Effect of secondary particles on image quality of dynamic flat panels in carbon ion scanning beam treatment

Objective: Real-time markerless tumour tracking using radiographic fluoroscopic imaging is one of the better solutions to improving respiratory-gated radiotherapy. However, particle beams cause secondary particles from patients, which could affect radiographs. Here, we evaluated the quality of radiographs during carbon ion pencil beam scanning (CPBS) irradiation for respiratory gating. Methods: A water phantom and chest phantom were used. The phantoms were irradiated with CPBS at 290 MeV n(-1) from orthogonal directions. Dose rates were 3.4x10(8), 1.14x10(8) and 3.79x10(7) particles per second. A dynamic flat panel detector (DFPD) was installed on the upstream (DFPD1) or downstream (DFPD2) side of the vertical irradiation port. DFPD images were acquired during CPBS at 15.00, 7.50 and 3.75 frames per second (fps). Charge on the DFPD was cleaned using fast readout technique every 30 fps. DFPD images were acquired during CPBS with radiographic exposure, and results with and without fast readout technique were compared. Results: Secondary particles were visualized as spots or streak-like shapes. Capture of secondary particles from the horizontal beam direction was lower with fast readout technique than without it. With regard to beam irradiation direction dependency, CPBS from the horizontal direction resulted in a greater magnitude of secondary particles reaching DFPD2 than reaching DFPD1. When CPBS was delivered from the vertical direction, however, the magnitude of secondary particles on both DFPDs was very similar. Conclusion: Fast readout technique minimized the effect of secondary particles on DFPD images during CPBS. Advances in knowledge: This technique may be useful for markerless tumour tracking for respiratory gating.