Developments in electronic portal imaging systems

Verification of geometric accuracy at the time of treatment delivery has always been a necessary part of the radiotherapy process. Since the introduction of conformal and intensity-modulated radiotherapy, the consequences of patient positioning errors are more serious. Portal imaging has played a large part in fulfilling the need for improved geometric accuracy. This review examines how portal imaging has progressed through the development and evolution of electronic portal imaging devices (EPIDs). Changes in technology, including the current commercial systems, and how image quality has changed are presented. The clinical usage of EPIDs and the technological innovations being devised for further improvements in image quality and systems are considered.

Dosimetric characteristics of the Elekta Beam Modulator™

The dosimetric characteristics of a production pilot multi-leaf collimator (Elekta Beam Modulator, Elekta Oncology Systems, Crawley, UK) having a 4 mm leaf width (at isocentre) have been investigated. Characteristics explored included leaf bank set-up, penumbra width (80-20%) as a function of leaf position, leaf positioning reproducibility, interleaf leakage and leaf transmission. The penumbra values for leaf ends were measured to be between 4.2 and 4.8 mm for various large rectangular fields studied using Kodak X-omat V film at isocentre (1.5 cm deep). Similar films were taken with a standard 1 cm width multi-leaf collimator (MLC) and the penumbra for leaf ends was found to range from 4.3 to 5.2 mm. Other results showed that the rounded leaf tip provided tight control of the penumbra across the leaves' full range of travel. The positioning of the leaves was within a 0.5 mm range when approaching from the same direction. The maximum interleaf leakage was found to be 1.7% and the average leaf transmission less than 1.0%. No major differences were observed in leakage and transmission with changing gantry angle.

Recording accelerator monitor units during electronic portal imaging: application to collimator position verification during IMRT

The application of multiple portal image acquisition to collimator position verification during dynamic multileaf collimation (DMLC) using a commercial camera-based electronic portal imaging device (EPID) (Theraview, Cablon Medical BV, Leusden, The Netherlands) mounted on an Elekta SL15i accelerator (Elekta Oncology Systems, Crawley, UK) is described. This is achieved using a custom-built dose acquisition system optically interfaced to both the camera control unit of the EPID and the monitor unit (MU) channel of the accelerator. The method uses the beam blanking camera control signal to trigger the dose acquisition system to read the cumulative accelerator MUs at the beginning and end of each period of image formation. A maximum delay of 15 ms has been estimated for recording of accelerator MUs in the current system. The camera interface was observed to have no effect on the operation of the EPID during normal clinical use and could therefore be left permanently in situ. Use of the system for collimator position verification of a test case is presented. The technique described uses a specific camera-based EPID and accelerator, although the general principle of using an EPID control signal to trigger recording of accelerator MUs may be applicable to other EPIDs/accelerators with suitable knowledge of the accelerator dosimetry system.

Measurement of the response of Gd2O2S:Tb phosphor to 6 MV x-rays

The phosphor GdO2S:Tb is widely used in camera-based electronic portal imaging devices (EPIDs). There is considerable interest in the application of EPIDs to dosimetry and the verification of intensity modulated radiation therapy produced by dynamic multileaf collimation (DMLC). This paper presents direct measurement of Gd2O2S:Tb phosphor luminescence under 6 MV x-ray irradiation from a linear accelerator using a photomultiplier tube. The luminescence following each radiation pulse (3 micros duration) was observed to decay with a dominant lifetime of 558 micros. Using a specialized electrometer, the temporal variation of the optical signal has been compared with the dose rate incident on the phosphor measured using a semiconductor diode detector. Under dose rates typical of those used in the clinic (1.2 Gy min(-1) to the phosphor), measurements at beam-start confirmed that the optical signal is linear with dose per radiation pulse. Measurements at beam termination following phosphor doses up to 4.4 Gy showed no residual signal associated with long-lived luminescence (afterglow) from the phosphor above the noise level of the optical signal (0.17% standard deviation). This measurement demonstrates that afterglow from Gd2O2S:Tb is not of significance for its application to DMLC verification. Additionally, it was confirmed that the accelerator pulse repetition frequency has no effect on the optical signal from the phosphor in the range 25-400 Hz.

A method for controlling image acquisition in electronic portal imaging devices

Certain types of camera-based electronic portal imaging devices (EPIDs) which initiate image acquisition based on sensing a change in video level have been observed to trigger unreliably at the beginning of dynamic multileaf collimation sequences. A simple, novel means of controlling image acquisition with an Elekta linear accelerator (Elekta Oncology Systems, Crawley, UK) is proposed which is based on illumination of a photodetector (ORP-12, Silonex Inc., Plattsburgh, NY, USA) by the electron gun of the accelerator. By incorporating a simple trigger circuit it is possible to derive a beam on/off status signal which changes at least 100 ms before any dose is measured by the accelerator. The status signal does not return to the beam-off state until all dose has been delivered and is suitable for accelerator pulse repetition frequencies of 50-400 Hz. The status signal is thus a reliable means of indicating the initiation and termination of radiation exposure, and thus controlling image acquisition of such EPIDs for this application.

Dosimetric properties of the Theraview fluoroscopic electronic portal imaging device

Electronic portal imaging devices (EPIDs) can be used for non-imaging applications in radiotherapy such as patient dosimetry. Of the systems available, the fluoroscopic camera-based EPID Theraview (InfiMed Inc.) has not been studied to date, and a review of the dosimetric properties of the system is presented here. In the "single set-up" mode of image acquisition, pixel intensity increases sublinearly with applied dose. The response was dependent on the system's video signal gain and showed a threshold dose to the detector in the range 0.05-0.35 cGy, and pixel saturation at detector doses in the range 1.2-1.6 cGy. Repeated exposures of the EPID were observed to be extremely reproducible (standard deviation 0.5%). The sensitivity of the system showed a linear decline of 0.04% day-1 over a 68-day period, during which time the relative off-axis response within 10 x 10 cm2 field was constant to within a standard deviation of 0.56%. The system shows spatial non-uniformity, which requires correction for application to dose measurements in two-dimensions. Warm-up of the camera control unit required a period of at least 40 min and was associated with an enhancement in pixel intensity of up to 12%. A radiation dose history effect was observed at doses as low as 0.2 Gy. Camera dark current was shown to be negligible at normal accelerator operation. No discernible image distortion was found. Mechanical stability on gantry rotation was also assessed and image displacement of up to 5 mm at the isocentre was observed. It was concluded that the device could be used for dosimetry provided necessary precautions were observed and corrections made.