Modeling and Evaluation of Customizable Immobilization Masks for Precision Radiotherapy

Accurate immobilization is critical in head and neck (H&N) radiotherapy to ensure precise dose delivery while minimizing irradiation of surrounding healthy tissues. However, conventional thermoplastic masks cannot secure 100% replicas of the patient's surface and are often limited by mechanical weakness, patient discomfort, and workflow inefficiencies. Recently, the best replicas of the patient's face have been obtained by exploring personal CT or MRI scans of patients that are used for manufacturing of immobilization masks. This study aimed to design and evaluate customizable immobilization masks using acrylonitrile butadiene styrene (ABS)-based composites reinforced with bismuth oxide (Bi₂O₃) and to compare their mechanical performance against commercial thermoplastic masks. ABS and ABS/Bi₂O₃ composite filaments (5, 10, and 20 wt%) were fabricated and characterized by tensile testing. A patient-specific virtual mask was modeled and subjected to finite element analysis (FEA) under clinically relevant loading scenarios, including neck flexion and lateral bending. Results were benchmarked against two commercial thermoplastic masks. ABS and ABS-based composites exhibited significantly higher stiffness (1.7-2.5 GPa) and yield strength (20-25 MPa) compared to commercial thermoplastics (0.25-0.3 GPa, ~7 MPa; <i>p</i> < 0.001). FEA simulations revealed markedly reduced displacement in ABS masks (1-5 mm at 2 mm thickness; <1 mm at 4 mm thickness) relative to commercial masks, which exceeded 20 mm under lateral load. Hybrid configurations with reinforced edges further optimized rigidity while limiting material usage. Customized ABS-based immobilization masks outperform conventional thermoplastics in mechanical stability and displacement control, with the potential to reduce planning margins and improve patient comfort. In addition, ABS-based masks can be recycled, and Bi₂O₃-filled composites can be reused for printing new immobilization masks, thus contributing to a reduced amount of plastic waste. These findings support their promise as next-generation immobilization devices for precision radiotherapy, warranting further clinical validation, workflow integration and sustainable implementation within a circular economy.