthew J. Webster
- Department of Radiation OncologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Dandan Zheng
- Department of Radiation OncologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
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Paul RL, Mille MM, Turkoglu DJ, Chen-Mayer HH. Prompt gamma ray activation analysis for determining chemical composition of 3D printing and casting materials used in biomedical applications. J Radioanal Nucl Chem 2023; 332:3285-3291. [PMID: 37545764 PMCID: PMC10399705 DOI: 10.1007/s10967-023-08967-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 05/16/2023] [Indexed: 08/08/2023]
Abstract
Three-dimensional printing and casting materials were analyzed by prompt gamma-ray activation analysis (PGAA) to determine their suitability as human tissue surrogates for the fabrication of phantoms for medical imaging and radiation dosimetry applications. Measured elemental compositions and densities of five surrogate materials simulating soft tissue and bone were used to determine radiological properties (x-ray mass attenuation coefficient and electron stopping power). When compared with radiological properties of International Commission on Radiation Units and Measurements (ICRU) materials, it was determined that urethane rubber and PLA plastic yielded the best match for soft tissue, while silicone rubber and urethane resin best simulated the properties of bone.
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Affiliation(s)
- Rick L Paul
- Material Measurement Laboratory, National Institute of Standards and Technology, Gaithersburg MD, USA
| | - Matthew M Mille
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville MD, USA
| | - Danyal J Turkoglu
- Material Measurement Laboratory, National Institute of Standards and Technology, Gaithersburg MD, USA
- Current address: USNC-Tech, Seattle, WA 98199 USA
| | - H Heather Chen-Mayer
- Material Measurement Laboratory, National Institute of Standards and Technology, Gaithersburg MD, USA
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Kunert P, Schlattl H, Trinkl S, Giussani A, Klein L, Janich M, Reichert D, Brix G. Reproduction of a conventional anthropomorphic female chest phantom by 3D-printing: Comparison of image contrasts and absorbed doses in CT. Med Phys 2023; 50:4734-4743. [PMID: 37415411 DOI: 10.1002/mp.16587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/10/2023] [Accepted: 06/11/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND The production of individualized anthropomorphic phantoms via three-dimensional (3D) printing methods offers promising possibilities to assess and optimize radiation exposures for specifically relevant patient groups (i.e., overweighed or pregnant persons) that are not adequately represented by standardized anthropomorphic phantoms. However, the equivalence of printed phantoms must be demonstrated exemplarily with respect to the resulting image contrasts and dose distributions. PURPOSE To reproduce a conventionally produced anthropomorphic phantom of a female chest and breasts and to evaluate their equivalence with respect to image contrasts and absorbed doses at the example of a computed tomography (CT) examination of the chest. METHODS In a first step, the effect of different print settings on the CT values of printed samples was systematically investigated. Subsequently, a transversal slice and breast add-ons of a conventionally produced female body phantom were reproduced using a multi-material extrusion-based printer, considering six different types of tissues (muscle, lung, adipose, and glandular breast tissue, as well as bone and cartilage). CT images of the printed and conventionally produced phantom parts were evaluated with respect to their geometric correspondence, image contrasts, and absorbed doses measured using thermoluminescent dosimeters. RESULTS CT values of printed objects are highly sensitive to the selected print settings. The soft tissues of the conventionally produced phantom could be reproduced with a good agreement. Minor differences in CT values were observed for bone and lung tissue, whereas absorbed doses to the relevant tissues were identical within the measurement uncertainties. CONCLUSION 3D-printed phantoms are with exception of minor contrast differences equivalent to their conventionally manufactured counterparts. When comparing the two production techniques, it is important to note that conventionally manufactured phantoms should not be considered as absolute benchmarks, as they also only approximate the human body in terms of its absorption, and attenuation of x-rays as well as its geometry.
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Affiliation(s)
- Patrizia Kunert
- Department of Medical and Occupational Radiation Protection, Federal Office for Radiation Protection, Oberschleißheim, Germany
| | - Helmut Schlattl
- Department of Medical and Occupational Radiation Protection, Federal Office for Radiation Protection, Oberschleißheim, Germany
| | - Sebastian Trinkl
- Department of Medical and Occupational Radiation Protection, Federal Office for Radiation Protection, Oberschleißheim, Germany
| | - Augusto Giussani
- Department of Medical and Occupational Radiation Protection, Federal Office for Radiation Protection, Oberschleißheim, Germany
| | - Lea Klein
- Department of Radiation Oncology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Martin Janich
- Department of Radiation Oncology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Detlef Reichert
- Department of Physics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Gunnar Brix
- Department of Medical and Occupational Radiation Protection, Federal Office for Radiation Protection, Oberschleißheim, Germany
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Fonseca GP, Rezaeifar B, Lackner N, Haanen B, Reniers B, Verhaegen F. Dual-energy CT evaluation of 3D printed materials for radiotherapy applications. Phys Med Biol 2023; 68. [PMID: 36584391 DOI: 10.1088/1361-6560/acaf4a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 12/30/2022] [Indexed: 12/31/2022]
Abstract
Objective. There is a continuous increase in 3D printing applications in several fields including medical imaging and radiotherapy. Although there are numerous advantages of using 3D printing for the development of customized phantoms, bolus, quality assurance devices and other clinical applications, material properties are not well known and printer settings can affect considerably the properties (e.g. density, isotropy and homogeneity) of the printed parts. This study aims to evaluate several materials and printer properties to identify a range of tissue-mimicking materials.Approach. Dual-energy CT was used to obtain the effective atomic number (Zeff) and relative electron density (RED) for thirty-one different materials including different colours of the same filament from the same manufacturer and the same type of filament from different manufacturers. In addition, a custom bone equivalent filament was developed and evaluated since a high-density filament with a composition similar to bone is not commercially available. Printing settings such as infill density, infill pattern, layer height and nozzle size were also evaluated.Main results. Large differences were observed for HU (288), RED (>10%) andZeff(>50%) for different colours of the same filament due to the colour pigment. Results show a wide HU variation (-714 to 1104), RED (0.277 to 1.480) andZeff(5.22 to 12.39) between the printed samples with some materials being comparable to commercial tissue-mimicking materials and good substitutes to a range of materials from lung to bone. Printer settings can result in directional dependency and significantly affect the homogeneity of the samples.Significance. The use of DECT to extract RED, andZeffallows for quantitative imaging and dosimetry using 3D printed materials equivalent to certified tissue-mimicking tissues.
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Affiliation(s)
- Gabriel P Fonseca
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Behzad Rezaeifar
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Niklas Lackner
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Britt Haanen
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Brigitte Reniers
- Research group NuTeC, Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Frank Verhaegen
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
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Okkalidis N, Bliznakova K, Kolev N. A filament 3D printing approach for CT-compatible bone tissues replication. Phys Med 2022; 102:96-102. [PMID: 36162230 DOI: 10.1016/j.ejmp.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 10/14/2022] Open
Abstract
PURPOSE The aim of this study is the development of a methodology for manufacturing 3D printed anthropomorphic structures, which mimic the X-ray properties of the human bone tissue. METHODS A mixing approach of two different materials is proposed for the fabrication of a radiologically equivalent hip bone for an anthropomorphic abdominal phantom. The materials employed for the phantom were polylactic acid (PLA) and Stonefil, while a custom-made dual motor filament extrusion setup and a custom-made software associating medical images directly with the 3D printing process were employed. RESULTS Three phantoms representing the hip bone were 3D printed utilizing two filaments under three different printing scenarios. The phantoms are based on a patient's abdominal CT scan images. Histograms of CT scans of the printed hip bone phantoms were calculated and compared to the original patient's hip bone histogram, demonstrating that a constant mixing composition of 30% Stonefil and 70% PLA with 0.0375 extrusion rate per voxel (93.75% flow for fulfilling a single voxel) for the cancellous bone, and using 100% Stonefil with 0.04 extrusion rate per voxel (100% flow) for the cortical bone results in a realistic anatomy replication of the hip bone. Reproduced HU varied between 700 and 800, which are close to those of the hip bone. CONCLUSIONS The study demonstrated that it is possible to mix two different filaments in real-time during the printing process to obtain phantoms with realistic and radiographically bone tissue equivalent attenuation. The results will be explored for manufacturing a CT-compatible abdominal phantom.
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Affiliation(s)
- Nikiforos Okkalidis
- Medical University of Varna, Bulgaria; Morphé, Praxitelous 1, Thessaloniki, Greece.
| | | | - Nikola Kolev
- Medical University of Varna, Bulgaria; First Clinic of Surgery in UMHAT "Saint Marina", Varna, Bulgaria
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Mettivier G, Sarno A, Varallo A, Russo P. Attenuation coefficient in the energy range 14–36 keV of 3D printing materials for physical breast phantoms. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac8966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 08/12/2022] [Indexed: 11/11/2022]
Abstract
Abstract
Objective. To measure the monoenergetic x-ray linear attenuation coefficient, μ, of fused deposition modeling (FDM) colored 3D printing materials (ABS, PLAwhite, PLAorange, PET and NYLON), used as adipose, glandular or skin tissue substitutes for manufacturing physical breast phantoms. Approach. Attenuation data (at 14, 18, 20, 24, 28, 30 and 36 keV) were acquired at Elettra synchrotron radiation facility, with step-wedge objects, using the Lambert–Beer law and a CCD imaging detector. Test objects were 3D printed using the Ultimaker 3 FDM printer. PMMA, Nylon-6 and high-density polyethylene step objects were also investigated for the validation of the proposed methodology. Printing uniformity was assessed via monoenergetic and polyenergetic imaging (32 kV, W/Rh). Main results. Maximum absolute deviation of μ for PMMA, Nylon-6 and HD-PE was 5.0%, with reference to literature data. For ABS and NYLON, μ differed by less than 6.1% and 7.1% from that of adipose tissue, respectively; for PET and PLAorange the difference was less than 11.3% and 6.3% from glandular tissue, respectively. PLAorange is a good substitute of skin (differences from −9.4% to +1.2%). Hence, ABS and NYLON filaments are suitable adipose tissue substitutes, while PET and PLAorange mimick the glandular tissue. PLAwhite could be printed at less than 100% infill density for matching the attenuation of glandular tissue, using the measured density calibration curve. The printing mesh was observed for sample thicknesses less than 60 mm, imaged in the direction normal to the printing layers. Printing dimensional repeatability and reproducibility was less 1%. Significance. For the first time an experimental determination was provided of the linear attenuation coefficient of common 3D printing filament materials with estimates of μ at all energies in the range 14–36 keV, for their use in mammography, breast tomosynthesis and breast computed tomography investigations.
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Ma D, Gao R, Li M, Qiu J. Mechanical and medical imaging properties of 3D-printed materials as tissue equivalent materials. J Appl Clin Med Phys 2021; 23:e13495. [PMID: 34878729 PMCID: PMC8833282 DOI: 10.1002/acm2.13495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/12/2021] [Accepted: 11/18/2021] [Indexed: 12/21/2022] Open
Abstract
Three materials of polylactic acid (PLA), polyamide 12 (PA12), and light curing resin (LCR) were used to construct phantom using 3D printing technology. The mechanical and medical imaging properties of the three materials, such as elastic modulus, density, effective atomic number, X‐ray attenuation coefficient, computed tomography (CT) number, and acoustic properties, were investigated. The results showed that the elastic modulus for PLA was 1.98 × 103 MPa, for PA12 was 848 MPa, for LCR was 1.18×103 MPa, and that of three materials was close to some bones. In the range of 40∼120 kV, the X‐ray attenuation coefficient of three materials decreased with increasing tube voltage. The CT number for PLA, PA12, and LCR was 144, −88, and 312 Hounsfield units at 120 kV tube voltage, respectively. The density and the effective atomic number product (ρ*Zeff) were computed from three materials and decreased in the order of LCR, PLA, and PA12. The acoustic properties of materials were also studied. The speeds of sound of three materials were similar with those of some soft tissues.
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Affiliation(s)
- Depeng Ma
- Medical Engineering and Technology Center, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, P. R. China.,Qingdao 3E3D Tech. Co. Ltd., Qingdao, P. R. China
| | - Ronghui Gao
- Health Care Department, Taishan Sanatorium of Shandong, Province, Taian, P. R. China
| | - Minghui Li
- Medical Engineering and Technology Center, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, P. R. China
| | - Jianfeng Qiu
- Medical Engineering and Technology Center, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, P. R. China.,Medical Science and Technology Innovation Center, Shandong First Medical University and Shandong Academy of Medical Sciences, Ji'nan, P. R. China.,Qingdao 3E3D Tech. Co. Ltd., Qingdao, P. R. China
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