Anthropomorphic Liver Phantom Research Articles

Technical and clinical considerations of a physical liver phantom for CT radiomics analysis.

This study identifies key characteristics to help build a physical liver computed tomography (CT) phantom for radiomics harmonization; particularly, the higher-order texture metrics. CT scans of a radiomics phantom comprising of 18 novel 3D printed inserts with varying size, shape, and material combinations were acquired on a 64-slice CT scanner (Brilliance 64, Philips Healthcare). The images were acquired at 120kV, 250mAs, CTDIvol of 16.36mGy, 2mm slice thickness, and iterative noise-reduction reconstruction (iDose, Philips Healthcare, Andover, MA). Radiomics analysis was performed using the Cancer Imaging Phenomics Toolkit (CaPTk), following automated segmentation of 3D regions of interest (ROI) of the 18 inserts. The findings were compared to three additional ROI obtained of an anthropomorphic liver phantom, a patient liver CT scan, and a water phantom, at comparable imaging settings. Percentage difference in radiomic metrics values between phantom and tissue was used to assess the biological equivalency and <10% was used to claim equivalent. The HU for all 18 ROI from the phantom ranged from -30 to 120 which is within clinically observed HU range of the liver, showing that our phantom material (T3-6B) is representative of biological CT tissue densities (liver) with >50% radiomic features having <10% difference from liver tissue. Based on the assessment of the Neighborhood Gray Tone Difference Matrix (NGTDM) metrics it is evident that the water phantom ROI show extreme values compared to the ROIs from the phantom. This result may further reinforce the difference between a structureless quantity such as water HU values and tissue HU values found in liver. The 3-D printed patterns of the constructed radiomics phantom cover a wide span of liver tissue textures seen in CT images. Using our results, texture metrics can be selectively harmonized to establish clinically relevant and reliable radiomics panels.

Investigating the role of imaging factors in the variability of CT-based texture analysis metrics.

This study assesses the robustness of first-order radiomic texture features namely interquartile range (IQR), coefficient of variation (CV) and standard deviation (SD) derived from computed tomography (CT) images by varying dose, reconstruction algorithms and slice thickness using scans of a uniform water phantom, a commercial anthropomorphic liver phantom, and a human liver in-vivo. Scans were acquired on a 16cm detector GE Revolution Apex Edition CT scanner with variations across three different nominal slice thicknesses: 0.625, 1.25, and 2.5mm, three different dose levels: CTDIvol of 13.86 mGy for the standard dose, 40% reduced dose and 60% reduced dose and two different reconstruction algorithms: a deep learning image reconstruction (DLIR-high) algorithm and a hybrid iterative reconstruction (IR) algorithm ASiR-V50% (AV50) were explored, varying one at a time. To assess the effect of non-linear modifications of images by AV50 and DLIR-high, images of the water phantom were also reconstructed using filtered back projection (FBP). Quantitative measures of IQR, CV and SD were extracted from twelve pre-selected, circular (1cm diameter) regions of interest (ROIs) capturing different texture patterns across all scans. Across all scans, imaging, and reconstruction settings, CV, IQR and SD were observed to increase with reduction in dose and slice thickness. An exception to this observation was found when using FBP reconstruction. Lower values of CV, IQR and SD were observed in DLIR-high reconstructions compared to AV50 and FBP. The Poisson statistics were more stringently noted in FBP than DLIR-high and AV50, due to the non-linear nature of the latter two algorithms. Variation in image noise due to dose reduction algorithms, tube current, and slice thickness show a consistent trend across phantom and patient scans. Prospective evaluation across multiple centers, scanners and imaging protocols is needed for establishing quality assurance standards of radiomics.

Development of a Deformable Anthropomorphic Liver Phantom for Multimodal Imaging With Ultrasound and CT

Development of a Deformable Anthropomorphic Liver Phantom for Multimodal Imaging With Ultrasound and CT

Development of an Artificial 3D Liver Phantom for Analysis of Radiotherapeutic Effects In Vitro

Over recent decades, stereotactic body radiotherapy has garnered increasing popularity. Unfortunately, conventional preclinical 2D in vitro models are often insufficient for studying radiotherapy effects. Therefore, in this study, we developed a novel anthropomorphic in vitro liver phantom, which simulates the relevant hepatocellular carcinoma (HCC) tumor microenvironment and spatial organization. The liver phantom was 3D printed, filled with tissue-mimicking agarose mixture, and designed to fit ten microfluidic chips (MCs), in which HepG2 cells were seeded. Airtight MCs induced hypoxic conditions, as verified by Hif1α staining. Irradiation was conducted with 20 Gy in one fraction using a CyberKnife, in either a 2D setup, or by irradiating MCs arranged in the 3D-printed liver model using an individually calculated treatment plan. Post-irradiation cellular damage was determined via γH2AX staining. Here, we demonstrate a new physiologically relevant approach to model HCC pathology following radiotherapy. Comparing γH2AX staining in normoxic conditions to cells grown in MCs (hypoxic conditions) revealed a reduction in cellular damage of 30.24% (p = 0.0001) in the hypoxic environment. Moreover, we compared the scattering effect of radiation on a conventional 2D in vitro model to our new 3D anthropomorphic liver phantom and observed a significant γH2AX intensity reduction of 9.6% (p = 0.0294) in HepG2 cells irradiated in the phantom. Our approach of utilizing a liver phantom takes into account the hypoxic tumor microenvironment and 3D scattering effects of tissue irradiation, thereby modeling both physical and biological parameters of HCC tumors. The use of tissue phantoms lays the groundwork for future examination of other hypoxic tumors and offers a more comprehensive approach for screening and analysis of novel cancer therapeutics.

Technical note: Controlling the attenuation of 3D-printed physical phantoms for computed tomography with a single material.

The purpose of this work was to characterize and improve the ability of fused filament fabrication to create anthropomorphic physical phantoms for CT research. Specifically, we sought to develop the ability to create multiple levels of X-ray attenuation with a single material. CT images of 3D printed cylinders with different infill angles and printing patterns were assessed by comparing their 2D noise power spectra to determine the conditions that produced minimal and uniform noise. A backfilling approach in which additional polymer was extruded into an existing 3D printed background layer was developed to create multiple levels of image contrast. A print with nine infill angles and a rectilinear infill pattern was found to have the best uniformity, but the printed objects were not as uniform as a commercial phantom. An HU dynamic range of 600 was achieved by changing the infill percentage from 40% to 100%. The backfilling technique enabled control of up to eight levels of contrast within one object across a range of 200 HU, similar to the range of soft tissue. A contrast detail phantom with six levels of contrast and an anthropomorphic liver phantom with four levels of contrast were printed with a single material. This work improves the uniformity and levels of contrast that can be achieved with fused filament fabrication, thereby enabling researchers to easily create more detailed physical phantoms, including realistic, anthropomorphic textures.

Comparing calculated and experimental activity and dose values obtained from image-based quantification of 90Y SPECT/CT Data

PurposeSelective internal radiation therapy (SIRT) is a treatment for various kinds of liver tumours by injecting 90Y bearing microspheres into the liver vessels. To perform meaningful post-treatment dosimetry, quantitative imaging is performed. MethodsThis work uses a Monte-Carlo based reconstruction software with scatter and attenuation correction and collimator modelling that allows the quantification of 90Y bremsstrahlung SPECT/CT data. A dataset comprising 17 patients and measurements on a Jaszczak phantom, a NEMA IEC Body phantom and an anthropomorphic liver phantom are analysed and activities and dose values are acquired. These measured values are compared with applied activities and pre-treatment calculations, allowing to assess the quality of the SPECT reconstruction. A detailed uncertainty budget is presented, including uncertainties of the dose calibrator, the count rate, non-included interactions and other factors. ResultsThe applied method is validated by finding measurements repeatable within the given uncertainty, and it is shown the influence of various parameters on the reconstruction process is negligible. Furthermore, activities and doses measured in the phantoms show good agreement with calculated values, if they are corrected for partial volume effects. ConclusionsThe strict observation of metrological requirements and the creation of an uncertainty budget increase the reliability and traceability of this novel approach to 90Y dosimetry. It gives an example of successful voxel-based dosimetry based on quantitative 90Y SPECT/CT image data.

Failure Modes in IROC Photon Liver Phantom Irradiations

PurposeOur purpose was to analyze and classify the patterns of failure for irradiations of the Imaging and Radiation Oncology Core photon liver phantom. Methods and MaterialsImaging and Radiation Oncology Core’s anthropomorphic liver phantom simulates multitarget liver disease with respiratory motion. Two hundred forty-nine liver phantom results from 2013 to 2019 were analyzed. Phantom irradiations that failed were categorized by the error attributed to the failure. Phantom results were also compared by demographic data, such as machine type, treatment planning system, motion management technique, number of isocenters, and whether the phantom was a first time or repeat irradiation. ResultsThe failure rate for the liver phantom was 27%. From the 68 irradiations that did not pass, 5 failure modes were identified. The most common failure mode was localization errors in the direction of motion, with over 50% of failures attributed to this mode. The second-most common failure mode was systematic dose errors. The internal target volume technique performed worse than other motion management techniques. Failure modes were different by the number of isocenters used, with multi-isocenter irradiations having more failure modes in a single phantom irradiation. ConclusionsMotion management techniques and proper alignment of moving targets play a large role in the successful irradiation of the liver phantom. These errors should be examined to ensure accurate patient treatment for liver disease or other sites where multiple moving targets are present.

Assessment of Radiation Dose Delivered and Volume Measurement By Low- and High-Dose Diagnostic Computed Tomography: Anthropomorphic Liver Phantom Study.

Aim:Liver volume measurement is a mandatory test before measure liver surgeries and transplantation. We aimed a study on the difference in volume measurement and radiation dose to an anthropomorphic liver phantom using high-dose and low-dose diagnostic computed tomography (CT).Materials and Methods:Several measurements of the manual total volume measurement done on an anthropomorphic liver phantom mounted with thermoluminescent dosimeter. We exposed the phantom with diagnostic CT, low-dose CT, and a low-dose CT with copper filter.Results:Phantom underwent ten scanning for each exposure. There was no significant difference in the total volume measurement in comparison to the phantom volume. The volume of phantom measured by low-dose CT, low-dose CT with copper phantom, and high-dose CT were 1869 ± 18 cm3, 1852 ± 24 cm3, and 1908 ± 12 cm3, (P = 0.3), respectively. However, the radiation dose delivered was significantly different (1.54 mGy, 0.77 mGy, and 5.84 mGy [P = 0.001], respectively).Conclusion:Total liver volume measurement provides essential clinical information in several clinical conditions. We recommended that the volume measured by a low-dose CT has an excellent correlation with the diagnostic quality CT and should be a routine in the routine clinical practice. CT volumetry achieves the same result while using very less radiation exposure. It may also be used with functional imaging to give complete information.

Precision and reliability of liver iodine quantification from spectral detector CT: evidence from phantom and patient data

To comprehensively assess precision, reproducibility, and repeatability of iodine maps from spectral detector CT (SDCT) in a phantom and in patients with repetitive examination of the abdomen. Seventy-seven patients who underwent examination two (n = 52) or three (n = 25) times according to clinical indications were included in this IRB-approved, retrospective study. The anthropomorphic liver phantom and all patients were scanned with a standardized protocol (SSDE in patients 15.8mGy). In patients, i.v. contrast was administered and portal venous images were acquired using bolus-tracking technique. The phantom was scanned three times at three time points; in one acquisition, image reconstruction was repeated three times. Region of interest (ROI) were placed automatically (phantom) or manually (patients) in the liver parenchyma (mimic) and the portal vein; attenuation in conventional images (CI [HU]) and iodine map concentrations (IM [mg/ml]) were recorded. The coefficient of variation (CV [%]) was used to compare between repetitive acquisitions. If present, additional ROI were placed in cysts (n = 29) and hemangioma (n = 29). Differences throughout all phantom examinations were < 2%. In patients, differences between two examinations were higher (CV for CI/IM: portal vein, 2.5%/3.2%; liver parenchyma, -0.5%/-3.0% for CI/IM). In 80% of patients, these differences were within a ± 20% limit. Differences in benign liver lesions were even higher (68% and 38%, for CI and IM, respectively). Iodine maps from SDCT allow for reliable quantification of iodine content in phantoms; while in patients, rather large differences between repetitive examinations are likely due to differences in biological distribution. This underlines the need for careful clinical interpretation and further protocol optimization. • Spectral detector computed tomography allows for reliable quantification of iodine in phantoms. • In patients, the offset between repetitive examinations varies by 20%, likely due to differences in biological distribution. • Clinically, iodine maps should be interpreted with caution and should take the intra-individual variability of iodine distribution over time into account.

Phantom and clinical evaluation of the effect of full Monte Carlo collimator modelling in post-SIRT yttrium-90 Bremsstrahlung SPECT imaging

BackgroundPost-therapy SPECT/CT imaging of 90Y microspheres delivered to hepatic malignancies is difficult, owing to the continuous, high-energy Bremsstrahlung spectrum emitted by 90Y. This study aimed to evaluate the utility of a commercially available software package (HybridRecon, Hermes Medical Solutions AB) which incorporates full Monte Carlo collimator modelling. Analysis of image quality was performed on both phantom and clinical images in order to ultimately provide a recommendation of an optimum reconstruction for post-therapy 90Y microsphere SPECT/CT imaging.A 3D-printed anthropomorphic liver phantom was filled with 90Y with a sphere-to-background ratio of 4:1 and imaged on a GE Discovery 670 SPECT/CT camera. Datasets were reconstructed using ordered-subsets expectation maximization (OSEM) 1–7 iterations in order to identify the optimal OSEM reconstruction (5 iterations, 15 subsets). Quantitative analysis was subsequently carried out on phantom datasets obtained using four reconstruction algorithms: the default OSEM protocol (2 iterations, 10 subsets) and the optimised OSEM protocol, both with and without full Monte Carlo collimator modelling. The quantitative metrics contrast recovery (CR) and background variability (BV) were calculated.The four algorithms were then used to retrospectively reconstruct 10 selective internal radiation therapy (SIRT) patient datasets which were subsequently blind scored for image quality by a consultant radiologist.ResultsThe optimised OSEM reconstruction (5 iterations, 15 subsets with full MC collimator modelling) increased the CR by 42% (p < 0.001) compared to the default OSEM protocol (2 iterations, 10 subsets). The use of full Monte Carlo collimator modelling was shown to further improve CR by 14% (30 mm sphere, CR = 90%, p < 0.05).The consultant radiologist had a significant preference for the optimised OSEM over the default OSEM protocol (p < 0.001), with the optimised OSEM being the favoured reconstruction in every one of the 10 clinical cases presented.ConclusionsOSEM (5 iterations, 15 subsets) with full Monte Carlo collimator modelling is quantitatively the optimal image reconstruction for post-SIRT 90Y Bremsstrahlung SPECT/CT imaging. The use of full Monte Carlo collimator modelling for correction of image-degrading effects significantly increases contrast recovery without degrading clinical image quality.

Anthropomorphic liver phantom with flow for multimodal image-guided liver therapy research and training

PurposeThe objective of this study was to develop a multimodal, permanent liver phantom displaying functional vasculature and common pathologies, for teaching, training and equipment development in laparoscopic ultrasound and navigation.MethodsMolten wax was injected simultaneously into the portal and hepatic veins of a human liver. Upon solidification of the wax, the surrounding liver tissue was dissolved, leaving a cast of the vessels. A connection was established between the two vascular trees by manually manipulating the wax. The cast was placed, along with different multimodal tumor models, in a liver shaped mold, which was subsequently filled with a polymer. After curing, the wax was melted and flushed out of the model, thereby establishing a system of interconnected channels, replicating the major vasculature of the original liver. Thus, a liquid can be circulated through the model in a way that closely mimics the natural blood flow.ResultsBoth the tumor models, i.e., the metastatic tumors, hepatocellular carcinoma and benign cyst, and the vessels inside the liver model, were clearly visualized by all the three imaging modalities: CT, MR and ultrasound. Doppler ultrasound images of the vessels proved the blood flow functionality of the phantom.ConclusionBy a two-step casting procedure, we produced a multimodal liver phantom, with open vascular channels, and tumor models, that is the next best thing to practicing imaging and guidance procedures in animals or humans. The technique is in principle applicable to any organ of the body.

SU-F-T-606: Monte Carlo Evaluation of Tissue Inhomogeneity Corrections in the Treatment of Liver Cancer Patients Using Stereotactic Body Radiotherapy

Purpose: To evaluate the dosimetric performance of X-ray Voxel Monte Carlo(XVMC) algorithm in effort to clinically validate Monte Carlo-approach in heterogeneous liver phantom and liver SBRT plans. Methods: An anthropomorphic RPC liver phantom incorporating a liver structure with two cylindrical targets and organs-at-risk (OARs) was used in phantom validation. Subsequently, five patients with metastatic liver cancer were treated using heterogeneity-corrected pencil-beam(PB-hete)algorithm were analyzed following RTOG-1112 criteria .ITV was delineated on MinIP and OARs were contoured on MeanIP images of 4D-CT. PTV was generated from ITV with 5-10mm uniform margin. Mean PTV was 81.3±46.4cc. Prescription was 30–45Gy in 5 fractions, with at least PTV(D95%)=100%. Hybrid SBRT plans were generated with noncoplanar/3D-conformal arcs plus static-beams at Novalis-TX consisting of HD-MLC and 6MV-SRS. SBRT plans were re-computed using XVMC algorithm utilizing identical beam-geometry, MLC-positions, and monitor units and subsequently compared to clinical PB-hete plans. Results: Our results using RPC liver motion phantom validation were all compliance with MD Anderson standards. However, compared to PB-hete, average target volume encompassed by the prescribed percent isodose (Vp) was 9.1% and 8.5% less for PTV1 and PTV2 with XVMC. For the clinical liver SBRT plans, PB-hete systematically overestimated PTV dose (D95, Dmean and D10) within ±2.0% (p<0.05) compared to XVMC. Mean value of Vp was about 3.8% less with XVMC compared to PB-hete (ranged 2.9–5.7% (p<0.003)). However, mean liver dose (MLD) was 3.2% higher (p<0.003), on average, with XVMC compared to clinical PB-hete (ranged −1.0to−3.9%). OARs doses were statistically insignificant. Conclusion: Results from our XVMC dose calculations and validation study for liver SBRT indicate small-to-moderate under-dosing of the tumor volume when compared to PB-hete. Results were consistent with phantom validation and patients plans. However, Vp was less by up to 5.7% for some liver SBRT patients with XVMC–suggesting under-dosing of the target volume and overdosing of MLD by up to 3.9% occurred with PB-hete plan. These differences between PB-hete and XVMC dose calculations may be of clinical interest.

Effect of a Noise-Optimized Second-Generation Monoenergetic Algorithm on Image Noise and Conspicuity of Hypervascular Liver Tumors: An In Vitro and In Vivo Study.

The purpose of this study is to investigate whether the reduction in noise using a second-generation monoenergetic algorithm can improve the conspicuity of hypervascular liver tumors on dual-energy CT (DECT) images of the liver. An anthropomorphic liver phantom in three body sizes and iodine-containing inserts simulating hypervascular lesions was imaged with DECT and single-energy CT at various energy levels (80-140 kV). In addition, a retrospective clinical study was performed in 31 patients with 66 hypervascular liver tumors who underwent DECT during the late hepatic arterial phase. Datasets at energy levels ranging from 40 to 80 keV were reconstructed using first- and second-generation monoenergetic algorithms. Noise, tumor-to-liver contrast-to-noise ratio (CNR), and CNR with a noise constraint (CNRNC) set with a maximum noise increase of 50% were calculated and compared among the different reconstructed datasets. The maximum CNR for the second-generation monoenergetic algorithm, which was attained at 40 keV in both phantom and clinical datasets, was statistically significantly higher than the maximum CNR for the first-generation monoenergetic algorithm (p < 0.001) or single-energy CT acquisitions across a wide range of kilovoltage values. With the second-generation monoenergetic algorithm, the optimal CNRNC occurred at 55 keV, corresponding to lower energy levels compared with first-generation algorithm (predominantly at 70 keV). Patient body size did not substantially affect the selection of the optimal energy level to attain maximal CNR and CNRNC using the second-generation monoenergetic algorithm. A noise-optimized second-generation monoenergetic algorithm significantly improves the conspicuity of hypervascular liver tumors.

SU‐E‐T‐103: An Evaluation of Multiple Irradiations of the IROC Houston QA Center Anthropomorphic Liver Phantom

Purpose:Analyze the results from irradiations of an anthropomorphic liver phantom based on irradiation technique and number of isocenters used for the SBRT delivery.Methods:The phantom consists of a water‐fillable plastic shell that has a polystyrene insert, representing the liver which includes two Solid WaterTM targets (PTV1 and PTV2) mimicking liver metastases. The two targets, PTV1 and PTV2 are non‐coplanar and are an ovoid 2 cm in diameter and 2.5 cm long and a 3 cm diameter sphere, respectively. Each PTV houses one TLD and 2 planes of radiochromic film. The phantom and a motion table to simulate respiratory motion is sent to institutions sthat are instructed to design and deliver a stereotactic treatment plan that delivers 6 Gy to ≥ 95% of each PTV. The maximum motion of the phantom on the motion table was 1 cm in the superior‐inferior direction.Results:Irradiations from 93 institutions have been analyzed. The acceptance criteria are ±7% for the TLD and 85% of the pixels in a region surrounding each PTV passing a ±7%/4 mm global gamma analysis. Sixty‐seven (71%) irradiations meet this criteria. The majority, 74 (80%), of the irradiations were performed with IMRT. 73% of the IMRT deliveries were within criteria and 68% of the 3D CRT delivery were within criteria. 32 of the irradiations had a single isocenter plan, 50 were performed with two isocenters and 11 irradiations were performed with CyberKnife and TomoTherapy units where the concept of isocenter is not applicable. The pass rate for the single, dual and no isocenter irradiations were 69%, 74% and 73%, respectively and are not statistically different.Conclusion:The pass rate for the anthropomorphic liver phantom is approximately 70%. There does not seem to be any correlation with number of isocenters used or irradiation technique used for the delivery.This work was supported by PHS CA180803 awarded by NCI, DHHS

Dual-energy MDCT in hypervascular liver tumors: effect of body size on selection of the optimal monochromatic energy level.

The purpose of this article is to investigate the effect of body size on the selection of optimal monochromatic energy level for maximizing the conspicuity of hypervascular liver tumors during late hepatic arterial phase using dual-energy MDCT. An anthropomorphic liver phantom in three body sizes and iodine-containing inserts simulating low- and high-contrast hypervascular lesions was imaged with dual- and single-energy MDCT at various energy levels (80, 100, 120, and 140 kVp). Dual-energy MDCT was also performed in 48 patients with 114 hypervascular liver tumors; virtual monochromatic images were reconstructed at energy levels from 40 to 140 keV. The effect of body size and lesion iodine concentration on noise and tumor-to-liver contrast-to-noise ratio was compared among different datasets for phantoms and patients. The highest tumor-to-liver contrast-to-noise ratio was noted at 80 kVp for all phantom sizes. On virtual monochromatic images, the minimum noise was noted at 70 keV for small and medium phantoms and at 80 keV for the large phantom. Tumor-to-liver contrast-to-noise ratio was highest at 50 keV for small and medium phantoms and at 60 keV for the large phantom (p<0.0001). Compared with 80-kVp images, an optimal monochromatic energy level yielded a significantly higher (p<0.0001) tumor-to-liver contrast-to-noise ratio for high-contrast lesions in the large body size and for low-contrast lesions in all phantom sizes. In patients, the optimal monochromatic energy level for tumor-to-liver contrast-to-noise ratio increased proportionally along with body size (p<0.0001). Selection of the optimal monochromatic energy level for maximizing the conspicuity of hypervascular liver tumors is significantly affected by patient's body size.

Effect of Reduced Radiation Exposure and Iterative Reconstruction on Detection of Low-Contrast Low-Attenuation Lesions in an Anthropomorphic Liver Phantom: An 18-Reader Study

To measure the effect of reduced radiation exposure on low-contrast low-attenuation liver lesion detection in an anthropomorphic abdominal phantom by using filtered back projection (FBP) and sinogram-affirmed iterative reconstruction. Eighteen radiologists blinded to phantom and study design interpreted randomized image data sets that contained 36 spherical simulated liver lesions of three sizes and three attenuation differences (5-mm diameter: 12, 18, and 24 HU less than the 90-HU background attenuation of the simulated liver insert; 10- and 15-mm diameter: 6, 12, and 18 HU less than the 90-HU background attenuation) scanned with four discrete exposure settings and reconstructed by using FBP and sinogram-affirmed iterative reconstruction. Response assessment included region-level lesion presence or absence on a five-point diagnostic confidence scale. Statistical evaluation included multireader multicase receiver operating characteristic curve analysis, with nonparametric methods and noninferiority analysis at a margin of -0.10. Pooled accuracy at 75% exposure for both FBP and sinogram-affirmed iterative reconstruction was noninferior to 100% exposure (P = .002 and P < .001, respectively). Subsequent exposure reductions resulted in a significant decrease in accuracy. When the smallest (5-mm-diameter) lesions were excluded from analysis, sinogram-affirmed iterative reconstruction was superior to FBP at 100% exposure (P = .011), and sinogram-affirmed iterative reconstruction at 25% and 50% exposure reduction was noninferior to FBP at 100% exposure (P ≤ .013). Reader confidence was greater with sinogram-affirmed iterative reconstruction than with FBP for 10- and 15-mm lesions (2.94 vs 2.76 and 3.62 vs 3.52, respectively). In this low-contrast low-attenuation liver lesion model, a 25% exposure reduction maintained noninferior diagnostic accuracy. However, detection was inferior with each subsequent exposure reduction, regardless of reconstruction method. Sinogram-affirmed iterative reconstruction and FBP performed equally well at modest exposure reduction (25%-50%). Readers had higher confidence levels with sinogram-affirmed iterative reconstruction for the 10- and 15-mm lesions.

SU‐E‐T‐410: Initial Results From Multiple Irradiations of An Anthropomorphic Liver Phantom

Purpose: To describe the Radiological Physics Center's new anthropomorphic liver phantom and to report the results from the initial irradiations. Methods: A new imaging and dosimetry insert was created for the RPC's pelvic phantom that includes non‐coplanar targets. The polystyrene insert represents the liver and includes two Solid WaterTM targets (PTV1 and PTV2) that mimic liver metastases. PTV1, located in the superior‐left‐posterior region of the insert, is an ovoid 2 cm in diameter and 2.5 cm long. PTV2, located in the inferior‐right‐anterior region of the insert is a 3 cm diameter sphere. The insert houses one TLD and 3 planes of radiochromic film in each PTV. The phantom, with a motion table to simulate respiratory motion, was sent to institutions planning to participate in an upcoming RTOG SBRT liver protocol. Institutions were instructed to design and deliver a stereotactic treatment plan that delivered 6 Gy to &gt;=95% of each PTV. The maximum motion of the phantom on the motion table was 1 cm in the superior‐inferior direction. Results: Irradiations from 8 institutions have been analyzed. The acceptance criteria, based on the results of the 8 irradiations, were set at ±7% for the TLD and 85% of the pixels in a region surrounding each PTV passing a ±7%/4 mm global gamma analysis. Five of the 8 irradiations passed these criteria. The three irradiations that did not meet the criteria failed to meet only the film criteria. Breath hold, ITV, gating, and tracking techniques were used to account for motion. Pinnacle, Eclipse, and MultiPlan treatment planning systems were used for planning. Conclusion: The new liver insert along with a motion table tests the ability of the institution's ability to deliver dose to multiple moving targets and is a useful credentialing tool for clinical trials using SBRT. Supported by PHS grant CA10953 and CA081647 from the NCI, DHHS.

Precision of Iodine Quantification in Hepatic CT: Effects of Iterative Reconstruction With Various Imaging Parameters

The objective of this study was to evaluate the feasibility of using iterative reconstructions in hepatic CT to improve the precision of Hounsfield unit quantification, which is the degree to which repeated measurements under unchanged conditions provide consistent results. An anthropomorphic liver phantom with iodinated lesions designed to simulate the enhancement of hypervascular tumors during the late hepatic arterial phase was imaged, and images were reconstructed with both filtered back projection (FBP) and iterative reconstructions, such as adaptive statistical iterative reconstruction (ASIR) and model-based iterative reconstruction (MBIR). This protocol was further expanded into various dose levels, tube voltages, and slice thicknesses to investigate the effect of iterative reconstructions under all these conditions. The iodine concentrations of the lesions were quantified, with their precision calculated in terms of repeatability coefficient. ASIR reduced image noise by approximately 35%, and improved the quantitative precision by approximately 5%, compared with FBP. MBIR reduced noise by more than 65% and improved the precision by approximately 25% compared with the routine protocol. MBIR consistently showed better precision across a thinner slice thickness, lower tube voltage, and larger patient, achieving the target precision level at a dose lower (≥ 40%) than that of FBP. ASIR blended with 50% of FBP indicated a moderate gain in quantitative precision compared with FBP but could achieve more with a higher percentage. A higher gain was achieved by MBIR. These findings may be used to reduce the dose required for reliable quantification and may further serve as a basis for protocol optimization in terms of iodine quantification.

Iterative reconstruction reduces abdominal CT dose

In medical imaging, lowering radiation dose from computed tomography scanning, without reducing diagnostic performance is a desired achievement. Iterative image reconstruction may be one tool to achieve dose reduction. This study reports the diagnostic performance using a blending of 50% statistical iterative reconstruction (ASIR) and filtered back projection reconstruction (FBP) compared to standard FBP image reconstruction at different dose levels for liver phantom examinations. An anthropomorphic liver phantom was scanned at 250, 185, 155, 140, 120 and 100 mAs, on a 64-slice GE Lightspeed VCT scanner. All scans were reconstructed with ASIR and FBP. Four readers evaluated independently on a 5-point scale 21 images, each containing 32 test sectors. In total 672 areas were assessed. ROC analysis was used to evaluate the differences. There was a difference in AUC between the 250 mAs FBP images and the 120 and 100 mAs FBP images. ASIR reconstruction gave a significantly higher diagnostic performance compared to standard reconstruction at 100 mAs. A blending of 50-90% ASIR and FBP may improve image quality of low dose CT examinations of the liver, and thus give a potential for reducing radiation dose.