Implementation of an iterative scatter correction, the influence of attenuation map quality and their effect on absolute quantitation in SPECT

We investigated the accuracy of qSPECT, a quantitative SPECT reconstruction algorithm we have developed which employs corrections for collimator blurring, photon attenuation and scatter, and provides images in units of absolute radiotracer concentrations (kBq cm(-3)). Using simulated and experimental phantom data with characteristics similar to clinical cardiac perfusion data, we studied the implementation of a scatter correction (SC) as part of an iterative reconstruction protocol. Additionally, with experimental phantom studies we examined the influence of CT-based attenuation maps, relative to those obtained from conventional SPECT transmission scans, on SCs and quantitation. Our results indicate that the qSPECT estimated scatter corrections did not change appreciably after the third iteration of the reconstruction. For the simulated data, qSPECT concentrations agreed with images reconstructed using ideal, scatter-free, simulated data to within 6%. For the experimental data, we observed small systematic differences in the scatter fractions for data using different combinations of SCs and attenuation maps. The SCs were found to be significantly influenced by errors in image coregistration. The reconstructed concentrations using CT-based corrections were more quantitatively accurate than those using attenuation maps from conventional SPECT transmission scans. However, segmenting the attenuation maps from SPECT transmission scans could provide sufficient accuracy for most applications.     

A 3D model of non-uniform attenuation and detector response for efficient iterative reconstruction in SPECT

A 3D physical model for iterative reconstruction in SPECT has been developed and applied to experimental data. The model incorporates non-uniform attenuation using reconstructed transmission CT data and distance-dependent detector response based on response function measurements over a range of distances from the detector. The 3D model has been implemented in a computationally efficient manner with practical memory requirements. The features of the model that provide efficiency are described including a new region-dependent reconstruction (RDR) technique. With RDR, filtered backprojection is used to reconstruct areas of the image of minimal clinical importance, and the result is used to supplement the iterative reconstruction of the clinically important areas of the image. The 3D model was incorporated into the maximum likelihood-expectation maximization (ML-EM) reconstruction algorithm and tested in three phantom studies--a point source, a uniform cylinder, and an anthropomorphic thorax--and a patient 9Tc(m) sestamibi study. Reconstructed images with the 3D method exhibited excellent noise and resolution characteristics. With the sestamibi data, the RDR technique produced essentially the conventional ML-EM estimate in the cardiac region with substantial time savings.     

Attenuation correction for small animal SPECT imaging using x-ray CT data

Photon attenuation in small animal nuclear medicine scans can be significant when using isotopes that emit lower energy photons such as iodine-125. We have developed a method to use microCT data to perform attenuation corrected small animal single-photon emission computed tomography (SPECT). A microCT calibration phantom was first imaged, and the resulting calibration curve was used to convert microCT image values to linear attenuation coefficient values that were then used in an iterative SPECT reconstruction algorithm. This method was applied to reconstruct a SPECT image of a uniform phantom filled with 125I-NaI. Without attenuation correction, the image suffered a 30% decrease in intensity in the center of the image, which was removed with the addition of attenuation correction. This reduced the relative standard deviation in the region of interest from 10% to 6%.     

Resolution recovery for list-mode reconstruction in SPECT

The purpose of the study was to evaluate the resolution recovery in the list-mode iterative reconstruction algorithm (LMIRA) for SPECT. In this study we compare the performance of the proposed method with other iterative resolution recovery methods for different noise levels. We developed an iterative reconstruction method which uses list-mode data instead of binned data. The new algorithm makes use of a more accurate model of the collimator structure. We compared the SPECT list-mode reconstruction with MLEM, OSEM and RBI, all including resolution recovery. For the evaluation we used Gaussian shaped sources with different FWHM at three different locations and three noise levels. For these distributions we calculated the reconstructed images for a different number of iterations. The absolute error for the reconstructed images was used to evaluate the performance. The performance of all four methods is comparable for the sources located in the centre of the field of view. For the sources located out of the centre, the error of the list-mode method is significantly lower than that of the other methods. Splitting the system model into a separate object-dependent and detector-dependent module gives us a flexible reconstruction method. With this we can very easily adapt the resolution recovery to different collimator types.     

Assessment of the severity of partial volume effects and the performance of two template-based correction methods in a SPECT/CT phantom experiment

We investigated the severity of partial volume effects (PVE), which may occur in SPECT/CT studies, and the performance of two template-based correction techniques. A hybrid SPECT/CT system was used to scan a thorax phantom that included lungs, a heart insert and six cylindrical containers of different sizes and activity concentrations. This phantom configuration allowed us to have non-uniform background activity and a combination of spill-in and spill-out effects for several compartments. The reconstruction with corrections for attenuation, scatter and resolution loss but not PVE correction accurately recovered absolute activities in large organs. However, the activities inside segmented 17-120 mL containers were underestimated by 20%-40%. After applying our PVE correction to the data pertaining to six small containers, the accuracy of the recovered total activity improved with errors ranging between 3% and 22% (non-iterative method) and between 5% and 15% (method with an iteratively updated background activity). While the non-iterative template-based algorithm demonstrated slightly better accuracy for cases with less severe PVE than the iterative algorithm, it underperformed in situations with considerable spill out and/or mixture of spill-in and spill-out effects.     

Low-dose CT reconstruction via edge-preserving total variation regularization

High radiation dose in computed tomography (CT) scans increases the lifetime risk of cancer and has become a major clinical concern. Recently, iterative reconstruction algorithms with total variation (TV) regularization have been developed to reconstruct CT images from highly undersampled data acquired at low mAs levels in order to reduce the imaging dose. Nonetheless, the low-contrast structures tend to be smoothed out by the TV regularization, posing a great challenge for the TV method. To solve this problem, in this work we develop an iterative CT reconstruction algorithm with edge-preserving TV (EPTV) regularization to reconstruct CT images from highly undersampled data obtained at low mAs levels. The CT image is reconstructed by minimizing energy consisting of an EPTV norm and a data fidelity term posed by the x-ray projections. The EPTV term is proposed to preferentially perform smoothing only on the non-edge part of the image in order to better preserve the edges, which is realized by introducing a penalty weight to the original TV norm. During the reconstruction process, the pixels at the edges would be gradually identified and given low penalty weight. Our iterative algorithm is implemented on graphics processing unit to improve its speed. We test our reconstruction algorithm on a digital NURBS-based cardiac-troso phantom, a physical chest phantom and a Catphan phantom. Reconstruction results from a conventional filtered backprojection (FBP) algorithm and a TV regularization method without edge-preserving penalty are also presented for comparison purposes. The experimental results illustrate that both the TV-based algorithm and our EPTV algorithm outperform the conventional FBP algorithm in suppressing the streaking artifacts and image noise under a low-dose context. Our edge-preserving algorithm is superior to the TV-based algorithm in that it can preserve more information of low-contrast structures and therefore maintain acceptable spatial resolution.     

Method for transforming CT images for attenuation correction in PET/CT imaging

A tube-voltage-dependent scheme is presented for transforming Hounsfield units (HU) measured by different computed tomography (CT) scanners at different x-ray tube voltages (kVp) to 511 keV linear attenuation values for attenuation correction in positron emission tomography (PET) data reconstruction. A Gammex 467 electron density CT phantom was imaged using a Siemens Sensation 16-slice CT, a Siemens Emotion 6-slice CT, a GE Lightspeed 16-slice CT, a Hitachi CXR 4-slice CT, and a Toshiba Aquilion 16-slice CT at kVp ranging from 80 to 140 kVp. All of these CT scanners are also available in combination with a PET scanner as a PET/CT tomograph. HU obtained for various reference tissue substitutes in the phantom were compared with the known linear attenuation values at 511 keV. The transformation, appropriate for lung, soft tissue, and bone, yields the function 9.6 x 10(-5). (HU+ 1000) below a threshold of approximately 50 HU and a (HU+ 1000)+b above the threshold, where a and b are fixed parameters that depend on the kVp setting. The use of the kVp-dependent scaling procedure leads to a significant improvement in reconstructed PET activity levels in phantom measurements, resolving errors of almost 40% otherwise seen for the case of dense bone phantoms at 80 kVp. Results are also presented for patient studies involving multiple CT scans at different kVp settings, which should all lead to the same 511 keV linear attenuation values. A linear fit to values obtained from 140 kVp CT images using the kVp-dependent scaling plotted as a function of the corresponding values obtained from 80 kVp CT images yielded y = 1.003 x -0.001 with an R2 value of 0.999, indicating that the same values are obtained to a high degree of accuracy.     

DoseLab软件检测CT图像噪声的程序改进及应用分析

目的:对DoseLab软件进行程序改进,增加检测CT图像噪声的功能,对改进的程序进行测试分析。方法:首先,通过使用圆的内接多边形顶点位置计算公式,得到圆内接正三十二边形顶点坐标值。然后,在DoseLab软件Catphan 504模体CTP486模块的图像分析程序中,添加一个正三十二边形的感兴趣区（ROI）,用于检测CT图像噪声。选取2018年每月由西门子CT模拟机日常质量检测（DQC）程序得到的水模体两个层面（S3和S4）的CT图像,对DoseLab改进程序进行测试。对DoseLab改进程序和DQC程序得到的CT图像噪声数据,进行统计分析和比较研究。结果:根据公式计算得到了半径4 cm圆的内接正三十二边形的32个顶点的坐标值,该多边形ROI的面积为49.94 cm2。计算DoseLab改进程序和DQC程序得到的CT图像噪声的差异（ΔN）。在120 kV情形,S3和S4层的ΔN值分别为（0.06±0.07） HU和（0.03±0.09） HU;在140 kV情形,S3和S4层的ΔN值分别为（0.10±0.09） HU和（0.08±0.09） HU。结论:通过添加正三十二边形ROI得到的DoseLab改进程序,可以自动分析水模体和Catphan模体,得到CT图像噪声数据。     

Automatic CT-SPECT registration of livers treated with radioactive microspheres

We have developed an automated technique to accurately register the CT and SPECT scans of the liver of patients treated with radioactive microspheres for tumour targeting assessment. An anthropomorphic phantom was used to validate the accuracy of the registration algorithm. The phantom liver and three fiducial markers placed on its surface were filled with 99mTc. The phantom was scanned with CT and SPECT scanners in different positions. The liver volume was contoured on the CT scans from which a three-dimensional liver mask was created. By constraining the liver volume to the volume obtained from the CT scans, another liver mask was automatically created from the SPECT images. An adaptive simulated annealing algorithm was used to minimize the difference between the two volumes formed by the two sets of masks. The algorithm involved rigid transformation of the SPECT mask to reach the optimization goal. The accuracy of the algorithm was evaluated by the superposition of the fiducial markers on the CT and SPECT. The registered SPECT overlaid on the CT scan of the phantom showed congruence of the fiducial markers on CT and SPECT images within 1 mm. The technique was applied to a patient image set who received the microsphere infusion procedure. The registered CT and SPECT images of the patient showed that the majority of the activity was concentrated in the tumour, indicating a successful tumour targeting.     

Design and performance of a multi-pinhole collimation device for small animal imaging with clinical SPECT and SPECT-CT scanners

A multi-pinhole collimation device is developed that uses the gamma camera detectors of a clinical SPECT or SPECT-CT scanner to produce high-resolution SPECT images. The device consists of a rotating cylindrical collimator having 22 tungsten pinholes with 0.9 mm diameter apertures and an animal bed inside the collimator that moves linearly to provide helical or ordered-subsets axial sampling. CT images also may be acquired on a SPECT-CT scanner for purposes of image co-registration and SPECT attenuation correction. The device is placed on the patient table of the scanner without attaching to the detectors or scanner gantry. The system geometry is calibrated in-place from point source data and is then used during image reconstruction. The SPECT imaging performance of the device is evaluated with test phantom scans. Spatial resolution from reconstructed point source images is measured to be 0.6 mm full width at half maximum or better. Micro-Derenzo phantom images demonstrate the ability to resolve 0.7 mm diameter rod patterns. The axial slabs of a Micro-Defrise phantom are visualized well. Collimator efficiency exceeds 0.05% at the center of the field of view, and images of a uniform phantom show acceptable uniformity and minimal artifact. The overall simplicity and relatively good imaging performance of the device make it an interesting low-cost alternative to dedicated small animal scanners.     

Noise and resolution in images reconstructed with FBP and OSC algorithms for CT

This paper presents a comparison between an analytical and a statistical iterative reconstruction algorithm for computed transmission tomography concerning their noise and resolution performance. The reconstruction of two-dimensional images from simulated fan-beam transmission data is performed with a filtered back-projection (FBP) type reconstruction and an iterative ordered subsets convex (OSC) maximum-likelihood method. A special software phantom, which allows measuring the resolution and noise in a nonambiguous way, is used to simulate transmission tomography scans with different signal-to-noise ratios (SNR). The noise and modulation transfer function is calculated for FBP and OSC reconstruction at several positions, distributed over the field-of-view (FOV). The reconstruction with OSC using different numbers of subsets shows an inverse linear relation to the number of iterations that are necessary to reach a certain resolution and SNR, i.e., increasing the number of subsets by a factor x reduces the number of required iterations by the same factor. The OSC algorithm is able to achieve a nearly homogeneous high resolution over the whole FOV, which is not achieved with FBP. The OSC method achieves a lower level of noise compared with FBP at the same resolution. The reconstruction with OSC can save a factor of up to nine of x-ray dose compared with FBP in the investigated range of noise levels.     

Accuracy of quantitative reconstructions in SPECT/CT imaging

The goal of this study was to determine the quantitative accuracy of our OSEM-APDI reconstruction method based on SPECT/CT imaging for Tc-99m, In-111, I-123, and I-131 isotopes. Phantom studies were performed on a SPECT/low-dose multislice CT system (Infinia-Hawkeye-4 slice, GE Healthcare) using clinical acquisition protocols. Two radioactive sources were centrally and peripherally placed inside an anthropometric Thorax phantom filled with non-radioactive water. Corrections for attenuation, scatter, collimator blurring and collimator septal penetration were applied and their contribution to the overall accuracy of the reconstruction was evaluated. Reconstruction with the most comprehensive set of corrections resulted in activity estimation with error levels of 3-5% for all the isotopes.     

Accuracy of the CT numbers of simulated lung nodules imaged with multi-detector CT scanners

A study was performed to determine the accuracies and reproducibilities of the CT numbers of simulated lung nodules imaged with multi-detector CT scanners. The nodules were simulated by spherical balls of three diameters (4.8, 9.5, and 16 mm) and two compositions (50 and 100 mg/cc CaCO3 in water-equivalent plastic). All were scanned in a liquid-water-filled container at the center of a water-equivalent-plastic phantom and in air cavities within the same phantom using GE multi-detector CT scanners. The nodules were also scanned within simulated lung regions in an anthropomorphic thorax section phantom that was bolused on both sides with water-equivalent slabs. Results were compared for three scanning protocols--the protocol for the National Lung Screening Trial (NLST), the protocol for the Lung Tissue Research Consortium (LTRC) study, and a high resolution (small pitch, thin slice and small scan interval) higher dose "gold standard" protocol. Scans were repeated three times with each protocol to assess reproducibility. The CT numbers of the nodules in water were found to be nearly independent of nodule size. However, the presence and the size of an air cavity surrounding a nodule had a significant effect (e.g., the CT number of a 50 mg/cc nodule was 64 HU in water, 37 HU in a 1.8 cm diameter air cavity, and 19 HU in a 4.4 cm diameter air cavity). This variability of CT number with size of air cavity may affect the results of the LTRC study in which patients are scanned at both full inspiration and full expiration. The CT numbers of the 9.5 and 16 mm diameter nodules within the anthropomorphic phantom were highly reproducible (average standard deviations of 2 HU or less) for all protocols. On the other hand, both accuracy and reproducibility were significantly degraded for the 4.8 mm diameter nodules, especially for the NLST (2.5 mm thickness, 2 mm slice interval) technique. Use of thinner slice (1.25 mm) and slice interval (1.25 mm) scans that can be reconstructed retrospectively from the multi-detector helical CT projection data of the standard NLST protocol yield CT numbers for the 4.8 mm diameter nodules that are more accurate and reproducible than those of the standard NLST technique. In general, the CT numbers of the nodules were found to be lower at positions near the centers of the lungs and near the spine, which is probably due to increased beam hardening in those regions. Also, larger nodules were found to have higher CT numbers than smaller nodules, consistent with results obtained on early single slice GE CT scanners. Until manufacturers develop quantitative CT scanners with improved x-ray beam hardening and scatter corrections, it is recommended that reference phantoms be employed to more accurately assess the calcium contents of patient lung nodules in screening and tissue characterization studies and in eventual computer-aided detection and diagnosis applications.     

平行束单光子发射成像的定量解析重建

单光子发射断层成像技术在心血管及脑功能疾病的诊断上具有重要的临床意义。本研究以Kunyansky及以前的研究工作为基础，针对平行束探测模式，推导及建立了有效的解析重建算法，可对噪声、散射、衰减及探测器响应进行同时补偿，用于获取SPECT定量快速成像。数字及Monte Carlo仿真实验表明，所提出的定量解析重建算法是可行的，它极大地改善了重建图像的对比度及分辨率，基本消除了图像中的伪迹。该算法在达到迭代算法精度的同时，计算量却大为降低，与常规滤波反投影重建法近似。     

The effects of CT drift on xenon/CT measurement of regional cerebral blood flow

A systematic increase in computed tomography (CT) number of approximately 0.13 Hounsfield unit per scan (HU/scan) was observed when serial DeltaScan 2020 CT scans of a uniform water phantom were equally spaced at 0.5, 1.0, or 2.0 min and a shaped aluminum beam-hardening filter was employed. Much smaller drifts (less than 0.06 HU/scan) were observed with flat aluminum or shaped beryllium oxide filters. This machine drift, which was not associated with a rise in water phantom temperature and did not consistently correlate with estimated x-ray tube heat, could result in a significant overestimation of regional cerebral blood flow (rCBF) for a xenon/CT rCBF protocol involving 5-7 sequential scans obtained at 1-min interscan intervals.     

The cardiofocal collimator: a variable-focus collimator for cardiac SPECT

Investigators in nuclear medicine have long been in search of a practical method to increase the number of detected events in cardiac SPECT. A clinically practical method requires a simple data acquisition protocol, clinically acceptable reconstruction times, artifact levels near or below visual threshold, and the use of currently available cameras and computers. Towards this end, we have developed the Cardiofocal collimator, a variable-focus collimator for cardiac SPECT that increases the number of detected events from the heart by more than a factor of two compared to that of a parallel-hole collimator with equivalent resolution. In both the transverse and axial dimensions, the focusing is strongest at the centre of the collimator, and gradually relaxes to nearly parallel-hole collimation at the edge of the collimator. The variable-focus concept provides an increase in the number of counts from organs imaged near the centre of the collimator, where the heart will spend most of the time during a cardiac SPECT study, while adequately sampling enough of the background activity distribution to prevent truncation artifacts in the reconstructed images. Images are reconstructed in clinically acceptable times using a filtered backprojection reconstruction algorithm. The algorithm supports both full-scan (360 degrees) and short-scan (180 degrees plus the fan angle) acquisitions. The results of simulations and phantom studies are included to demonstrate the performance of the Cardiofocal collimator.     

Respiration-correlated spiral CT: a method of measuring respiratory-induced anatomic motion for radiation treatment planning

We describe a method for generating CT images at multiple respiratory phases with a single spiral CT scan, referred to as respiratory-correlated spiral CT (RCCT). RCCT relies on a respiration wave form supplied by an external patient monitor. During acquisition this wave form is recorded along with the initiation time of the CT scan, so as to "time stamp" each reconstructed slice with the phase of the respiratory cycle. By selecting the appropriate slices, a full CT image set is generated at several phases, typically 7-11 per cycle. The CT parameters are chosen to optimize the temporal resolution while minimizing the spatial gap between slices at successive respiratory cycles. Using a pitch of 0.5, a gantry rotation period of 1.5 s, and a 180 degrees reconstruction algorithm results in approximately 5 mm slice spacing at a given phase for typical respiration periods, and a respiratory motion within each slice that is acceptably small, particularly near end expiration or end inspiration where gated radiotherapy is to occur. We have performed validation measurements on a phantom with a moving sphere designed to simulate respiration-induced tumor motion. RCCT scans of the phantom at respiratory periods of 4, 5, and 6 s show good agreement of the sphere's motion with that observed under fluoroscopic imaging. The positional deviations in the sphere's centroid between RCCT and fluoroscopy are 1.1+/-0.9 mm in the transaxial direction (average over all scans at all phases +/-1 s.d.) and 1.2+/-1.0 mm in the longitudinal direction. Reconstructed volumes match those expected on the basis of stationary-phantom scans to within 5% in all cases. The surface distortions of the reconstructed sphere, as quantified by deviations from a mathematical reference sphere, are similar to those from a stationary phantom scan and are correlated with the speed of the phantom. A RCCT scan of the phantom undergoing irregular motion, demonstrates that successful reconstruction can be achieved even with irregular respiration. Limitations from x-ray tube heating in our current CT unit restrict the length of the scan region to 9 cm for the RCCT settings used, though this will not be a limitation for a multislice scanner. RCCT offers an alternative to the current method of respiration-triggered axial scans. Multiple phases of respiration are imaged with RCCT in approximately the same scanning time required to image a single phase with a triggered axial scan. RCCT scans can be used in connection with respiratory-gated treatment to identify the patient-specific phase of minimum tumor motion, determine residual tumor motion within the gate interval, and compare treatment plans at different phases.     

Pinhole collimation for ultra-high-resolution, small-field-of-view SPECT

The objective of this investigation was to evaluate small-field-of-view, ultra-high-resolution pinhole collimation for a rotating-camera SPECT system that could be used to image small laboratory animals. Pinhole collimation offers distinct advantages over conventional parallel-hole collimation when used to image small objects. Since geometric sensitivity increases markedly for points close to the pinhole, small-diameter and high-magnification pinhole geometries may be useful for selected imaging tasks when used with large-field-of-view scintillation cameras. The use of large magnifications can minimize the loss of system resolution caused by the intrinsic resolution of the scintillation camera. A pinhole collimator has been designed and built that can be mounted on one of the scintillation cameras of a triple-head SPECT system. Three pinhole inserts with approximate aperture diameters of 0.6, 1.2 and 2.0 mm have been built and can be mounted individually on the collimator housing. When a ramp filter is used with a three-dimensional (3D) filtered backprojection (FBP) algorithm, the three apertures have in-plane SPECT spatial resolutions (FWHM) at 4 cm of 1.5, 1.9 and 2.8 mm, respectively. In-air point source sensitivities at 4 cm from the apertures are 0.9, 2.6 and 5.7 counts s(-1) microCi(-1) (24, 70 and 154 counts s(-1) MBq(-1)) for the 0.6, 1.2 and 2.0 mm apertures, respectively. In vitro image quality was evaluated with a micro-cold-rod phantom and a micro-Defrise phantom using both the 3D FBP algorithm and a 3D maximum likelihood-expectation maximization (ML-EM) algorithm. In vivo image quality was evaluated using two (315 and 325 g) rats. Ultra-high-resolution pinhole SPECT is an inexpensive and simple approach for imaging small animals that can be used with existing rotating-camera SPECT system.     

Implementation of an accelerated iterative algorithm for cone-beam SPECT

In this paper we describe the implementation of an accelerated iterative reconstruction algorithm (AIRA) for cone-beam (CB) projections using a single circular orbit in single-photon-emission computed tomography (SPECT). This algorithm is a modified maximum-likelihood-expectation-maximization (ML-EM) algorithm and several approaches have been used to accelerate the reconstruction process. These approaches include: (i) the use of ordered subsets; (ii) the use of active areas and volumes; and (iii) the storing in memory of the transition vector for a given ray (during the forward projection step). This algorithm, which compensates for collimator geometric sensitivity variation as a function of position and makes uniform attenuation corrections has been evaluated using experimentally acquired phantom data. The results demonstrate a two-orders-of-magnitude decrease of the computational time of this algorithm over the conventional ML-EM algorithm with similar convergence properties.     

Stereotactic imaging for radiotherapy: accuracy of CT,MRI, PET and SPECT

CT, MRI, PET and SPECT provide complementary information for treatment planning in stereotactic radiotherapy. Stereotactic correlation of these images requires commissioning tests to confirm the localization accuracy of each modality. A phantom was developed to measure the accuracy of stereotactic localization for CT, MRI, PET and SPECT in the head and neck region. To this end. the stereotactically measured coordinates of structures within the phantom were compared with their mechanically defined coordinates. For MRI, PET and SPECT, measurements were performed using two different devices. For MRI, T1- and T2-weighted imaging sequences were applied. For each measurement, the mean radial deviation in space between the stereotactically measured and mechanically defined position of target points was determined. For CT, the mean radial deviation was 0.4 +/- 0.2 mm. For MRI, the mean deviations ranged between 0.7 +/- 0.2 mm and 1.4 +/- 0.5 mm, depending on the MRI device and the imaging sequence. For PET, mean deviations of 1.1 +/- 0.5 mm and 2.4 +/- 0.3 mm were obtained. The mean deviations for SPECT were 1.6 +/- 0.5 mm and 2.0 +/- 0.6 mm. The phantom is well suited to determine the accuracy of stereotactic localization with CT, MRI, PET and SPECT in the head and neck region. The obtained accuracy is well below the physical resolution for CT, PET and SPECT, and of comparable magnitude for MRI. Since the localization accuracy may be device dependent, results obtained at one device cannot be generalized to others.