A comparison of field-only electronic portal imaging hard copies with double exposure port films in radiation therapy treatment setup confirmation to determine its clinical application in a radiotherapy center

Purpose: To determine in which treatment sites held-only hard copy electronic portal images (EPI) captured during a treatment exposure could replace traditional double exposed port films in a busy radiation oncology department. Methods and Materials: The three linear accelerators in the William Buckland Radiotherapy Centre (WBRC) at the Alfred-Hospital in Melbourne are each equipped with an electronic portal imaging device (EPID). These devices can be used daily on all patients where the treatment fields are within the size constraint of the cassette, for example, less than 25 x 25 cm. Port films using radiographic film in hard cassettes were previously considered the standard method of field placement verification. After the radiation therapists were trained in all program aspects of capturing, enhancing, and producing hard copies of EPIs, a study was developed to evaluate the possibility of replacing port films with EPI hard copies within the established departmental procedures. Comparison of EPI hard copy with the simulator film and the port film of the same field was carried out by the radiation oncologist specialists. Seventy-eight comparison sets were generated and grouped into seven anatomical regions for evaluation by the radiation oncologist specialist responsible for each particular region. The outcome decision was the preferred imaging option. Where no preference was stated, EPI became the modality of choice, as it increased the efficiency of work practice. Results: The results indicate that field-only EPI can be considered to be at least as clinically useful for treatment verification in the following sites: breast, chest,hip, spine, and large pelvic fields. Port films using a standard, double exposure technique were considered necessary for partial brain fields, small pelvis fields, extremities, and radical head and neck fields. Conclusion: The quality of field-only images captured using an EPID has been favorably assessed to be equivalent to, or an improvement on, the traditional double exposed port films for some treatment areas. Departmental policy has been altered to incorporate this new imaging modality as a practical alternative to port films, resulting in a direct benefit in terms of resource management and patient care. Continuing research is currently evaluating open area exposed EPI hard copies as a potential alternative to port films. (C) 1999 Elsevier Science Inc.