Supply Chain Intermediation: A Bargaining Theoretic Framework

Abstract

Purpose: Electronic portal imaging devices (EPIDs) based on active matrix, flat-panel imagers (AMFPIs) have become the gold standard for portal imaging and are currently being investigated for megavoltage cone-beam computed tomography (CBCT) and cone-beam digital tomosynthesis (CBDT). However, the practical realization of such volumetric imaging techniques is constrained by the relatively low detective quantum efficiency (DQE) of AMFPI-based EPIDs at radiotherapy energies, similar to 1% at 6 MV. In order to significantly improve DQE, the authors are investigating thick, segmented scintillators, consisting of 2D matrices of scintillating crystals separated by septal walls. Methods: A newly constructed segmented BGO scintillator (11.3 mm thick) and three segmented CsI:Tl scintillators (11.4, 25.6, and 40.0 mm thick) were evaluated using a 6 MV photon beam. X-ray sensitivity, modulation transfer function, noise power spectrum, DQE, and phantom images were obtained using prototype EPIDs based on the four scintillators. Results: The BGO and CsI: Tl prototypes were found to exhibit improvement in DQE ranging from similar to 12 to 25 times that of a conventional AMFPI-based EPID at zero spatial frequency. All four prototype EPIDs provide significantly improved contrast resolution at extremely low doses, extending down to a single beam pulse. In particular, the BGO prototype provides contrast resolution comparable to that of the conventional EPID, but at 20 times less dose, with spatial resolution sufficient for identifying the boundaries of low-contrast objects. For this prototype, however, the BGO scintillator exhibited an undesirable radiation-induced variation in x-ray sensitivity. Conclusions: Prototype EPIDs based on thick, segmented BGO and CsI: Tl scintillators provide significantly improved portal imaging performance at extremely low dose (i.e., down to 1 beam pulse corresponding to similar to 0.022 cGy), creating the possibility of soft-tissue visualization using MV CBCT and CBDT at clinically practical dose. (C) 2009 American Association of Physicists in Medicine. [DOI: 10.1118/1.3259721]