Use of wall-less ¹⁸F-doped gelatin phantoms for improved volume delineation and quantification in PET/CT

Positron emission tomography (PET) with (18)F-FDG is a valuable tool for staging, planning treatment, and evaluating the treatment response for many different types of tumours. The correct volume estimation is of utmost importance in these situations. To date, the most common types of phantoms used in volume quantification in PET utilize fillable, hollow spheres placed in a circular or elliptical cylinder made of polymethyl methacrylate. However, the presence of a non-radioactive sphere wall between the hotspot and the background activity in images of this type of phantom could cause inaccuracies. To investigate the influence of the non-active walls, we developed a phantom without non-active sphere walls for volume delineation and quantification in PET. Three sizes of gelatin hotspots were moulded and placed in a Jaszczak phantom together with hollow plastic spheres of the same sizes containing the same activity concentration. (18)F PET measurements were made with zero background activity and with tumour-to-background ratios of 12.5, 10, 7.5, and 5. The background-corrected volume reproducing threshold, Tvol, was calculated for both the gelatin and the plastic spheres. It was experimentally verified that the apparent background dependence of Tvol, i.e., a decreasing Tvol with increasing background fraction, was not present for wall-less spheres; the opposite results were seen in plastic, hollow spheres in commercially-available phantoms. For the types of phantoms commonly used in activity quantification, the estimation of Tvol using fillable, hollow, plastic spheres with non-active walls would lead to an overestimate of the tumour volume, especially for small volumes in a high activity background.