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In this work, a dual detector system for simultaneous in-vivo dosimetry and MV imaging was investigated. The ability to measure real-time water equivalent dose post transit for a heterogeneous phantom was demonstrated, illustrating its advantage over non-water equivalent EPID dosimetry. Identification of incorrect MU delivery as well as patient misalignment can be identified in the dose profiles and confirmed through co-registration with EPID images. The dual detector comprising of a silicon array detector "Magic Plate" (MP) and an EPID was positioned beneath the patient couch at a source to detector distance of 150 cm. Two pseudo lung phantoms were utilised in this study; identical, except for the inclusion of a water equivalent hidden target mimicking a tumour. The dosimetric accuracy of the MP was evaluated with EBT3 film and TPS calculations. The presence and position of the hidden target was detected and accurately co-registered between the dose profiles measured with MP and the EPID image. The system measured a difference in post transit doses through the two phantoms of (5.0 ±1.6) cGy due to the presence of the target, in agreement with the TPS calculation of 5.16 cGy. The capability of the system for error detection was confirmed when a deliberate 7 mm lateral shift of the phantom was observed in both the dose profiles measured with MP and the EPID images. The MP as a dosimetric real time detector is lucent in MV photon fields and does not obstruct the EPID field of view.

In this paper the sensitivity of an Electronic Portal Imaging Device (EPID) to detecting introduced Volumetric Arc Therapy (VMAT) treatment errors was studied using the Collapsed Arc method. Two clinical Head and Neck (H& N) and Prostate treatment plans had gantry dependent dose and MLC errors introduced to the plans. These plans were then delivered to an Elekta Synergy Linear Accelerator EPID and compared to the original treatment planning system Collapsed Arc dose matrix. With the Collapsed Arc technique the EPID was able to detect MLC errors down to 2mm and dose errors of down to 3% depending on the treatment plan complexity and gamma tolerance used.

Purpose: To test the feasibility of a dual detector concept for comprehensive verification of external beam radiotherapy. Specifically, the authors test the hypothesis that a portal imaging device coupled to a 2D dosimeter provides a system capable of simultaneous imaging and dose verification, and that the presence of each device does not significantly detract from the performance of the other. Methods: The dual detector configuration comprised of a standard radiotherapy electronic portal imaging device (EPID) positioned directly on top of an ionization-chamber array (ICA) with 2 cm solid water buildup material (between EPID and ICA) and 5 cm solid backscatter material. The dose response characteristics of the ICA and the imaging performance of the EPID in the dual detector configuration were compared to the performance in their respective reference clinical configurations. The reference clinical configurations were 6 cm solid water buildup material, an ICA, and 5 cm solid water backscatter material as the reference dosimetry configuration, and an EPID with no additional buildup or solid backscatter material as the reference imaging configuration. The dose response of the ICA was evaluated by measuring the detectors response with respect to off-axis position, field size, and transit object thickness. Clinical dosimetry performance was evaluated by measuring a range of clinical intensity-modulated radiation therapy (IMRT) beams in transit and nontransit geometries. The imaging performance of the EPID was evaluated quantitatively by measuring the contrast-to-noise ratio (CNR) and spatial resolution. Images of an anthropomorphic phantom were also used for qualitative assessment. Results: The measured off-axis and field size response with the ICA in both transit and nontransit geometries for both dual detector configuration and reference dosimetry configuration agreed to within 1%. Transit dose response as a function of object thickness agreed to within 0.5%. All IMRT

3D Gamma index is one of the metrics which have been widely used for clinical routine patient specific quality assurance for IMRT, Tomotherapy and VMAT. The algorithms for calculating the 3D Gamma index using global and local methods implemented in two software tools: PTW-VeriSoft (R) r as a part of OCTIVIUS 4D dosimeter systems and 3DVH (TM) from Sun Nuclear were assessed. The Gamma index calculated by the two systems was compared with manual calculated for one data set. The Gamma pass rate calculated by the two systems was compared using 3%/3mm, 2%/2mm, 3%/2mm and 2%/3mm for two additional data sets. The Gamma indexes calculated by the two systems were accurate, but Gamma pass rates calculated by the two software tools for same data set with the same dose threshold were different due to the different interpolation of raw dose data by the two systems and different implementation of Gamma index calculation and other modules in the two software tools. The mean difference was -1.3%+/-3.38 (1SD) with a maximum difference of 11.7%.

Delivery quality assurance (DQA) has been performed for each Tomotherapy patient either using ArcCHECK or MatriXX Evolution in our clinic since 2012. ArcCHECK is a quasi-3D dosimeter whereas MatriXX is a 2D detector. A review of DQA results was performed for all patients in the last three years, a total of 221 DQA plans. These DQA plans came from 215 patients with a variety of treatment sites including head-neck, pelvis, and chest wall. The acceptable Gamma pass rate in our clinic is over 95% using 3mm and 3% of maximum planned dose with 10% dose threshold. The mean value and standard deviation of Gamma pass rates were 98.2% +/- 1.98(1SD) for MatriXX and 98.5%+/- 1.88 (1SD) for ArcCHECK. A paired t-test was also performed for the groups of patients whose DQA was performed with both the ArcCHECK and MatriXX. No statistical dependence was found in terms of the Gamma pass rate for ArcCHECK and MatriXX. The considered 3D and 2D dosimeters have achieved similar results in performing routine patient-specific DQA for patients treated on a TomoTherapy unit.

The purpose of this study was to investigate the dose response of amorphous silicon (a-Si) electronic portal imaging devices (EPIDs) under different acquisition settings for both open jaw defined fields and segmented intensity-modulated radiation therapy (IMRT) fields. Four different EPIDs were used. Two Siemens and one Elekta plus a standalone Perkin Elmer research EPID. Each was operated with different acquisition systems and settings. Dose response linearity was measured for open static jaw defined fields and 'simple' segmented IMRT fields for a range of equipment and system settings. Six 'simple' segmented IMRT fields were used. The segments of each IMRT field were fixed at 10 x 10 cm 2 field size with equal MU per segment, each field having a total of 20 MU. Simultaneous measurements with an ionization chamber array (ICA) and EPID were performed to separate beam and detector response characteristics. Three different pixel calibration methods were demonstrated and compared for an example 'clinical IMRT field'. The dose response with the Elekta EPID for 'simple' segmented IMRT fields versus static fields agreed to within 2.5% for monitor unit (MU) ≥ 2. The dose response for the Siemens systems was difficult to interpret due to the poor reproducibility for segmented delivery, at MU ≤ 5, which was not observed with the standalone research EPID nor ICA on the same machine. The dose response measured under different acquisition settings and different linac/EPID combinations matched closely (≤ 1%), except for the Siemens EPID. Clinical IMRT EPID dosimetry implemented with the different pixel-to-dose calibration methods indicated that calibration at 20 MU provides equivalent results to implementing a ghosting correction model. The nonlinear dose response was consistent across both clinical EPIDs and the standalone research EPID, with the exception of the poor reproducibility seen with Siemens EPID images of IMRT fields. The nonlinear dose response was relatively insens

Digitally reconstructed radiographs (DRRs) play a vital role for verifying patient position for many radiotherapy treatments. As DRRs are generated from CT scans, image quality may be affected by the scanning mode (axial or helical). The aim of this study was to investigate the high and low contrast resolution and the spatial linearity in DRRs as a function of CT scanning mode and to highlight the significance of this variation, if any. A commercial CT phantom (Fluke Biomedical Model 76-417) was scanned with a Siemens Somatom Sensation 4 CT scanner using six variations of field of view, scanning mode and helical pitch. The image quality of the DRR's produced from the scans was evaluated in terms of high contrast resolution using the modulation transfer function, low contrast resolution using Image Quality Score method and spatial linearity. The results indicated that the high contrast resolution for the axial mode was comparable to that for the helical modes. The low contrast resolution with axial scanning was comparable to scans performed with a helical pitch of 1 but deteriorated at pitches greater than 1. The field of view was not found to impact the low contrast resolution. When changing scanning parameters the impact on DRR quality should be considered. For DRRs, particularly where visualisation of low contrast structures is desired, a helical scan with a pitch of 1 is recommended.

Development of a software tool to ease the Intensity Modulated Radiation Therapy (IMRT) pre-treatment Quality Assurance process is presented in this study. The delivery of IMRT involves equipment from multiple vendors. The limitations of the equipment involved in this chain will impact on the best choice of equipment. This often results in the user needing to use multiple pieces of equipment before determining the most appropriate choices to optimise the QA work flow. This is a time consuming process and potentially delays the start of patient treatment. Software was developed in-house to assist the decision making process, validating deliverability of beam delivery parameters and selecting appropriate detector systems and configuration for QA of IMRT plans. The software has been demonstrated to be accurate and improves efficiency of IMRT pre-treatment QA.

Two clinical intensity modulated radiotherapy plans were selected. Eleven plan variations were created with systematic errors introduced: Multi-Leaf Collimator (MLC) positional errors with all leaf pairs shifted in the same or the opposite direction, and collimator rotation offsets. Plans were measured using an Electronic Portal Imaging Device (EPID) and an ionisation chamber array. The plans were evaluated using gamma analysis with different criteria. The gamma pass rates remained around 95% or higher for most cases with MLC positional errors of 1 mm and 2 mm with 3%/3mm criteria. The ability of both devices to detect delivery errors was similar.

To perform a comparative study assessing potential benefits of endorectal-balloons (ERB) in post-prostatectomy patients. Ten retrospective post-prostatectomy patients treated without ERB and ten prospective patients treated with the ERB in situ were recruited. All patients received IMRT and IGRT using kilovoltage cone-beam computed tomography (kVCBCT). kVCBCT datasets were registered to the planning dataset, recontoured and the original plan recalculated on the kVCBCTs to recreate anatomical conditions during treatment. The imaging, structure and dose data were imported into in-house software for the assessment of geometric variation and cumulative equivalent uniform dose (EUD) in the two groups. The difference in location (DCOV) for the bladder between planning and each CBCT was similar for each group. The use of ERBs in the post-prostatectomy setting did improve geometric reproducibility of the target and surrounding normal tissues, however no improvement in dosimetric stability was observed for the margins employed.

Purpose: Current amorphous silicon electronic portal imaging devices (a-Si EPIDs) that are frequently used in radiotherapy applications employ a metal platephosphor screen configuration to optimize x-ray detection efficiency. The phosphor acts to convert x rays into an optical signal that is detected by an underlying photodiode array. The dosimetric response of EPIDs has been well characterized, in part through the development of computational models. Such models, however, have generally made simplifying assumptions with regards to the transport of optical photons within these detectors. The goal of this work was to develop and experimentally validate a new Monte Carlo (MC) model of an a-Si EPID that simulates both x-ray and optical photon transport in a self-contained manner. Using this model the authors establish a definitive characterization of the effects of optical transport on the dosimetric response of a-Si EPIDs employing gadolinium oxysulfide phosphor screens. Methods: The Geant4 MC toolkit was used to develop a model of an a-Si EPID that employs standard electromagnetic and optical physics classes. The sensitivity of EPID response to uncertainties in optical transport parameters was evaluated by investigating their effects on the EPID point spread function (PSF). An optical blur kernel was also calculated to isolate the component of the PSF resulting purely from optical transport. A 6 MV photon source model was developed and integrated into the MC model to investigate EPID dosimetric response. Field size output factors and relative dose profiles were calculated for a set of open fields by separately scoring energy deposited in the phosphor and optical absorption events in the photodiode. These were then compared to quantify effects resulting from optical photon transport. The EPID model was validated against experimental measurements taken using a research EPID. Results: Optical photon scatter within the phosphor screen noticeably broadened the PSF. Variat

Purpose: Standard amorphous silicon electronic portal imaging devices (a-Si EPIDs) are x-ray imagers used frequently in radiotherapy that indirectly detect incident x-rays using a metal plate and phosphor screen. These detectors may also be used as two-dimensional dosimeters; however, they have a well-characterized nonwater-equivalent dosimetric response. Plastic scintillating (PS) fibers, on the other hand, have been shown to respond in a water-equivalent manner to x-rays in the energy range typically encountered during radiotherapy. In this study, the authors report on the first experimental measurements taken with a novel prototype PS a-Si EPID developed for the purpose of performing simultaneous imaging and dosimetry in radiotherapy. This prototype employs an array of PS fibers in place of the standard metal plate and phosphor screen. The imaging performance and dosimetric response of the prototype EPID were evaluated experimentally and compared to that of the standard EPID. Methods: Clinical 6 MV photon beams were used to first measure the detector sensitivity, linearity of dose response, and pixel noise characteristics of the prototype and standard EPIDs. Second, the dosimetric response of each EPID was evaluated relative to a reference water-equivalent dosimeter by measuring the off-axis and field size response in a nontransit configuration, along with the off-axis, field size, and transmission response in a transit configuration using solid water blocks. Finally, the imaging performance of the prototype and standard EPIDs was evaluated quantitatively by using an image quality phantom to measure the contrast to noise ratio (CNR) and spatial resolution of images acquired with each detector, and qualitatively by using an anthropomorphic phantom to acquire images representative of human anatomy. Results: The prototype EPID's sensitivity was 0.37 times that of the standard EPID. Both EPIDs exhibited responses that were linear with delivered dose over a range of 1

Radiation therapy treatment verification is currently limited to image-guided radiotherapy to verify patient and target location. There is no widely available method for direct verification of the delivered dose. Imaging has been widely implemented with amorphous silicon (a-Si) flat panel imagers. a- Si imagers can also be used to verify dose delivered to the patient, but current detector designs are problematic for dosimetry. Our group is investigating new detector designs optimized for simultaneous imaging and dosimetry. Detector specifications for megavoltage radiographic imaging and radiation dosimetry are in some respects contradictory to each other, presenting a significant technical challenge for detector design. The first generation of our prototype detectors consist of plastic scintillator fiber arrays interfaced directly onto a-Si imagers. Experimental and modeling studies are being conducted to optimize this design and determine the feasibility. Results to-date demonstrate excellent dosimetry and promising imaging performance, with significant potential for improvement. Ongoing detector developments are focused on improving detective quantum efficiency for imaging performance. We have demonstrated the feasibility of the plastic scintillator based detector and continue to optimize the design to develop a detector for comprehensive radiation therapy treatment verification.

Current electronic portal imaging devices (EPIDs) are generally used for megavoltage imaging in radiotherapy and employ a thin Cu plate/phosphor screen to convert x-ray energies into optical photons . In order to achieve a high spatial resolution, thin screens are used which subsequently results in low x-ray absorption and thus a low detective quantum efficiency (DQE) for megavoltage x-rays. Additionally, the high atomic number Cu/phosphor screen materials is not ideal for dosimetric applications. To improve the imaging and dosimetry dual-functionality of EPIDs, water equivalent plastic scintillators have been proposed. Plastic scintillator fibers may however be susceptible to radiation damage caused primarily by ionizations from low energy secondary electrons. An accumulation or clustering of these ionization events, within regions corresponding to the volume of the plastic polymer chains, may lead to chain breaks. This could result in changes to the optical photon absorption properties and optical yield of the fiber, affecting the overall imaging performance of the detector. Here we used Monte Carlo radiation transport simulations for a preliminary investigation into the distribution of ionizations within a single plastic fiber. We find a large number of ionization events can accumulate along the fiber length, which over repeated exposures could lead to damage. To determine the effect of damage on the imaging performance, two fiber arrays were modeled with and without areas of damage. The damaged fiber array was found to produce approximately half the number of counts as the undamaged array.