Computed chest radiography for total body irradiation: image quality and clinical feasibility.

Objective.In myeloablative total body irradiation (TBI), lung shielding blocks are used to reduce the dose to the lungs and hence decrease the risk of radiation pneumonitis. Some centers are still using mega-Volt (MV) imaging with dedicated silver halide-based films during simulation and treatment for lung delineation and position verification. However, the availability of these films has recently become an issue. This study examines the clinical performance of a computed radiography (CR) solution in comparison to radiographic films and potential improvement of image quality by filtering and post-processing.Approach.We compared BaFBrI-based CR plates to radiographic films. First, images of an aluminum block were analyzed to assess filter impact on scatter reduction. Secondly, a dedicated image quality phantom was used to assess signal linearity, signal-to-noise ratio (SNR), contrast and spatial resolution. Ultimately, a clinical performance study involving two impartial observers was conducted on an anthropomorphic chest phantom, employing visual grading analysis (VGA). Various filter materials and positions as well as post-processing were examined, and the workflow between CR and film was compared.Main results.CR images exhibited high SNR and linearity but demonstrated lower spatial and contrast resolution when compared to film. However, filtering improved contrast resolution and SNR, while positioning filters inside the cassette additionally enhanced sharpness. Image processing improved VGA scores, while additional filtering also resulted in higher spine visibility scores. CR shortened TBI simulation by over 10 minutes for one patient, alongside a dose reduction by order of 0.1 Gy.Significance.This study highlights potential advantages of shifting from conventional radiographic film to CR for TBI. Overall, CR with the incorporation of processing and filtering proves to be suitable for TBI chest imaging. When compared to radiographic film, CR offers advantages such as reduced simulation time and dose delivery, re-usability of image plates and digital workflow integration.

New optically stimulated luminescence dosimetry film optimized for energy dependence guided by Monte Carlo simulations.

Optically stimulated luminescence (OSL) film dosimeters, based on BaFBr:Eu2+phosphor material, have major dosimetric advantages such as dose linearity, high spatial resolution, film re-usability, and immediate film readout. However, they exhibit an energy-dependent over-response at low photon energies because they are not made of tissue-equivalent materials. In this work, the OSL energy-dependent response was optimized by lowering the phosphor grain size and seeking an optimal choice of phosphor concentration and film thickness to achieve sufficient signal sensitivity. This optimization process combines measurement-based assessments of energy response in narrow x-ray beams with various energy response calculation methods applied to different film metrics. Theoretical approaches and MC dose simulations were used for homogeneous phosphor distributions and for isolated phosphor grains of different dimensions, where the dose in the phosphor grain was calculated. In total 8 OSL films were manufactured with different BaFBr:Eu2+median particle diameters (D50): 3.2µm, 1.5µm and 230 nm and different phosphor concentrations (1.6%, 5.3% and 21.3 %) and thicknesses (from 5.2 to 49µm). Films were irradiated in narrow x-ray spectra (N60, N80, N-150 and N-300) and the signal intensity relative to the nominal dose-to-water value was normalized to Co-60. Finally, we experimentally tested the response of several films in Varian 6MV TrueBeam STx linear accelerator using the following settings: 10 × 10 cm2field, 0deggantry angle, 90 cm SSD, 10 cm depth. The x-ray irradiation experiment reported a reduced energy response for the smallest grain size with an inverse correlation between response and grain size. The N-60 irradiation showed a 43% reduction in the energy over-response when going from 3µm to 230 nm grain size for the 5% phosphor concentration. Energy response calculation using a homogeneous dispersion of the phosphor underestimated the experimental response and was not able to obtain the experimental correlation between grain size and energy response. Isolated grain size modeling combined with MC dose simulations allowed to establish a good agreement with experimental data, and enabled steering the production of optimized OSL-films. The clinical 6 MV beam test confirmed a reduction in energy dependence, which is visible in small-grain films where a decrease in out-of-field over-response was observed.

Phase-engineering compact and flexible CsPbBr3 microcrystal films for robust X-ray detection.

All-inorganic CsPbBr3 perovskites have gained significant attention due to their potential in direct X-ray detection. The fabrication of stable, pinhole-free thick films remains challenging, hindering their integration in durable, large-area high-resolution devices. In this study, we propose a facile strategy using a non-conductive polymer to create a flexible, compact thick film under ambient conditions. Furthermore, we investigate the effect of introducing the 2D CsPb2Br5 phase into CsPbBr3 perovskite crystals on their photophysical properties and charge transport. Upon X-ray exposure, the devices consisting of the dual phase exhibit improved stability and more effective operation at higher voltages. Rietveld refinement shows that, due to the presence of the second phase, local distortions and Pb-vacancies are introduced within the CsPbBr3 lattice. This in turn presumably increases the ion migration energy barrier, resulting in a very low dark current and hence, enhanced stability. This feature might benefit local charge extraction and, ultimately, the X-ray image resolution. These findings also suggest that introducing a second phase in the perovskite structure can be advantageous for efficient photon-to-charge carrier conversion, as applied in medical imaging.

Optically stimulated luminescence system as an alternative for radiochromic film for 2D reference dosimetry in UHDR electron beams.

Radiotherapy is part of the treatment of over 50% of cancer patients. Its efficacy is limited by the radiotoxicity to the healthy tissue. FLASH-RT is based on the biological effect that ultra-high dose rates (UHDR) and very short treatment times strongly reduce normal tissue toxicity, while preserving the anti-tumoral effect. Despite many positive preclinical results, the translation of FLASH-RT to the clinic is hampered by the lack of accurate dosimetry for UHDR beams. To date radiochromic film is commonly used for dose assessment but has the drawback of lengthy and cumbersome read out procedures. In this work, we investigate the equivalence of a 2D OSL system to radiochromic film dosimetry in terms of dose rate independency. The comparison of both systems was done using the ElectronFlash linac. We investigated the dose rate dependence by variation of the (1) modality, (2) pulse repetition frequency, (3) pulse length and (4) source to surface distance. Additionally, we compared the 2D characteristics by field size measurements. The OSL calibration showed transferable between conventional and UHDR modality. Both systems are equally independent of average dose rate, pulse length and instantaneous dose rate. The OSL system showed equivalent in field size determination within 3 sigma. We show the promising nature of the 2D OSL system to serve as alternative for radiochromic film in UHDR electron beams. However, more in depth characterization is needed to assess its full potential.

Addressing Current Challenges in OSL Dosimetry Using MgB4O7:Ce,Li: State of the Art, Limitations and Avenues of Research.

The objective of this work is to review and assess the potential of MgB4O7:Ce,Li to fill in the gaps where the need for a new material for optically stimulated luminescence (OSL) dosimetry has been identified. We offer a critical assessment of the operational properties of MgB4O7:Ce,Li for OSL dosimetry, as reviewed in the literature and complemented by measurements of thermoluminescence spectroscopy, sensitivity, thermal stability, lifetime of the luminescence emission, dose response at high doses (>1000 Gy), fading and bleachability. Overall, compared with Al2O3:C, for example, MgB4O7:Ce,Li shows a comparable OSL signal intensity following exposure to ionizing radiation, a higher saturation limit (ca 7000 Gy) and a shorter luminescence lifetime (31.5 ns). MgB4O7:Ce,Li is, however, not yet an optimum material for OSL dosimetry, as it exhibits anomalous fading and shallow traps. Further optimization is therefore needed, and possible avenues of investigation encompass gaining a better understanding of the roles of the synthesis route and dopants and of the nature of defects.

Calibration and time fading characterization of a new optically stimulated luminescence film dosimeter.

BACKGROUND: Optically stimulated luminescence (OSL) dosimeters produce a signal linear to the dose, which fades with time due to the spontaneous recombination of energetically unstable electron/hole traps. When used for radiotherapy (RT) applications, fading affects the signal-to-dose conversion and causes an error in the final dose measurement. Moreover, the signal fading depends to some extent on treatment-specific irradiation conditions such as irradiation times. PURPOSE: In this work, a dose calibration function for a novel OSL film dosimeter was derived accounting for signal fading. The proposed calibration allows to perform dosimetry evaluation for different RT treatment regimes. METHODS: A novel BaFBr:Eu2+ -based OSL film (Zeff , 6 MV  = 4.7) was irradiated on a TrueBeam STx using a 6 MV beam with setup: 0° gantry angle, 90 cm SSD, 10 cm depth, 10 × 10 cm2 field. A total of 86 measurements were acquired for dose-rates ( D ̇ $\dot{D}$ ) of 600, 300, and 200 MU/min for irradiation times (tir ) of 0.2, 1, 2, 4.5, 12, and 23 min and various readout times (tscan ) between 4 and 1440 min from the start of the exposure (beam-on time). The OSL signal, S ( D ̇ , t i r , t s c a n ) $S(\dot{D},{t}_{ir},{t}_{scan})$ , was modeled via robust nonlinear regression, and two different power-law fading models were tested, respectively, independent (linear model) and dependent on the specific t i r ${t}_{ir}$ (delivery-dependent model). RESULTS: After 1 day from the exposure, the error on the dose measurement can be as high as 48% if a fading correction is not considered. The fading contribution was characterized by two accurate models with adjusted-R2 of 0.99. The difference between the two models is <4.75% for all t i r ${t}_{ir}$ and t s c a n ${t}_{scan}$ . For different beam-on times, 3, 10.5, and 20 min, the optimum t s c a n ${t}_{scan}$ was calculated in order to achieve a signal-to-dose conversion with a model-related error <1%. In the case of a 3 min irradiation, this condition is already met when the OSL-film is scanned immediately after the end of the irradiation. For an irradiation of 10.5 and 20 min, the minimum scanning time to achieve this model-related error increases, respectively, to 30 and 90 min. Under these conditions, the linear model can be used for the signal-to-dose conversion as an approximation of the delivery-dependent model. The signal-to-dose function, D(Mi , j , t s c a n $\ {t}_{scan}$ ), has a residual mean error of 0.016, which gives a residual dose uncertainty of 0.5 mGy in the region of steep signal fading (i.e., t s c a n ${t}_{scan}\ $ = 4 min). The function of two variables is representable as a dose surface depending on the signal (Mi , j ) measured for each i,j-pixel and the time of scan ( t s c a n ${t}_{scan}$ ). CONCLUSIONS: The calibration of a novel OSL-film usable for dosimetry in different RT treatments was corrected for its signal fading with two different models. A linear calibration model independent from the treatment-specific irradiation condition results in a model-related error <1% if a proper scanning time is used for each irradiation length. This model is more practical than the delivery-dependent model because it does not need a pixel-to-pixel fading correction for different t i r ${t}_{ir}$ .

Point scintillator dosimetry in ultra-high dose rate electron "FLASH" radiation therapy: A first characterization.

FLASH radiation therapy is a novel technique combining ultra-high dose rates (UHDR) with very short treatment times to strongly decrease normal tissue toxicity while preserving the anti-tumoral effect. However, the radiobiological mechanisms and exact conditions for obtaining the FLASH-effect are still under investigation. There are strong indications that parameters defining the beam structure, such as dose per pulse, instantaneous dose rate and pulse repetition frequency (PRF) are of importance. UHDR irradiations therefore come with dosimetric challenges, including both dose assessment and temporal ones. In this work, a first characterization of 6 real-time point scintillating dosimeters with 5 phosphors (Al2O3:C,Mg; Y2O3:Eu; Al2O3:C; (C38H34P2)MnBr4 and (C38H34P2)MnCl4, was performed in an UHDR pulsed electron beam. The dose rate independence of the calibration was tested by calibrating the detector at conventional and UHDR. Dose rate dependence was observed, however, further investigation, including intermediate dose rates, is needed. Linearity of the response with dose was tested by varying the number of pulses and a linearity with R2> 0.9989 was observed up to at least 200 Gy. Dose per pulse linearity was investigated by variation of the pulse length and SSD. All point scintillators showed saturation effects up to some extent and the instantaneous dose rate dependence was confirmed. A PRF dependence was observed for the Al2O3:C,Mg and Al2O3:C- based point scintillators. This was expected as the luminescence decay time of these materials exceeds the inter-pulse time.

On the relevance of modulation transfer function measurements in digital mammography quality control.

Purpose: The relevance of presampling modulation transfer function (MTF) measurements in digital mammography (DM) quality control (QC) is examined. Two studies are presented: a case study on the impact of a reduction in MTF on the technical image quality score and analysis of the robustness of routine QC MTF measurements. Approach: In the first study, two needle computed radiography (CR) plates with identical sensitivities were used with differences in the 50% point of the MTF ( f MTF 0.5 ) larger than the limiting value in the European guidelines ( > 10 % change between successive measurements). Technical image quality was assessed via threshold gold thickness of the CDMAM phantom and threshold microcalcification diameter of the L1 structured phantom. For the second study, presampling MTF results from 595 half-yearly QC tests of 55 DM systems (16 types, six manufacturers) were analyzed for changes from the baseline value and changes in f MTF 0.5 between successive tests. Results: A reduction of 20% in f MTF 0.5 of the two CR plates was observed. There was a tendency to a lower score for task-based metrics, but none were significant. Averaging over 55 systems, the absolute relative change in f MTF 0.5 between consecutive tests (with 95% confidence interval) was 3% (2.5% to 3.4%). Analysis of the maximum relative change from baseline revealed changes of up to - 10 % for one a-Se based system and - 15 % for a group of CsI-based systems. Conclusions: A limit of 10% is a relevant action level for investigation. If exceeded, then the impact on performance has to be verified with extra metrics.

Storage Phosphors for Medical Imaging.

Computed radiography (CR) uses storage phosphor imaging plates for digital imaging. Absorbed X-ray energy is stored in crystal defects. In read-out the energy is set free as blue photons upon optical stimulation. In the 35 years of CR history, several storage phosphor families were investigated and developed. An explanation is given as to why some materials made it to the commercial stage, while others did not. The photo stimulated luminescence mechanism of the current commercial storage phosphors, BaFBr:Eu2+ and CsBr:Eu2+ is discussed. The relation between storage phosphor plate physical characteristics and image quality is explained. It is demonstrated that the morphology of the phosphor crystals in the CR imaging plate has a very significant impact on its performance.

Validation of an image simulation technique for two computed radiography systems: an application to neonatal imaging.

PURPOSE: The purpose of this study is to develop a computer model to simulate the image acquisition for two computed radiography (CR) imaging systems used for neonatal chest imaging: (1) The Agfa ADC Compact, a flying spot reader with powder phosphor image plates (MD 40.0); and (2) the Agfa DX-S, a line-scanning CR reader with needle crystal phosphor image plates (HD 5.0). The model was then applied to compare the image quality of the two CR imaging systems. METHODS: Monte Carlo techniques were used to simulate the transport of primary and scattered x rays in digital x-ray systems. The output of the Monte Carlo program was an image representing the energy absorbed in the detector material. This image was then modified using physical characteristics of the CR imaging systems to account for the signal intensity variations due to the heel effect along the anode-cathode axis, the spatial resolution characteristics of the imaging system, and the various sources of image noise. The simulation was performed for typical acquisition parameters of neonatal chest x-ray examinations. To evaluate the computer model, the authors compared the threshold-contrast detectability in simulated and experimentally acquired images of a contrast-detail phantom. Threshold-contrast curves were computed using a commercially available scoring program. RESULTS: The threshold-contrast curves of the simulated and experimentally acquired images show good agreement; for the two CR systems, 93% of the threshold diameters calculated from the simulated images fell within the confidence intervals of the threshold diameter calculated from the experimentally assessed images. Moreover, the superiority of needle based CR plates for neonatal imaging was confirmed. CONCLUSIONS: The good agreement between simulated and experimental acquired results indicates that the computer model is accurate.

Comparison of edge analysis techniques for the determination of the MTF of digital radiographic systems.

The modulation transfer function (MTF) is well established as a metric to characterize the resolution performance of a digital radiographic system. Implemented by various laboratories, the edge technique is currently the most widespread approach to measure the MTF. However, there can be differences in the results attributed to differences in the analysis technique employed. The objective of this study was to determine whether comparable results can be obtained from different algorithms processing identical images representative of those of current digital radiographic systems. Five laboratories participated in a round-robin evaluation of six different algorithms including one prescribed in the International Electrotechnical Commission (IEC) 62220-1 standard. The algorithms were applied to two synthetic and 12 real edge images from different digital radiographic systems including CR, and direct- and indirect-conversion detector systems. The results were analysed in terms of variability as well as accuracy of the resulting presampled MTFs. The results indicated that differences between the individual MTFs and the mean MTF were largely below 0.02. In the case of the two simulated edge images, all algorithms yielded similar results within 0.01 of the expected true MTF. The findings indicated that all algorithms tested in this round-robin evaluation, including the IEC-prescribed algorithm, were suitable for accurate MTF determination from edge images, provided the images are not excessively noisy. The agreement of the MTF results was judged sufficient for the measurement of the MTF necessary for the determination of the DQE.

Validation of MTF measurement for digital mammography quality control.

The modulation transfer function (MTF) describes the spatial resolution properties of imaging systems. In this work, the accuracy of our implementation of the edge method for calculating the presampled MTF was examined. Synthetic edge images with known MTF were used as gold standards for determining the robustness of the edge method. These images simulated realistic data from clinical digital mammography systems, and contained intrinsic system factors that could affect the MTF accuracy, such as noise, scatter, and flat-field nonuniformities. Our algorithm is not influenced by detector dose variations for MTF accuracy up to 1/2 the sampling frequency. We investigated several methods for noise reduction, including truncating the supersampled line spread function (LSF), windowing the LSF, applying a local exponential fit to the LSF, and applying a monotonic constraint to the supersampled edge spread function. Only the monotonic constraint did not introduce a systematic error; the other methods could result in MTF underestimation. Overall, our edge method consistently computed MTFs which were in good agreement with the true MTF. The edge method was then applied to images from a commercial storage-phosphor based digital mammography system. The calculated MTF was affected by the size (sides of 2.5, 5, or 10 cm) and the composition (lead or tungsten) of the edge device. However, the effects on the MTF were observed only with regard to the low frequency drop (LFD). Scatter nonuniformity was dependent on edge size, and could lead to slight underestimation of LFD. Nevertheless, this negative effect could be minimized by using an edge of 5 cm or larger. An edge composed of lead is susceptible to L-fluorescence, which causes overestimation of the LFD. The results of this work are intended to underline the need for clear guidelines if the MTF is to be given a more crucial role in acceptance tests and routine assessment of digital mammography systems: the MTF algorithm and edge object test tool need to be publicly validated.

Quantification of Al-equivalent thickness of just visible microcalcifications in full field digital mammograms.

Characterization of digital mammography systems is often performed by means of contrast-detail curves using a homogeneous phantom with inserts of different sizes and thicknesses. In this article, a more direct measure of the threshold contrast-detail characteristics of microcalcifications in clinical mammograms is proposed, which also takes into account routine processing and display. The proposed method scores the detectability of simulated microcalcifications with known size and aluminum-equivalent thickness. Thickness estimates, based on x-ray transmission coefficients, were first validated for Al particles. The same approach was then applied to associate Al-equivalent thickness with simulated microcalcifications. Thirty-five mammograms of patients were acquired using a full field digital mammography (FFDM) system operating under standard exposure conditions. Different microcalcifications were simulated using templates of real microcalcifications as described in Med. Phys. 30, 2234-2240 (2003). These templates were first modified such that they simulated a template of the same microcalcification for an ideally sharp detector. They were then adjusted for the imaging characteristics of the FFDM, beam quality, and breast thickness. Microcalcification sizes in the image plane ranged from 200 to 800 microm. Their peak Al-equivalent thickness varied between 70 and 1000 microm. Software phantoms were created. They consisted of 0-10 simulated microcalcifications randomly distributed in 2 cm by 2 cm frames embedded within digital mammograms. Routine processing and printing followed. Three experienced radiologists recorded the locations of the microcalcifications, and confidence ratings were given. Free response receiver operating characteristics (FROC) analysis was performed. Using a binary score, the fractions of detected microcalcifications were plotted as a function of equivalent diameter for the different Al-equivalent thicknesses. Pair-wise agreement of the detected microcalcifications was calculated for the different Al-equivalent thickness groups. The FROC curves of each radiologist indicated similar true positive fractions for a given number of false positives per image. One radiologist applied a more conservative scoring. Detected fractions for the different sizes of the microcalcifications showed the same trend for all observers. In addition, the observer with the least FP also detected less microcalcifications. The pair-wise agreement of the detected microcalcifications was good. The average detected fractions were >0.5 for microcalcifications with equivalent diameter >400 microm and Al-equivalent thickness >400 microm. An average detected fraction >0.5 was also seen for microcalcifications with equivalent diameter <400 microm and equivalent thickness >800 microm. The detected fractions of smaller microcalcifications were <0.5. The results obtained with this method indicate that it may be possible to quantify the performance of a digital mammography detector including processing and viewing for the detection of microcalcifications. We hypothesize that the FROC curves and detected fractions of simulated microcalcifications of different sizes reflect the clinical reality.