• Radiation Oncology Journal
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• v.17 no.3
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• pp.249-255
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• 1999

Purpose : The purpose of this study is to investigate fundamental aspects of the dose response of fluorescent screen-based electronic portal imaging devices (EPIDS). Materials and Methods : We acquired scanned signal across portal planes as we varied the radiation that entered the EPID by changing the thickness and anatomy of the phantom as well as the air gap between the phantom and the EPID. In addition, we simulated the relative contribution of the scintillation light signal in the EPID system. Results : We have shown that the dose profile across portal planes is a function of the air gap and phantom thickness. We have also found that depending on the density change within the phantom geometry, errors associated with dose response based on the EPID scan can be as high as $7\%$. We also found that scintillation light scattering within the EPID system is an important source of error. Conclusion : This study revealed and demonstrated fundamental characteristics of dose response of EPID, as relative to that of ion chambers. This study showed that EPID based on fluorescent screen cannot be an accurate dosimetry system.

• The Journal of Korean Society for Radiation Therapy
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• v.35
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• pp.15-21
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• 2023

Purpose: The purpose of this study is to compare the performance of the anisotropic analytical algorithm (AAA) and portal dose image prediction (PDIP) for patient-specific quality assurance based on electronic portal imaging device, and to evaluate the clinical feasibility of portal dosimetry using AAA. Subjects and methods: We retrospectively selected a total of 32 patients, including 15 lung cancer patients and 17 liver cancer patients. Verification plans were generated using PDIP and AAA. We obtained gamma passing rates by comparing the calculated distribution with the measured distribution and obtained MLC positional difference values. Results: The mean gamma passing rate for lung cancer patients was 99.5% ± 1.1% for 3%/3 mm using PDIP and 90.6% ± 5.8% for 1%/1 mm. Using AAA, the mean gamma passing rate was 98.9% ± 1.7% for 3%/3 mm and 87.8% ± 5.2% for 1%/1 mm. The mean gamma passing rate for liver cancer patients was 99.9% ± 0.3% for 3%/3 mm using PDIP and 96.6% ± 4.6% for 1%/1 mm. Using AAA, the mean gamma passing rate was 99.6% ± 0.5% for 3%/3 mm and 89.5% ± 6.4% for 1%/1 mm. The MLC positional difference was small at 0.013 mm ± 0.002 mm and showed no correlation with the gamma passing rate. Conclusion: The AAA algorithm can be clinically used as a portal dosimetry calculation algorithm for patientspecific quality assurance based on electronic portal imaging device.

• Progress in Medical Physics
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• v.28 no.2
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• pp.54-60
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• 2017

This study was designed to measure transit dose with an electronic portal imaging device (EPID) in eight patients treated with intensity modulated radiotherapy (IMRT), and to verify the accuracy of dose delivery to patients. The calculated dose map of the treatment planning system (TPS) was compared with the EPID based dose measured on the same plane with a gamma index method. The plan for each patient was verified prior to treatment with a diode array (MapCHECK) and portal dose image prediction (PDIP). To simulate possible patient positioning errors during treatment, outcomes were evaluated after an anthropomorphic phantom was displaced 5 and 10 mm in various directions. Based on 3%/3 mm criteria, the $mean{\pm}SD$ passing rates of MapCHECK, PDIP (pre-treatment QA) for 47 IMRT were $99.8{\pm}0.1%$, $99.0{\pm}0.7%$, and, respectively. Besides, passing rates using transit dosimetry was $90.0{\pm}1.5%$ for the same condition. Setup errors of 5 and 10 mm reduced the mean passing rates by 1.3% and 3.0% (inferior to superior), 2.2% and 4.3% (superior to inferior), 5.9% and 10.9% (left to right), and 8.9% and 16.3% (right to left), respectively. These findings suggest that the transit dose-based IMRT verification method using EPID, in which the transit dose from patients is compared with the dose map calculated from the TPS, may be useful in verifying various errors including setup and/or patient positioning error, inhomogeneity and target motions.

• The Korean Journal of Pain
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• v.9 no.1
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• pp.69-74
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• 1996

Background: Efficacy of spinal opioids for the treatment of intractable cancer pain has been reported by several authors. The epidural route seems to be a more reliable and effective method of pain control as compared to the intrathecal route which can lead to opioids by portal system. Methods: Medical records were reviewed of 18 patients who had been treated with epidural morphine via an implanted port-A-Cath from Mar. 1991 to Sep. 1994. Results: Patients were treated for a mean of 92 days. There were wide variation of dose requirements. The minimum daily dose ranged from 2 to 10mg, and maximum daily dose from 3 to 30 mg. Verbal rating scale were below moderate until 100th days after posrtal implantation. When 3 patients suffered from aggravated pain associated with vertebral metastasis. Five of 11 patients who were administered medication longer than 50 days reguired increased doses ranging from 3 mg to 25 mg which were higher as compared to initial doses. These patients also experienced pain due to vertebral metastasis. There were no report of epidural scarring, respiratory depression, epidural infections, meningitis, or catheter blockade. Conclusion: Continuous epidural morphine administration via Port-A-Cath is an effective method with minimal complication.

• Progress in Medical Physics
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• v.25 no.2
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• pp.65-71
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• 2014

A Varian Portal Dosimetry system was compared to an isocentrically mounted MapCHECK 2 diode array for volumetric modulated arc therapy (VMAT) QA. A Varian TrueBeam STx with an aS-1000 digital imaging panel was used to acquire VMAT QA images for 13 plans using four photon energies (6, 8, 10 and 15 MV). The EPID-based QA images were compared to the Portal Dose Image Prediction calculated in the Varian Eclipse treatment planning system (TPS). An isocentrically mounted Sun Nuclear MapCHECK 2 diode array with 5 cm water-equivalent buildup was also used for the VMAT QAs and the measurements were compared to a composite dose plane from the Eclipse TPS. A ${\gamma}$ test was implemented in the Sun Nuclear Patient software with 10% threshold and absolute comparison at 1%/1 mm (dose difference/distance-to-agreement), 2%/2 mm, and 3%/3 mm criteria for both QA methods. The two-tailed paired Student's t-test was employed to analyze the statistical significance at 95% confidence level. The average ${\gamma}$ passing rates were greater than 95% at 3%/3 mm using both methods for all four energies. The differences in the average passing rates between the two methods were within 1.7% and 1.6% of each other when analyzed at 2%/2 mm and 3%/3 mm, respectively. The EPID passing rates were somewhat better than the MapCHECK 2 when analyzed at 1%/1 mm; the difference was lower for 8 MV and 10 MV. However, the differences were not statistically significant for all criteria and energies (p-values >0.05). The EPID-based QA showed large off-axis over-response and dependence of ${\gamma}$ passing rate on energy, while the MapCHECK 2 was susceptible to the MLC tongue-and-groove effect. The two fluence-based QA techniques can be an alternative tool of VMAT QA to each other, if the limitations of each QA method (mechanical sag, detector response, and detector alignment) are carefully considered.

• Progress in Medical Physics
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• v.25 no.1
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• pp.23-30
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• 2014

The purpose of this study is to evaluate the developed dose verification program for in vivo dosimetry based on transit dose in radiotherapy. Five intensity modulated radiotherapy (IMRT) plans of lung cancer patients were used in the irradiation of a homogeneous solid water phantom and anthropomorphic phantom. Transit dose distribution was measured using electronic portal imaging device (EPID) and used for the calculation of in vivo dose in patient. The average passing rate compared with treatment planning system based on a gamma index with a 3% dose and a 3 mm distance-to-dose agreement tolerance limit was 95% for the in vivo dose with the homogeneous phantom, but was reduced to 81.8% for the in vivo dose with the anthropomorphic phantom. This feasibility study suggested that transit dose-based in vivo dosimetry can provide information about the actual dose delivery to patients in the treatment room.

• Progress in Medical Physics
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• v.32 no.4
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• pp.116-121
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• 2021

Purpose: To investigate the effects of dose rate on intensity-modulated radiation therapy (IMRT) quality assurance (QA). Methods: We performed gamma tests using portal dose image prediction and log files of a multileaf collimator. Thirty treatment plans were randomly selected for the IMRT QA plan, and three verification plans for each treatment plan were generated with different dose rates (200, 400, and 600 monitor units [MU]/min). These verification plans were delivered to an electronic portal imager attached to a Varian medical linear accelerator, which recorded and compared with the planned dose. Root-mean-square (RMS) error values of the log files were also compared. Results: With an increase in dose rate, the 2%/2-mm gamma passing rate decreased from 90.9% to 85.5%, indicating that a higher dose rate was associated with lower radiation delivery accuracy. Accordingly, the average RMS error value increased from 0.0170 to 0.0381 cm as dose rate increased. In contrast, the radiation delivery time reduced from 3.83 to 1.49 minutes as the dose rate increased from 200 to 600 MU/min. Conclusions: Our results indicated that radiation delivery accuracy was lower at higher dose rates; however, the accuracy was still clinically acceptable at dose rates of up to 600 MU/min.

• Progress in Medical Physics
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• v.11 no.2
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• pp.117-122
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• 2000

The IP(imaging plate) has been widely used to measure the two-dimensional distribution of incident radiation since it has a high sensitivity, reusability, a wide dynamic range, a high position resolution. Particularly, the easiness of acquiring digitized image using IP poses a strong merit because recent trend of data handling prefers image digitization. In order to test its usefulness in photon beam dosimetry, we measured the off-axis ratio(OAR) on portal planes and percent depth dose(PDD) within a phantom using IP, and compared the results with the data based on EGS4 Monte Carlo particle transport code, ion-chambers, conventional films. For the measurement, we used 6 MV X-rays, various field sizes. As a result, IP showed significant deviation from ion-chamber measurement: a significant overresponse, 100% greater than that of ion-chamber measurement at deep part of the phantom. Filtration of low-energy scattered photons at deep part of the phantom using 0.5 mm thick lead sheets did improve the result, only to the unacceptable extent. However, portal dose measurement showed possibilities of If as a dosimeter by showing errors less than 5%, as compared with film measurement.

• Progress in Medical Physics
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• v.24 no.4
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• pp.253-258
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• 2013

The purpose of this study is to evaluate and analyze the relationship between the external radiation dose reconstruction which is transmitted from the patient who receives radiation treatment through electronic portal imaging device (EPID) and the internal dose derived from the Monte Carlo simulation. As a comparative analysis of the two cases, it is performed to provide a basic indicator for similar studies. The geometric information of the experiment and that of the radiation source were entered into Monte Carlo n-particle (MCNPX) which is the computer simulation tool and to derive the EPID images, a tally card in MCNPX was used for visualizing and the imaging of the dose information. We set to source to surface distance (SSD) 100 cm for internal measurement and EPID. And the water phantom was set to be 100 cm of the source to surface distance (SSD) for the internal measurement and EPID was set to 90 cm of SSD which is 10 cm below. The internal dose was collected from the water phantom by using mesh tally function in MCNPX, accumulated dose data was acquired by four-portal beam exposures. At the same time, after getting the dose which had been passed through water phantom, dose reconstruction was performed using back-projection method. In order to analyze about two cases, we compared the penetrated dose by calibration of itself with the absorbed one. We also evaluated the reconstructed dose using EPID and partially accumulated (overlapped) dose in water phantom by four-portal beam exposures. The sum dose data of two cases were calculated as each 3.4580 MeV/g (absorbed dose in water) and 3.4354 MeV/g (EPID reconstruction). The result of sum dose match from two cases shows good agreement with 0.6536% dose error.

• Radiation Oncology Journal
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• v.16 no.4
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• pp.497-504
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• 1998

Purpose : To evaluate the usefulness of electronic portal imaging device through objective compare of the images acquired using an EPID and a conventional port film Materials and Methods : From Apr. to Oct. 1997, a total of 150 sets of images from 20 patients who received radiation therapy in the pelvis area were evaluated in the Inha University Hospital and Severance Hospital. A dual image recording technique was devised to obtain both electronic portal images and port film images simultaneously with one treatment course. We did not perform double exposure five to ten images were acquired from each patient. All images were acquired from posteroanterior (PA) view except images from two patients. A dose rate of 100-300 Mu/min and a 10-MV X-ray beam were used and 2-10 MUs were required to produce a verification image during treatment. Kodak diagnostic film with metal/film imaging cassette which was located on the top of the EPID detector was used for the port film. The source to detector distance was 140 cm. Eight anatomical landmarks (pelvic brim, sacrum, acetabulum. iliopectineal line, symphysis, ischium, obturator foramen, sacroiliac joint) were assessed. Four radiation oncologist joined to evaluate each image. The individual landmarks in the port film or in the EPID were rated - very clear (1), clear (2), visible (3), not clear (4), not visible (5). Results : Using an video camera based EPID system. there was no difference of image quality between no enhanced EPID images and port film images. However, when we provided some change with window level for the portal image, the visibility of the sacrum and obturator foramen was improved in the portal images than in the port film images. All anatomical landmarks were more visible in the portal images than in the port film when we applied the CLAHE mode enhancement. The images acquired using an matrix ion chamber type EPID were also improved image qualify after window level adjustment. Conclusion : The quality of image acquired using an electronic portal imaging device was comparable to that of the port film. When we used the enhance mode or window level adjustment. the image quality of the EPID was superior to that of the port film. EPID may replace the port film.