Simulation system for understanding the lag effect in fluoroscopic images.

Real-time tumor tracking in external radiotherapy can be achieved by diagnostic (kV) X-ray imaging with a dynamic flat-panel detector (FPD). It is crucial to understand the effects of image lag for real-time tumor tracking. Our purpose in this study was to develop a lag simulation system based on the image lag properties of an FPD system. Image lag properties were measured on flat-field images both in direct- and indirect-conversion dynamic FPDs. A moving target with image lag was simulated based on the lag properties in all combinations of FPD types, imaging rates, exposure doses, and target speeds, and then compared with actual moving targets for investigation of the reproducibility of image lag. Image lag was simulated successfully and agreed well with the actual lag as well as with the predicted effect. In the indirect-conversion FPD, a higher dose caused greater image lag on images. In contrast, there were no significant differences among dose levels in a direct-conversion FPD. There were no relationships between target speed and amount of image blurring in either type of FPD. The maximum contour blurring and the rate of increase in pixel value due to image lag were 1.1 mm and 10.0 %, respectively, in all combinations of imaging parameters examined in this study. Blurred boundaries and changes in pixel value due to image lag were estimated under various imaging conditions with use of the simulation system. Our system would be helpful for a better understanding of the effects of image lag in fluoroscopic images.