Rapid portal imaging with a high-efficiency, large field-of-view detector

Full modulation transfer functions of thick parallel- and focused-element scintillator arrays obtained by a Monte Carlo optical transport model

BACKGROUND

Arrays of thick segmented crystalline scintillators are useful x-ray converters for image-guided radiation therapy using electronic portal imaging (EPI) and megavoltage cone-beam computed tomography (MV-CBCT). Ionizing-radiation-only simulations previously showed relatively low modulation transfer function (MTF) in parallel-element arrays because of beam divergence. Hence, a focused-element geometry (matching the beam divergence) has been proposed. The "full" (ionizing and optical) MTF performance of such a focused geometry compared to its radiation-only MTF has, however, not been fully investigated.

PURPOSE

To study the full MTF performance of such arrays in a more realistic situation in which optical characteristics are also included using an in-house detector model that supports light transport, and quantify the errors in MTF estimation when the optical stage is ignored.

METHODS

First, radiation (x-ray and electron) transport was simulated. Then, transport of the generated optical photons was modeled using ScintSim2, an optical Monte Carlo (MC) code developed in MATLAB for simulation of two-dimensional (2D) parallel- and focused-element scintillator arrays. The full-MTF responses of focused- and parallel-element geometries, for a large array of 3 × 3 mm² CsI:Tl detector elements of 10, 40, and 60 mm thicknesses, were examined. For each configuration, a composite line spread function (LSF) was calculated to obtain the MTF.

RESULTS

At the Nyquist frequency, for 10 mm-thick central elements and 60 mm-thick peripheral parallel elements, full-MTF exhibited a drop of up to 15 and 79 times, respectively, compared with radiation-only MTF. This was found to be partly attributable to the angular distribution of the light emerging from the detector-element exit face and the dependence on its aspect ratio, since the light exiting thicker scintillators exhibited a more forward-directed distribution. Focused elements provided an increase of up to nine times in peripheral-area full MTF values.

CONCLUSIONS

Full MTF was up to 79 times lower than radiation-only MTF. Focused arrays preserved full MTF by up to nine times compared to parallel elements. The differences in the results obtained with and without inclusion of optical photons emphasize the need to include light transport when optimizing thick segmented scintillation detectors. Besides their application in detector optimization for radiotherapy megavoltage photon imaging, these findings can also be useful for other segmented-scintillator-based imaging systems, for example, in nuclear medicine, or in 2D detection systems for quality assurance of MR-linacs.

Frequency-dependent optimal weighting approach for megavoltage multilayer imagers

Multi-layer imaging (MLI) devices improve the detective quantum efficiency (DQE) while maintaining the spatial resolution of conventional mega-voltage (MV) x-ray detectors for applications in radiotherapy. To date, only MLIs with identical detector layers have been explored. However, it may be possible to instead use different scintillation materials in each layer to improve the final image quality. To this end, we developed and validated a method for optimally combining the individual images from each layer of MLI devices that are built with heterogeneous layers. Two configurations were modeled within the GATE Monte Carlo package by stacking different layers of a terbium doped gadolinium oxysulfide Gd2O2S:Tb (GOS) phosphor and a LKH-5 glass scintillator. Detector response was characterized in terms of the modulation transfer function (MTF), normalized noise power spectrum (NNPS) and DQE. Spatial frequency-dependent weighting factors were then analytically derived for each layer such that the total DQE of the summed combination image would be maximized across all spatial modes. The final image is obtained as the weighted sum of the sub-images from each layer. Optimal weighting factors that maximize the DQE were found to be the quotient of MTF and NNPS of each layer in the heterogeneous MLI detector. Results validated the improvement of the DQE across the entire frequency domain. For the LKH-5 slab configuration, DQE(0) increases between 2%-3% (absolute), while the corresponding improvement for the LKH-5 pixelated configuration was 7%. The performance of the weighting method was quantitatively evaluated with respect to spatial resolution, contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) of simulated planar images of phantoms at 2.5 and 6 MV. The line pair phantom acquisition exhibited a twofold increase in CNR and SNR, however MTF was degraded at spatial frequencies greater than 0.2 lp mm^-1. For the Las Vegas phantom, the weighting improved the CNR by around 30% depending on the contrast region while the SNR values are higher by a factor of 2.5. These results indicate that the imaging performance of MLI systems can be enhanced using the proposed frequency-dependent weighting scheme. The CNR and SNR of the weighted combined image are improved across all spatial scales independent of the detector combination or photon beam energy.

Advances in Treatment with Intensity-Modulated Conformal Radiotherapy

The modern practice of radiotherapy centres on the development of conformai radiotherapy, techniques to ensure the high-dose volume is tightly wrapped around the diseased tissue and excluded as far as possible from adjacent normal structures. The development of conformai radiotherapy is a chain of processes involving treatment planning, development of new methods to deliver radiation, verification of the accuracy of radiation delivery and improvement of biological outcome. This is an enormous field of activity. This invited review paper summarises some of the main elements of progress towards implementing intensity-modulated conformai radiotherapy. This is the newest and most exciting development and, when achieved clinically, will lead to a quantum leap in tumour control probability with a fixed level of normal tissue damage.

Modelling the transport of optical photons in scintillation detectors for diagnostic and radiotherapy imaging

Computational modelling of radiation transport can enhance the understanding of the relative importance of individual processes involved in imaging systems. Modelling is a powerful tool for improving detector designs in ways that are impractical or impossible to achieve through experimental measurements. Modelling of light transport in scintillation detectors used in radiology and radiotherapy imaging that rely on the detection of visible light plays an increasingly important role in detector design. Historically, researchers have invested heavily in modelling the transport of ionizing radiation while light transport is often ignored or coarsely modelled. Due to the complexity of existing light transport simulation tools and the breadth of custom codes developed by users, light transport studies are seldom fully exploited and have not reached their full potential. This topical review aims at providing an overview of the methods employed in freely available and other described optical Monte Carlo packages and analytical models and discussing their respective advantages and limitations. In particular, applications of optical transport modelling in nuclear medicine, diagnostic and radiotherapy imaging are described. A discussion on the evolution of these modelling tools into future developments and applications is presented.

Monte Carlo simulation of a quantum noise limited Čerenkov detector based on air-spaced light guiding taper for megavoltage x-ray imaging

PURPOSE

Electronic Portal Imaging Devices (EPIDs) have been widely used in radiation therapy and are still needed on linear accelerators (Linacs) equipped with kilovoltage cone beam CT (kV-CBCT) or MRI systems. Our aim is to develop a new high quantum efficiency (QE) Čerenkov Portal Imaging Device (CPID) that is quantum noise limited at dose levels corresponding to a single Linac pulse.

METHODS

Recently a new concept of CPID for MV x-ray imaging in radiation therapy was introduced. It relies on Čerenkov effect for x-ray detection. The proposed design consisted of a matrix of optical fibers aligned with the incident x-rays and coupled to an active matrix flat panel imager (AMFPI) for image readout. A weakness of such design is that too few Čerenkov light photons reach the AMFPI for each incident x-ray and an AMFPI with an avalanche gain is required in order to overcome the readout noise for portal imaging application. In this work the authors propose to replace the optical fibers in the CPID with light guides without a cladding layer that are suspended in air. The air between the light guides takes on the role of the cladding layer found in a regular optical fiber. Since air has a significantly lower refractive index (∼ 1 versus 1.38 in a typical cladding layer), a much superior light collection efficiency is achieved.

RESULTS

A Monte Carlo simulation of the new design has been conducted to investigate its feasibility. Detector quantities such as quantum efficiency (QE), spatial resolution (MTF), and frequency dependent detective quantum efficiency (DQE) have been evaluated. The detector signal and the quantum noise have been compared to the readout noise.

CONCLUSIONS

Our studies show that the modified new CPID has a QE and DQE more than an order of magnitude greater than that of current clinical systems and yet a spatial resolution similar to that of current low-QE flat-panel based EPIDs. Furthermore it was demonstrated that the new CPID does not require an avalanche gain in the AMFPI and is quantum noise limited at dose levels corresponding to a single Linac pulse.

ScintSim1: A new Monte Carlo simulation code for transport of optical photons in 2D arrays of scintillation detectors

Two-dimensional (2D) arrays of thick segmented scintillators are of interest as X-ray detectors for both 2D and 3D image-guided radiotherapy (IGRT). Their detection process involves ionizing radiation energy deposition followed by production and transport of optical photons. Only a very limited number of optical Monte Carlo simulation models exist, which has limited the number of modeling studies that have considered both stages of the detection process. We present ScintSim1, an in-house optical Monte Carlo simulation code for 2D arrays of scintillation crystals, developed in the MATLAB programming environment. The code was rewritten and revised based on an existing program for single-element detectors, with the additional capability to model 2D arrays of elements with configurable dimensions, material, etc., The code generates and follows each optical photon history through the detector element (and, in case of cross-talk, the surrounding ones) until it reaches a configurable receptor, or is attenuated. The new model was verified by testing against relevant theoretically known behaviors or quantities and the results of a validated single-element model. For both sets of comparisons, the discrepancies in the calculated quantities were all <1%. The results validate the accuracy of the new code, which is a useful tool in scintillation detector optimization.

Countering beam divergence effects with focused segmented scintillators for high DQE megavoltage active matrix imagers

The imaging performance of active matrix flat-panel imagers designed for megavoltage imaging (MV AMFPIs) is severely constrained by relatively low x-ray detection efficiency, which leads to a detective quantum efficiency (DQE) of only ∼1%. Previous theoretical and empirical studies by our group have demonstrated the potential for addressing this constraint through the utilization of thick, two-dimensional, segmented scintillators with optically isolated crystals. However, this strategy is constrained by the degradation of high-frequency DQE resulting from spatial resolution loss at locations away from the central beam axis due to oblique incidence of radiation. To address this challenge, segmented scintillators constructed so that the crystals are individually focused toward the radiation source are proposed and theoretically investigated. The study was performed using Monte Carlo simulations of radiation transport to examine the modulation transfer function and DQE of focused segmented scintillators with thicknesses ranging from 5 to 60 mm. The results demonstrate that, independent of scintillator thickness, the introduction of focusing largely restores spatial resolution and DQE performance otherwise lost in thick, unfocused segmented scintillators. For the case of a 60 mm thick BGO scintillator and at a location 20 cm off the central beam axis, use of focusing improves DQE by up to a factor of ∼130 at non-zero spatial frequencies. The results also indicate relatively robust tolerance of such scintillators to positional displacements, of up to 10 cm in the source-to-detector direction and 2 cm in the lateral direction, from their optimal focusing position, which could potentially enhance practical clinical use of focused segmented scintillators in MV AMFPIs.

Low-dose megavoltage cone-beam CT imaging using thick, segmented scintillators

Megavoltage, cone-beam computed tomography (MV CBCT) employing an electronic portal imaging device (EPID) is a highly promising technique for providing soft-tissue visualization in image-guided radiotherapy. However, current EPIDs based on active matrix flat-panel imagers (AMFPIs), which are regarded as the gold standard for portal imaging and referred to as conventional MV AMFPIs, require high radiation doses to achieve this goal due to poor x-ray detection efficiency (∼2% at 6 MV). To overcome this limitation, the incorporation of thick, segmented, crystalline scintillators, as a replacement for the phosphor screens used in these AMFPIs, has been shown to significantly improve the detective quantum efficiency (DQE) performance, leading to improved image quality for projection imaging at low dose. Toward the realization of practical AMFPIs capable of low dose, soft-tissue visualization using MV CBCT imaging, two prototype AMFPIs incorporating segmented scintillators with ∼11 mm thick CsI:Tl and Bi(4)Ge(3)O(12) (BGO) crystals were evaluated. Each scintillator consists of 120 × 60 crystalline elements separated by reflective septal walls, with an element-to-element pitch of 1.016 mm. The prototypes were evaluated using a bench-top CBCT system, allowing the acquisition of 180 projection, 360° tomographic scans with a 6 MV radiotherapy photon beam. Reconstructed images of a spatial resolution phantom, as well as of a water-equivalent phantom, embedded with tissue equivalent objects having electron densities (relative to water) varying from ∼0.28 to ∼1.70, were obtained down to one beam pulse per projection image, corresponding to a scan dose of ∼4 cGy--a dose similar to that required for a single portal image obtained from a conventional MV AMFPI. By virtue of their significantly improved DQE, the prototypes provided low contrast visualization, allowing clear delineation of an object with an electron density difference of ∼2.76%. Results of contrast, noise and contrast-to-noise ratio are presented as a function of dose and compared to those from a conventional MV AMFPI.

Performance evaluation of polycrystalline HgI2 photoconductors for radiation therapy imaging

PURPOSE

Electronic portal imaging devices based on megavoltage (MV), active matrix, flat-panel imagers (AMFPIs) are presently regarded as the gold standard in portal imaging for external beam radiation therapy. These devices, employing indirect detection of incident radiation by means of a metal plate plus phosphor screen combination, offer a quantum efficiency of only approximately 2% at 6 MV, leading to a detective quantum efficiency (DQE) of only approximately 1%. In order to significantly improve the DQE performance of MV AMFPIs, a strategy based on the development of direct detection imagers incorporating thick films of polycrystalline mercuric iodide (HgI2) photoconductor was undertaken and is reported.

METHODS

Two MV AMFPI prototypes, one incorporating an approximately 300 microm thick HgI2 layer created through physical vapor deposition (PVD) and a second incorporating an approximately 460 microm thick HgI2 layer created through screen-printing of particle-in-binder (PIB) material, were quantitatively evaluated using a 6 MV photon beam. The reported measurements include empirical determination of x-ray sensitivity, lag, modulation transfer function (MTF), noise power spectrum, and DQE.

RESULTS

For both prototypes, MTF and DQE results were found to be consistent with theoretical expectations and the MTFs were also found to be higher than that measured from a conventional MV AMFPI. In addition, the DQE results exhibit input-quantum-limited behavior, even at extremely low doses. Compared to PVD, the PIB prototype exhibits much lower dark current, slightly higher lag, and similar DQE. Finally, the challenges associated with this approach, as well as strategies for achieving considerably higher DQE through thicker HgI2 layers, are discussed.

CONCLUSIONS

The DQE of each of the prototypes is found to be comparable to that of conventional MV AMFPIs, commensurate with the modest photoconductor thicknesses of these early samples. It is anticipated that thicker layers of HgI2 based on PIB deposition can provide higher DQE while maintaining good material properties.

Monte Carlo investigations of the effect of beam divergence on thick, segmented crystalline scintillators for radiotherapy imaging

The use of thick, segmented scintillators in electronic portal imagers offers the potential for significant improvement in x-ray detection efficiency compared to conventional phosphor screens. Such improvement substantially increases the detective quantum efficiency (DQE), leading to the possibility of achieving soft-tissue visualization at clinically practical (i.e. low) doses using megavoltage (MV) cone-beam computed tomography. While these DQE increases are greatest at zero spatial frequency, they are diminished at higher frequencies as a result of degradation of spatial resolution due to lateral spreading of secondary radiation within the scintillator--an effect that is more pronounced for thicker scintillators. The extent of this spreading is even more accentuated for radiation impinging the scintillator at oblique angles of incidence due to beam divergence. In this paper, Monte Carlo simulations of radiation transport, performed to investigate and quantify the effects of beam divergence on the imaging performance of MV imagers based on two promising scintillators (BGO and CsI:Tl), are reported. In these studies, 10-40 mm thick scintillators, incorporating low-density polymer, or high-density tungsten septal walls, were examined for incident angles corresponding to that encountered at locations up to approximately 15 cm from the central beam axis (for an imager located 130 cm from a radiotherapy x-ray source). The simulations demonstrate progressively more severe spatial resolution degradation (quantified in terms of the effect on the modulation transfer function) as a function of increasing angle of incidence (as well as of the scintillator thickness). Since the noise power behavior was found to be largely independent of the incident angle, the dependence of the DQE on the incident angle is therefore primarily determined by the spatial resolution. The observed DQE degradation suggests that 10 mm thick scintillators are not strongly affected by beam divergence for detector areas up to approximately 30x30 cm2. For thicker scintillators, the area that is relatively unaffected is significantly reduced, requiring a focused scintillator geometry in order to preserve spatial resolution, and thus DQE.

High-DQE EPIDs based on thick, segmented BGO and CsI:Tl scintillators: performance evaluation at extremely low dose

PURPOSE

Electronic portal imaging devices (EPIDs) based on active matrix, flat-panel imagers (AMFPIs) have become the gold standard for portal imaging and are currently being investigated for megavoltage cone-beam computed tomography (CBCT) and cone-beam digital tomosynthesis (CBDT). However, the practical realization of such volumetric imaging techniques is constrained by the relatively low detective quantum efficiency (DQE) of AMFPI-based EPIDs at radiotherapy energies, approximately 1% at 6 MV. In order to significantly improve DQE, the authors are investigating thick, segmented scintillators, consisting of 2D matrices of scintillating crystals separated by septal walls.

METHODS

A newly constructed segmented BGO scintillator (11.3 mm thick) and three segmented CsI:Tl scintillators (11.4, 25.6, and 40.0 mm thick) were evaluated using a 6 MV photon beam. X-ray sensitivity, modulation transfer function, noise power spectrum, DQE, and phantom images were obtained using prototype EPIDs based on the four scintillators.

RESULTS

The BGO and CsI:Tl prototypes were found to exhibit improvement in DQE ranging from approximately 12 to 25 times that of a conventional AMFPI-based EPID at zero spatial frequency. All four prototype EPIDs provide significantly improved contrast resolution at extremely low doses, extending down to a single beam pulse. In particular, the BGO prototype provides contrast resolution comparable to that of the conventional EPID, but at 20 times less dose, with spatial resolution sufficient for identifying the boundaries of low-contrast objects. For this prototype, however, the BGO scintillator exhibited an undesirable radiation-induced variation in x-ray sensitivity.

CONCLUSIONS

Prototype EPIDs based on thick, segmented BGO and CsI:T1 scintillators provide significantly improved portal imaging performance at extremely low dose (i.e., down to 1 beam pulse corresponding to approximately 0.022 cGy), creating the possibility of soft-tissue visualization using MV CBCT and CBDT at clinically practical dose.

The adaptation of megavoltage cone beam CT for use in standard radiotherapy treatment planning

Potential areas where megavoltage computed tomography (MVCT) could be used are second- and third-phase treatment planning in 3D conformal radiotherapy and IMRT, adaptive radiation therapy, single fraction palliative treatment and for the treatment of patients with metal prostheses. A feasibility study was done on using MV cone beam CT (CBCT) images generated by proprietary 3D reconstruction software based on the FDK algorithm for megavoltage treatment planning. The reconstructed images were converted to a DICOM file set. The pixel values of megavoltage cone beam computed tomography (MV CBCT) were rescaled to those of kV CT for use with a treatment planning system. A calibration phantom was designed and developed for verification of geometric accuracy and CT number calibration. The distance measured between two marker points on the CBCT image and the physical dimension on the phantom were in good agreement. Point dose verification for a 10 cm x 10 cm beam at a gantry angle of 0 degrees and SAD of 100 cm were performed for a 6 MV beam for both kV and MV CBCT images. The point doses were found to vary between +/-6.1% of the dose calculated from the kV CT image. The isodose curves for 6 MV for both kV CT and MV CBCT images were within 2% and 3 mm distance-to-agreement. A plan with three beams was performed on MV CBCT, simulating a treatment plan for cancer of the pituitary. The distribution obtained was compared with those corresponding to that obtained using the kV CT. This study has shown that treatment planning with MV cone beam CT images is feasible.

A literature review of electronic portal imaging for radiotherapy dosimetry

Electronic portal imaging devices (EPIDs) have been the preferred tools for verification of patient positioning for radiotherapy in recent decades. Since EPID images contain dose information, many groups have investigated their use for radiotherapy dose measurement. With the introduction of the amorphous-silicon EPIDs, the interest in EPID dosimetry has been accelerated because of the favourable characteristics such as fast image acquisition, high resolution, digital format, and potential for in vivo measurements and 3D dose verification. As a result, the number of publications dealing with EPID dosimetry has increased considerably over the past approximately 15 years. The purpose of this paper was to review the information provided in these publications. Information available in the literature included dosimetric characteristics and calibration procedures of various types of EPIDs, strategies to use EPIDs for dose verification, clinical approaches to EPID dosimetry, ranging from point dose to full 3D dose distribution verification, and current clinical experience. Quality control of a linear accelerator, pre-treatment dose verification and in vivo dosimetry using EPIDs are now routinely used in a growing number of clinics. The use of EPIDs for dosimetry purposes has matured and is now a reliable and accurate dose verification method that can be used in a large number of situations. Methods to integrate 3D in vivo dosimetry and image-guided radiotherapy (IGRT) procedures, such as the use of kV or MV cone-beam CT, are under development. It has been shown that EPID dosimetry can play an integral role in the total chain of verification procedures that are implemented in a radiotherapy department. It provides a safety net for simple to advanced treatments, as well as a full account of the dose delivered. Despite these favourable characteristics and the vast range of publications on the subject, there is still a lack of commercially available solutions for EPID dosimetry. As strategies evolve and commercial products become available, EPID dosimetry has the potential to become an accurate and efficient means of large-scale patient-specific IMRT dose verification for any radiotherapy department.

Anatomical imaging for radiotherapy

The goal of radiation therapy is to achieve maximal therapeutic benefit expressed in terms of a high probability of local control of disease with minimal side effects. Physically this often equates to the delivery of a high dose of radiation to the tumour or target region whilst maintaining an acceptably low dose to other tissues, particularly those adjacent to the target. Techniques such as intensity modulated radiotherapy (IMRT), stereotactic radiosurgery and computer planned brachytherapy provide the means to calculate the radiation dose delivery to achieve the desired dose distribution. Imaging is an essential tool in all state of the art planning and delivery techniques: (i) to enable planning of the desired treatment, (ii) to verify the treatment is delivered as planned and (iii) to follow-up treatment outcome to monitor that the treatment has had the desired effect. Clinical imaging techniques can be loosely classified into anatomic methods which measure the basic physical characteristics of tissue such as their density and biological imaging techniques which measure functional characteristics such as metabolism. In this review we consider anatomical imaging techniques. Biological imaging is considered in another article. Anatomical imaging is generally used for goals (i) and (ii) above. Computed tomography (CT) has been the mainstay of anatomical treatment planning for many years, enabling some delineation of soft tissue as well as radiation attenuation estimation for dose prediction. Magnetic resonance imaging is fast becoming widespread alongside CT, enabling superior soft-tissue visualization. Traditionally scanning for treatment planning has relied on the use of a single snapshot scan. Recent years have seen the development of techniques such as 4D CT and adaptive radiotherapy (ART). In 4D CT raw data are encoded with phase information and reconstructed to yield a set of scans detailing motion through the breathing, or cardiac, cycle. In ART a set of scans is taken on different days. Both allow planning to account for variability intrinsic to the patient. Treatment verification has been carried out using a variety of technologies including: MV portal imaging, kV portal/fluoroscopy, MVCT, conebeam kVCT, ultrasound and optical surface imaging. The various methods have their pros and cons. The four x-ray methods involve an extra radiation dose to normal tissue. The portal methods may not generally be used to visualize soft tissue, consequently they are often used in conjunction with implanted fiducial markers. The two CT-based methods allow measurement of inter-fraction variation only. Ultrasound allows soft-tissue measurement with zero dose but requires skilled interpretation, and there is evidence of systematic differences between ultrasound and other data sources, perhaps due to the effects of the probe pressure. Optical imaging also involves zero dose but requires good correlation between the target and the external measurement and thus is often used in conjunction with an x-ray method. The use of anatomical imaging in radiotherapy allows treatment uncertainties to be determined. These include errors between the mean position at treatment and that at planning (the systematic error) and the day-to-day variation in treatment set-up (the random error). Positional variations may also be categorized in terms of inter- and intra-fraction errors. Various empirical treatment margin formulae and intervention approaches exist to determine the optimum strategies for treatment in the presence of these known errors. Other methods exist to try to minimize error margins drastically including the currently available breath-hold techniques and the tracking methods which are largely in development. This paper will review anatomical imaging techniques in radiotherapy and how they are used to boost the therapeutic benefit of the treatment.

Monte Carlo investigations of megavoltage cone-beam CT using thick, segmented scintillating detectors for soft tissue visualization

Megavoltage cone-beam computed tomography (MV CBCT) is a highly promising technique for providing volumetric patient position information in the radiation treatment room. Such information has the potential to greatly assist in registering the patient to the planned treatment position, helping to ensure accurate delivery of the high energy therapy beam to the tumor volume while sparing the surrounding normal tissues. Presently, CBCT systems using conventional MV active matrix flat-panel imagers (AMFPIs), which are commonly used in portal imaging, require a relatively large amount of dose to create images that are clinically useful. This is due to the fact that the phosphor screen detector employed in conventional MV AMFPIs utilizes only approximately 2% of the incident radiation (for a 6 MV x-ray spectrum). Fortunately, thick segmented scintillating detectors can overcome this limitation, and the first prototype imager has demonstrated highly promising performance for projection imaging at low doses. It is therefore of definite interest to examine the potential performance of such thick, segmented scintillating detectors for MV CBCT. In this study, Monte Carlo simulations of radiation energy deposition were used to examine reconstructed images of cylindrical CT contrast phantoms, embedded with tissue-equivalent objects. The phantoms were scanned at 6 MV using segmented detectors having various design parameters (i.e., detector thickness as well as scintillator and septal wall materials). Due to constraints imposed by the nature of this study, the size of the phantoms was limited to approximately 6 cm. For such phantoms, the simulation results suggest that a 40 mm thick, segmented CsI detector with low density septal walls can delineate electron density differences of approximately 2.3% and 1.3% at doses of 1.54 and 3.08 cGy, respectively. In addition, it was found that segmented detectors with greater thickness, higher density scintillator material, or lower density septal walls exhibit higher contrast-to-noise performance. Finally, the performance of various segmented detectors obtained at a relatively low dose (1.54 cGy) was compared with that of a phosphor screen similar to that employed in conventional MV AMFPIs. This comparison indicates that for a phosphor screen to achieve the same contrast-to-noise performance as the segmented detectors approximately 18 to 59 times more dose is required, depending on the configuration of the segmented detectors.

Effect of recombination in a high quantum efficiency prototype ionization-chamber-based electronic portal imaging device

The quantum efficiency (QE) of an imaging detector can be increased by utilizing a thick, high-density detection medium to increase the number of quantum interactions. However, image quality is more accurately described by the detection quantum efficiency (DQE). If a significant fraction of the increase in the number of detected quanta from a thick, dense detector were to result in useful imaging signal, this represents a favorable case where enhanced QE leads to increased DQE. However, for ionization-type detectors, one factor that limits DQE is the recombination between ion pairs that acts as a secondary quantum sink due to which enhancement in QE may not result in higher DQE depending on the extent of the signal loss from recombination. Therefore, an analysis of signal loss mechanisms or quantum sinks in an imaging system is essential for validating the overall benefit of high QE detectors. In this paper, a study of ion recombination as a secondary quantum sink is presented for a high QE prototype ion-chamber-based electronic portal imaging device (EPID): the kinestatic charge detector (KCD). The KCD utilizes a high pressure noble gas (krypton or xenon at 100 atm) and an arbitrarily large detector thickness (of the order of centimeters), resulting in a high QE imager. Compared with commercial amorphous silicon flat panel imagers that provide DQE(0) approximately 0.01, the KCD has much higher DQE. Studies indicated that DQE(0) = 0.20 for 6.1 cm thick, 100 atm (rho = 3.4 g/cm3) xenon chamber, and DQE(0)=0.34 for a 9.1 cm thick chamber. A series of experiments was devised and conducted to determine the signal loss due to recombination for a KCD chamber. The measurements indicated a fractional recombination loss of about 14% for a krypton chamber and about 18% for a xenon chamber under standard operating conditions (100 atm chamber pressure and 1275 V/cm electric field intensity). A theoretical treatment of the effect of recombination on imaging signal-to-noise ratio was applied to quantify the loss in DQE. These calculations indicated that recombination had a limited effect (<2%) on DQE under standard operating conditions. This was validated by good agreement between experimentally measured DQE and that obtained using Monte Carlo simulations that did not account for recombination.

Electronic portal imaging based on Cerenkov radiation: A new approach and its feasibility

Most electronic portal imaging devices (EPIDs) developed so far use a Cu plate/phosphor screen to absorb x rays and convert their energies into light, and the light image is then read out. The main problem with this approach is that the Cu plate/phosphor screen must be thin (approximately 2 mm thick) in order to obtain a high spatial resolution, resulting in a low x-ray absorption or low quantum efficiency for megavoltage x rays (typically 2-4%). In addition, the phosphor screen contains high atomic number (high-Z) materials, resulting in an over-response of the detector to low-energy x rays in dosimetric verification. In this paper, we propose a new approach that uses Cerenkov radiation to convert x-ray energy absorbed by the detector into light for portal imaging applications. With our approach, a thick (approximately 10-30 cm) energy conversion layer made of a low-Z dielectric medium, such as a large-area, thick fiber-optic taper consisting of a matrix of optical fibers aligned with the incident x rays, is used to replace the thin Cu plate/phosphor screen. The feasibility of this approach has been investigated using a single optical fiber embedded in a solid material. The spatial resolution expressed by the modulation transfer function (MTF) and the sensitivity of the detector at low doses (approximately one Linac pulse) have been measured. It is predicted that, using this approach, a detective quantum efficiency of an order of magnitude higher at zero frequency can be obtained while maintaining a reasonable MTF, as compared to current EPIDs.

Study of a prototype high quantum efficiency thick scintillation crystal video-electronic portal imaging device

Image quality in portal imaging suffers significantly from the loss in contrast and spatial resolution that results from the excessive Compton scatter associated with megavoltage x rays. In addition, portal image quality is further reduced due to the poor quantum efficiency (QE) of current electronic portal imaging devices (EPIDs). Commercial video-camera-based EPIDs or VEPIDs that utilize a thin phosphor screen in conjunction with a metal buildup plate to convert the incident x rays to light suffer from reduced light production due to low QE (<2% for Eastman Kodak Lanex Fast-B). Flat-panel EPIDs that utilize the same luminescent screen along with an a-Si:H photodiode array provide improved image quality compared to VEPIDs, but they are expensive and can be susceptible to radiation damage to the peripheral electronics. In this article, we present a prototype VEPID system for high quality portal imaging at sub-monitor-unit (subMU) exposures based on a thick scintillation crystal (TSC) that acts as a high QE luminescent screen. The prototype TSC system utilizes a 12 mm thick transparent CsI(Tl) (thallium-activated cesium iodide) scintillator for QE=0.24, resulting in significantly higher light production compared to commercial phosphor screens. The 25 X 25 cm2 CsI(Tl) screen is coupled to a high spatial and contrast resolution Video-Optics plumbicon-tube camera system (1240 X 1024 pixels, 250 microm pixel width at isocenter, 12-bit ADC). As a proof-of-principle prototype, the TSC system with user-controlled camera target integration was adapted for use in an existing clinical gantry (Siemens BEAMVIEW(PLUS)) with the capability for online intratreatment fluoroscopy. Measurements of modulation transfer function (MTF) were conducted to characterize the TSC spatial resolution. The measured MTF along with measurements of the TSC noise power spectrum (NPS) were used to determine the system detective quantum efficiency (DQE). A theoretical expression of DQE(0) was developed to be used as a predictive model to propose improvements in the optics associated with the light detection. The prototype TSC provides DQE(0)=0.02 with its current imaging geometry, which is an order of magnitude greater than that for commercial VEPID systems and comparable to flat-panel imaging systems. Following optimization in the imaging geometry and the use of a high-end, cooled charge-coupled-device (CCD) camera system, the performance of the TSC is expected to improve even further. Based on our theoretical model, the expected DQE(0)=0.12 for the TSC system with the proposed improvements, which exceeds the performance of current flat-panel EPIDs. The prototype TSC provides high quality imaging even at subMU exposures (typical imaging dose is 0.2 MU per image), which offers the potential for daily patient localization imaging without increasing the weekly dose to the patient. Currently, the TSC is capable of limited frame-rate fluoroscopy for intratreatment visualization of patient motion at approximately 3 frames/second, since the achievable frame rate is significantly reduced by the limitations of the camera-control processor. With optimized processor control, the TSC is expected to be capable of intratreatment imaging exceeding 10 frames/second to monitor patient motion.

Segmented crystalline scintillators: Empirical and theoretical investigation of a high quantum efficiency EPID based on an initial engineering prototype CsI(Tl) detector

Modern-day radiotherapy relies on highly sophisticated forms of image guidance in order to implement increasingly conformal treatment plans and achieve precise dose delivery. One of the most important goals of such image guidance is to delineate the clinical target volume from surrounding normal tissue during patient setup and dose delivery, thereby avoiding dependence on surrogates such as bony landmarks. In order to achieve this goal, it is necessary to integrate highly efficient imaging technology, capable of resolving soft-tissue contrast at very low doses, within the treatment setup. In this paper we report on the development of one such modality, which comprises a nonoptimized, prototype electronic portal imaging device (EPID) based on a 40 mm thick, segmented crystalline CsI(Tl) detector incorporated into an indirect-detection active matrix flat panel imager (AMFPI). The segmented detector consists of a matrix of 160 x 160 optically isolated, crystalline CsI(Tl) elements spaced at 1016 microm pitch. The detector was coupled to an indirect detection-based active matrix array having a pixel pitch of 508 microm, with each detector element registered to 2 x 2 array pixels. The performance of the prototype imager was evaluated under very low-dose radiotherapy conditions and compared to that of a conventional megavoltage AMFPI based on a Lanex Fast-B phosphor screen. Detailed quantitative measurements were performed in order to determine the x-ray sensitivity, modulation transfer function, noise power spectrum, and detective quantum efficiency (DQE). In addition, images of a contrast-detail phantom and an anthropomorphic head phantom were also acquired. The prototype imager exhibited approximately 22 times higher zero-frequency DQE (approximately 22%) compared to that of the conventional AMFPI (approximately 1%). The measured zero-frequency DQE was found to be lower than theoretical upper limits (approximately 27%) calculated from Monte Carlo simulations, which were based solely on the x-ray energy absorbed in the detector-indicating the presence of optical Swank noise. Moreover, due to the nonoptimized nature of this prototype, the spatial resolution was observed to be significantly lower than theoretical expectations. Nevertheless, due to its high quantum efficiency (approximately 55%), the prototype imager exhibited significantly higher DQE than that of the conventional AMFPI across all spatial frequencies. In addition, the frequency-dependent DQE was observed to be relatively invariant with respect to the amount of incident radiation, indicating x-ray quantum limited behavior. Images of the contrast-detail phantom and the head phantom obtained using the prototype system exhibit good visualization of relatively large, low-contrast features, and appear significantly less noisy compared to similar images from a conventional AMFPI. Finally, Monte Carlo-based theoretical calculations indicate that, with proper optimization, further, significant improvements in the DQE performance of such imagers could be achieved. It is strongly anticipated that the realization of optimized versions of such very high-DQE EPIDs would enable megavoltage projection imaging at very low doses, and tomographic imaging from a "beam's eye view" at clinically acceptable doses.

Dose comparison of megavoltage cone-beam and orthogonal-pair portal images

The technique of megavoltage cone‐beam computed tomography (MV CBCT) is available for image‐guided radiation therapy to improve the accuracy of patient setup and tumor localization. However, development of strategies to efficiently and effectively implement this technique or to replace the current orthogonal portal images technique remains challenging in the clinical environment. It is useful to compare the difference in absorbed dose between the MV CBCT technique and the orthogonal portal images technique, the current standard practice for treatment verification. Our study analyzed the doses generated from these two imaging techniques for six treatment sites (pelvis, abdomen, lung, head and neck, breast, prostate). The analysis was made by simulating the MV CBCT technique with an arc beam and a beam‐on time of 9 monitor units (MUs), and the orthogonal pair technique with a double‐exposure anterior–posterior and lateral pair and a beam‐on time of 4 MUs. The results are presented as dose per MU (cGy/MU) and absolute dose (cGy). The isocenter doses, integral doses, maximum doses, and mean doses to tumor and critical organs, and the two‐dimensional isodose distributions and dose–volume histograms of each critical organ were investigated. The absolute dose difference between MV CBCT and orthogonal pair at the isocenter was 4.02±0.59 cGy. Major differences were seen between the two techniques in critical organs whose locations are away from the tumor. These organs, such as the contralateral breast (difference: 0.17±0.10 cGy/MU) and lung (difference: 0.15±0.20 cGy/MU), receive a higher dose from MV CBCT images than from orthogonal portal images. Additionally, higher doses and larger dose areas involving more normal tissues were observed for MV CBCT images than for orthogonal portal images in our analysis methodology, which used 200 beam projections delivered from various angles for the MV CBCT simulation and from just two perpendicular angles for the orthogonal pair simulation. In our selected clinical cases, the high‐dose area from the orthogonal pair technique was always located inside the tumor; with MV CBCT, the high‐dose area will most likely be outside the tumor. Therefore, the potentially higher doses to critical organs from MV CBCT images should be properly analyzed to ensure that they do not exceed the tolerance dose when therapy is delivered using that technique. On the other hand, to obtain good image quality, the higher MUs with MV CBCT images may be necessary. The absorbed dose for the tumor and for other critical organs should be calculated accordingly in the treatment plans. Images by MV CBCT are a great tool for three‐dimensional verification of patient treatment position. The trade‐off is that the MV CBCT technique for patient treatment verification might have a higher chance of increasing the dose to normal tissue during image acquisition.

PACS number: 87.53.Oq

Segmented crystalline scintillators: An initial investigation of high quantum efficiency detectors for megavoltage x-ray imaging

Electronic portal imaging devices (EPIDs) based on indirect detection, active matrix flat panel imagers (AMFPIs) have become the technology of choice for geometric verification of patient localization and dose delivery in external beam radiotherapy. However, current AMFPI EPIDs, which are based on powdered-phosphor screens, make use of only approximately 2% of the incident radiation, thus severely limiting their imaging performance as quantified by the detective quantum efficiency (DQE) (approximately 1%, compared to approximately 75% for kilovoltage AMFPIs). With the rapidly increasing adoption of image-guided techniques in virtually every aspect of radiotherapy, there exist strong incentives to develop high-DQE megavoltage x-ray imagers, capable of providing soft-tissue contrast at very low doses in megavoltage tomographic and, potentially, projection imaging. In this work we present a systematic theoretical and preliminary empirical evaluation of a promising, high-quantum-efficiency, megavoltage x-ray detector design based on a two-dimensional matrix of thick, optically isolated, crystalline scintillator elements. The detector is coupled with an indirect detection-based active matrix array, with the center-to-center spacing of the crystalline elements chosen to match the pitch of the underlying array pixels. Such a design enables the utilization of a significantly larger fraction of the incident radiation (up to 80% for a 6 MV beam), through increases in the thickness of the crystalline elements, without loss of spatial resolution due to the spread of optical photons. Radiation damage studies were performed on test samples of two candidate scintillator materials, CsI(Tl) and BGO, under conditions relevant to radiotherapy imaging. A detailed Monte Carlo-based study was performed in order to examine the signal, spatial spreading, and noise properties of the absorbed energy for several segmented detector configurations. Parameters studied included scintillator material, septal wall material, detector thickness, and the thickness of the septal walls. The results of the Monte Carlo simulations were used to estimate the upper limits of the modulation transfer function, noise power spectrum and the DQE for a select number of configurations. An exploratory, small-area prototype segmented detector was fabricated by infusing crystalline CsI(Tl) in a 2 mm thick tungsten matrix, and the signal response was measured under radiotherapy imaging conditions. Results from the radiation damage studies showed that both CsI(Tl) and BGO exhibited less than approximately 15% reduction in light output after 2500 cGy equivalent dose. The prototype CsI(Tl) segmented detector exhibited high uniformity, but a lower-than-expected magnitude of signal response. Finally, results from Monte Carlo studies strongly indicate that high scintillator-fill-factor configurations, incorporating high-density scintillator and septal wall materials, could achieve up to 50 times higher DQE compared to current AMFPI EPIDs.

Development of high quantum efficiency, flat panel, thick detectors for megavoltage x-ray imaging: a novel direct-conversion design and its feasibility

Most electronic portal imaging devices (EPIDs) developed to date, including recently developed flat panel systems, have low x-ray absorption, i.e., low quantum efficiency (QE) of 2%-4% as compared to the theoretical limit of 100%. A significant increase of QE is desirable for applications such as a megavoltage cone-beam computed tomography (MVCT) and megavoltage fluoroscopy. However, the spatial resolution of an imaging system usually decreases significantly with an increase of QE. The key to the success in the design of a high QE detector is therefore to maintain the spatial resolution. Recently, we demonstrated theoretically that it is possible to design a portal imaging detector with both high QE and high resolution [see Pang and Rowlands, Med. Phys. 29, 2274 (2002)]. In this paper, we introduce such a novel design consisting of a large number of microstructured plates (made by, e.g., photolithographic patterning of evaporated or electroplated layers) packed together and aligned with the incident x rays. On each plate, microstrip charge collectors are focused toward the x-ray source to collect charges generated in the ionization medium (e.g., air or gas) surrounded by high-density materials that act as x-ray converters. The collected charges represent the x-ray image and can be read out by various means, including a two-dimensional (2-D) active readout matrix. The QE, spatial resolution, and sensitivity of the detector have been calculated. It has been shown that the new design will have a QE of more than an order of magnitude higher and a spatial resolution equivalent to that of flat panel systems currently used for portal imaging. The new design is also quantum noise limited down to very low doses (approximately 1-2 radiation pulses of the linear accelerator).

Segmented phosphors: MEMS-based high quantum efficiency detectors for megavoltage x-ray imaging

Current electronic portal imaging devices (EPIDs) based on active matrix flat panel imager (AMFPI) technology use a metal plate+phosphor screen combination for x-ray conversion. As a result, these devices face a severe trade-off between x-ray quantum efficiency (QE) and spatial resolution, thus, significantly limiting their imaging performance. In this work, we present a novel detector design for indirect detection-based AMFPI EPIDs that aims to circumvent this trade-off. The detectors were developed using micro-electro-mechanical system (MEMS)-based fabrication techniques and consist of a grid of up to approximately 2 mm tall, optically isolated cells of a photoresist material, SU-8. The cells are dimensionally matched to the pixels of the AMFPI array, and packed with a scintillating phosphor. In this paper, various design considerations for such detectors are examined. An empirical evaluation of three small-area (approximately 7 x 7 cm2) prototype detectors is performed in order to study the effects of two design parameters--cell height and phosphor packing density, both of which are important determinants of the imaging performance. Measurements of the x-ray sensitivity, modulation transfer function (MTF) and noise power spectrum (NPS) were performed under radiotherapy conditions (6 MV), and the detective quantum efficiency (DQE) was determined for each prototype SU-8 detector. In addition, theoretical calculations using Monte Carlo simulations were performed to determine the QE of each detector, as well as the inherent spatial resolution due to the spread of absorbed energy. The results of the present studies were compared with corresponding measurements published in an earlier study using a Lanex Fast-B phosphor screen coupled to an indirect detection array of the same design. The SU-8 detectors exhibit up to 3 times higher QE, while achieving spatial resolution comparable or superior to Lanex Fast-B. However, the DQE performance of these early prototypes is significantly lower than expected due to high levels of optical Swank noise. Consequently, the SU-8 detectors presently exhibit DQE values comparable to Lanex Fast-B at zero spatial frequency and significantly lower than Fast-B at higher frequencies. Finally, strategies for reducing Swank noise are discussed and theoretical calculations, based on the cascaded systems model, are presented in order to estimate the performance improvement that can be achieved through such noise reduction.

Modeling scintillator-photodiodes as detectors for megavoltage CT

The use of cadmium tungstate (CdWO4) and cesium iodide [CsI(Tl)] scintillation detectors is studied in megavoltage computed tomography (MVCT). A model describing the signal acquired from a scintillation detector has been developed which contains two steps: (1) the calculation of the energy deposited in the crystal due to MeV photons using the EGSnrc Monte Carlo code; and (2) the transport of the optical photons generated in the crystal voxels to photodiodes using the optical Monte Carlo code DETECT2000. The measured detector signals in single CdWO4 and CsI(Tl) scintillation crystals of base 0.275 x 0.8 cm2 and heights 0.4, 1, 1.2, 1.6 and 2 cm were, generally, in good agreement with the signals calculated with the model. A prototype detector array which contains 8 CdWO4 crystals, each 0.275 x 0.8 x 1 cm3, in contact with a 16-element array of photodiodes was built. The measured attenuation of a Cobalt-60 beam as a function of solid water thickness behaves linearly. The frequency dependent modulation transfer function [MTF(f)], noise power spectrum [NPS(f)], and detective quantum efficiency [DQE(f)] were measured for 1.25 MeV photons (in a Cobalt-60 beam). For 6 MV photons, only the MTF(f) was measured from a linear accelerator, where large pulse-to-pulse fluctuations in the output of the linear accelerator did not allow the measurement of the NPS(f). A two-step Monte Carlo simulation was used to model the detector's MTF(f), NPS(f) and DQE(f). The DQE(0) of the detector array was found to be 26% and 19% for 1.25 MeV and 6 MV photons, respectively. For 1.25 MeV photons, the maximum discrepancies between the measured and modeled MTF(f), relative NPS(f) and the DQE(f) were found to be 1.5%, 1.2%, and 1.9%, respectively. For the 6 MV beam, the maximum discrepancy between the modeled and the measured MTF(f) was found to be 2.5%. The modeling is sufficiently accurate for designing appropriate detectors for MVCT.

Verification of step-and-shoot IMRT delivery using a fast video-based electronic portal imaging device

We present an investigation into the use of a fast video-based electronic portal-imaging device (EPID) to study intensity modulated radiation therapy (IMRT) delivery. The aim of this study is to test the feasibility of using an EPID system to independently measure the orchestration of collimator leaf motion and beam fluence; simultaneously measuring both the delivered field fluence and shape as it exits the accelerator head during IMRT delivery. A fast EPID that consists of a terbium-doped gadolinium oxysulphide (GdO2S:Tb) scintillator coupled with an inexpensive commercial 30 frames-per-second (FPS) CCD-video recorder (16.7 ms shutter time) was employed for imaging IMRT delivery. The measurements were performed on a Varian 2100 C/D linear accelerator equipped with a 120-leaf multileaf-collimator (MLC). A characterization of the EPID was performed that included measurements of spatial resolution, linac pulse-rate dependence, linear output response, signal uniformity, and imaging artifacts. The average pixel intensity for fields imaged with the EPID was found to be linear in the delivered monitor units of static non-IMRT fields between 3x3 and 15x15 cm2. A systematic increase of the average pixel intensity was observed with increasing field size, leading to a maximum variation of 8%. Deliveries of a clinical step-and-shoot mode leaf sequence were imaged at 600 MU/min. Measurements from this IMRT delivery were compared with experimentally validated MLC controller log files and were found to agree to within 5%. An analysis of the EPID image data allowed identification of three types of errors: (1) 5 out of 35 segments were undelivered; (2) redistributing all of the delivered segment MUs; and (3) leaf movement during segment delivery. Measurements with the EPID at lower dose rates showed poor agreement with log files due to an aliasing artifact. The study was extended to use a high-speed camera (1-1000 FPS and 10 micros shutter time) with our EPID to image the same delivery to demonstrate the feasibility of imaging without aliasing artifacts. High-speed imaging was shown to be a promising direction toward validating IMRT deliveries with reasonable image resolution and noise.

Megavoltage cone-beam computed tomography using a high-efficiency image receptor

PURPOSE

To develop an image receptor capable of forming high-quality megavoltage CT images using modest radiation doses.

METHODS AND MATERIALS

A flat-panel imaging system consisting of a conventional flat-panel sensor attached to a thick CsI scintillator has been fabricated. The scintillator consists of individual CsI crystals 8 mm thick by 0.38 mm x 0.38-mm pitch. Five sides of each crystal are coated with a reflecting powder/epoxy mixture, and the sixth side is in contact with the flat-panel sensor. A timing interface coordinates acquisition by the imaging system and pulsing of the linear accelerator. With this interface, as little as one accelerator pulse (0.023 cGy at the isocenter) can be used to form projection images. Different CT phantoms irradiated by a 6-MV X-ray beam have been imaged to evaluate the performance of the imaging system. The phantoms have been mounted on a rotating stage and rotated while 360 projection images are acquired in 48 s. These projections have been reconstructed using the Feldkamp cone-beam CT reconstruction algorithm.

RESULTS AND DISCUSSION

Using an irradiation of 16 cGy (360 projections x 0.046 cGy/projection), the contrast resolution is approximately 1% for large objects. High-contrast structures as small as 1.2 mm are clearly visible. The reconstructed CT values are linear (R(2) = 0.98) for electron densities between 0.001 and 2.16 g/cm(3), and the reconstruction time for a 512 x 512 x 512 data set is 6 min. Images of an anthropomorphic phantom show that soft-tissue structures such as the heart, lung, kidneys, and liver are visible in the reconstructed images (16 cGy, 5-mm-thick slices).

CONCLUSIONS

The acquisition of megavoltage CT images with soft-tissue contrast is possible with irradiations as small as 16 cGy.

Development of high quantum efficiency flat panel detectors for portal imaging: intrinsic spatial resolution

Recently developed flat panel detectors have been proven to have a much better image quality than conventional electronic portal imaging devices (EPIDs). They are, however, not yet the ideal systems for portal imaging application due to the low x-ray absorption, i.e., low quantum efficiency (QE), which is typically on the order of 2-4% as compared to the theoretical limit of 100%. The QE of current flat panel systems can be improved by significantly increasing the thickness of the energy conversion layer (i.e., amorphous selenium or phosphor screen). This, however, will be at the expense of a decrease in spatial resolution mainly due to x-ray scatter in the conversion layer (and also the spread of optical photons in the case of phosphor screen). In this paper, we investigate theoretically the intrinsic spatial resolution of a high QE flat panel detector with a new energy conversion layer that is much denser and thicker than that of current flat panel systems. The modulation transfer function (MTF) of the system is calculated based on a theoretical model using a novel approach, which uses an analytical expression for absorbed dose. It is found that if appropriate materials are used for the conversion layer, then the intrinsic MTF of the high QE flat panel is better than that of current EPIDs, and in addition they have a high QE (e.g., approximately 60%). Some general rules for the design of the conversion layer to achieve both high QE and high resolution as well as high DQE are also discussed.

Theoretical analysis and experimental evaluation of a Csl(TI) based electronic portal imaging system

This article discusses the design and analysis of a portal imaging system based on a thick transparent scintillator. A theoretical analysis using Monte Carlo simulation was performed to calculate the x-ray quantum detection efficiency (QDE), signal to noise ratio (SNR) and the zero frequency detective quantum efficiency [DQE(0)] of the system. A prototype electronic portal imaging device (EPID) was built, using a 12.7 mm thick, 20.32 cm diameter, Csl(Tl) scintillator, coupled to a liquid nitrogen cooled CCD TV camera. The system geometry of the prototype EPID was optimized to achieve high spatial resolution. The experimental evaluation of the prototype EPID involved the determination of contrast resolution, depth of focus, light scatter and mirror glare. Images of humanoid and contrast detail phantoms were acquired using the prototype EPID and were compared with those obtained using conventional and high contrast portal film and a commercial EPID. A theoretical analysis was also carried out for a proposed full field of view system using a large area, thinned CCD camera and a 12.7 mm thick CsI(TI) crystal. Results indicate that this proposed design could achieve DQE(0) levels up to 11%, due to its order of magnitude higher QDE compared to phosphor screen-metal plate based EPID designs, as well as significantly higher light collection compared to conventional TV camera based systems.

On the verification of the incident energy fluence in tomotherapy IMRT

For any radiotherapy verification technique, it is desirable that issues with the accelerator, multileaf collimator and patient position be detected. In previous works, an effective method for this level of verification was presented. This paper identifies second-order issues affecting the part of the process in which the incident energy fluence is verified. These problems will affect any rotational intensity-modulated radiotherapy delivery that divides each rotation or arc into projections: however the solutions offered in this paper are specific to the method previously developed. The issues affecting the energy fluence verification method include leaf bouncing. delivery implementation and leaf latency. All three matters were found to introduce small errors in the verified energy fluence values for a small fraction of leaf states. The overall effect on the deposited dose over the course of a rotational delivery involving thousands of beam pulses per rotation is negligible. Regardless, effective correction strategies are presented; these are utilized in order to characterize both the delivered energy fluence and deposited dose as accurately as possible.

Portal imaging

Portal imaging is the acquisition of images with a radiotherapy beam. Imaging theory suggests that the quality of portal images could be much higher if the efficiency of the imaging media in detecting radiation could be improved. Introduction of new media (films and electronic portal imaging devices) has confirmed this by markedly increasing the quality of portal images. Images from these devices can then be used to verify a patient's treatment. Geometric verification requires the portal image to be registered with a reference image. Dosimetric verification requires the portal imager to be calibrated for dose. This review gives a brief overview of the current areas of interest in portal imaging: imaging theory; imaging media, film and electronic portal imaging devices; image registration; and dosimetry using these devices.

Sampling considerations for intensity modulated radiotherapy verification using electronic portal imaging

A model has been developed to describe the sampling process that occurs when intensity modulated radiotherapy treatments (delivered with a multileaf collimator) are imaged with an electronic portal imaging device that acquires a set of frames with a finite dead-time between them. The effects of the imaging duty cycle and frame rate on the accuracy of dosimetric verification have been studied. A frame interval of 1 s with 25%, 50% and 75% duty cycle, and a 50% duty cycle with frame intervals of 1, 2, 4, 8, and 16 s have been studied for a smoothly varying hemispherical intensity profile, and a 50% duty cycle with frame intervals of 1, 2, 4, and 8 s for a pixellated distribution. In addition an intensity modulated beam for breast radiotherapy has been modeled and imaged for 0.33 s frame time and 1, 2, and 3 s frame separation. The results show that under sparse temporal sampling conditions, errors of the order of 10% may ensue and occur with an oscillatory pattern. For the beams studied, imaging with a 1 or 2 s frame interval resulted in small errors at the 1%-2% level, for all duty cycles shown.

Leaf position verification during dynamic beam delivery: a comparison of three applications using electronic portal imaging

The use of a dynamic multileaf collimator (MLC) to deliver intensity-modulated beams presents a problem for conventional verification techniques. The use of electronic portal imaging to track MLC leaves during beam delivery has been shown to provide a solution to this problem. An experimental comparison of three different verification systems, each using a different electronic portal imaging technology, is presented. Two of the systems presented are commercially available imagers with in-house modifications, with the third system being an in-house built experimental system. The random and systematic errors present in each of the verifications systems are measured and presented, together with the study of the effects of varying dose rate and leaf speed on verification system performance. The performance of the three systems is demonstrated to be very similar, with an overall accuracy in comparing measured and prescribed collimator trajectories of approximately +/-1.0 mm. Systematic errors in the percentage delivered dose signal provided by the accelerator are significant and must be corrected for good performance of the current systems. It is demonstrated that, with suitable modifications, commercially available portal imaging systems can be used to verify dynamic MLC beam delivery.

Optical scattering in camera-based electronic portal imaging

An investigation of scintillation light scattering within camera-based electronic portal imaging devices is presented. A simple analytical scatter model is adapted for the precise geometries of two different camera-based imaging systems and the results of modelling and experimental measurements are compared. The results of the study strongly suggest that the main source of optical scattering is multiple reflection between the scintillation screen and 45 degree mirror in both systems. The scattered light has a highly non-uniform distribution, which is strongly dependent upon field size. For large radiation fields the scatter contribution can be over 20% of the primary signal scintillation light intensity in the centre of the field. A purely optical method of removing the scattered light signal using a louvre grid on the surface of the scintillation screen is then presented and experimentally demonstrated to be effective.

A cone-beam megavoltage CT scanner for treatment verification in conformal radiotherapy

PURPOSE

A prototype scanner for large-volume megavoltage computed tomography (MVCT) in a clinical set-up is described. The ultimate aim is to improve treatment accuracy in conformal radiotherapy through patient set-up error reduction and transit dosimetry.

MATERIALS AND METHODS

The scanner consists of a custom-built 2D CsI(Tl) crystal array viewed by a lens and a CCD camera. Image acquisition is synchronized with radiation pulses. The 2D projections resulting from a single continuous 360 degrees gantry rotation are reconstructed using a cone-beam tomography algorithm. Prior to reconstruction, the raw projections are calibrated and corrected for centre of rotation movement and accelerator output fluctuation. The performance of the system has been evaluated by reconstructing projections of open fields, test objects and a humanoid phantom.

RESULTS

Hundreds of 2D projections can be acquired with a clinically-acceptable data collection time (about 2 min) and dose (approximately 40 cGy, with a possible four-fold reduction). A maximum density resolution of about 2% is achieved offering some soft tissue discrimination without using image enhancement tools. A spatial resolution of 2.5 mm is obtained. The reconstructed image intensity is linear with electron density over the range of interest. Coronal or sagittal slices through the 3D reconstruction of the humanoid phantom show a better delineation of structures than the corresponding portal images taken at the same orientation.

CONCLUSIONS

A similar image quality to our current single-slice MVCT scanner is achieved with the advantage of providing tens of tomographic slices for a single gantry rotation. This work demonstrates the feasibility of clinical cone-beam MVCT and indicates how this prototype can be improved.