title: A phantom for testing of 4D-CT for radiotherapy of small lesions.
abstract: OBJECTIVE
  The use of time-resolved four-dimensional computed tomography (4D-CT) in radiotherapy requires strict quality assurance to ensure the accuracy of motion management protocols. The aim of this work was to design and test a phantom capable of large amplitude motion for use in 4D-CT, with particular interest in small lesions typical for stereotactic body radiotherapy.
  
  
  METHODS
  The phantom of "see-saw" design is light weight, capable of including various sample materials and compatible with several surrogate marker signal acquisition systems. It is constructed of polymethylmethacrylate (Perspex) and its movement is controlled via a dc motor and drive wheel. It was tested using two CT scanners with different 4D acquisition methods: the Philips Brilliance Big Bore CT (helical scan, pressure belt) and a General Electric Discovery STE PET∕CT (axial scan, infrared marker). Amplitudes ranging from 1.5 to 6.0 cm and frequencies of up to 40 cycles per minute were used to study the effect of motion on image quality. Maximum intensity projections (MIPs), as well as average intensity projections (AIPs) of moving objects were investigated and their quality dependence on the number of phase reconstruction bins assessed.
  
  
  RESULTS
  CT number discrepancies between moving and stationary objects were found to have no systematic dependence on amplitude, frequency, or specific interphase variability. MIP-delineated amplitudes of motion were found to match physical phantom amplitudes to within 2 mm for all motion scenarios tested. Objects undergoing large amplitude motions (>3.0 cm) were shown to cause artefacts in MIP and AIP projections when ten phase bins were assigned. This problem can be mitigated by increasing the number of phase bins in a 4D-CT scan.
  
  
  CONCLUSIONS
  The phantom was found to be a suitable tool for evaluating the image quality of 4D-CT motion management technology, as well as providing a quality assurance tool for intercenter∕intervendor testing of commercial 4D-CT systems. When imaging objects with large amplitudes, the completeness criterion described here indicates the number of phase bins required to prevent missing data in MIPs and AIPs. This is most relevant for small lesions undergoing large motions.
authors.affiliation: School of Applied Sciences and Health Innovations Research Institute, RMIT University, Melbourne, Australia.
authors.forename: L
authors.initials: L
authors.lastname: Dunn
authors.forename: T
authors.initials: T
authors.lastname: Kron
authors.forename: M L
authors.initials: ML
authors.lastname: Taylor
authors.forename: J
authors.initials: J
authors.lastname: Callahan
authors.forename: R D
authors.initials: RD
authors.lastname: Franich
mesh_terms: D016477:Artifacts; D056973:Four-Dimensional Computed Tomography / Q000295:instrumentation*; D009369:Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D019047:Phantoms, Imaging; D016634:Radiosurgery / Q000379:methods*; D047368:Tumor Burden