Development of patient-specific phantoms for verification of stereotactic body radiation therapy planning in patients with metallic screw fixation

A new technique for manufacturing a patient-specific dosimetric phantom using three-dimensional printing (PSDP-3DP) was developed, and its geometrical and dosimetric accuracy was analyzed. External body contours and structures of the spine and metallic fixation screws (MFS) were delineated from CT images of a patient with MFS who underwent stereotactic body radiation therapy for spine metastasis. Contours were converted into a STereoLithography file format using in-house program. A hollow, four-section PSDP was designed and manufactured using three types of 3DP to allow filling with a muscle-equivalent liquid and insertion of dosimeters. To evaluate the geometrical accuracy of PSDP-3DP, CT images were obtained and compared with patient CT data for volume, mean density, and Dice similarity coefficient for contours. The dose distribution in the PSDP-3DP was calculated by applying the same beam parameters as for the patient, and the dosimetric characteristics of the PSDP-3DP were compared with the patient plan. The registered CT of the PSDP-3DP was well matched with that of the real patient CT in the axial, coronal, and sagittal planes. The physical accuracy and dosimetric characteristics of PSDP-3DP were comparable to those of a real patient. The ability to manufacture a PSDP representing an extreme patient condition was demonstrated.