Abstract

Purpose:Flattening filter free photon energies are commonly used for high dose treatments such as SBRT, where localization accuracy is essential. Often, MV cine imaging may be employed to verify correct localization. TrueBeam Electronic Portal Imaging Devices (EPIDs) equipped with the 40×30cm2 Image Detection Unit (IDU) are prone to image saturation at the image center especially for higher dose rates. While saturation often does not occur for cine imaging during treatment because the beam is attenuated by the patient, the flood field calibration is affected when the standard calibration procedure is followed. Here we describe the hardware and protocol to achieve improved image quality for this model of TrueBeam EPID.Methods:A stainless steel filter of uniform thickness was designed to have sufficient attenuation to avoid panel saturation for both 6XFFF and 10XFFF at the maximum dose rates (1400 MU/min & 2400 MU/min, respectively). The cine imaging flood field calibration was then acquired with the filter in place for the FFF energies under the standard calibration geometry (SDD=150cm). Image quality during MV cine was assessed with & without the modified flood field calibration using a low contrast resolution phantom and an anthropomorphic phantom.Results:When the flood field is acquired using the standard procedure (no filter in place), a pixel gain artifact is clearly present in the image center (r=3cm for 10XFFF at 2400 MU/min) which appears similar to and may be mis‐attributed to panel saturation in the subject image. The artifact obscured all low contrast inserts at the image center and was also visible on the anthropomorphic phantom. Using the filter for flood field calibration eliminated the artifact.Conclusion:Use of a modified flood field calibration procedure improves image quality for cine MV imaging with TrueBeams equipped with the 40×30cm2 IDU.

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