Recording accelerator monitor units during electronic portal imaging: application to collimator position verification during IMRT.

The application of multiple portal image acquisition to collimator position verification during dynamic multileaf collimation (DMLC) using a commercial camera-based electronic portal imaging device (EPID) (Theraview, Cablon Medical BV, Leusden, The Netherlands) mounted on an Elekta SL15i accelerator (Elekta Oncology Systems, Crawley, UK) is described. This is achieved using a custom-built dose acquisition system optically interfaced to both the camera control unit of the EPID and the monitor unit (MU) channel of the accelerator. The method uses the beam blanking camera control signal to trigger the dose acquisition system to read the cumulative accelerator MUs at the beginning and end of each period of image formation. A maximum delay of 15 ms has been estimated for recording of accelerator MUs in the current system. The camera interface was observed to have no effect on the operation of the EPID during normal clinical use and could therefore be left permanently in situ. Use of the system for collimator position verification of a test case is presented. The technique described uses a specific camera-based EPID and accelerator, although the general principle of using an EPID control signal to trigger recording of accelerator MUs may be applicable to other EPIDs/accelerators with suitable knowledge of the accelerator dosimetry system.

Measurement of the response of Gd2O2S:Tb phosphor to 6 MV x-rays.

The phosphor GdO2S:Tb is widely used in camera-based electronic portal imaging devices (EPIDs). There is considerable interest in the application of EPIDs to dosimetry and the verification of intensity modulated radiation therapy produced by dynamic multileaf collimation (DMLC). This paper presents direct measurement of Gd2O2S:Tb phosphor luminescence under 6 MV x-ray irradiation from a linear accelerator using a photomultiplier tube. The luminescence following each radiation pulse (3 micros duration) was observed to decay with a dominant lifetime of 558 micros. Using a specialized electrometer, the temporal variation of the optical signal has been compared with the dose rate incident on the phosphor measured using a semiconductor diode detector. Under dose rates typical of those used in the clinic (1.2 Gy min(-1) to the phosphor), measurements at beam-start confirmed that the optical signal is linear with dose per radiation pulse. Measurements at beam termination following phosphor doses up to 4.4 Gy showed no residual signal associated with long-lived luminescence (afterglow) from the phosphor above the noise level of the optical signal (0.17% standard deviation). This measurement demonstrates that afterglow from Gd2O2S:Tb is not of significance for its application to DMLC verification. Additionally, it was confirmed that the accelerator pulse repetition frequency has no effect on the optical signal from the phosphor in the range 25-400 Hz.

A method for controlling image acquisition in electronic portal imaging devices.

Certain types of camera-based electronic portal imaging devices (EPIDs) which initiate image acquisition based on sensing a change in video level have been observed to trigger unreliably at the beginning of dynamic multileaf collimation sequences. A simple, novel means of controlling image acquisition with an Elekta linear accelerator (Elekta Oncology Systems, Crawley, UK) is proposed which is based on illumination of a photodetector (ORP-12, Silonex Inc., Plattsburgh, NY, USA) by the electron gun of the accelerator. By incorporating a simple trigger circuit it is possible to derive a beam on/off status signal which changes at least 100 ms before any dose is measured by the accelerator. The status signal does not return to the beam-off state until all dose has been delivered and is suitable for accelerator pulse repetition frequencies of 50-400 Hz. The status signal is thus a reliable means of indicating the initiation and termination of radiation exposure, and thus controlling image acquisition of such EPIDs for this application.

Considerations for cosmetic surgery in the black population.

The availability of cosmetic surgical procedures to the general public, especially blacks, has become increasingly widespread. Aesthetic surgeons should not be deterred from performing these procedures in blacks. The myth that all black patients develop keloids or dyspigmentation after surgery should be dispelled; however, in those patients with a history of keloid formation or hypertrophic scarring, elective cosmetic procedures should be either withheld or performed with extreme caution. In general, the cosmetic surgeon can proceed with surgery in blacks and attain good aesthetic results if the procedures are slightly modified when indicated to minimize pigmentary changes and scarring and to maintain ethnic congruency.