A Novel Elastography Phantom Prototype for Assessment of Ultrasound Elastography Imaging Performance

The aims of this study were firstly to manufacture and evaluate a novel elastography test phantom and secondly to assess the performance of an elastography system using this phantom. A novel Leicester-St. Thomas' Elastography Pipe (L-STEP) test phantom consisting of five soft polyvinyl acrylic-cryogel pipes of varying diameters (2-12 mm), embedded at 45° within an agar-based tissue-mimicking material was developed. A shear-wave elastography (SWE) scanner was used by two blinded operators to image and assess longitudinal sections of the pipes. Young's modulus estimates were dependent on the diameter of pipes and at superficial depths were greater than deeper depths (mean 98 kPa vs. 59 kPa) and had lower coefficients of variation (mean 21% vs. 53%). The penetration depth (maximum depth at which a SWE signal was obtained) increased with increasing pipe diameter. Penetration depth measurements had excellent inter- and intra-operator reproducibility (intra-class correlation coefficients >0.8) and coefficient of variation range of 2%-12%. A new metric, called the summative performance index, was defined as the sum of the ratios of the penetration depth/pipe diameter. The L-STEP phantom is suitable for assessing key aspects of elastography imaging performance: resolution, accuracy, reproducibility, depth dependence, sensitivity and our novel summative performance index.