D.V. Leonov1, O.V. Vlasova2, O.V. Omelyanskaya3, Y.A. Vasilev4

1–4 Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Health Care Department (Moscow, Russia)
1 National Research University «Moscow Power Engineering Institute» (Moscow, Russia)
1 Federal Research Center «Computer Science and Control» of the Russian Academy of Sciences (Moscow, Russia)
1 strat89@mail.ru, 2 VlasovaOV10@zdrav.mos.ru, 3 OmelyanskayaOV@zdrav.mos.ru, 4 VasilevYA1@zdrav.mos.ru

Liver phantoms play an important role in ultrasound imaging, as they are used to educate professionals and prepare them to work with patients. In addition, they can contribute to the development of new ultrasound diagnostic techniques. However, the creation of phantoms requires careful selection of materials that should mimic the acoustic properties of human liver tissue as closely as possible.

The aim of the work was to review the materials used for the manufacture of liver phantoms and to provide detailed information on their ultrasound characteristics. In the study the main publications for the last 10 years devoted to materials for liver phantoms were studied. The most commonly used materials are agar-agar, gelatin, silicone, polyurethane, polyvinyl chloride, polyvinyl alcohol. Each of the materials has its own advantages and disadvantages, about which it is important to know the developers of phantoms.

The results of the study can be useful for phantom developers as it provides information about the advantages and disadvantages of different materials. This allows to choose the most suitable materials for specific tasks, which helps to improve the quality of training of specialists and improve the methods of ultrasound diagnostics. In addition, the study may stimulate further developments for more accurate and functional phantoms.

Leonov D.V., Vlasova O.V., Omelyanskaya O.V., Vasilev Y.A. Materials for simulating liver characteristics in ultrasound imaging. Biomedicine Radioengineering. 2025. V. 28. № 6. P. 83–90. DOI: https:// doi.org/10.18127/j15604136-202506-09 (In Russian)

1. Asrani S.K., Devarbhavi H., Eaton J. and Kamath P.S. Burden of liver diseases in the world. J Hepatol. 2019. 70. 151–171.
2. Xiao J., Wang F., Yuan Y., Gao J., Xiao L., Yan C., Guo F., Zhong J., Che Z., Li W., Lan T., Tacke F., Shah V.H., Li C., Wang H., Dong E. Epidemiology of liver diseases: global disease burden and forecasted research trends. Science China Life Sciences. 2025. 68(2). 541–557.
3. Devarbhavi H., Asrani S.K., Arab J.P., Nartey Y.A., Pose E., Kamath P.S. Global burden of liver disease: 2023 update. J Hepatol. 2023. 79. 516–537.
4. Singal A.K., Mathurin P. Diagnosis and treatment of alcohol-associated liver disease: a re-view. Jama. 2021. 326(2). 165–176.
5. Ferraioli G., Barr R.G., Berzigotti A., Sporea I., Wong V.W.S., Reiberger T., Karlas T., Thiele M., Cardoso A.C., Ayonride O.T., Castera L., Dietrich C.F., Iijima H., Lee D.H., Kemp W., Oliveira C.P., Sarin S.K. WFUMB guideline/guidance on liver multiparametric ultrasound: Part 1. Update to 2018 guidelines on liver ultrasound elastography. Ultrasound in medicine & biology. 2024.
6. Chazot N., Romero J.C., Peters T.M., Rankin A. & Chen E.C. Development of a multi-modal liver phantom with flow for the validation and training of focal ablation procedures. In Medical Imaging 2022: Image-Guided Procedures, Robotic Interventions, and Modeling. 2022. V. 12034. P. 648–656.
7. Vasil`ev Yu.A. i dr. Ispol`zovanie fantomov v processe obucheniya ul`trazvukovoj diagnostike: uchebnoe posobie. M.: Izdatel`skie resheniya. 2025. 84 s.
8. Nasibullina A.A., Lejchenko D.V., Suslina L.A., Leonov D.V. Obuchayushhie fantomy` dlya ul`trazvukovoj diagnostiki. Virtual`ny`e texnologii v medicine. 2022;(3):252–254.
9. Vasil`ev Yu.A., Omelyanskaya O.V., Nasibullina A.A., Leonov D.V., Bulgakova Yu.V., Axmedzyanova D.A., Shumskaya Yu.F., Reshet­nikov R.V. Antropomorfny`e fantomy` molochnoj zhelezy` dlya luchevoj diagnostiki: nauchny`j obzor. Digital Diagnostics. 2023. T. 4. № 4. S. 569–592.
10. Valls-Esteve A., Tejo-Otero A., Lustig-Gainza P., Buj-Corral I., Fenollosa-Artés F., Rubio-Palau J., de la Torre I.B.-M., Munuera J., Fondevila C., Krauel L. Patient-specific 3D printed soft models for liver surgical planning and hands-on training. Gels. 2023. 9(4), 339.
11. Nopper H., Schendel O., Karayagiz F., Freitas U., Lück T., Stadie T., Lampe M., Reinschluessel A., Doering T., Salzman D., Weyhe D. Advanced training scenarios for liver surgery with realistic interactive 3D-printed phantoms. Transactions on Additive Manufacturing Meets Medicine. 2021. 3(1), 502–502.
12. Osipov L.V., Kul`berg N.S., Leonov D.V., Morozov S.P. Trexmernoe ul`trazvukovoe issledovanie: osobennosti vizualizacii ob``emny`x danny`x. Medicinskaya texnika. 2020. № 2 (320). S. 51–55.
13. Osipov L.V., Kul`berg N.S., Leonov D.V., Morozov S.P. Trexmernoe ul`trazvukovoe issledovanie: texnologii, tendencii razvitiya. Medicinskaya texnika. 2018. № 3 (309). S. 39–43.
14. Carson P.L., Russ M.K., Pinter S.Z., Dekker S. Simple but rigorous procedure for ultrasound quality assurance. Medical Physics. 2025.
15. Pacioni A., Carbone M., Freschi C., Viglialoro R., Ferrari V., Ferrari M. Patient-specific ultrasound liver phantom: materials and fabrication method. Int J Comput Assist Radiol Surg. 2015 Jul; 10(7):1065–75. doi: 10.1007/s11548-014-1120-y.
16. Nenadic I.Z., Qiang B., Urban M.W., Zhao H., Sanchez W., Greenleaf J.F., Chen S. Attenuation measuring ultrasound shearwave elastography and in vivo application in post-transplant liver patients. Phys Med Biol. 2017 Jan 21;62(2):484–500. doi: 10.1088/1361-6560/aa4f6f
17. Rethy A., Sæternes J.O., Halgunset J., Mårvik R., Hofstad E.F., Sánchez-Margallo J.A., Langø T. Anthropomorphic liver phantom with flow for multimodal image-guided liver therapy re-search and training. Int J Comput Assist Radiol Surg. 2018 Jan;13(1):61–72. doi: 10.1007/s11548-017-1669-3
18. Ehrbar S., Jöhl A., Kühni M., Meboldt M., Ozkan Elsen E., Tanner C., Goksel O., Klöck S., Unkelbach J., Guckenberger M., Tanadini-Lang S. ELPHA: Dynamically deformable liver phantom for real-time motion-adaptive radiotherapy treatments. Med Phys. 2019 Feb;46(2):839–850. doi: 10.1002/mp.13359
19. de Jong T.L., Moelker A., Dankelman J., van den Dobbelsteen J.J. Designing and validating a PVA liver phantom with respiratory motion for needle-based interventions. Int J Comput Assist Radiol Surg. 2019 Dec;14(12):2177–2186. doi: 10.1007/s11548-019-02029-6
20. Lv S., Long Y., Su Z., Zheng R., Li K., Zhou H., Qiu C., Yin T., Xu E. Investigating the Accuracy of Ultrasound-Ultrasound Fusion Ima­ging for Evaluating the Ablation Effect via Special Phan-tom-Simulated Liver Tumors. Ultrasound Med Biol. 2019 Nov;45(11):3067–3074. doi: 10.1016/j.ultrasmedbio.2019.07.415
21. Ahmad M.S., Suardi N., Shukri A., Nik Ab Razak NNA, Oglat A.A., Makhamrah O., Mohammad H. Dynamic Hepatocellular Carcinoma Model Within a Liver Phantom for Multimodality Imaging. Eur J Radiol Open. 2020 Sep 3;7:100257. doi: 10.1016/j.ejro.2020.100257.
22. Al-Zogbi L., Bock B., Schaffer S., Fleiter T., Krieger A. A 3-D-Printed Patient-Specific Ultra-sound Phantom for FAST Scan. Ultrasound Med Biol. 2021 Mar;47(3):820–832. doi: 10.1016/j.ultrasmedbio.2020.11.004
23. Tan X., Li D., Jeong M., Yu T., Ma Z., Afat S., Grund K.E., Qiu T. Soft Liver Phantom with a Hollow Biliary System. Ann Biomed Eng. 2021 Sep;49(9):2139–2149. doi: 10.1007/s10439-021-02726-x
24. Morr A.S., Herthum H., Schrank F., Görner S., Anders M.S., Lerchbaumer M., Müller H.P., Fischer T., Jenderka K.V., Hansen H.H.G., Janmey P.A., Braun J., Sack I., Tzschätzsch H. Liquid-Liver Phantom: Mimicking the Viscoelastic Dispersion of Human Liver for Ultrasound- and MRI-Based Elastography. Invest Radiol. 2022 Aug 1;57(8):502–509. doi: 10.1097/RLI.0000000000000862
25. Antoniou A., Evripidou N., Georgiou L., Chrysanthou A., Ioannides C., Damianou C. Tumor phantom model for MRI-guided focused ultrasound ablation studies. Med Phys. 2023 Oct;50(10):5956–5968. doi: 10.1002/mp.16480
26. Leonov D.V. Development of a liver phantom for training in the diagnosis of metastases and ultrasound-guided insertion of intratissue ablation electrodes. Biomed Eng. 2024. 58, 93–96. https://doi.org/10.1007/s10527-024-10373-4
27. Elisei R.C., Graur F., Szold A., Melzer A., Moldovan S.C., Motrescu M., Moiş E., Popa C., Pîsla D., Vaida C., Tudor T., Coţe A., Al-Hajjar N. Gelatin-based liver phantoms for Training purposes: a cookbook Approach. Journal of Clinical Medicine. 2024. 13(12), 3440.
28. Seitzinger M., Gnatzy F., Kern S., Steinhausen R., Klammer J., Schlosser T., Blank V., Karlas T. Development, evaluation, and overview of standardized training phantoms for abdominal ultra-sound-guided interventions. Ultraschall Med. 2024 Apr;45(2):176–183. English. doi: 10.1055/a-2242-7074
29. Elisei R.C., Graur F., Melzer A., Moldovan S.C., Tiu C., Popa C., Mois E., Pisla D., Vaida C., Ştefănescu H., Coţe A., Al-Hajjar N. Liver Phantoms Cast in 3D-Printed Mold for Image-Guided Procedures. Diagnostics. 2024. 14(14), 1521.
30. Jawli A., Nabi G., Huang Z. A Polyvinyl Alcohol (PVA)-Based Phantom for Prostate Cancer Detection Using Multiparametric Ultrasound: A Validation Study. Bioengineering. 2024. 11(11), 1052.
31. Ferraioli G., Berzigotti A., Barr R.G., Choi B.I., Cui X.W., Dong Y., Gilja O.H., Lee J.Y., Lee D.H., Moriyasu F., Piscaglia F., Sugimoto K., Wong G.L.-H., Wong V.W.-S., Dietrich C.F. Quantification of liver fat content with ultrasound: a WFUMB position paper. Ultrasound in medicine & biology. 2024. 47(10), 2803–2820.
32. Leonov D., Nasibullina A., Grebennikova V., Vlasova O., Bulgakova Y., Belyakova E., Shestakova D., Costa- Júnior J.F.S., Omelianskaya O., Vasilev Y. Design and evaluation of an anthropomorphic neck phantom for improved ultrasound diagnostics of thyroid gland tumors. International Journal of Computer Assisted Radiology and Surgery. 2024. 19(8), 1637–1645.
33. Leonov D., Venidiktova D., Costa-Júnior J.F.S., Nasibullina A., Tarasova O., Pashinceva K., Vetsheva N., Bulgakova J., Kulberg N., Borsukov A., Saikia M.J. Development of an anatomical breast phantom from polyvinyl chloride plastisol with lesions of various shape, elasticity and echogenicity for teaching ultrasound examination. International Journal of Computer Assisted Radiology and Surgery. 2024. 19(1), 151–161.
34. Patent RF 2797398. Sposob izgotovleniya fantoma dlya ul`trazvukovy`x issledovanij. D.V. Leonov, N.S. Kul`berg, A.A. Nasibullina, A.I. Gromov, D.Yu. Venediktova, O.K. Tarasova, K.S. Pashinceva, N.N. Vetsheva. Zayavl. 22.11.2022; opubl. 05.06.2023.
35. McGarry C.K., Grattan L.J., Ivory A.M., Leek F., Liney G.P., Liu Y., Miloro P., Rai R., Robinson A.J., Zeqiri B., Clark C.H. Tissue mimi­cking materials for imaging and therapy phantoms: a review. Physics in Medicine & Biology. 2020. 65(23), 23TR01.
36. Gilligan L.A., Trout A.T., Bennett P., Dillman J.R. Repeatability and Agreement of Shear Wave Speed Measurements in Phantoms and Human Livers Across 6 Ultrasound 2-Dimensional Shear Wave Elastography Systems. Invest Radiol. 2020 Apr;55(4):191–199. doi: 10.1097/RLI.0000000000000627
37. Pozowski P., Bilski M., Bedrylo M., Sitny P., Zaleska-Dorobisz U. Modern ultrasound techniques for diagnosing liver steatosis and fibrosis: A systematic review with a focus on biopsy comparison. World Journal of Hepatology. 2025. 17(2), 100033.