INTRODUCTION: The process of fabricating physical medical skull models requires many steps, each of which is a potential source of geometric error. The aim of this study was to demonstrate inaccuracies and differences caused by DICOM to STL conversion in additively manufactured medical skull models. MATERIAL AND METHODS: Three different institutes were requested to perform an automatic reconstruction from an identical DICOM data set of a patients undergoing tumour surgery into an STL file format using their software of preference. The acquired digitized STL data sets were assessed and compared and subsequently used to fabricate physical medical skull models. The three fabricated skull models were then scanned, and differences in the model geometries were assessed using established CAD inspection software methods. RESULTS: A large variation was noted in size and anatomical geometries of the three physical skull models fabricated from an identical (or "a single") DICOM data set. CONCLUSIONS: A medical skull model of the same individual can vary markedly depending on the DICOM to STL conversion software and the technical parameters used. Clinicians should be aware of this inaccuracy in certain applications.

BIT Research Centre Department of Industrial Engineering and Management School of Science and Technology Aalto University P O Box 15500 FI 00076 Helsinki Finland

Dept of Otolaryngology Head and Neck Surgery Helsinki University Hospital and University of Helsinki P O Box 220 FI 00029 Helsinki Finland

Institute of Solid Mechanics Mechatronics and Biomechanics Faculty of Mechanical Engineering Brno University of Technology Technická 2896 2 616 69 Brno Czech Republic

Medical Imaging Center Department of Radiology Tampere University Hospital P O Box 2000 FI 33521 Tampere Finland

Oral and Maxillofacial Unit Department of Otorhinolaryngology Tampere University Hospital P O Box 2000 FI 33521 Tampere Finland

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