title: The electronic portal imaging system Siemens Beamview Plus versus the conventional verification films CEA-TVS and DuPont COL-7. A critical appraisal of visual image quality.
abstract: OBJECTIVE
  The aim of this study was the validation of the visual image quality of electronic portal imaging devices (EPID) and conventional verification films from the point of view of the end-viewers of portal films, the radiotherapists.
  
  
  METHODS
  The verification image was represented in two different forms, viz. an electronic portal image employing Siemens Beamview Plus (on a computer monitor) and two different portal films using the conventional verification films CEA-TVS and DuPont CQL-7 (on a negatoscope). A total of 270 image sets (simulation film and portal image) were evaluated by each radiotherapist, evaluation extending to 90 sets of each type of verification film. Each set was evaluated by three specialists in radiotherapy examining subjective visual image quality whereby the following aspects served as evaluation criteria: contrast, artifacts, determination of actual radiation field edge position, anatomical structures and main structural feature for the determination of treatment field position. In addition, the anatomical structures employed for visual feature correlation between reference and portal films were classified according to their importance.
  
  
  RESULTS
  In general the electronic portal image was rated significantly "visible" or better. Only the evaluation of artifacts showed an appreciable disadvantage for electronic portal imaging caused by physical artifacts due to radiographic technique and data processing aspects peculiar to the Siemens Beamview Plus 1.1. and also caused by different image processing tools reducing physical artifacts and enhancing the visibility of anatomical structures and likewise of anatomical artifacts (e.g. intestinal gas). By calculating the Spearman correlation coefficient to detect a possible relationship between the different criteria of subjective visual image quality, the research demonstrated that artifacts when limited to a tolerable proportion had no significant impact on the other criteria.
  
  
  CONCLUSIONS
  As data of EPIDS are digital, images can be postprocessed and enhanced in a wide variety of ways. Using this tool the electronic portal imaging device provides images that, in terms of visual image quality, are at least comparable to the two evaluated types of radiographic films and also have the added advantage that such images are stored and can be transferred electronically being presupposition for digital patient documentation.
authors.affiliation: Department of Radiotherapy, RWTH Aachen, Germany. Bernd.Gagel@post.rwth-aachen.de
authors.forename: Bernd
authors.initials: B
authors.lastname: Gagel
authors.forename: Oliver
authors.initials: O
authors.lastname: Schramm
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Harms
authors.forename: Andrew
authors.initials: A
authors.lastname: Mulhern
authors.forename: Frederik
authors.initials: F
authors.lastname: Wenz
authors.forename: Michael
authors.initials: M
authors.lastname: van Kampen
authors.forename: Michael
authors.initials: M
authors.lastname: Wannenmacher
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Eble
mesh_terms: D016477:Artifacts; D003627:Data Interpretation, Statistical; D003952:Diagnostic Imaging / Q000295:instrumentation*; D004582:Electronics, Medical; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D009369:Neoplasms / Q000532:radiotherapy; D011786:Quality Control; D018787:Radiation Oncology / Q000295:instrumentation*; D011859:Radiography / Q000295:instrumentation; D011880:Radiotherapy Planning, Computer-Assisted; D011881:Radiotherapy, Computer-Assisted / Q000295:instrumentation* / Q000379:methods / Q000592:standards; D012984:Software; D013679:Technology, Radiologic; D014057:Tomography, X-Ray Computed; D014962:X-Ray Film