An anthropomorphic phantom for receiver operating characteristic studies in CT imaging of liver lesions

The purpose of the study was to develop a methodology that allowed quantitative assessment of image quality in CT and its relationship to dose. An anthropomorphic phantom was designed for use in receiver operating characteristic (ROC) studies of the detectability of liver lesions with CT. The lesions were simulated by different mixtures of glycerol and water that were filled into holes of different diameters in a liver tissue substitute. A pilot study was carried out on five different scanners that were operated at various exposure settings. A positive correlation was demonstrated for each of the scanners between the weighted CT dose index (CTDIw) and the area under the ROC curve. For the exposure settings used in the clinical routine in the five laboratories, the CTDIw ranged from 15 to 31 mGy. Three observers who read the corresponding set of five phantom images agreed, as judged from the areas under the ROC curves, that there was a marked difference in quality between the three best images and the other two. The two newest scanners in the study had the lowest CTDIw, and at the same time the best ROC results. The phantom and the ROC methodology may, with a set of suggested improvements, be used for comparison of the performance in different CT laboratories, and to establish the dose needed to ensure adequate image quality for a particular scanner.