In the largest early-stage NSCLC SBRT data set to date, a high rate of local control was achieved, which was correlated with a PD(BED10) of 105 Gy or more. Failures were primarily distant, severe toxicities were rare, and overall survival was encouraging in operable patients.
The quality of images generated with radiographic imaging systems can be degraded if an inadequate number of secondary quanta are used at any stage before production of the final image. A theoretical technique known as a "quantum accounting diagram" (QAD) analysis has been developed recently to predict the detective quantum efficiency (DQE) of an imaging system as a function of spatial frequency based on an analysis of the propagation of quanta. It is used to determine the "quantum sink" stage(s) (stages which degrade the DQE of an imaging system due to quantum noise caused by a finite number of quanta), and to suggest design improvements to maximize image quality. We have used this QAD analysis to evaluate a video-based portal imaging system to determine where changes in design will have the most benefit. The system consists of a thick phosphor layer bonded to a 1 mm thick copper plate which is viewed by a T.V. camera. The imaging system has been modeled as ten cascaded stages, including: (i) conversion of x-ray quanta to light quanta; (ii) collection of light by a lens; (iii) detection of light quanta by a T.V. camera; (iv) the various blurring processes involved with each component of the imaging system; and, (v) addition of noise from the T.V. camera. The theoretical DQE obtained with the QAD analysis is in excellent agreement with the experimental DQE determined from previously published data. It is shown that the DQE is degraded at low spatial frequencies (< 0.25 cycles/mm) by quantum sinks both in the number of detected x rays and the number of detected optical quanta. At higher spatial frequencies, the optical quantum sink becomes the limiting factor in image quality. The secondary quantum sinks can be prevented, up to a spatial frequency of 0.5 cycles/mm, by increasing the overall system gain by a factor of 9 or more, or by improving the modulation transfer function (MTF) of components in the optical chain.
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