Purpose: Electronic portal imaging devices based on megavoltage ͑MV͒, active matrix, flat-panel imagers ͑AMFPIs͒ are presently regarded as the gold standard in portal imaging for external beam radiation therapy. These devices, employing indirect detection of incident radiation by means of a metal plate plus phosphor screen combination, offer a quantum efficiency of only ϳ2% at 6 MV, leading to a detective quantum efficiency ͑DQE͒ of only ϳ1%. In order to significantly improve the DQE performance of MV AMFPIs, a strategy based on the development of direct detection imagers incorporating thick films of polycrystalline mercuric iodide ͑HgI 2 ͒ photoconductor was undertaken and is reported. Methods: Two MV AMFPI prototypes, one incorporating an ϳ300 m thick HgI 2 layer created through physical vapor deposition ͑PVD͒ and a second incorporating an ϳ460 m thick HgI 2 layer created through screen-printing of particle-in-binder ͑PIB͒ material, were quantitatively evaluated using a 6 MV photon beam. The reported measurements include empirical determination of x-ray sensitivity, lag, modulation transfer function ͑MTF͒, noise power spectrum, and DQE. Results: For both prototypes, MTF and DQE results were found to be consistent with theoretical expectations and the MTFs were also found to be higher than that measured from a conventional MV AMFPI. In addition, the DQE results exhibit input-quantum-limited behavior, even at extremely low doses. Compared to PVD, the PIB prototype exhibits much lower dark current, slightly higher lag, and similar DQE. Finally, the challenges associated with this approach, as well as strategies for achieving considerably higher DQE through thicker HgI 2 layers, are discussed.
Conclusions:The DQE of each of the prototypes is found to be comparable to that of conventional MV AMFPIs, commensurate with the modest photoconductor thicknesses of these early samples. It is anticipated that thicker layers of HgI 2 based on PIB deposition can provide higher DQE while maintaining good material properties.