S Blake

Characterization of a novel EPID designed for simultaneous imaging and dose verification in radiotherapy

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 EPIDs sensitivity was 0.37 times that of the standard EPID. Both EPIDs exhibited responses that were linear with delivered dose over a range of 1-100 monitor units. Over this range, the prototype and standard EPID central axis responses agreed to within 1.6%. Images taken with the prototype EPID were noisier than those taken with the standard EPID, with fractional uncertainties of 0.2% and 0.05% within the central 1 cm(2), respectively. For all dosimetry measurements, the prototype EPID exhibited a near water-equivalent response whereas the standard EPID did not. The CNR and spatial resolution of images taken with the standard EPID were greater than those taken with the prototype EPID. CONCLUSIONS A prototype EPID employing an array of PS fibers has been developed and the first experimental measurements are reported. The prototype EPID demonstrated a much morewater-equivalent dose response than the standard EPID. While the imaging performance of the standard EPID was superior to that of the prototype, the prototype EPID has many design characteristics that may be optimized to improve imaging performance. This investigation demonstrates the feasibility of a new detector design for simultaneous imaging and dosimetry treatment verification in radiotherapy.

Characterization of optical transport effects on EPID dosimetry using Geant4

PURPOSE Current amorphous silicon electronic portal imaging devices (a-Si EPIDs) that are frequently used in radiotherapy applications employ a metal plate/phosphor 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. Variations in optical transport parameters reported in the literature caused fluctuations in the PSF full width at half maximum (FWHM) and full width at tenth maximum (FWTM) of less than 3% and 5%, respectively, confirming model robustness. Greater deviations (up to 9.5% and 36% for FWHM and FWTM, respectively) were observed when optical parameters were largely different from reference values. When scoring energy deposition in the phosphor, measured and calculated output factors agreed within statistical uncertainties and at least 94% of the MC simulated profile data points passed 3%/3 mm γ-index criterion for all field sizes considered. Despite statistical uncertainties in optical simulations arising from computational limitations, no differences were observed between optical and energy deposition profiles. CONCLUSIONS Simulations demonstrated noticeable blurring of the EPID PSF when scoring optical absorption events in the photodiode relative to energy deposition in the phosphor. However, modeling the standard electromagnetic transport alone should suffice when using MC methods to predict EPID dose-response to static, open 6 MV fields with a standard a-Si photodiode array. Therefore, using energy deposition in the phosphor as a surrogate for EPID dose-response is a valid approach that should not require additional corrections for optical transport effects in current a-Si EPIDs employing phosphor screens.

In silico investigation of factors affecting the MV imaging performance of a novel water-equivalent EPID

PURPOSE A Geant4 model of a novel, water-equivalent electronic portal imaging device (EPID) prototype for radiotherapy imaging and dosimetry utilising an array of plastic scintillating fibres (PSFs) has been developed. Monte Carlo (MC) simulations were performed to quantify the PSF-EPID imaging performance and to investigate design aspects affecting performance for optimisation. METHODS Using the Geant4 model, the PSF-EPIDs imaging performance for 6 MV photon beams was quantified in terms of its modulation transfer function (MTF), noise power spectrum (NPS) and detective quantum efficiency (DQE). Model parameters, including fibre dimensions, optical cladding reflectivity and scintillation yield, were varied to investigate impact on imaging performance. RESULTS The MC-calculated DQE(0) for the reference PSF-EPID geometry employing 30mm fibres was approximately nine times greater than values reported for commercial EPIDs. When using 10mm long fibres, the PSF-EPID DQE(0) was still approximately three times greater than that of a commercial EPID. Increased fibre length, cladding reflectivity and scintillation yield produced the greatest decreases in NPS and increases in DQE. CONCLUSIONS The potential to develop an optimised next-generation water-equivalent EPID with MV imaging performance at least comparable to commercial EPIDs has been demonstrated. Factors most important for optimising prototype design include fibre length, cladding reflectivity and scintillation yield.

A new concept in detector design for radiation therapy: Simultaneous imaging and dosimetry for comprehensive treatment verification

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.

Monte Carlo simulation of the transit dosimetric response of an a-Si electronic portal imaging device

Amorphous silicon (a-Si) electronic portal imaging devices (EPIDs) are x-ray detectors frequently used in radiotherapy imaging and dosimetry applications. EPIDs employ a copper plate and gadolinium oxysulfide phosphor screen with an array of a-Si photodiodes to indirectly detect incident radiation. In this study, a previously developed Monte Carlo (MC) model of an a-Si EPID has been extended for transit dosimetry. The GEANT4 MC toolkit was used to integrate an a-Si EPID model with two phantoms and a 6 MV x-ray source. A solid water phantom was used to simulate EPID transmission factors, field size output factors and relative dose profiles and results were compared to experimental measurements. An anthropomorphic head phantom was used to qualitatively compare simulated and measured portal images of humanoid anatomy. Calculated transmission factors and field size output factors agreed to within 2.0% and 1.9% of experimental measurements, respectively. A comparison of calculated and measured relative dose profiles yielded >98% of points passing a gamma analysis with 3%/3 mm criterion for all field sizes. The simulated anthropomorphic head phantom image shows macroscopic anatomical features and qualitatively agrees with the measured image. Results validate the suitability of the MC model for predicting EPID response in transit dosimetry.

WE-DE-BRA-06: Evaluation of the Imaging Performance of a Novel Water-Equivalent EPID

PURPOSE To evaluate the megavoltage imaging performance of a novel, water-equivalent electronic portal imaging device (EPID) developed for simultaneous imaging and dosimetry applications in radiotherapy. METHODS A novel EPID prototype based on active matrix flat panel imager technology has been developed by our group and previously reported to exhibit a water-equivalent dose response. It was constructed by replacing all components above the photodiode detector in a standard clinical EPID (including the copper plate and phosphor screen) with a 15 × 15 cm2 array of plastic scintillator fibers. Individual fibers measured 0.5 × 0.5 × 30 mm3 . Spatial resolution was evaluated experimentally relative to that of a standard EPID with the thin slit technique to measure the modulation transfer function (MTF) for 6 MV x-ray beams. Monte Carlo (MC) EPID models were used to benchmark simulated MTFs against the measurements. The zero spatial frequency detective quantum efficiency (DQE(0)) was simulated for both EPID configurations and a preliminary optimization of the prototype was performed by evaluating DQE(0) as a function of fiber length up to 50 mm. RESULTS The MC-simulated DQE(0) for the prototype EPID configuration was ∼7 times greater than that of the standard EPID. The prototypes DQE(0) also increased approximately linearly with fiber length, from ∼1% at 5 mm length to ∼11% at 50 mm length. The standard EPID MTF was greater than the prototype EPIDs for all spatial frequencies, reflecting the trade off between x-ray detection efficiency and spatial resolution with thick scintillators. CONCLUSION This study offers promising evidence that a water-equivalent EPID previously demonstrated for radiotherapy dosimetry may also be used for radiotherapy imaging applications. Future studies on optimising the detector design will be performed to develop a next-generation prototype that offers improved megavoltage imaging performance, with the aim to at least match that of current clinical EPIDs. Funding for this project was provided by an Australian Research Council Linkage Project grant (2015) between The University of Sydney, South Western Sydney Local Health District and Perkin-Elmer Pty Ltd.

A high DQE water‐equivalent EPID employing an array of plastic‐scintillating fibers for simultaneous imaging and dosimetry in radiotherapy

PURPOSE First measurements of the imaging performance of a novel prototype water-equivalent electronic portal imaging device (EPID) designed for simultaneous imaging and dose verification in radiotherapy and previously characterized by our group for dosimetry are reported. Experiments were conducted to characterize the prototypes imaging performance relative to a standard commercial EPID and Monte Carlo (MC) simulations were performed to quantify the impact of several detector parameters on image quality and to inform the design of a proposed next-generation prototype. METHODS The prototype EPID utilizes an array of 3 cm long plastic-scintillating fibers in place of the metal plate/phosphor screen in standard EPIDs. Using a clinical 6 MV photon beam, the prototypes modulation transfer function (MTF), noise power spectrum (NPS), and detective quantum efficiency (DQE) were measured and compared to measurements taken using a standard commercial EPID. A sensitivity analysis was then performed using the MC model by quantifying these metrics while varying the values of several geometrical and optical transport parameters that were unspecified by the prototype manufacturer. Finally, the MC model was used to quantify the imaging performance of a proposed next-generation prototype incorporating 1.5 cm long fibers that is better suited for integration with clinical portal imaging and dosimetry systems. RESULTS The prototype EPIDs zero spatial frequency DQE exceeded 3%, more than doubling that measured with the standard EPID (1.25%). This increased DQE was a consequence of using a prototype array detector with a greater equivalent thickness than the combined copper plate and phosphor screen in a standard EPID. The increased thickness of our prototype decreased spatial resolution relative to the standard EPID; however, the prototype EPID NPS was also lower than that measured with the standard EPID across all spatial frequencies. The sensitivity analysis demonstrated that the NPS was strongly affected by the roughness of the boundaries between fiber core and cladding regions. By comparison, the MTF was most sensitive to beam divergence and the presence of air between the fiber array and underlying photodiode panel. Simulations demonstrated that by optimizing these parameters, DQE(0) >4% may be achievable with the proposed next-generation prototype design. CONCLUSIONS The first measurements characterizing the imaging performance of a novel water-equivalent EPID for imaging and dosimetry in radiotherapy demonstrated a DQE(0) more than double that of a standard EPID. MC simulations further demonstrated the potential for developing a next-generation prototype better suited for clinical translation with even higher DQE.

Light output enhancement for a plastic scintillator using nanofibers

Electronic portal imaging devices (EPIDs) are x-ray detector systems conventionally used for medical imaging applications in cancer radiotherapy. Our group has developed a novel prototype EPID with the unique capability of performing both imaging and dose measurements. Our prototype utilizes an array of plastic scintillating fibers in place of the standard copper and gadolinium dioxysulfide phosphor components1. While our prototype EPID exhibits a detective quantum efficiency that exceeds that of commercial products, there is further scope for improvement. In particular, there is scope to improve optical coupling between the scintillating fiber array and the underlying photodetector where currently an air gap exists. Here, we investigate the effect of a layer of polystyrene nanofibers placed at the end interface of the scintillator array on light extraction efficiency using finite element modelling. We demonstrate that the total light extraction, which depends on the polarization of the incident light, can be enhanced by up to 14%. This enhancement stems from two effects: Bragg diffraction arising from the periodic arrangement of the fibers and Whispering Gallery Modes (WGMs) formed at each fiber’s cross-section due to Mie resonances. We show that the nanofibers increase optical transmittance above the critical angle. Moreover, we demonstrate that the light extraction efficiency strongly depends on the polarization of the incident light (s- and p-polarizations), as well as the diameter and periodicity of the nanofibers.

SU-D-201-01: A Multi-Institutional Study Quantifying the Impact of Simulated Linear Accelerator VMAT Errors for Nasopharynx.

PURPOSE To quantify the impact of differing magnitudes of simulated linear accelerator errors on the dose to the target volume and organs at risk for nasopharynx VMAT. METHODS Ten nasopharynx cancer patients were retrospectively replanned twice with one full arc VMAT by two institutions. Treatment uncertainties (gantry angle and collimator in degrees, MLC field size and MLC shifts in mm) were introduced into these plans at increments of 5,2,1,-1,-2 and -5. This was completed using an in-house Python script within Pinnacle3 and analysed using 3DVH and MatLab. The mean and maximum dose were calculated for the Planning Target Volume (PTV1), parotids, brainstem, and spinal cord and then compared to the original baseline plan. The D1cc was also calculated for the spinal cord and brainstem. Patient average results were compared across institutions. RESULTS Introduced gantry angle errors had the smallest effect of dose, no tolerances were exceeded for one institution, and the second institutions VMAT plans were only exceeded for gantry angle of ±5° affecting different sided parotids by 14-18%. PTV1, brainstem and spinal cord tolerances were exceeded for collimator angles of ±5 degrees, MLC shifts and MLC field sizes of ±1 and beyond, at the first institution. At the second institution, sensitivity to errors was marginally higher for some errors including the collimator error producing doses exceeding tolerances above ±2 degrees, and marginally lower with tolerances exceeded above MLC shifts of ±2. The largest differences occur with MLC field sizes, with both institutions reporting exceeded tolerances, for all introduced errors (±1 and beyond). CONCLUSION The plan robustness for VMAT nasopharynx plans has been demonstrated. Gantry errors have the least impact on patient doses, however MLC field sizes exceed tolerances even with relatively low introduced errors and also produce the largest errors. This was consistent across both departments. The authors acknowledge funding support from the NSW Cancer Council.

SU-F-T-384: Step and Shoot IMRT, VMAT and Autoplan VMAT Nasopharnyx Plan Robustness to Linear Accelerator Delivery Errors

PURPOSE To identify the robustness of different treatment techniques in respect to simulated linac errors on the dose distribution to the target volume and organs at risk for step and shoot IMRT (ssIMRT), VMAT and Autoplan generated VMAT nasopharynx plans. METHODS A nasopharynx patient dataset was retrospectively replanned with three different techniques: 7 beam ssIMRT, one arc manual generated VMAT and one arc automatically generated VMAT. Treatment simulated uncertainties: gantry, collimator, MLC field size and MLC shifts, were introduced into these plans at increments of 5,2,1,-1,-2 and -5 (degrees or mm) and recalculated in Pinnacle. The mean and maximum doses were calculated for the high dose PTV, parotids, brainstem, and spinal cord and then compared to the original baseline plan. RESULTS Simulated gantry angle errors have <1% effect on the PTV, ssIMRT is most sensitive. The small collimator errors (±1 and ±2 degrees) impacted the mean PTV dose by <2% for all techniques, however for the ±5 degree errors mean target varied by up to 7% for the Autoplan VMAT and 10% for the max dose to the spinal cord and brain stem, seen in all techniques. The simulated MLC shifts introduced the largest errors for the Autoplan VMAT, with the larger MLC modulation presumably being the cause. The most critical error observed, was the MLC field size error, where even small errors of 1 mm, caused significant changes to both the PTV and the OAR. The ssIMRT is the least sensitive and the Autoplan the most sensitive, with target errors of up to 20% over and under dosages observed. CONCLUSION For a nasopharynx patient the plan robustness observed is highest for the ssIMRT plan and lowest for the Autoplan generated VMAT plan. This could be caused by the more complex MLC modulation seen for the VMAT plans. This project is supported by a grant from NSW Cancer Council.