Introduction: Anatomical models and X-ray phantoms play an important role in radiographer education by deepening anatomical understanding and enabling training in complex imaging procedures. Among these procedures is invasive coronary angiography, for which accurate three-dimensional anatomical perception is essential because of anatomical and pathological variations in the course of the coronary arteries. As commercially available X-ray phantoms for this application are not yet available, three-dimensional printing represents a promising approach for their development. Purpose: This study aimed to develop an anatomically accurate, three-dimensionally printed X-ray heart phantom with coronary arteries suitable for educating and training radiographers in invasive coronary angiography. Methods: In the empirical part, two heart phantoms, each representing either the left or right coronary artery, were created by segmenting cardiac computed tomography images, using computer-aided modeling, and performing dual-material three-dimensional printing. Stainless steel filament was used to visualize the coronary arteries. The quality and anatomical accuracy of the phantoms were evaluated with fluoroscopic and computed tomography imaging. Results: By optimizing the printing parameters, two anatomically accurate X-ray heart phantoms with separate visualization of the left and right coronary arteries were produced. Validation with fluoroscopic imaging and computed tomography demonstrated a high degree of correspondence with reference angiograms and the original computed tomography images, with the coronary arteries clearly visible and distinguishable from surrounding structures. Discussion and conclusion: The study showed that image segmentation combined with multi-material three-dimensional printing enables the creation of an X-ray heart phantoms with radiopaque coronary arteries and a high level of anatomical fidelity compared with the original images. The selection of appropriate materials and optimization of printing parameters were crucial for ensuring anatomical representativeness, mechanical stability, and minimal imaging artifacts. Because the phantoms provide clear visualization of the coronary arteries during fluoroscopic imaging, they represent a cost-effective and highly valuable educational tool for radiographers.
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