A tungsten anode spectral model using interpolating polynomials (TASMIP) was used to compute x-ray spectra at 1 keV intervals over the range from 30 kV to 140 kV. The TASMIP is not semi-empirical and uses no physical assumptions regarding x-ray production, but rather interpolates measured constant potential x-ray spectra published by Fewell et al. [Handbook of Computed Tomography X-ray Spectra (U.S. Government Printing Office, Washington, D.C., 1981)]. X-ray output measurements (mR/mAs measured at 1 m) were made on a calibrated constant potential generator in our laboratory from 50 kV to 124 kV, and with 0-5 mm added aluminum filtration. The Fewell spectra were slightly modified (numerically hardened) and normalized based on the attenuation and output characteristics of a constant potential generator and metal-insert x-ray tube in our laboratory. Then, using the modified Fewell spectra of different kVs, the photon fluence phi at each 1 keV energy bin (E) over energies from 10 keV to 140 keV was characterized using polynomial functions of the form phi (E) = a0[E] + a1[E] kV + a2[E] kV2 + ... + a(n)[E] kVn. A total of 131 polynomial functions were used to calculate accurate x-ray spectra, each function requiring between two and four terms. The resulting TASMIP algorithm produced x-ray spectra that match both the quality and quantity characteristics of the x-ray system in our laboratory. For photon fluences above 10% of the peak fluence in the spectrum, the average percent difference (and standard deviation) between the modified Fewell spectra and the TASMIP photon fluence was -1.43% (3.8%) for the 50 kV spectrum, -0.89% (1.37%) for the 70 kV spectrum, and for the 80, 90, 100, 110, 120, 130 and 140 kV spectra, the mean differences between spectra were all less than 0.20% and the standard deviations were less than approximately 1.1%. The model was also extended to include the effects of generator-induced kV ripple. Finally, the x-ray photon fluence in the units of photons/mm2 per mR was calculated as a function of HVL, kV, and ripple factor, for various (water-equivalent) patient thicknesses (0, 10, 20, and 30 cm). These values may be useful for computing the detective quantum efficiency, DQE(f), of x-ray detector systems. The TASMIP algorithm and ancillary data are made available on line at http:/(/)www.aip.org/epaps/epaps.html.

An accurate method for computer-generating tungsten anode x-ray spectra from 30 to 140 kV.

AAPM Task Group 58 was created to provide materials to help the medical physicist and colleagues succeed in the clinical implementation of electronic portal imaging devices (EPIDs) in radiation oncology. This complex technology has matured over the past decade and is capable of being integrated into routine practice. However, the difficulties encountered during the specification, installation, and implementation process can be overwhelming. TG58 was charged with providing sufficient information to allow the users to overcome these difficulties and put EPIDs into routine clinical practice. In answering the charge, this report provides; comprehensive information about the physics and technology of currently available EPID systems; a detailed discussion of the steps required for successful clinical implementation, based on accumulated experience; a review of software tools available and clinical use protocols to enhance EPID utilization; and specific quality assurance requirements for initial and continuing clinical use of the systems. Specific recommendations are summarized to assist the reader with successful implementation and continuing use of an EPID.

/pdf/clinical-use-of-electronic-portal-imaging-report-of-aapm-3twciqxruq.pdf

Clinical use of electronic portal imaging: Report of AAPM Radiation Therapy Committee Task Group 58

A review of electronic portal imaging devices (EPIDs) used in external beam, megavoltage radiation therapy is presented. The review consists of a brief introduction to the definition, role and clinical significance of portal imaging, along with a discussion of radiotherapy film systems and the motivations for EPIDs. This is followed by a summary of the challenges and constraints inherent to portal imaging along with a concise, historical review of the technologies that have been explored and developed. The paper then examines, in greater depth, the two first-generation technologies that have found widespread clinical use starting from the late 1980s. This is followed by a broad overview of the physics, operation, properties and advantages of active matrix, flat-panel, megavoltage imagers, presently being commercially introduced to clinical environments or expected to be introduced in the future. Finally, a survey of contemporary research efforts focused on improving portal imaging performance by addressing various weaknesses in existing commercial systems is presented.

/pdf/electronic-portal-imaging-devices-a-review-and-historical-32u0ia4a2l.pdf

Electronic portal imaging devices: a review and historical perspective of contemporary technologies and research

Advances in active-matrix array flat panels for displays over the last decade have led to the development of flat-panel X-ray image detectors. Recent flat-panel detectors have shown image quality exceeding that of X-ray film/screen cassettes. They can also permit the instantaneous capture, readout, and display of digital X-ray images and, hence, enable the clinical transition to digital radiography. There are two general approaches to flat panel detector technology: 1) direct and 2) indirect conversion. The present paper outlines the operating principles for direct-conversion detectors based on the use of photoconductors. It formulates and reviews the required X-ray photoconductor properties for such applications and examines to what extent potential materials fulfill these requirements. The quantum efficiency, X-ray sensitivity, noise, and detective quantum efficiency factors are discussed with reference to current and potential large area X-ray photoconductors.

Direct-conversion flat-panel X-ray image sensors for digital radiography

Recently developed direct conversion flat-panel X-ray image detectors provide not only potentially superior images but also enable a simple and convenient means of achieving digital radiography. The present flat-panel sensors use stabilized a-Se as an X-ray photoconductor to convert absorbed X-ray photons to collectable charge carriers. The present paper outlines the basics of the direct conversion flat-panel X-ray detector, formulates and reviews the required X-ray photoconductor properties and examines to what extent stabilized amorphous selenium (a-Se) fulfills these requirements and how it compares with other potential X-ray photoconductors that have been proposed. Charge transport and the electron–hole pair creation energy in stabilized a-Se are reviewed within the context of our present knowledge. Current materials problems and future potential developments are also critically discussed.

Review X-ray photoconductors and stabilized a-Se for direct conversion digital flat-panel X-ray image-detectors

The increased beam-on times which characterize intensity-modulated radiation therapy (IMRT) could lead to an increase in the dose received by radiation therapists due to induced activity. To examine this, gamma ray spectrometry was used to identify the major isotopes responsible for activation at a representative location in the treatment room of an 18 MV accelerator (Varian Clinac 21EX). These were found to be 28Al, 56Mn, and 24Na. The decay of the dose rate measured at this location following irradiation was analyzed in terms of the known half-lives to yield saturation dose rates of 9.6, 12.4, and 6.2 microSv/h, respectively. A formalism was developed to estimate activation dose (microSv/week) due to successive patient irradiation cycles, characterized by the number of 18 MV fractions per week, F, the number of MU per fraction, M, the in-room time between fractions, td (min), and the treatment delivery time t'r (min). The results are represented by the sum of two formulas, one for the dose from 28Al 1.8 x 10(-3) F M (1-e(-03t'(r))/t'r and one for the dose from the other isotopes approximately 1.1 x 10(-6) F(1.7) Mt(d). For conventional therapy doses are about 60 microSv/week for an 18 MV workload of 60,000 MU/week. Irradiation for QA purposes can significantly increase the dose. For IMRT as currently practiced, lengthy treatment delivery times limit the number of fractions that can be delivered per week and hence limit the dose to values similar to those in conventional therapy. However for an IMRT regime designed to maximize patient throughput, doses up to 330 microSv/week could be expected. To reduce dose it is recommended that IMRT treatments should be delivered at energies lower than 18 MV, that in multienergy IMRT, high-energy treatments should be scheduled in the latter part of the day, and that equipment manufacturers should strive to minimize activation in the design of high-energy accelerators.

Dose to radiation therapists from activation at high-energy accelerators used for conventional and intensity-modulated radiation therapy.

Recently, the clinical application of electronic portal imaging devices has enabled more frequent verification of patient setup for radiation treatment. However, the image quality has sometimes proven to be inadequate, motivating the investigation of alternative sensors with better image quality. Amorphous selenium ( a -Se) is potentially one such sensor since the electrostaticimage formation process has high resolution. To fully evaluate the potential of a -Se for portal imaging, it is necessary to investigate all the imaging properties at high x-ray energies. Here, measurements of the sensitivity of a -Se to incident x-ray spectra ranging in energy from 40 kVp to 18 MV and for a -Se thicknesses ranging from ∼10 to 300 μm under full buildup conditions are described. When x rays or energetic electrons deposit energy in a photoconductor with an applied electric field, F, electrons and holes are released. The x-ray conversion sensitivity may be defined as 1/W ± , where W ± is the energy required to release an electron–hole pair. Consistent with the results of previous investigators, W ± is found to vary approximately with F −2/3 . Unexpectedly, over the energy range of 40 kVp to 18 MV, W ± was found to decrease by a factor of nearly 3. These dependencies are compared to the predictions of two competing charge recombination models, geminate and columnar. The results are explained by a microdosimetric model in which the sensitivity at megavoltage energies is governed by geminate recombination, but at lower energies, both mechanisms are involved. Thus, the sensitivity of a -Se to x rays spanning the diagnostic and radiotherapy range has been measured and the physical basis for this behavior established.

Sensitivity of amorphous selenium to x rays from 40 kVp to 18 MV: measurements and implications for portal imaging.

In fluoroscopic portal imaging systems, a metal plate is bonded to a phosphor screen and together these act as the primary x‐ray sensor. The light from the screen is collected and imaged by a lens on the target of a video camera. The demagnification (M) between the large area of the phosphor being imaged and the small active area of the video camera results in poor optical coupling between the screen and the video camera. Consequently x‐ray quantum noise is small compared to other noise sources. By reducing the demagnification, the light from the screen is collected more efficiently, so we were able to increase the x‐ray quantum noise relative to other noise sources and thus unambiguously identify it. The noise power spectrum was measured as a function of M to determine the relationship between the x‐ray quantum noise, shot noise, and amplifiernoise. It was found by extrapolation to clinical demagnifications that the amplifiernoise dominates x‐ray quantum noise at all spatial frequencies, but the shot noise was less than the x‐ray quantum noise at low spatial frequencies. For low spatial frequencies, this implies that a secondary quantum sink can be avoided. If amplifiernoise could be sufficiently reduced, x‐ray quantum limited images could be obtained in clinical systems at low spatial frequencies.

Measurement of quantum noise in fluoroscopic systems for portal imaging.

The spatial frequency dependent detective quantum efficiency (DQE(f )) of a high-resolution selenium-based imaging system has been measured at megavoltage energies. These results have been compared with theoretical calculations. The imaging system was a video tube with a 5 µm amorphous selenium (a-Se) target which was irradiated by 1.25 MeV -rays. The modulation transfer function (MTF) decreased rapidly with spatial frequency (determined by spread of electrons in the build-up material) while the noise power spectrum was constant as a function of spatial frequency. The DQE obtained from these MTF and noise power measurements was compared with a Monte Carlo model of the pulse height spectrum of the detector. The DQE(0) model accounted for the interaction of x-rays with the detector as well as the energy-dependent gain (charge generated/energy deposition). Good agreement between the calculated and measured DQE(0) was found. The model was also used to estimate the DQE(f ) of a metal plate + a-Se detector which was compared with a metal plate + phosphor system of the same mass thickness. The DQE(f )s of both detectors are very similar, indicating that the choice of which detector is better will be based upon criteria other than DQE(f ), such as read-out approach, ease of manufacture or sensitivity.

http://iopscience.iop.org/article/10.1088/0031-9155/44/5/320/pdf

J. Alan Rawlinson

Papers

Dose to radiation therapists from activation at high-energy accelerators used for conventional and intensity-modulated radiation therapy.

Sensitivity of amorphous selenium to x rays from 40 kVp to 18 MV: measurements and implications for portal imaging.

Measurement of quantum noise in fluoroscopic systems for portal imaging.

Detective quantum efficiency of an amorphous selenium detector to megavoltage radiation