X-ray scatter in megavoltage transmission radiography: physical characteristics and influence on image quality.

The physical characteristics of x rays scattered by the patient and reaching the imaging detector, as well as their effect on verification (portal) image quality, were investigated for megavoltage (0.1-20 MeV) x-ray beams. Monte Carlo calculations and experimental measurements were used to characterize how the scatter and primary fluences at the detector plane were influenced by scattering geometry and the energy spectrum of the incident beam. The calculated scatter fluences were differentiated according to photon energy and scattering process. Scatter fractions were measured on a medical linear accelerator (Clinac 2100c, 6 MV) for a typical imaging geometry using an ionization chamber and a silicon diode. After correction for the energy dependence of the chamber and diode, the scatter fractions generated by the Monte Carlo simulations were found to be in excellent agreement with the measured results. In order to estimate the effect of scatter on image quality, the scatter and primary signals (i.e., energy deposited) produced in five different types of portal imaging detectors (lead plate/film, storage phosphor alone, lead plate/storage phosphor, compton recoil-electron detector, and a copper plate/Gd2O2S phosphor) were calculated. The results show that, for a specified geometry, the scatter fraction can vary by an order of magnitude, depending on the sensitivity of the imaging detector to low-energy (< 1 MeV) scattered radiation. For a common portal imaging detector (copper plate/Gd2O2S phosphor), the scattered radiation (i) reduced contrast by much as 50% for a fixed display-contrast system, and (ii) decreased the differential-signal-to-noise ratio (DSNR) by 10%-20% for a quantum-noise-limited portal imaging system. For currently available TV-camera-based portal imaging systems, which have variable display contrast, the reduction in DSNR depends on the light collection efficiency and the noise characteristics of the TV camera. Overall, these results show that scattered radiation can reduce contrast significantly in portal films while deteriorating image quality only moderately in on-line systems.