AccScience Publishing / ARNM / Online First / DOI: 10.36922/ARNM026270031
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ORIGINAL RESEARCH ARTICLE

Design, characterization, and fabrication of a 3D-printed patient-specific and personalized cranial immobilization system for radiotherapy treatment

NourElHouda Touil1 Karim Benkahila2 Faycal Kharfi1*
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1 Department of Physics, Faculty of Sciences, University Sétif1-Ferhat Abbas, Sétif , Algeria
2 Department of Radiotherapy, Fighting against Cancer Medical Centre of Sétif, Sétif , Algeria
Received: 4 July 2026 | Revised: 6 September 2026 | Accepted: 10 September 2026 | Published online: 23 September 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Abstract

Accurate immobilization is essential in cranial radiotherapy because modern treatment techniques rely on high geometric precision and tight setup tolerances. Conventional thermoplastic masks remain the clinical standard, but they may be uncomfortable, anxiety-provoking, and insufficiently adapted to individual facial anatomy. This study investigates the design, fabrication, and preclinical validation of a personalized immobilization system composed of a facial shell and fixation belts. The necessary facial surface was acquired using an EinScan Pro+ scanner. The facial shell was designed in Meshmixer, while the fixation belts and hooks were modeled in Fusion 360 according to the geometry of a Klarity Optek™ indexing board. Final components were sliced in Cura and fabricated on an Artillery Sidewinder X1 printer. Polylactic acid (PLA) and thermoplastic polyurethane (TPU) were numerically evaluated in COMSOL Multiphysics 6.3 for thermal phase transition during printing, irradiation-induced heating under a 6 MV radiotherapy photon beam (400 MU/min for 15 min), and tensile mechanical behavior of the fixation belts. The workflow successfully produced a 2.5-mm-thick patient-specific immobilization device with excellent anatomical conformity and compatibility with the clinical support system. Simulated peak temperatures remained low for both PLA (27.85 °C) and TPU (28.45 °C), indicating thermal stability during photon irradiation. Mechanical simulations showed peak stress of approximately 0.7 MPa and maximum displacement (deformation) of 0.012 mm for PLA and 0.4 mm for TPU, both below a 1-mm tolerance threshold. The proposed workflow supports the feasibility of personalized 3D-printed cranial immobilization devices, with TPU emerging as a promising material because it combines structural stability with greater flexibility and patient comfort.

Graphical abstract
Keywords
Radiotherapy
Cranial immobilization
Personalized medicine
3D printing
Structured-light scanning
Patient-specific device
COMSOL Multiphysics simulation
Funding
None.
Conflict of interest
The authors declare they have no competing interests.
References
  1. Khan FM. The Physics of Radiation Therapy. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2003.
  2. Delaney G, Jacob S, Featherstone C, Barton M. The role of radiotherapy in cancer treatment. Cancer. 2005;104(6):1129-1137. doi: 10.1002/cncr.21324
  3. Baskar R, Lee KA, Yeo R, Yeoh KW. Cancer and radiation therapy: current advances and future directions. Int J Med Sci. 2012;9(3):193-199. doi: 10.7150/ijms.3635
  4. Verellen D, De Ridder M, Linthout N, Tournel K, Soete G, Storme G. Innovations in image-guided radiotherapy. Nat Rev Cancer. 2007;7(12):949-960. doi: 10.1038/nrc2288
  5. Mackie TR, Kapatoes J, Ruchala K, et al. Image guidance for precise conformal radiotherapy. Int J Radiat Oncol Biol Phys. 2003;56:89-105. doi: 10.1016/s0360-3016(03)00090-7
  6. Rosenthal DI, Chambers MS, Fuller CD, et al. Beam path toxicities to non-target structures during intensity-modulated radiation therapy for head and neck cancer. Int J Radiat Oncol Biol Phys. 2008;72(3):747-755. doi: 10.1016/j.ijrobp.2008.01.012
  7. Tryggestad E, Christian M, Ford E, et al. Inter- and intrafraction patient positioning uncertainties for intracranial radiotherapy: a study of four frameless, thermoplastic mask-based immobilization strategies using daily cone-beam CT. Int J Radiat Oncol Biol Phys. 2011;80(1):281-290. doi: 10.1016/j.ijrobp.2010.06.022
  8. Li G, Ballangrud A, Kuo LC, et al. Motion monitoring for cranial frameless stereotactic radiosurgery using video-based three-dimensional optical surface imaging. Med Phys. 2011;38(7):3981-3994. doi: 10.1118/1.3596526
  9. Onimaru R, Shirato H, Fujino M, et al. The effect of tumor location and respiratory function on tumor movement estimated by real-time tracking radiotherapy (RTRT) system. Int J Radiat Oncol Biol Phys. 2005;63(1):164-169. doi: 10.1016/j.ijrobp.2005.01.025
  10. Cerviño LI, Gupta S, Rose MA, Yashar C, Jiang SB. Using surface imaging and visual coaching to improve the reproducibility and stability of deep-inspiration breath hold for left-breast-cancer radiotherapy. Phys Med Biol. 2009;54(22):6853-6865. doi: 10.1088/0031-9155/54/22/007
  11. Rengier F, Mehndiratta A, von Tengg-Kobligk H, et al. 3D printing based on imaging data: review of medical applications. Int J Comput Assist Radiol Surg. 2010;5(4):335-341. doi: 10.1007/s11548-010-0476-x
  12. Mitsouras D, Liacouras P, Imanzadeh A, et al. Medical 3D Printing for the Radiologist. Radiographics. 2015;35(7):1965-1988. doi: 10.1148/rg.2015140320
  13. Martelli N, Serrano C, van den Brink H, et al. Advantages and disadvantages of 3-dimensional printing in surgery: A systematic review. Surgery. 2016;159(6):1485-1500. doi: 10.1016/j.surg.2015.12.017
  14. Fredieu JR, Kerbo J, Herron M, Klatte R, Cooke M. Anatomical models: a digital revolution. Med Sci Educ. 2015;25(2):183-194. doi: 10.1007/s40670-015-0115-9
  15. Canters RA, Lips IM, Wendling M, et al. Clinical implementation of 3D printing in the construction of patient specific bolus for electron beam radiotherapy for non-melanoma skin cancer. Radiother Oncol. 2016;121(1):148-153. doi: 10.1016/j.radonc.2016.07.011
  16. Burleson S, Baker J, Hsia AT, Xu Z. Use of 3D printers to create a patient-specific 3D bolus for external beam therapy. J Appl Clin Med Phys. 2015;16(3):166-178. doi: 10.1120/jacmp.v16i3.5247
  17. Rooney MK, Rosenberg DM, Braunstein S, et al. Three-dimensional printing in radiation oncology: A systematic review of the literature. J Appl Clin Med Phys. 2020;21(8):15-26. doi: 10.1002/acm2.12907
  18. Katamesh AA, Subaiea GM, Mostafa M, et al. Revolutionizing Cancer Care: The Role of 3D Printing in Personalized Oncology. ACS Omega. 2025;10(35):39350-39370. doi: 10.1021/acsomega.5c01642
  19. Bell T, Li B, Zhang S. Structured Light Techniques and Applications. In: Webster JG, ed. Wiley Encyclopedia of Electrical and Electronics Engineering. Hoboken, New Jersey: Wiley; 2016. doi: 10.1002/047134608x.w8298
  20. Geng J. Structured-light 3D surface imaging: a tutorial. Adv Opt Photonics. 2011;3(2):128-160. doi: 10.1364/AOP.3.000128
  21. Sansoni G, Trebeschi M, Docchio F. State-of-the-art and applications of 3D imaging sensors in industry, cultural heritage, medicine, and criminal investigation. Sensors. 2009;9(1):568-601. doi: 10.3390/s90100568
  22. Kharfi F, Belatar M, Benkahila K. 3D-printed personalized bolus designed through structured-light scanning for adaptive radiotherapy. Adv Radiother Nucl Med. 2025;3(4):38-48. doi: 10.36922/ARNM025250032
  23. Dhawan AP, D’Alessandro B, Fu X. Optical imaging modalities for biomedical applications. IEEE Rev Biomed Eng. 2010;3:69-92. doi: 10.1109/RBME.2010.2081975
  24. Baumann FW, Schuermann M, Odefey U, Pfeil M. From G-code to STL: reconstruct models from 3D printing as a service. In: IOP Conference Series: Materials Science and Engineering. Bristol: IOP Publishing; 2017;280(1):012033. doi: 10.1088/1757-899X/280/1/012033
  25. Chia HN, Wu BM. Recent advances in 3D printing of biomaterials. J Biol Eng. 2015;9:4. doi: 10.1186/s13036-015-0001-4
  26. Ventola CL. Medical applications for 3D printing: current and projected uses. Pharm Ther. 2014;39(10):704-711.
  27. Javaid M, Haleem A. Current status and challenges of Additive manufacturing in orthopaedics: An overview. J Clin Orthop Trauma. 2019;10(2):380-386. doi: 10.1016/j.jcot.2018.05.008
  28. Tack P, Victor J, Gemmel P, Annemans L. 3D-printing techniques in a medical setting: a systematic literature review. Biomed Eng Online. 2016;15(1):115. doi: 10.1186/s12938-016-0236-4
  29. Salmi M. Additive manufacturing processes in medical applications. Materials. 2021;14(1):191. doi: 10.3390/ma14010191
  30. Rankin TM, Giovinco NA, Cucher DJ, Watts G, Hurwitz B, Armstrong DG. Three-dimensional printing surgical instruments: are we there yet? J Surg Res. 2014;189(2):193-197. doi: 10.1016/j.jss.2014.02.020
  31. Schubert C, van Langeveld MC, Donoso LA. Innovations in 3D printing: a 3D overview from optics to organs. Br J Ophthalmol. 2014;98(2):159-161. doi: 10.1136/bjophthalmol-2013-304446
  32. Melchels FPW, Domingos MAN, Klein TJ, Malda J, Bartolo PJ, Hutmacher DW. Additive manufacturing of tissues and organs. Prog Polym Sci. 2012;37(8):1079-1104. doi: 10.1016/j.progpolymsci.2011.11.007
  33. Gross BC, Erkal JL, Lockwood SY, Chen C, Spence DM. Evaluation of 3D printing and its potential impact on biotechnology and the chemical sciences. Anal Chem. 2014;86(7):3240-3253. doi: 10.1021/ac403397r
  34. Javaid M, Haleem A, Vaishya R, Bahl S, Suman R, Vaish A. Industry 4.0 technologies and their applications in fighting COVID-19 pandemic. Diabetes Metab Syndr. 2020;14(4):419-422. doi: 10.1016/j.dsx.2020.04.032
  35. Direkwatana C, Rattanapan N. 3D printing process for patient-specific models and applications. Rama Med J. 2025;48(2):e270830. doi: 10.33165/rmj.48.02.e270830
  36. Salmi M, Tuomi J, Paloheimo K, et al. Patient‐specific reconstruction with 3D modeling and DMLS additive manufacturing. Rapid Prototyp J. 2012;18(3):209-214. doi: 10.1108/13552541211218126
  37. Rybicki FJ. Medical 3D printing and the physician-artist. Lancet. 2018;391(10121):651-652. doi: 10.1016/S0140-6736(18)30212-5
  38. Kharfi F, Benkahila K, Boulkhessaim F, et al. Implementation of 3D Printing and Modeling Technologies for the Fabrication of Dose Boluses for External Radiotherapy at the CLCC of Sétif, Algeria. Technol Cancer Res Treat. 2024;23. doi: 10.1177/15330338241266479
  39. Ghediri N, Kharfi F, Benkahila K, et al. Dosimetric Validation and Surface Fit Evaluation of 3D-Printed Dose Boluses for Radiation Therapy Applications. Int J Cancer Manag. 2025;18(1):e159515. doi: 10.5812/ijcm-159515
  40. Contesini M, Guberti M, Saccani R, et al. Setup errors in patients with head-neck cancer (HNC), treated using the Intensity Modulated Radiation Therapy (IMRT) technique: how it influences the customised immobilisation systems, patient’s pain and anxiety. Radiat Oncol. 2017;12(1):72. doi: 10.1186/s13014-017-0807-y
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Advances in Radiotherapy & Nuclear Medicine, Electronic ISSN: 2972-4392 Print ISSN: 3060-8554, Published by AccScience Publishing