Development of an anthropomorphic multimodality pelvis phantom for PET/MRI- and CT-based RT planning

Purpose
The aim of the study is the further development of an anthropomorphic multimodality pelvis phantom (ADAM, [1]) for the integration of PSMA-PET/MRI-based treatment planning of prostate cancer patients.
Materials/Methods
CT and 3T-MRI characteristics of different tissue types are mimicked using agarose gels (Agarose NEEO Ultra-Qualität Carl Roth GmbH + Co. KG, Germany) mixed with different concentrations of Gadolinium (Gd, MultiHance® 0.5 M, Bracco Imaging Deutschland GmbH) and sodium fluoride (NaF, Carl Roth GmbH + Co. KG). Gels were scanned using a 3T PET/MRI (Biograph mMR, Siemens Healthineers, Erlangen, Germany) using a saturation recovery sequence with multiple inversion times and a spin-echo sequence with multiple echo times. Based on the resulting images, T1- and T2-relaxation times were determined using in-house written software. CT scans of the agarose mixtures were performed on a stand-alone CT scanner (Somatom Definition Flash, Siemens Healthineers) at 120kV and 390 mAs.
The gels can be doped with radioactive tracers to simulate tumors in PET. Agarose mixtures that agreed best with reference values derived from literature data [2-4] were subsequently doped with patient-specific activity concentrations of 18F and 68Ga (e.g. 3kBq/ml 68Ga and 11kBq/ml 18F for the primary tumor). Organ shells (prostate with two intraprostatic lesions,
ESTRO abstract Noa Homolka, Physics Track lymph nodes and bone metastases) were printed using a 3D printer (Stratasys Objet 300 Connex 3, print material: VeroClear). The doped, liquid agarose gels were filled into the organ shells where they solidified within seconds. Organ shells were scanned at the 3T PET/MRI scanner (PET acquisition time: 10 min, MRI: T2-weighted morphological sequence).
Results
The final compositions of agarose gels are the following (given as mass fractions of agarose/NaF/Gd): Prostate (1.35%/3.2%/0.011%), tumor (2.25%/3.2%/0.0085%), lymph nodes (3.2%/1.4%/0.025%).
T1- and T2-relaxation times and CT numbers of the developed agarose gels fit well to reference values (Figure 1). Exemplary PET- and MR-images of a prostate with two intraprostatic lesions doped with 11 kBq/mL 18F are shown in Figure 2. The PET signal can be detected and the tumors appear hypointense on T2-weighted MRI.
Conclusion
Agarose gel mixtures with organ-specific MR-relaxation times at 3T and CT numbers have been developed and doped with radioactive tracers. The gels will be used in the pelvis phantom which will be central to simulate and optimize the technical workflow for the integration of PSMA-PET/MRI-based RT planning of prostate cancer patients.