European Radiology

, Volume 29, Issue 3, pp 1384–1390 | Cite as

Paper-based 3D printing of anthropomorphic CT phantoms: Feasibility of two construction techniques

  • Paul JahnkeEmail author
  • Stephan Schwarz
  • Marco Ziegert
  • Felix Benjamin Schwarz
  • Bernd Hamm
  • Michael Scheel
Computed Tomography



To develop and evaluate methods for assembling radiopaque printed paper sheets to realistic patient phantoms for CT dose and image quality testing.


CT images of two patients were radiopaque printed with aqueous potassium iodide solution (0.6 g/ml) on paper. Two methods were developed for assembling the paper sheets to head and neck phantoms. (1) Printed sheets were fed to a paper-based 3D printer along with corresponding 3D printable STL files. (2) Paper stacks of 5-mm thickness were glued with toner, cut to the patient shape and assembled to a phantom. In a sample application study, both phantoms were examined with five different tube current settings. Images were reconstructed using filtered-back projection (FBP) and iterative reconstruction (AIDR 3D) with three strength levels. Dose length product (DLP), signal-to-noise ratios (SNR) and contrast-to-noise ratios (CNRs) were analysed. Data were analysed using 2-way analysis of variance (ANOVA).


Both methods achieved anthropomorphic phantoms with detailed patient anatomy. The 3D printer yielded a precise reproduction of the external patient shape, but caused visible glue artefacts. Gluing with toner avoided these artefacts and yielded more flexibility with regard to phantom size. In the sample application study, non-inferior SNR and CNR and up to 83.7% lower DLP were achieved on the phantoms with AIDR 3D compared with FBP.


Two methods for assembling radiopaque printed paper sheets to phantoms of individual patients are presented. The sample application demonstrates potential for simulation of patient imaging and systematic CT dose and image quality assessment.

Key Points

Two methods were developed to create realistic CT phantoms of individual patients from radiopaque printed paper sheets.

Analysis of five tube current and four reconstruction settings on two radiopaque 3D printed patient phantoms yielded non-inferior SNR and CNR and up to 83.7% lower dose with iterative reconstruction in comparison with filtered back projection.

Radiopaque 3D printed phantoms can simulate patients and allow systematic analysis of CT dose and image quality parameters.


Printing Three-dimensional Phantoms, imaging Tomography, X-ray computed 



Adaptive iterative dose reduction 3D


Analysis of variance


Automated tube current modulation


Common carotid artery


Computed tomography


Contrast-to-noise ratio


Display field of view


Dose length product


Filtered back projection


Hounsfield units


Laminated object manufacturing


Radiopaque 3D printing


Region of interest


Standard deviation


Signal-to-noise ratio



The authors would like to acknowledge the assistance of Asmaa Shatir, Department of Radiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany.


This study has received funding by the Bundesministerium für Wirtschaft und Energie (DE): 03EFHBE093.

Compliance with ethical standards


The scientific guarantor of this publication is Dr. Paul Jahnke.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.


Patent applications for the 3D printing method were filed by Dr. Jahnke and PD Dr. Scheel: DE202015104282U1, EP000003135199A1, US020170042501A1.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from the patients.

Ethical approval

Institutional Review Board approval was obtained.


• Prospective

• Experimental

• Performed at one institution

Supplementary material

330_2018_5654_MOESM1_ESM.docx (38 kb)
ESM 1 (DOCX 38.3 kb)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of RadiologyCharité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of HealthBerlinGermany

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