Study of dose dependence on density in planar 3D-printed applicators for HDR Ir192 surface brachytherapy

Published:November 28, 2022DOI:



      This paper describes a method to evaluate the influence of 3D printed plesiotherapy applicators densities in the most clinically relevant dosimetric planes of these brachytherapy treatments. Studied densities range goes from that of water to that of air including the intermediate applicators densities made of acrylonitrile butadiene styrene and polylactic acid, materials used as Fused Deposition Modelling (FDM) filaments.

      Methods and materials

      All applicators were manufactured by means of FDM 3D printing and a special empty applicator of ABS walls was designed to be filled with water or air. In each of these applicators, the values of the dose and gamma index at the surface and at the prescription depth were measured in clinical conditions, using EBT films.


      Analysis of results allow us to conclude that the influence of the applicators density on the dose value in the studied materials depends on the distance at which the dose is measured. Thus, at the prescription depth no influence is observed, however this influence becomes noticeable near the surface of the applicators with dose differences of more than 10% for densities close to 0.4 g/cm3.


      Therefore, the density of FDM manufactured applicators should be taken into account when calculating surface dose for low density applicators, as variations caused by density can have clinical implications because is the surface dose that is associated with the toxicity of brachytherapy skin treatments.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Brachytherapy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Guinot JL
        • Rembielak A
        • Perez-Calatayud J
        • et al.
        GEC ESTRO ACROB recommendations in skin brachytherapy.
        Radiother Oncol. 2018; 126: 377-385
        • Ouhib Z
        • Kasper M
        • Perez-Calatayud J
        • et al.
        Aspects of dosimetry and clinical practice of skin brachytherapy. The American Brachytherapy.
        Brachytherapy. 2015; 14: 840-858
        • Culmone C
        • Smit G
        • Breedveld P.
        Additive manufacturing of medical instruments: a state-of-the-art review.
        Addit Manuf. 2019; 27: 461-473
        • Tino R
        • Yeo A
        • Leary M
        • et al.
        A systematic review on 3D-printed and dosimetry phantoms in radiation therapy.
        Technol Cancer Res Treat Vol. 2019; 18: 1-14
        • Bassi S
        • Langan B
        • Malone C.
        Dosimetry assessment of patient-specific 3D printable materials for HDR surface brachytherapy.
        Phys Med. 2019; 67: 166-175
        • Ricotti R
        • Vavassori A
        • Bazani A
        • et al.
        3D-printed applicators for high dose rate brachytherapy: dosimetric assessment at different infill percentage.
        Phys Med. 2016; 32: 1698-1706
        • Granero D
        • Perez-Calatayud J
        • Vijande J
        • et al.
        Limitations of the TG-43 formalism for skin high-dose-rate brachytherapy dose calculations.
        Med Phys. 2014; 41 (021703-1-021703-8)
        • Rasmussen K
        • Stanley D
        • Eng T
        • et al.
        SU-G-201-07: dosimetric verification of a 3D printed HDR skin brachytherapy applicator.
        Med Phys. 2016; 43: 3624
        • Harris BD
        • Nilsson S
        • Poole CM.
        A feasibility study for using ABS plastic and a low-cost 3D printer for patient-specific brachytherapy mould design.
        Aust Phys Eng Sci Med. 2015; 38: 399-412
        • Jones EL
        • Baldion AT
        • Thomas C
        • et al.
        Introduction of novel 3D-printed superficial applicators for high-dose-rate skin brachytherapy.
        Brachytherapy. 2016; 16: 409-414
        • Cumming I
        • Joshi CP
        • Lasso A
        • et al.
        SU-E-T-04: 3D printed patient-specific surface mould applicators for brachytherapy treatment of superficial lesions.
        Med Phys. 2014; 41: 222
        • Guthier CV
        • O'Farrell DA
        • Bhagwat MS
        • et al.
        Automated high-dose-rate surface brachytherapy treatment planning for complex head and neck cases with 3D-printable masks.
        Int J Radiat Oncol Biol Phys. 2018; 102: 54-55
        • Valerga AP
        • Batista M
        • Salguero J
        • Girot F.
        Influence of PLA filament conditions on characteristics of FDM parts.
        Materials. 2018; 11: 1-13
        • Valerga AP
        • Batista M
        • Puyana R
        • et al.
        Preliminary study of PLA wire colour effects on geometric characteristics of parts manufactured by FDM.
        Proc Manuf. 2017; 13: 924-931
        • Low DA
        • Harms WB
        • Mutic S
        • Purdy JA.
        A technique for the quantitative evaluation of dose distributions.
        Med Phys. 1998; 25: 656-661
      1. JCGM 100:2008. Evaluation of measurement data-Guide to the expression of uncertainty in measurement, International Organization for Standardization (ISO), .Joint Committee for Guides in Metrology, corrected version 2010. Available at±100%3A2008&_search_portlet_source=BIPM. (Accessed June 13, 2022)

        • Rivard MJ
        • Coursey BM
        • DeWerd LA
        • et al.
        Update of AAPM Task Group No. 43 report: a revised AAPM protocol for brachytherapy dose calculations.
        Med Phys. 2004; 31: 633-674
        • Okamoto H
        • Aikawa A
        • Wakita A
        • Yoshio K.
        Dose error from deviation of dwell time and source position for high dose-rate 192Ir in remote afterloading system.
        J Radiat Res. 2014; 55: 780-787
        • Bassi S
        • Cummins D
        • McCavana P.
        Energy and dose dependence of GafChromic EBT3-V3 film across a wide energy range.
        Rep Pract Oncol Radiother. 2020; 25: 60-63
        • Huang L
        • Gaballa H
        • Chang J.
        Evaluating dosimetric accuracy of the 6 MV calibration on EBT3 film in the use of Ir-192 high dose rate brachytherapy.
        Radiat Oncol Phys. 2022; 23: 1-14
        • Miften M
        • Olch A
        • Mihailidis D
        • et al.
        Tolerance limits and methodologies for IMRT measurement-based verification QA: recommendations of AAPM Task Group No. 218.
        Med Phys. 2018; 45: 53-83