Characterization of a fluoroscopic imaging system for kV and MV radiography

An on-line kilovoltage (kV) imaging system has been implemented on a medical linear accelerator to verify radiotherapy field placement. A kV x-ray tube is mounted on the accelerator at 90 degrees to the megavoltage (MV) source and shares the same isocenter. Nearly identical CCD-based fluoroscopic imagers are mounted opposite the two x-ray sources. These systems are being used in a clinical study of patient setup error that examines the advantage of kV imaging for on-line localization. In the investigation reported here, the imaging performance of the kV and MV systems are characterized to provide support to the conclusions of the studies of setup error. A spatial-frequency-dependent linear systems model is used to predict the detective quantum efficiencies (DQEs) of the two systems. Each is divided into a series of gain and spreading stages. The parameters of each stage are either measured or obtained from the literature. The model predicts the system gain to within 7% of the measured gain for the MV system and to within 10% for the kV system. The systems' noise power spectra (NPSs) and modulation transfer functions (MTFs) are measured to construct the measured DQEs. X-ray fluences are calculated using modeled polyenergetic spectra. Measured DQEs agree well with those predicted by the model. The model reveals that the MV system is well optimized, and is x-ray quantum noise limited at low spatial frequencies. The kV system is suboptimal, but for purposes of patient positioning yields images superior to those produced by the MV system. This is attributed to the kV system's higher DQE and to the inherently higher contrasts present at kV energies.