First clinical experience with a newly developed electronic portal imaging device.

In our institute an electronic portal imaging device (PID) has been developed and it recently became available for routine clinical practice. Images are available within 3 to 6 seconds after the start of irradiation; they are displayed on a video monitor next to the control console of the accelerator. The image quality is similar to the quality of images obtained with films. Because of its cassette-like shape and its low weight, the PID can easily be handled by technicians. An important advantage of the PID over conventional films is its pseudo-real time viewing facility. Typically, 5 to 10 images of each field can be made during one treatment session. In case a high accuracy in setup is demanded, the field edges of the first image, obtained with about 10% of the fraction dose, can be studied for acceptability before the rest of the dose is delivered. Using two prototype PID's first clinical experience has been obtained with patients treated for malignant tumors at various sites. Intra-treatment motion as a result of breathing, swallowing, or patient motion in a cast was seen. Motion of high contrast objects, for example, a field edge during irradiation, can be followed. This feature is important for future applications in computer controlled radiotherapy. Another advantage of the PID over film is that the image is digitally available. Therefore it can be further processed for quality improvement and quantitative analysis. Simple processing is done within seconds on the PID unit. A local network for the transfer of images from the accelerators to the evaluation room, where a detailed analysis of the field placement is performed, is under installation. Simulator film images are digitized in this room and are sent to the PID at the accelerator for a quick comparison with portal images during irradiation. We conclude that our device can replace the conventional film detector for portal imaging, that useful images are obtained within seconds during irradiation, and that the position of the field outline relative to the patient anatomy can be followed during dose delivery.