Portal Dose Images Research Articles

Portal dose measurements by a 2D array

A 2D array (PTW, type 10024), equipped with 729 vented plane parallel ion-chambers, has been calibrated as a detector for the in vivo comparison between measured and predicted portal doses for head–neck tumors. The comparison of absolute portal doses measured to ones predicted by a commercial treatment planning system within the field of view of the CT scanner, can help the delivered dose verification during different treatment fractions, in particular when the patient's present weight loss. This paper reports the preliminary results of the comparison of the portal doses measured by a PTW 2D array during several radiotherapy fractions and the predicted portal doses for seven patients undergoing head–neck tumor radiotherapy. The gamma index analysis supplied an agreement of more than 95% of the dose-point P γ > 95% within acceptance criteria, in terms of dose difference, Δ D max, and distance-agreement, Δ d max, equal to 5% and 4 mm, respectively. After the third week, one patient showed a decrease of P γ values due to the markedly reduced patient's thickness. Even if the spatial resolution of the 2D array was 1 cm, there were two advantages in the use of this 2D array as a portal dose device for IMRT quality control. The first one was the use of a stable and efficient absolute dosimeter for in vivo verification, although its construction and behavior for other gantry angles need to be tested, and the second one was the time efficiency in verifying the correct dose delivery in several fractions of the therapy. This study presents acceptance criteria for the comparison of TPS-predicted portal dose images with in vivo 2D ion-chamber measurements for IMRT. In particular, portal dose measurements offer clues for additional studies as to which indicators can signal the need for replanning during treatment.

3D dose reconstruction for clinical evaluation of IMRT pretreatment verification with an EPID

Background and purpose Pretreatment verification with an electronic portal imaging device is an important part of our patient-specific quality assurance program for advanced treatment techniques. Up to now, this verification has been performed for over 400 IMRT patient plans. For every treatment field, a 2D portal dose image (PDI) is measured and compared with a predicted PDI. Often it is not straightforward to interpret dose deviations found in these 2D comparisons in terms of clinical implications for the patient. Therefore, a method to derive the 3D patient dose based on the measured PDIs was implemented. Methods and materials For reconstruction of the 3D patient dose, the actual fluences delivered by the accelerator are derived from measured portal dose images using an iterative method. The derived fluence map for each beam direction is then used as input for the treatment planning system to generate an adapted 3D patient dose distribution. The accuracy of this method was assessed by measurements in a water phantom. Clinical evaluation of the 3D dose reconstruction was performed for 17 IMRT patients with different tumor sites. Dose differences with respect to the original treatment plan were evaluated in individual CT slices using dose difference maps and a 3D γ analysis and by comparing dose-volume histograms (DVHs). Results The measurements indicated that the accuracy of the 3D dose reconstruction was within 2%/2 mm. For the patients observed dose differences with respect to the original plan were generally within 2%, except at the field edges and in the sharp dose gradients around the planning target volume (PTV). Gamma analysis showed that the dose differences were within 2%/2 mm for more than 95% of the points in all cases. Differences in DVH parameters for the PTV and organs at risk were also within 2% in nearly all cases. Conclusion A method to derive actual delivered fluence maps from measured PDIs and to use them to reconstruct the 3D patient dose was implemented. The reconstruction eases the estimation of the clinical relevance of observed dose differences in the pretreatment measurements.

Dosimetric pre-treatment verification of IMRT using an EPID; clinical experience

Background and purpose In our clinic a QA program for IMRT verification, fully based on dosimetric measurements with electronic portal imaging devices (EPID), has been running for over 3 years. The program includes a pre-treatment dosimetric check of all IMRT fields. During a complete treatment simulation at the linac, a portal dose image (PDI) is acquired with the EPID for each patient field and compared with a predicted PDI. In this paper, the results of this pre-treatment procedure are analysed, and intercepted errors are reported. An automated image analysis procedure is proposed to limit the number of fields that need human intervention in PDI comparison. Materials and methods Most of our analyses are performed using the γ index with 3% local dose difference and 3 mm distance to agreement as reference values. Scalar parameters are derived from the γ values to summarize the agreement between measured and predicted 2D PDIs. Areas with all pixels having γ values larger than one are evaluated, making decisions based on clinically relevant criteria more straightforward. Results In 270 patients, the pre-treatment checks revealed four clinically relevant errors. Calculation of statistics for a group of 75 patients showed that the patient-averaged mean γ value inside the field was 0.43 ± 0.13 (1 SD) and only 6.1 ± 6.8% of pixels had a γ value larger than one. With the proposed automated image analysis scheme, visual inspection of images can be avoided in 2/3 of the cases. Conclusion EPIDs may be used for high accuracy and high resolution routine verification of IMRT fields to intercept clinically relevant dosimetric errors prior to the start of treatment. For the majority of fields, PDI comparison can fully rely on an automated procedure, avoiding excessive workload.

A Monte Carlo based three‐dimensional dose reconstruction method derived from portal dose images

The verification of intensity-modulated radiation therapy (IMRT) is necessary for adequate quality control of the treatment. Pretreatment verification may trace the possible differences between the planned dose and the actual dose delivered to the patient. To estimate the impact of differences between planned and delivered photon beams, a three-dimensional (3-D) dose verification method has been developed that reconstructs the dose inside a phantom. The pretreatment procedure is based on portal dose images measured with an electronic portal imaging device (EPID) of the separate beams, without the phantom in the beam and a 3-D dose calculation engine based on the Monte Carlo calculation. Measured gray scale portal images are converted into portal dose images. From these images the lateral scattered dose in the EPID is subtracted and the image is converted into energy fluence. Subsequently, a phase-space distribution is sampled from the energy fluence and a 3-D dose calculation in a phantom is started based on a Monte Carlo dose engine. The reconstruction model is compared to film and ionization chamber measurements for various field sizes. The reconstruction algorithm is also tested for an IMRT plan using 10 MV photons delivered to a phantom and measured using films at several depths in the phantom. Depth dose curves for both 6 and 10 MV photons are reconstructed with a maximum error generally smaller than 1% at depths larger than the buildup region, and smaller than 2% for the off-axis profiles, excluding the penumbra region. The absolute dose values are reconstructed to within 1.5% for square field sizes ranging from 5 to 20 cm width. For the IMRT plan, the dose was reconstructed and compared to the dose distribution with film using the gamma evaluation, with a 3% and 3 mm criterion. 99% of the pixels inside the irradiated field had a gamma value smaller than one. The absolute dose at the isocenter agreed to within 1% with the dose measured with an ionization chamber. It can be concluded that our new dose reconstruction algorithm is able to reconstruct the 3-D dose distribution in phantoms with a high accuracy. This result is obtained by combining portal dose images measured prior to treatment with an accurate dose calculation engine.

A novel approach to accurate portal dosimetry using CCD‐camera based EPIDs

A new method for portal dosimetry using CCD camera-based electronic portal imaging devices (CEPIDs) is demonstrated. Unlike previous approaches, it is not based on a priori assumptions concerning CEPID cross-talk characteristics. In this method, the nonsymmetrical and position-dependent cross-talk is determined by directly imaging a set of cross-talk kernels generated by small fields ("pencil beams") exploiting the high signal-to-noise ratio of a cooled CCD camera. Signal calibration is achieved by imaging two reference fields. Next, portal dose images (PDIs) can be derived from electronic portal dose images (EPIs), in a fast forward-calculating iterative deconvolution. To test the accuracy of these EPI-based PDIs, a comparison is made to PDIs obtained by scanning diode measurements. The method proved accurate to within 0.2+/-0.7% (1 SD), for on-axis symmetrical and asymmetrical fields with different field widths and homogeneous phantom thicknesses, off-axis Alderson thorax fields and a strongly modulated IMRT field. Hence, the proposed method allows for fast, accurate portal dosimetry. In addition, it is demonstrated that the CEPID cross-talk signal is not only induced by optical photon reflection and scatter within the CEPID structure, but also by high-energy back-scattered radiation from CEPID elements (mirror and housing) towards the fluorescent screen.

Portal dose image verification: the collapsed cone superposition method applied with different electronic portal imaging devices

Two different commercial electronic portal imaging devices (EPIDs), one based on a liquid ion chamber matrix and the other based on a fluoroscopic CCD camera, were used to acquire readings that, through a calibration procedure, provided images proportional to the absolute dose to a virtual water slab located at the EPID plane. The transformation of the matrix ion chamber image into a portal dose image (PDI) was based on a published relationship between dose rate and ionization current. For the fluoroscopic CCD-camera-based system, the transformation was based on a deconvolution with a radial light scatter kernel. Local response variations were corrected in the images from both systems using open field fluence maps. The acquired PDIs were compared with PDIs calculated with the collapsed cone superposition method for a three-dimensional detector model in water equivalent buildup material. The calculation model was based on the beam modelling and geometrical description of the treatment unit and energy used for treatment planning in a kernel-based system. The validity of the calculation method was evaluated for several field shapes and thicknesses of patient phantoms for the matrix ion chamber at 6 MV x-rays and for the camera-based EPID at 6 and 15 MV x-rays. The agreement between predicted and measured PDIs was evaluated with dose comparisons at points of interest and gamma index calculations. The average area failing the passing criteria in dose and position deviation was analysed to validate the performance of the method. For the matrix ion chamber on average an area less than 1% fails the passing criteria of 3 mm and 3%. For the camera-based EPID, the average area is 7% and 1% for 6 and 15 MV, respectively. The overall agreement centrally in the fields was 0.1 ± 1.6% (1 sd) for the camera-based EPID and −0.1 ± 1.6% (1 sd) for the matrix ion chamber. Thus, an absolute dose calibrated EPID could validate the delivered dose to the patient by comparing a calculated and a measured PDI.

Experimental verification of a portal dose prediction model

Electronic portal imaging devices (EPIDs) can be used to measure a two-dimensional (2D) dose distribution behind a patient, thus allowing dosimetric treatment verification. For this purpose we experimentally assessed the accuracy of a 2D portal dose prediction model based on pencil beam scatter kernels. A straightforward derivation of these pencil beam scatter kernels for portal dose prediction models is presented based on phantom measurements. The model is able to predict the 2D portal dose image (PDI) behind a patient, based on a PDI without the patient in the beam in combination with the radiological thickness of the patient, which requires in addition a PDI with the patient in the beam. To assess the accuracy of portal dose and radiological thickness values obtained with our model, various types of homogeneous as well as inhomogeneous phantoms were irradiated with a 6 MV photon beam. With our model we are able to predict a PDI with an accuracy better than 2% (mean difference) if the radiological thickness of the object in the beam is symmetrically situated around the isocenter. For other situations deviations up to 3% are observed for a homogeneous phantom with a radiological thickness of 17 cm and a 9 cm shift of the midplane-to-detector distance. The model can extract the radiological thickness within 7 mm (maximum difference) of the actual radiological thickness if the object is symmetrically distributed around the isocenter plane. This difference in radiological thickness is related to a primary portal dose difference of 3%. It can be concluded that our model can be used as an easy and accurate tool for the 2D verification of patient treatments by comparing predicted and measured PDIs. The model is also able to extract the primary portal dose with a high accuracy, which can be used as the input for a 3D dose reconstruction method based on back-projection.

TU‐C‐T‐6E‐01: Accurate IMRT Verification with Fluoroscopic EPIDs: A Generally Applicable Method Based On Direct Imaging of Cross‐Talk Kernels

Purpose: CCD camera‐based electronic portal imaging devices (CEPIDs) are well suited for absolute dosimetric measurements and are applied routinely for IMRT verification in our institute. CEPID dosimetry is mainly hampered by cross‐talk, which originates predominantly from optical photons reflected within the EPID structure. Previously, this cross‐talk was corrected for based on specific assumptions. However, the sensitive cameras in our present CEPIDs allow for direct imaging of the low‐amplitude, spatially extended cross‐talk kernels. Thus complete, position dependent characterization of the cross‐talk has become feasible. Here, we investigate the accuracy with which portal dose images (PDIs) can be derived from CEPID images (EPIs), using this cross‐talk characterization. Method and Materials: Cross‐talk kernels were obtained from EPIs of 2×2 cm2 ‘pencil’ beams, centered on a 30‐position grid covering the EPID sensitive area. In the experimental set‐up and post‐processing, care was taken to exclude contributions of low‐magnitude long‐range incident MeV‐radiation to the kernels. By interpolation of the measured kernels, a high resolution kernel‐database was generated. Using this database, PDIs can be derived from EPIs by iterative deconvolution of the cross‐talk contribution. Absolute PDI calibration was based on EPIs and corresponding PDIs, obtained by scanning a linear diode array (LDA), for two reference fields. To test the accuracy of this method, we compared EPI‐derived PDIs with LDA‐based PDIs for a series of symmetric and asymmetric fields, including Alderson‐phantom thorax and IMRT fields. Results: The measured cross‐talk kernels were asymmetrical and position‐dependent. PDIs derived from EPIs with these cross‐talk kernels matched with LDA‐based PDIs to within 1% (1 SD) for all investigated fields (including IMRT), both inside and outside the field penumbras. Conclusion: We have developed a generally applicable method to determine position‐dependent cross‐talk kernels via direct imaging. With these kernels, we can derive accurate PDIs from EPIs that are well‐suited for dosimetric IMRT verification.

Experimental method to obtain scattering contribution in portal dose images

A method for evaluating scattered dose contribution in portal images acquired under clinical conditions (phantom-device distance of 30 cm) is presented. This method is based on radiographic film and ionisation chamber measurements and is valid for homogenecus polystyrene phantoms and square fields of different size. The portal imaging device consisted of a radiographic film placed between slabs of polystyrene under full build-up conditions (1.5 cm for 6 MV beam and 3 cm for 18 MV and 1 cm of polystyrene backscatter material. First the primary dose image in the portal plane P(i,j) is obtained using a projection algorithm, then the scattered dose image S(i,j) is found by subtracting the primary dose image in the portal plane P(i,j) from the total dose image acqu red in the portal plane T(i,j). The ratio S(i,j)/T between the scattered dose distribution and the dose value measured on the bearn axis in the portal plane was found to be uniform within the radiation field for all the geometrical configuration of phantoms and fields studied. Under these conditions the mean value of the scatter fraction S/T evaluated within a ROI centred on the bearn axis accurately describes the scatter fraction distribution S(i,j)/T within the whole radiation field. S/T ranges from 7.4% to 31.1% in the 6 MV beam and from 8.9% to 30.8% in the 18 MV beam. Finally an analytical method to evaluate the ratio S/T has been developed from the experimental results. It comprises phantom, accelerator head and portal imaging device contributions and depends on field size and phantom thickness.

SIFT: a method to verify the IMRT fluence delivered during patient treatment using an electronic portal imaging device.

Radiotherapy patients are increasingly treated with intensity-modulated radiotherapy (IMRT) and high tumor doses. As part of our quality control program to ensure accurate dose delivery, a new method was investigated that enables the verification of the IMRT fluence delivered during patient treatment using an electronic portal imaging device (EPID), irrespective of changes in patient geometry. Each IMRT treatment field is split into a static field and a modulated field, which are delivered in sequence. Images are acquired for both fields using an EPID. The portal dose image obtained for the static field is used to determine changes in patient geometry between the planning CT scan and the time of treatment delivery. With knowledge of these changes, the delivered IMRT fluence can be verified using the portal dose image of the modulated field. This method, called split IMRT field technique (SIFT), was validated first for several phantom geometries, followed by clinical implementation for a number of patients treated with IMRT. The split IMRT field technique allows for an accurate verification of the delivered IMRT fluence (generally within 1% [standard deviation]), even if large interfraction changes in patient geometry occur. For interfraction radiological path length changes of 10 cm, deliberately introduced errors in the delivered fluence could still be detected to within 1% accuracy. Application of SIFT requires only a minor increase in treatment time relative to the standard IMRT delivery. A new technique to verify the delivered IMRT fluence from EPID images, which is independent of changes in the patient geometry, has been developed. SIFT has been clinically implemented for daily verification of IMRT treatment delivery.

The use of an aSi-based EPID for routine absolute dosimetric pre-treatment verification of dynamic IMRT fields

Background and purposeIn parallel with the increased use of intensity modulated radiation treatment (IMRT) fields in radiation therapy, flat panel amorphous silicon (aSi) detectors are becoming the standard for online portal imaging at the linear accelerator. In order to minimise the workload related to the quality assurance of the IMRT fields, we have explored the possibility of using a commercially available aSi portal imager for absolute dosimetric verification of the delivery of dynamic IMRT fields. Patients and methodsWe investigated the basic dosimetric characteristics of an aSi portal imager (aS500, Varian Medical Systems), using an acquisition mode especially developed for portal dose (PD) integration during delivery of a—static or dynamic-radiation field. Secondly, the dose calculation algorithm of a commercially available treatment planning system (Cadplan, Varian Medical Systems) was modified to allow prediction of the PD image, i.e. to compare the intended fluence distribution with the fluence distribution as actually delivered by the dynamic multileaf collimator. Absolute rather than relative dose prediction was applied. The PD image prediction was compared to the corresponding acquisition for several clinical IMRT fields by means of the gamma evaluation method. Results and conclusionsThe acquisition mode is accurate in integrating all PD over a wide range of monitor units, provided detector saturation is avoided. Although the dose deposition behaviour in the portal image detector is not equivalent to the dose to water measurements, it is reproducible and self-consistent, lending itself to quality assurance measurements. Gamma evaluations of the predicted versus measured PD distribution were within the pre-defined acceptance criteria for all clinical IMRT fields, i.e. allowing a dose difference of 3% of the local field dose in combination with a distance to agreement of 3 mm.

Performance of electronic portal imaging devices (EPIDs) used in radiotherapy: Image quality and dose measurements

The aim of our study was to compare the image and dosimetric quality of two different imaging systems. The first one is a fluoroscopic electronic portal imaging device (first generation), while the second is based on an amorphous silicon flat-panel array (second generation). The parameters describing image quality include spatial resolution [modulation transfer function (MTF)], noise [noise power spectrum (NPS)], and signal-to-noise transfer [detective quantum efficiency (DQE)]. The dosimetric measurements were compared with ionization chamber as well as with film measurements. The response of the flat-panel imager and the fluoroscopic-optical device was determined performing a two-step Monte Carlo simulation. All measurements were performed in a 6 MV linear accelerator photon beam. The resolution (MTF) of the fluoroscopic device (f 1/2 = 0.3 mm(-1)) is larger than of the amorphous silicon based system (f 1/2 = 0.21 mm(-1)), which is due to the missing backscattered photons and the smaller pixel size. The noise measurements (NPS) show the correlation of neighboring pixels of the amorphous silicon electronic portal imaging device, whereas the NPS of the fluoroscopic system is frequency independent. At zero spatial frequency the DQE of the flat-panel imager has a value of 0.008 (0.8%). Due to the minor frequency dependency this device may be almost x-ray quantum limited. Monte Carlo simulations verified these characteristics. For the fluoroscopic imaging system the DQE at low frequencies is about 0.0008 (0.08%) and degrades with higher frequencies. Dose measurements with the flat-panel imager revealed that images can only be directly converted to portal dose images, if scatter can be neglected. Thus objects distant to the detector (e.g., inhomogeneous dose distribution generated by a modificator) can be verified dosimetrically, while objects close to a detector (e.g., a patient) cannot be verified directly and must be scatter corrected prior to verification. This is justified by the response of the flat-panel imaging device revealing a strong dependency at low energies.

Portal dose image verification: formalism and application of the collapsed cone superposition method

A formalism tailored for portal dose image verification is proposed to facilitate the comparison of calculated and measured portal dose distributions. Each portal image is converted into a dose proportional image and normalized to the reference beam calibration dose per monitor unit. The calculated or measured dose to a detector phantom is accordingly normalized so as to enable direct comparison.The collapsed cone kernel superposition method is adapted and evaluated for calculation of portal dose distributions in a water-equivalent detector phantom through comparisons with Monte Carlo calculations and with measurements. The deviation compared with Monte Carlo calculations for 6 and 15 MV was between +0.9% (the 0.9 quantile) and −2.1% (the 0.1 quantile) for a range of investigated geometries. Collapsed cone calculations compared with measurements for clinical fields agreed within [−1.9%, +2.4%] for 15 MV and [−0.9%, +3.2%] for 6 MV for the 0.1 and 0.9 quantiles, respectively. Hence, the absolute portal dose to a detector phantom could be calculated and verified well within the present accuracy requirements for clinical dose calculations.

Portal dose image prediction for dosimetric treatment verification in radiotherapy. II. An algorithm for wedged beams

A method is presented for calculation of a two-dimensional function, T(wedge)(x,y), describing the transmission of a wedged photon beam through a patient. This in an extension of the method that we have published for open (nonwedged) fields [Med. Phys. 25, 830-840 (1998)]. Transmission functions for open fields are being used in our clinic for prediction of portal dose images (PDI, i.e., a dose distribution behind the patient in a plane normal to the beam axis), which are compared with PDIs measured with an electronic portal imaging device (EPID). The calculations are based on the planning CT scan of the patient and on the irradiation geometry as determined in the treatment planning process. Input data for the developed algorithm for wedged beams are derived from (the already available) measured input data set for transmission prediction in open beams, which is extended with only a limited set of measurements in the wedged beam. The method has been tested for a PDI plane at 160 cm from the focus, in agreement with the applied focus-to-detector distance of our fluoroscopic EPIDs. For low and high energy photon beams (6 and 23 MV) good agreement (approximately 1%) has been found between calculated and measured transmissions for a slab and a thorax phantom.

Development of a portal dose image prediction algorithm for arbitrary detector systems

This thesis presents the development of a two‐step model that predicts dose deposition in arbitrary portal image detectors. The algorithm requires patient computed tomographic data, source‐detector distance, and knowledge of the incident photon beam fluence. The first step predicts the photon fluence entering a portal imaging detector located behind the patient. Primary fluence is obtained through simple ray tracing techniques, while scatter fluence prediction requires a library of scatter fluence kernels generated by Monte Carlo simulation. These kernels allow prediction of basic radiation transport parameters characterizing the scattered photons, including fluence and energy. The second step of the algorithm involves a superposition of Monte Carlo‐generated pencil beam kernels, describing dose deposition in a specific detector, with the predicted incident fluence of primary and scattered photons. The algorithm is tested on a variety of simple slab and anthropomorphic phantoms. Clinical parameters were varied over a wide range of interest, including 6, 18, and 23 MV photon beam spectra and 10–80 cm air gap between phantom and portal imaging detector. Both low and high atomic number detectors were used to verify the algorithm, including a linear array of fluid ionization chambers and a solid state, amorphous silicon detector. Agreement between predicted and measured portal dose is better than 5% in areas of low dose gradient (<30%/cm) and better than 5 mm in areas of high dose gradient (>30%/cm) for the variety of situations tested here. It is concluded that this portal dose prediction algorithm is fast, accurate, allows separation of primary and scatter dose, and can model dose image formation in arbitrary detector systems.

Dosimetric investigation and portal dose image prediction using an amorphous silicon electronic portal imaging device.

A two step algorithm to predict portal dose images in arbitrary detector systems has been developed recently. The current work provides a validation of this algorithm on a clinically available, amorphous silicon flat panel imager. The high-atomic number, indirect amorphous silicon detector incorporates a gadolinium oxysulfide phosphor scintillating screen to convert deposited radiation energy to optical photons which form the portal image. A water equivalent solid slab phantom and an anthropomorphic phantom were examined at beam energies of 6 and 18 MV and over a range of air gaps (approximately 20-50 cm). In the many examples presented here, portal dose images in the phosphor were predicted to within 5% in low-dose gradient regions, and to within 5 mm (isodose line shift) in high-dose gradient regions. Other basic dosimetric characteristics of the amorphous silicon detector were investigated, such as linearity with dose rate (+/- 0.5%), repeatability (+/- 2%), and response with variations in gantry rotation and source to detector distance. The latter investigation revealed a significant contribution to the image from optical photon spread in the phosphor layer of the detector. This phenomenon is generally known as "glare," and has been characterized and modeled here as a radially symmetric blurring kernel. This kernel is applied to the calculated dose images as a convolution, and is successfully demonstrated to account for the optical photon spread. This work demonstrates the flexibility and accuracy of the two step algorithm for a high-atomic number detector. The algorithm may be applied to improve performance of dosimetric treatment verification applications, such as direct image comparison, backprojected patient dose calculation, and scatter correction in megavoltage computed tomography. The algorithm allows for dosimetric applications of the new, flat panel portal imager technology in the indirect configuration, taking advantage of a greater than tenfold increase in detector sensitivity over a direct configuration.

A two-step algorithm for predicting portal dose images in arbitrary detectors.

Recently, portal imaging systems have been successfully demonstrated in dosimetric treatment verification applications, where measured and predicted images are quantitatively compared. To advance this approach to dosimetric verification, a two-step model which predicts dose deposition in arbitrary portal image detectors is presented. The algorithm requires patient CT data, source-detector distance, and knowledge of the incident beam fluence. The first step predicts the fluence entering a portal imaging detector located behind the patient. Primary fluence is obtained through ray-tracing techniques, while scatter fluence prediction requires a library of Monte Carlo-generated scatter fluence kernels. These kernels allow prediction of basic radiation transport parameters characterizing the scattered photons, including fluence and mean energy. The second step of the algorithm involves a superposition of Monte Carlo-generated pencil beam kernels, describing dose deposition in a specific detector, with the predicted incident fluence. This process is performed separately for primary and scatter fluence, and yields a predicted dose image. A small but noticeable improvement in prediction is obtained by explicitly modeling the off-axis energy spectrum softening due to the flattening filter. The algorithm is tested on a slab phantom and a simple lung phantom (6 MV). Furthermore, an anthropomorphic phantom is utilized for a simulated lung treatment (6 MV), and simulated pelvis treatment (23 MV). Data were collected over a range of air gaps (10-80 cm). Detectors incorporating both low and high atomic number buildup are used to measure portal image profiles. Agreement between predicted and measured portal dose is better than 3% in areas of low dose gradient (<30%/cm) for all phantoms, air gaps, beam energies, and detector configurations tested here. It is concluded that this portal dose prediction algorithm is fast, accurate, allows separation of primary and scatter dose, and can model arbitrary detectors.

Dosimetry with a fluoroscopic electronic portal imaging device

Techniques for dosimetric verification of radiotherapy treatments using a CCD camera based fluoroscopic electronic portal imaging device (EPID) are described. The dosimetric characteristics of the EPID were investigated and a method was developed to derive portal dose images (PDIs) from measured EPID images. EPID and ionization chamber measurements agreed to within 1% (1σ). Subsequently, an algorithm was developed to predict these PDIs using the planning CT data of the patient and the irradiation geometry as determined in the treatment planning process. Furthermore, a method was developed to derive the on‐axis patient dose from an EPID measurement, which was then compared with the intended dose. The method allows the discrimination of errors that are due to changes in patient anatomy and errors due to a deviating cGy/MU value. For 115 prostate cancer patients the differences between the average on‐axis measured portal dose and the predicted portal dose for the three open beams were small: −0.3±2.3% (1σ). However, large (up to 15%) off‐axis differences between measured and predicted PDIs were found, which were caused by frequently occurring gas pockets inside the rectum of the patients during treatment or during acquisition of the planning CT scan. The detected gas pockets did sometimes extend into the tumor volume area as outlined in the CT scan, implying internal organ motion. Finally, methods were developed for pretreatment verification of intensity modulated fields produced with compensators or dynamic multileaf collimation (DMLC). EPID measurements of dose profiles generated with DMLC agreed within 2% (1σ) with predictions and ionization chamber measurements.

Characterization of a high-elbow, fluoroscopic electronic portal imaging device for portal dosimetry

The application of a newly developed fluoroscopic (CCD-camera based) electronic portal imaging device (EPID) in portal dosimetry is investigated. A description of the EPID response to dose is presented in terms of stability, linearity and optical cross-talk inside the mechanical structure. The EPID has a relatively large distance (41 cm on-axis) between the fluorescent screen and the mirror (high-elbow), which results in cross-talk with properties quite different from that of the low-elbow fluoroscopic EPIDs that have been studied in the literature. In contrast with low-elbow systems, the maximum cross-talk is observed for points of the fluorescent screen that have the largest distance to the mirror, which is explained from the geometry of the system. An algorithm to convert the images of the EPID into portal dose images (PDIs) is presented. The correction applied for cross-talk is a position-dependent additive operation on the EPID image pixel values, with a magnitude that depends on a calculated effective field width. Deconvolution with a point spread function, as applied for low-elbow systems, is not required. For a 25 MV beam, EPID PDIs and ionization chamber measurements in the EPID detector plane were obtained behind an anthropomorphic phantom and a homogeneous absorber for various field shapes. The difference in absolute dose between the EPID and ionization chamber measurements, averaged over the four test fields presented in this paper, was 0.1±0.5% (1 SD) over the entire irradiation field, with no deviation larger than 2%.

Transit dosimetry with an electronic portal imaging device (EPID) for 115 prostate cancer patients

Purpose: Comparison of predicted portal dose images (PDIs) with PDIs measured with an electronic portal imaging device (EPID) may be used to detect errors in the dose delivery to patients. However, these comparisons cannot reveal errors in the MU calculation of a beam, since the calculated number of MU is used both for treatment (and thus affects the PDI measurement) and for PDI prediction. In this paper a method is presented that enables “ in vivo” verification of the MU calculation of the treatment beams. The method is based on comparison of the intended on-axis patient dose at 5 cm depth for each treatment beam, D 5, with D 5 as derived from the portal dose D p measured with an EPID. The developed method has been evaluated clinically for a group of 115 prostate cancer patients. Methods and Materials: The patient dose D 5 was derived from the portal dose measured with a fluoroscopic EPID using (i) the predicted beam transmission (i.e., the ratio of the portal dose with and without the patient in the beam) calculated with the planning CT data of the patient, and (ii) an empirical relation between portal doses D p and patient doses D 5. For each beam separately, the derived patient dose D 5 was compared with the intended dose as determined from the relative dose distribution as calculated by the treatment planning system and the prescribed isocenter dose (2 Gy). For interpretation of observed deviating patient doses D 5, the corresponding on-axis measured portal doses D p were also compared with predicted portal doses. Results: For three beams, a total of 7828 images were analyzed. The mean difference between the predicted patient dose and the patient dose derived from the average measured portal dose was: 0.4 ± 3.4% (1 SD) for the anterior–posterior (AP) beam and −1.5 ± 2.4% (1 SD) for the lateral beams. For 7 patients the difference between the predicted portal dose and the average measured portal dose for the AP beam and the corresponding difference in patient dose were both greater than 5%. All these patients had relatively large gas pockets (3–3.5 cm in AP direction) in the rectum during acquisition of the planning CT, which were not present during (most) treatments. Conclusions: An accurate method for verification of the MU calculation of an x-ray beam using EPID measurements has been developed. The method allows the discrimination of errors that are due to changes in patient anatomy related to appearance or disappearance of gas pockets in the rectum and errors due to a deviating cGy/MU-value.