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Objectives To evaluate the effects of anatomical phantom structure on task-based image quality assessment compared with a uniform phantom background. Methods Two neck phantom types of identical shape were investigated: a uniform type containing 10-mm lesions with 4, 9, 18, 30, and 38 HU contrast to the surrounding area and an anatomically realistic type containing lesions of the same size and location with 10, 18, 30, and 38 HU contrast. Phantom images were acquired at two dose levels (CTDIvol of 1.4 and 5.6 mGy) and reconstructed using filtered back projection (FBP) and adaptive iterative dose reduction 3D (AIDR 3D). Detection accuracy was evaluated by seven radiologists in a 4-alternative forced choice experiment. Results Anatomical phantom structure impaired lesion detection at all lesion contrasts ( p  &lt; 0.01). Detectability in the anatomical phantom at 30 HU contrast was similar to 9 HU contrast in uniform images (91.1% vs. 89.5%). Detection accuracy decreased from 83.6% at 5.6 mGy to 55.4% at 1.4 mGy in uniform FBP images ( p  &lt; 0.001), whereas AIDR 3D preserved detectability at 1.4 mGy (80.7% vs. 85% at 5.6 mGy,  p  = 0.375) and was superior to FBP ( p  &lt; 0.001). In the assessment of anatomical images, superiority of AIDR 3D was not confirmed and dose reduction moderately affected detectability (74.6% vs. 68.2%,  p  = 0.027 for FBP and 81.1% vs. 73%,  p  = 0.018 for AIDR 3D). Conclusions A lesion contrast increase from 9 to 30 HU is necessary for similar detectability in anatomical and uniform neck phantom images. Anatomical phantom structure influences task-based assessment of iterative reconstruction and dose effects. Key Points • A lesion contrast increase from 9 to 30 HU is necessary for similar low-contrast detectability in anatomical and uniform neck phantom images. • Phantom background structure influences task-based assessment of iterative reconstruction and dose effects. • Transferability of CT assessment to clinical imaging can be expected to improve as the realism of the test environment increases.

Comparison of low-contrast detectability between uniform and anatomically realistic phantoms—influences on CT image quality assessment