An in-house step-wedge phantom for the calibration of pixel values in CT localizer radiographs for water-equivalent diameter measurement

Abstract Introduction: To develop an in-house acrylic-based step-wedge phantom with several thickness configurations for calibrating computed tomography (CT) localizer radiographs in order to measure the water-equivalent diameter (Dw) and the size-specific dose estimate (SSDE). Method: We developed an in-house step-wedge phantom using 3 mm thick acrylic, filled with water. The phantom had five steps with thicknesses of 6, 12, 18, 24, and 30 cm. The phantom was scanned using a 64-slice Siemens Definition AS CT scanner with tube currents of 50, 100, 150, 200, and 250 mA. The relationship between pixel value (PV) and water-equivalent thickness (tw) was obtained for the different step thicknesses. This was used to calibrate the CT localizer radiographs in order to measure Dw and SSDE. The results of Dw and SSDE from the radiographs were compared with those calculated from axial CT images. Results: The relationship between PV and tw from CT localizer radiographs of the phantom step-wedge produced a linear relationship with R2 > 0.990. The linear relationships of the Dw and SSDE values obtained from CT localizer radiographs and axial CT images had R2 values > 0.94 with a statistical test of p-value > 0.05. The Dw difference between those from CT localizer radiographs and axial CT images was 3.7% and the SSDE difference between both was 4.3%. Conclusion: We have successfully developed a step-wedge phantom to calibrate the relationship between PV and tw. Our phantom can be easily used to calibrate CT localizer radiographs in order to measure Dw and SSDE.