Characterization of a Varian aS1000 EPID Courtney Buckey Diagnostic Imaging 2, Spring 2010 Based on work completed with Xiaoming

oming Chen PhD and published work by Menon and Sloboda [3] Introduction Portal images are taken to verify patient set-up and positioning prior to radiation therapy treatment. Historically these were taken using film, but this method has gradually been phased out in favor of using an electronic portal imaging device (EPID). The newest linear accelerator at the CTRC in San Antonio, Texas is a Varian Novalis Tx, which is equipped with an amorphous silicon based EPID, the aS1000. The advantages of using an EPID for portal dosimetry are great. The verification is faster than with film, and the image can be stored and manipulated later. Physicians can check set-ups without having to come to the treatment room each time an image is taken, and the ability to adjust image display parameters such as window and level means that more images are acceptable the first time, eliminating the dose to the patient from subsequent radiographs. Recently the role of EPIDs has been expanded beyond patient imaging, to become a useful tool for radiotherapy dosimetry and periodic .[1] In the United States, almost all new linear accelerators and an increasing majority of presently installed linear accelerators are equipped with EPIDs. Because of this, interest in using the EPID for dosimetry and other potential clinical applications such as in adaptive radiotherapy is high.[1] Compared to conventional quality assurance (QA) methods which require separate QA equipment, EPIDs have the potential to reduce costs and provide additional conveniences including reducing setup time for a QA procedure. In a study presently underway at the CTRC, an integrated EPID-based mechanical QA system is being developed, which aims to replace the conventional device-dependent methods for daily/monthly QA tasks. The framework of the system for some basic QA tasks, such as beam flatness and symmetry, and isocenter verification, have been presented and discussed at national and international meetings including AAPM and ICCR. While all of the possible uses of EPIDs are important, they are only as good as the measuring device itself. In light of that, this investigation will report on the contrast resolution, image quality, relative modulation transfer function, critical frequency and contrast-to-noise ratio obtained for this EPID. Background The Varian aS1000 (PortalVision, Varian Medical Systems, Palo Alto, CA) is an amorphous silicon flat panel imaging device mounted on a robotic arm. This arm allows it to be positioned at source to EPID (SED) distances from 95 cm to 180 cm. (Figure 1) It has an active imaging area of 40 x 30 cm2 (at an SSD of 105 cm). The image matrix is created from an array of 1024 x 768 pixels. The maximum frame acquisition rate is 9.574 frames/second, the permitted dose range is 4-25 MV, and the permitted dose rates are 50-600 MU/min.[2] The detector has four main components. Inside the exterior plastic housing there is a Copper build-up plate, 1 mm in thickness. This is useful in MV imaging to absorb x-ray photons and emit recoil

electrons. It also helps to improve the efficiency of the entire imaging system, by partially shielding the downstream components (including the scintillation screen) from scattered radiation. Underneath this plate lies the phosphor screen. In this EPID it is a Kodak Lanex Fast B scintillating screen, made up of a 0.4mm thick Gadolinium Oxysulfide (Gd2O2S:Tb) phosphor. This component absorbs the recoil electrons coming from the Copper plate, and transforms them into visible light. Below the phosphor, there is a 1024 x 768 pixel matrix, deposited on a 1 mm glass substrate. This constitutes the sensitive image forming layer of the photodiode system, and it is 1.5 m thick. Each pixel consists of a Si n-i-photodiode to integrate the incoming light in charge captures and a thin film transistor (TFT) to act as a three- terminal switch for readout.
Figure 1: Image of the aS1000 attached to a Varian linear accelerator. Minimum and maximum positions are denoted by the horizontal red lines. Modified, from [2].

The final major component is the accessory electronics, which drive the TFT switches and read out the charge captures. The gate driver powers the gate lines during the time that the data lines are feeding the accumulated charge to the read-out electronics. When a voltage is applied to a gate-line, all of the TFTs in that row become transparent and the charge is then transferred to the data lines. Each row is read out in succession, and as one row is read the TFTs in the next row become transparent. External charge sensitive amplifiers capture the charge data. To form one frame of an image, a sequential readout of all of the rows is necessary. A side view of the EPID components can be seen in Figure 2a. Figure 2b shows a simplified schematic of the electronics.


Figure 2: a) A cross sectional view of the Varian aS1000. Modified, from [2]. b) A simplified schematic of the electronics in the Varian aS1000. From [3].

Measurements Before each set of EPID images is acquired is it advisable to first calibrate the detector. This can be accomplished by obtaining a dark field and delivering a flood field. The premise is that taking these images will allow for the elimination of background noise and provide a uniform response for imaging. Specifically, the dark field image provides information about background noise, and is obtained by reading out each pixel in the absence of radiation. The resulting image, seen in Figure 3, is a series of narrow vertical stripes, which result from the photodiode leakage current and varying electrometer offsets. The flood field image, on the other hand, is taken with the entire matrix exposed to a uniform dose. This allows the PortalVision software to internally correct for individual pixel sensitivities. A sample flood field image can be seen in Figure 4. There is much to say about the acquisition and use of these images inside the PortalVision software package. However, because the software forces you to take these images before it will allow you to acquire your desired phantom or patient images, we accept that they are necessary and invariable, and choose to end our discussion of them here.
Figure 3: Image of a dark field taken with the Varian aS1000.


Figure 4: Image of a flood field, using 6MV photons, taken with the Varian aS1000.

Contrast Resolution Contrast resolution is a measure of how well an object can be distinguished from its background. It can be defined using the following equation: where Io is the intensity of the object and Ib is the intensity of the background. Two different contrast detail phantoms were used in this investigation. One is supplied with the Varian imaging system; the other was made by a competing company (TheraView Inc., Exton, PA) for use with their own EPIDs. Photographs of the phantoms can be seen in Figures 5 and 6. The EPID was set to 100 cm SED, and each the phantom was placed directly on top of the plastic housing. Images were taken using both the 6 MV and 10 MV photon energies available on the Novalis Tx. Samples of these images can be seen in Figures 7 and 8. The object contrast, found using the above equation can be seen in Table 1. For the monthly EPID quality assurance checks carried out at CTRC, the number of holes in each column visible to the naked eye are reported. Instead of reporting this as a table, a contrast-detail curve was created for each energy and is shown in Figure 9.


Figure 5: The contrast detail phantom provided by Varian. The 140 140 21.75-mm3 aluminum phantom has holes of depths 0.25, 0.50, 1.0, 2.0, and 3.0 mm arranged in 5 rows. The holes in each column have diameters of 1, 2, 4, 7, 10, and 15 mm, respectively.

Figure 6: The contrast detail phantom provided by TheraView. The 126 220 8-mm3 aluminum phantom has holes of depths 4.572, 3.175, 2.286, 1.651, 1.143, 0.762, 0.508, 0.3556, 0.254 and 0.1778 mm arranged in ten columns. The holes in each column have diameters of 1.270, 1.013, 0.721, 0.532, 0.465, 0.395, 0.275, 0.240, 0.172 and 0.086 mm, respectively


Figure 7: Image of the Varian contrast detail phantom, using 6 MV photons, taken with the Varian aS1000.

Figure 8: Image of the TheraView contrast detail phantom, using 6MV photons, taken with the Varian aS1000.


Table 1: Object contrast for the Varian aS1000 EPID. The contrast for the 0.178 mm hole using 10 MV photons could not be determined.

TheraView Phantom Object Hole Depth (mm) Contrast % 6 MV 10 MV 4.572 4.266 3.422 3.175 3.780 3.599 2.286 2.908 3.578 1.651 2.379 3.499 1.143 2.113 3.412 0.762 1.877 3.179 0.508 1.807 2.786 0.356 1.991 2.138 0.254 1.795 1.140 0.178 0.695 Varian Phantom Object Hole Depth (mm) Contrast % 6 MV 10 MV 3.00 1.921 1.960 2.00 1.420 1.348 1.00 0.867 0.560 0.50 0.245 0.221 0.25 0.290 0.066

Figure 9: Contrast detail curve using both energies, and both phantoms, for the Varian aS1000.

Image Quality Image quality was assessed using a QC-3 phantom (Standard Imaging, Middleton, WI) and the PIPSpro Software (Standard Imaging, Middleton, WI). The rectangular phantom has dimensions of 13.5 11.3 3.6 cm3 and is comprised of an aluminum and an acrylic slab, each 1.8-cm thick, bonded together. The aluminum slab contains 5 sets of high-contrast rectangular bars made of lead and Delrin plastic having spatial frequencies of 0.1, 0.2, 0.25, 0.4, and 0.75 lp/mm. The central 3 bar patterns are surrounded by 6 uniform regions of lead, aluminum, and plastic of different thicknesses. A photograph of the phantom is shown in Figure 10.
Figure 10: Image of the QC-3 phantom from Standard Imaging.

The phantom was placed a respect to the long axis of the treatment couch, to prevent aliasing. The EPID was set to 100 cm SED, and the phantom was placed directly on top of the plastic housing. Images were taken using both the 6 MV and 10 MV photon energies available on the Novalis Tx. Relative Modulation Transfer Function (RMTF) Typically, the MTF of an imaging system is taken to be the ratio of output to input modulation at varying spatial frequencies. RMTF is a similar measure, but renormalized by dividing each MTF value by the MTF of the lowest frequency measured. For the QC-3 phantom, the lowest frequency is 0.1 lp/mm. Using the following equation, the RMTFs of the phantom were determined for both 6 MV and 10 MV, and they are plotted in Figure 11:


Figure 11: RMTF curves, created using the PIPSpro Software. The 6 MV curve is on the left, and the 10 MV curve is on the right.

Critical Frequency (f50) Critical frequency is defined as the spatial resolution corresponding to 50% RMTF. This value is obtained using a piecewise linear interpolation of the RMTF graph shown in Figure 10, to locate the 50% relative frequency response. The critical frequency value for the 6 MV image was 0.420. The critical frequency value for the 10 MV image was 0.356. It makes sense that the spatial resolution is degraded for the 10 MV beam, as compared to the 6 MV beam, because as energy is increased, penumbral broadening caused by increased lateral scatter increases, forcing more high-energy photons through the bar patterns.[4,5] Contrast-to-Noise Ratio A high quality image typically has a large CNR. This can be manipulated by increasing the contrast, decreasing the noise, or a combination of both. CNR is defined by the following equation: where Pbright is the average pixel value in the areas receiving the least radiation, Pdark is the average pixel value in the areas receiving the most radiation dose, and Noise represents the average noise value calculated from the uniformly irradiated regions. The CNR value for the 6 MV image was 3.539. The CNR value for the 10 MV image was 6.434. Conclusion Unfortunately there is not a lot of published information regarding the Varian aS1000 EPID, making it difficult to compare these results. Its predecessor, the aS500 is discussed in a significant amount of publications which reference its reliability and characteristics. The data seem reasonable when anecdotally compared with the aS500, and are self-consistent in that the higher energy deliveries give worse imaging results. As the main portion of this project continues, we anticipate measuring these values (using these same techniques) on a daily basis to evaluate variation in EPID response.

References [1] van Elmpt W, McDermott L, Nijsten S, et al. 2008. A literature review of electronic portal imaging for radiotherapy dosimetry. Radiotherapy and Oncology 88: 289-309. [2] Matsumoto, Okumura, Asai, et al. 2008. Dosimetric Properties of an Amorphous Silicon Electric Portal Imaging Device for Verification of Dynamic IMRT. ASTRO Powerpoint Presentation. Retrieved from: http://astro2008.abstractsnet.com/handouts/501011_2008_ASTRO.ppt [3] Menon, Sloboda. 2004. Quality Assurance Measurements of a-Si EPID Performance. Medical Dosimetry 29: 11-17. [4] Rajapakshe, Luchka, et al. 1996. A quality control test tool for electronic portal imaging devices. Medical Physics 23: 1237-44. [5] Drogee. 1983. A practical method to routinely monitor resolution in digital images. Medical Physics 10: 37-43.