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The relationship between the pixel value and exit dose was investigated for a new commercially available amorphous silicon electronic portal imaging device. The pixel to dose mapping function was established to be linear for detector distances between 116.5 cm to 150 cm from the source, radiation field sizes from 5 x 5 cm2 to 20 x 20 cm2 and beam energies of 6 to 18 MV. Coefficients in the mapping function were found to be dependent on beam energy and field size. Open and wedged field profiles measured with the device showed agreement to a maximum of 5% and 8%, respectively, as compared to film. A comparison of relative transmission measurements between the EPID and ion chamber indicate a maximum deviation of 6% and 2% at 6 and 18 MV, respectively, for an attenuator thickness of 21 cm and SDD > or = 130 cm. It was found that accuracies of better than 1% could be obtained if detector position and field size specific fitting parameters were used to generate unique mapping functions for each configuration.

The radiation dose to the cochlea is strongly predictive for subsequent hearing deterioration. It is essential for the cochlea to be outlined as an organ at risk, and for radiation techniques to be optimized, to improve long-term hearing preservation.

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The relationship between rectal dose distribution and the incidence of late rectal complications following external-beam radiotherapy has been previously studied using dose-volume histograms or dose-surface histograms. However, they do not account for the spatial dose distribution. This study proposes a metric based on both surface dose and distance that can predict the incidence of rectal bleeding in prostate cancer patients treated with radical radiotherapy. One hundred and forty-four patients treated with radical radiotherapy for prostate cancer were prospectively followed to record the incidence of grade ≥2 rectal bleeding. Radiotherapy plans were used to evaluate a dose-distance metric that accounts for the dose and its spatial distribution on the rectal surface, characterized by a logistic weighting function with slope a and inflection point d₀. This was compared to the effective dose obtained from dose-surface histograms, characterized by the parameter n which describes sensitivity to hot spots. The log-rank test was used to determine statistically significant (p < 0.05) cut-off values for the dose-distance metric and effective dose that predict for the occurrence of rectal bleeding. For the dose-distance metric, only d₀ = 25 and 30 mm combined with a > 5 led to statistical significant cut-offs. For the effective dose metric, only values of n in the range 0.07-0.35 led to statistically significant cut-offs. The proposed dose-distance metric is a predictor of rectal bleeding in prostate cancer patients treated with radiotherapy. Both the dose-distance metric and the effective dose metric indicate that the incidence of grade ≥2 rectal bleeding is sensitive to localized damage to the rectal surface.