A new thin-target method (patent pending) is described for portal imaging with low-energy (tens of keV) photons from a medical linear accelerator operating in a special mode. Low-energy photons are usually produced in the accelerator target, but are absorbed by the target and flattening filter, both made of medium- or high-Z materials such as Cu or W. Since the main contributor to absorption of the low-energy photons is self-absorption by the thick target through the photoelectric effect, it is proposed to lower the thickness of the portal imaging target to the minimum required to get the maximum low-energy photon fluence on the exit side of the target, and to lower the atomic number of the target so that predominantly photoelectric absorption is reduced. To determine the minimum thickness of the target, EGS4 Monte Carlo calculations were performed. As a result of these calculations, it was concluded that the maximum photon fluence for a 4 MeV electron beam is obtained with a 1.5 mm Cu target. This value is approximately five times less than the thickness of the Cu target routinely used for bremsstrahlung production in radiotherapeutic practice. Two sets of experiments were performed: the first with a 1.5 mm Cu target and the second with a 5 mm Al target (Cu mass equivalent) installed in the linear accelerator. Portal films were taken with a Rando anthropomorphic phantom. To emphasize the low-energy response of the new thin target we used a Kodak Min-R mammographic film and cassette combination, with a strong low-energy response. Because of its high sensitivity, only 1 cGy is required. The new portal images show a remarkable improvement in sharpness and contrast in anatomical detail compared with existing ones. It is also shown that further lowering of the target's atomic number (for example to C or Be) produces no significant improvement.

Low-energy photons (<150 keV) are essential for obtaining high quality x-ray radiographs. These photons are usually produced in the accelerator target, but are effectively absorbed by the flattening filter and, at least partially, by the target itself. Experimental proof is presented for the existence of low-energy photons in the unflattened x-ray beam produced by a 6 MeV electron beam normally incident on the thinner of the two existing ports of the all-Cu radiotherapeutic target of a Clinac 18 (Varian Associates) linear accelerator. A number of one-shot absorption measurements were carried out with 12 foils of Pb absorbers with thicknesses varying from 0.25 to 3 mm in steps of 0.25 mm arranged symmetrically around the central axis on a 7.2 cm radius circumference. A Kodak ECL film-screen-cassette combination was used as a detector in the absorption measurements, in which optical density was measured as a function of the thickness of the Pb absorbers. Two sets of absorption measurements were carried out: the first one with the Clinac 18 6 MV unflattened beam and the second one with the Clinac 600C 6 MV therapeutic counterpart beam. There is a striking difference between the two sets: the optical density versus Pb-absorber thickness curve shows a sharp increase in optical density at small absorber thicknesses in the case of the unflattened 6 MV x-ray beam as compared with a gently sloping dependence in the case of the 6 MV therapeutic beam. A semi-quantitative assessment of the low-energy photon contribution to the whole optical density/contrast is presented. A 0.85 mm thick Pb absorber intercepting the 6 MV unflattened x-ray beam eliminates almost totally the sharp peak in the optical density curve at small Pb-absorber thicknesses. This constitutes additional evidence for the existence of low-energy photons (<150 keV) in the unflattened 6 MV beam from the Cu therapeutic target.

An analytical method to generate portal film charts for 10-MV photon beams, which takes into account the presence of the cassette front screen is presented. The selection of the best film-screen combination was based on the new AAPM recommendations for radiotherapy portal imaging [AAPM Rep. No. 24, AAPM Task Group No. 28 (1987)]: 2-g/cm2-thick copper front screen and 0.4-g/cm2-thick copper rear screen, and X-OMAT TL Kodak unwrapped film. Doses at the film position were measured as a function of patient thickness, field size, air gap, and the results compared well with the doses derived from the analytical method: within +/- 15%. An optical density of 1.6 was selected for construction of the portal film charts. The application of the method for routine treatment planning quality assurance allows a quick and precise determination of the best exposures to the portal films.

The aim of this study was to assess portal imaging for quality assurance of patient positioning in external beam radiotherapy. We present a retrospective study of the variability of patient position in the treatment of 34 prostate cancer patients who were treated with whole pelvic irradiation followed by arc therapy or boost field (Series I) and 25 patients treated by 'small' pelvic 4-field box technique (Series II). Weekly anteroposterior-posteranterior (AP-PA) and left-lateral portal images were compared to simulation films by using a fiducial point-pair registration technique based on the computer-assisted portal imaging quality assurance program PIPSpro, developed specifically for the verification of treatment positioning in radiation therapy. Series I consisted of 34 patients and 194 portal films (97 AP-PA and 97 left-lateral). Overirradiated (OA) and underirradiated (UA) areas were computed in terms of percentage of the reference field size. For the AP-PA portals, the average OA was 2.75% and average UA was 2.74%. For left-lateral portals, an average OA of 2.49% and UA of 2.78% were measured. Series II consisted of 25 patients and 194 portal films (98 AP-PA and 96 left-lateral). The average OA was 0.88% and average UA was 0.86% in AP-PA portals, and 1.03 and 0.82% for left-lateral portals, respectively. The accuracy of patient positioning in irradiation of prostate cancer in our institution is in the range of 2.69% for whole pelvic fields and 1.0% for small fields. We conclude that PIPSpro is an effective and useful tool for quality assurance in radiotherapy.