USER MANUAL

Software Version: 5.0.6348.26243

Rev.03 April 2018

Advanced Specialty Ingredients, G.P.

1005 Rt. 202/206
Bridgewater, NJ, USA 08807
table of contents
Introduction ................................................................................................................... 3

Installation ...................................................................................................................... 5

Getting Started ........................................................................................................... 10

Operations
Menu Bar...................................................................................................................... 11
Case Data Selector Panel ......................................................................................... 19
Image Panel ................................................................................................................ 23
Film Evaluation Panel .................................................................................................. 26

Processes
Calibration ................................................................................................................... 32
Dose MapTM ................................................................................................................. 43
Plan to Dose Comparison .......................................................................................... 52
One Scan Protocol ..................................................................................................... 69

Physics Modules
Star Shot Analysis ......................................................................................................... 77
Flatness and Symmetry Analysis ................................................................................ 97
Picket Fence Analysis ............................................................................................... 100

Editors
Bitmap Color Translation .......................................................................................... 107
Color Translations Map ............................................................................................. 108

Configuration
Managing the Libraries............................................................................................. 112
Troubleshooting ......................................................................................................... 114

Appendices
Calibration Protocol ................................................................................................. 117
Efficient Protocol for Radiochromic Film Dosimetry ............................................... 126
One Scan Protocol ................................................................................................... 130
Post-Exposure Change ............................................................................................. 135
Film Calibration (Mosaic) ......................................................................................... 137

Index........................................................................................................................... 140

References................................................................................................................. 141

2
Introduction (video: http://www.youtube.com/watch?v=A26tTy2iF88)

tool specifically designed

to simplify and streamline the intensity-modulated radiation therapy quality
assurance (IMRT QA) process. The program allows the user to scan or open
images of exposed application films and calculate the optimized dose maps.
The calculation is based on a scanner-dependent function generated from
calibrated data derived from three color channels (red, green and blue). The
three-color channels are produced by using Gafchromic EBT3, MD-V3 or HD-V2
films. These self-developing radiochromic dosimetry films are intended
specifically for applications in radiotherapy.

FilmQA Pro complements Gafchromic dosimetry films. When these Gafchromic

films are used, the optimized dose maps include corrections for thickness
artifacts by using the blue color channel to measure the absorbance of the
yellow marker-dye in the films. When the films are used with a professional flat-
-to-use features are ideal for the fast-
paced, processor-less environment of the modern hospital.

The purpose of this guide is to familiarize the user with the many useful features
of FilmQA Pro, with a particular focus on the basic functions of calibration,
calculation of a dose map from an exposed film, comparison of a dose map to
a patient-specific treatment plan and execution of machine QA functions like
star shot analysis, flatness and symmetry determination and assessment of MLC
function. In addition to the contents of this User Guide, a number of instructional
videos are available for view on YouTube. Use the table of contents in this guide
to easily navigate to the desired section or read through the instructions step-by-
step. In the end, our goal is to provide both an in-depth introduction to, and a
quick reference for, all the features available in FilmQA Pro.
Disclaimer

The information contained in this manual and the various products described
are intended for use only by persons having technical skill and at their own
discretion and risk after they have performed necessary technical investigations,
tests, and evaluations of the products and their uses. While the information
herein is believed to be reliable, we do not guarantee its accuracy and a
purchaser must make their own determination of a product's suitability for the
purchaser's use, for the protection of the environment, and for the health and
safety of its employees and the purchasers of its products. Neither Ashland
Specialty Ingredients G.P. nor its affiliates shall be responsible for the use of this
information, or of any product, method, formulation, or apparatus described in
this manual. Nothing herein waives any of Ashland Specialty Ingredients G.P. or
its affiliates' condition of sale and we make no warranty, expressed or implied, of
merchantability or fitness of any product for a particular use or purpose. We also
make no warranty against infringement of any patents by reason of purchaser's
use of any information, product, method, or apparatus described in this manual.

technology.

4
installation

Recommended computer requirements

Hardware:
Processor: i7
RAM: 8 GB, 1333 MHz
Graphics: UXGA+ (1600 x 1200), HD (1920 x 1080) or WQXGA (2560
x 1600)
Input Devices: keyboard and mouse; tablets and touchscreens are
not supported
Scanners: Epson 12000XL Photo Scanner, Epson 11000XL Photo
Scanner, and 10000XL Photo Scanner with Epson Twain
Drivers 32-bit drivers

Minimum computer requirements for FilmQA Pro:

Hardware:
Processor: i5
RAM: 4 GB, 1333 MHz
Graphics: Wide XGA+ (1440 x 990), XGA (1152 x 864)

Software:
Operating
System:
Windows 10
Windows 8
Windows 7 [with Microsoft® .NET Framework 4.0 Full]
Windows Vista [with Microsoft® .NET Framework 4.0
Full]
Windows XP [with Service Pack 3 (SP3), Microsoft® .NET
Framework 4 Full and Microsoft® Visual C++ 2010
Redistributable Package (x86)]
Please refer to the software license key for an expiration date. Notice to user:
any serious incident that occurs in relation to this device should be reported to
the manufacturer.

For technical assistance in the U.S., email AdvancedMaterials@Ashland.com.

For technical assistance outside the U.S., contact your local distributor or email
AdvancedMaterials@Ashland.com for the name of your local distributor.
1. Complete the Software Download Request form and then download the
installation file from http://gafchromic.com/filmqa-
software/filmqapro/softwareDownloadRegistration.asp

2. Run the installation file:

6
3. Navigate through the following prompts by hitting

4. proceed

5. folder
6. llation of FilmQA
7. the installation process

8.

9.
user to generate a license (see the following message below):

10. K

8
11. .

12. Email the saved file to AdvancedMaterials@Ashland.com to obtain your

license key.

13. After receiving the license key, save the key to the application folder in
\Program Files\Ashland Advanced Materials\FilmQA Pro 20XX\
NOTE: Only one (1) license key can be stored in the application folder.

14. to
start the program.
GETTING STARTED (Video: http://www.youtube.com/watch?v=5mAidqhL5qM)

When Fi appear:

There are three sections:

o To the left is the Case Data Selector Panel , which allows the user to add
selected image objects from a saved file or directly from a scanner. This
panel contains the case tree and its branches are a collection of the
case objects required to execute a case. For instance, to compare dose
measurements to a patient-specific plan, the tree requires a Film
Calibration Object, a Dose Map Object and a Dose-to-Plan Comparison
Object. The objects added to the case tree are dependent on preceding
objects. For example, a dose map object cannot function unless the case
tree contains a calibration object. Click the - signs to expand or
compress any branch of the tree.
o The center se
o

10
 window can also display properties of a selected image, for example, its
source, time stamp, image resolution, dose range, data statistics, as well
as the cursor position and location/size of all user-define areas of interest
and the size and position of a user-defined profile path across an image.

Navigating t , use the keyboard and mouse point-

and-click commands to select an item (left click) or to access a drop-down
menu (right click). Hovering over any icon will display its name and explain its
function.

MENU BAR

At the top of the window is a Menu bar with four tabs: File, Panel, Data and
Help. This bar controls a multitude
of functions, including the saving or
loading of a treatment case, changing configuration or unit settings, generating
a license key or finding helpful resources.

an existing treatment case, save a treatment case or review the most recent
treatment cases. Users can also configure certain
parameters or change the unit of measurement for the
system. After selecting
available:

o Retrieve a
stored treatment case from file.
o Close the current
treatment case and start a new one.
o Save the current
 treatment case under a different name or in a different location.
o Load most recently used treatment cases
from a new panel that opens to the right.
o Loads/saves gs from a
new drop-down list.
o Saves the configuration automatically each time the
user exits the application.
o Opens treatment case with
the same configuration that was set the last time the case was
opened.
o Recalls location of saved files.
o Reset the configuration to system default.
o panel.
o Save the units automatically each time the user exits
the application.
o
exclude the loading of number formats.
o Closes FilmQA Pro.
o -
button is clicked.

"Panel" is the next category. It helps the user configure the various tools utilized in
FilmQA Pro.

o
user to select the tools
available in the software.
o
will change the tool set
back to the original
factory configuration.

12
 o
all of the time.
o drop-down menu selections.
o
various objects to be activated and therefore available from the
drop-down list in the Case Data Selector Panel. User-written
functions can be added to the library.
o
back to default settings.
o
to see the default object list all the time.
o
to import user-written treatment objects from other cases.
o
treatment- planning software, e.g. Pinnacle, Brain Lab, Eclipse, etc. User-
written functions can be added to the library.
o
in the drop-down list.
o
the default settings.
o gives the user the option to
see the default reader types all of the time.
o l always
open a separate window to select the reader type.
o equations
from a library of functions correlating film response with radiation dose
User-written functions can be added to the library.
o
function list back to default settings.
o
 see the default calibration equations all the time.
o
selector either left, top, right or bottom.

Data , includes all data related to the patient, treatment case or scanner. This
tab also allows the changing of measurement units and adjustment of software
preferences.

o to
create a new patient and add or
remove a patient from the database.
o
user to create a new treatment case
and add or remove a case from the
database.
o r remove a scanner from the
database.
o
software.

14
o the
appearance and layout of FilmQA

o
helpful information in the
software (hover the cursor
over the icon or area of
interest).
o
of space around each section
of the software. The range for
the frame is between 0 and 50
pixels. Horizontal and vertical adjustments range from 1 to 20 pixels.
o he user to choose between various character types
and sizes.
o

another option to select predetermined color mixes. Colors can

always be returned to

o
 o cated at the bottom of the screen and does the
following:
1. Informs the user of the
current software condition;
2. Allows changes to be made
to the status history;
3. Allows the user to configure

4. Provides the user a means to copy a screen shot.

choices:

1. bar.

2. information
is automatically erased from the status bar.

o allows the user to

view the history of software
exceptions, which are events the
application could not complete.
tool to aid in
identifying and fixing software
bugs. By
inside the
window, the user can select:

o the number of lines displayed related

to that particular event

o The number of events allowed to view

16
 o Clear all events.

o Wrap the words to fit the window width.

o criterion to
reduce the number of visible exceptions in the window. See
detailed descriptions and examples in

o
complete history of
conditions since the
application was opened.
the
window, options become
available to

o (see

o image of the
current screen.

o history when

o T es a popup
window when an exception occurs.

o of
the screen. When the application is idle, the icon will appear as ,
otherwise the icon will look like similar to this . The number on the
left indicates the number of calculation tasks in process. To cancel the
current task, right click on the icon and select .

o File management is the last option under this heading. The option
 toggles on-off the ability to let FilmQA Pro remember the last open file
location, the last saved file location and to sync the last open and
saved file locations.

"Help" is the last category and

provides instructional
information such
manual, license data
generator, license expiration
notification and related web
links.

o software.
o "Generate License copies the license data.
For details on how to obtain a license key, see Installation (Page 4, Step
#8).
o before the
license expires. Choices are for 1, 2, 7, 14, 21, 50 and 100 days. The default
setting is 14 days.
o Pro.
o vides installation information on FilmQA Pro
(i.e., Version Number, License ID, License Renewal Data, etc.).

18
CASE DATA SELECTOR PANEL

The Case Description is a default addition to

the case tree. To store patient or case
information, go to the Case Data Selector

Description The tree will expand to show

Not Data Not Assigned .

o drop-down list to select an existing patient from

the database. By choosing

database.
o drop-down list to select case specific information
related to the patient. Double-click the icon to open the pop-up window
the
patient name of the treatment case selected.

Case Object Management allows objects to be added to the Case Tree to

 o Fi Scan or
open a file containing a single image to
generate a calibration curve.
o (Mosaic) Scan or
open multiple image files to generate a
calibration curve.
o Film Calibration Dose Maps calculates
a dose map, consistency map and
uniformity map from the image or images
used to generate the calibration curve.
o Scanner
opens multiple image files. The images can be averaged or fused
together and the resultant image can be saved or copied to be used as
required.
o Scan) Scan or open an image file for conversion to a
dose map from a Film Calibration Object. A calibration curve is required in
the Case Tree before a dose map can be generated. Note: By default
the first Film Calibration Object in the case is used. In the Dose Map
branch of the Case Tree select a different dependency if the case
contains multiple Calibration Objects and one of the subsequent ones is
to be used.
o Import a treatment plan from a file, TPS or
DICOM and do a gamma analysis against a treatment film. A Dose Map
Object is required in the Case Tree before a dose-to-plan comparison can
be done. Note: By default the first Dose Map in the case is used. In the
Dose-to-plan Comparison branch of the Case Tree select a different
dependency if the case contains multiple Dose Map Objects and one of
the subsequent ones is to be used.
o Scan or open a file of an image to perform a
star shot analysis.

20
 o Scan or open a file of an image to
perform a picket fence analysis.
o Scan or open multiple files of an
image to perform beam uniformity analysis.
o Analyze a dose map
generated from a scanned film or image file using of the calibration
function of a Film Calibration Object. Note: By default the first Film
Calibration Object in the case is used. In the Flatness and Symmetry
Physics QA (Dose Map) branch of the Case Tree select a different
dependency if the case contains multiple Calibration Objects and one of
the subsequent ones is to be used.
o Open a case object from file

Under drop-down list provides options to select a

template of objects to create a treatment case.

o Opens a
template for a full treatment case that
includes the following case objects: Film
Calibration (Ordinary), Dose Map (Single
Scan) and Dose to Plan Comparison.
o Erases everything

o Opens a
case object from file.
 Case Data Selector shows the case management
tree, which allows the user to add selected image
objects into case data. It is located on the left side
of the screen. The case data selector allows the user
to add patient information, calibration data, and
film images and data analysis from a file or directly
from a scanner. Remember: each object added to
the tree is dependent on the objects above it. At
the foot of the panel are a number of icons:

o file.

the computer. All

objects opened in the case data selector are
saved as one case.
the selected treatment object
tree node.

scanner configuration.

o the desired scanner. Select the

appropriate scanner in the pop-up
window.

o Show Twain Parameter Panel before

nables the scanner panel
to open each time when scanning.

o spatial
resolution of the scans. Choices are 36,
48, 60, 72, 96, 144 and 192 DPI.

o
scanner.

22
 o to
rotate the image 90° to match the display with the scanner information.
This feature is used for some scanner drivers which would auto rotate the
image without rotating the device information (e.g. Epson used in
conjunction with Windows XP).

o
forces the detection of image rotation when the
automatic feature is disabled.

o
scanner to rotate the displayed image 90°.

o Options displays a new window with various

choices. Among others, the user can enable 24-bit rgb images (not
recommended
Remember full- frame, high resolution images can get very large and slow
down an analysis.

IMAGE PANEL

Image Panel displays the image and user-

defined regions of interest for dose calibration
and measurement. It is located at the center of
the screen. The image panel allows the users to
view the active image and to select the region
of interest (ROI) for dose calibration and
calculation. Fifteen icons are designated as tools and appear on the bar to the
left of the image panel. These tools are Selection Frame, Fiducial Management,
Color Leveling, Pause, Image Scaling, Color Channel Selector, Color Range
Spreader, Magnifier, Undo/Redo Buffer, Flip/ Rotation, Cropping, Filtering, Color
Translation, Image Exporter and Editor Configuration. Right-clicking on any tool
opens a pop-up window of additional options.
 o Selection Frame, allows the user to select one or more regions of
interest (rectangular, square, circular, elliptical) on the image displayed.

o Fiducial Management, allows the user to select points of reference

manually or turn-on an algorithm to automatically detect those reference
regions on the image displayed.
o Color Leveling, allows the user to adjust the brightness and contrast
levels of the image displayed.
o Profile Path, displays the path line when the Profile tab is enabled.

o Pause, allows the user to stop all the image tools selected.
o Image Scaling, allows the user to select image coordinate system and

axis units. When this tool is selected, the user can change the coordinate
system between the image or the scanner. This ability allows the user to
compare scanner effec allows
the user to change the configuration of the axis, image grid and color of
the scanner background when scanner coordinates are used.

Color Channel Selector, allows you to select, invert, or gray the color channels
of the image displayed. Note: This tool does not change the bitmap of the image.
The screen view only changes.

Color Range Spreader allows you to select a range of color channels to apply to the

o Delete Color Channel Scaling to change the channel scaling back to full range.

o Color Channel Scaling Dialog

the minimum and maximum values for all three channels the same.

o Auto Scale Color Channels to range of Selected Frame sets the image color
channel range to color channels of the selected frame in real time.

o Scale Color Channels to Image Range sets the color ranges to the ones of
the displayed image.

24
 Magnifier allows you to zoom in and out of the image. By clicking on the
icon, one can scroll up to zoom in and scroll down to zoom out using the
mouse.

o Auto Fit fits the image automatically to your preference every time the
image is displaye

Undo/Redo Buffer allows you to undo and redo the changes made to the image.
Flip/Rotation, allows you to flip or rotate the entire image or region of
the current image selected.
Cropping, allows you to crop the region of the image displayed.

Filtering, filters the entire image or region of the image displayed by

allowing pixel modifications using a filter matrix to combine surrounding
pixels. To define and edit filters, open the filtering tool.
Color Translation, allows you to translate colors of the entire image or
region of image displayed.
o Equalize Color Channel divides all color values by a normalized color

divided by the normalized red value.

o Equalized Color Channel Density divides all color channel densities by

selected, all color channel densities are divided by a normalized red

density.
o Other options are to invert, translate or manage the color through
densities or maps (See Bitmap Color Translation Editor and Color
Translation Maps Editor).

Image Exporter, , allows the user to export to a file or clipboard the entire
image, the image with color channel selected or region of the image displayed.

Editor Configuration, , allows the user to adjust the configuration of the editor
(i.e. enable icons, adjust axis, etc.)
FILM EVALUATION PANEL

displays evaluation data for any image or dose

map in the Image Panel. The panel has tabs to
access eight sub-panels: Info, Cursor, Statistics,
Profile, Contour, Iso-map, Surface and Report.
Info Panel displays information pertaining to the
image (i.e. size, pixel, resolution, and color
channel range, memory and scanner
information) as well as the sizes and locations of
any areas of interest displayed on the image.
Right-click in the panel to change the units of measurement.

Cursor Panel displays information from the red dashed box area overlaid on the
image - see red arrow below.
In the red box, the pixel
statistics shows the
information contained in the
red dashed box (look for red
arrow to the right). Right click
in the area outlined in red to
change the units of
measurement. In the yellow
box, the window displays an enlarged image of the red dashed box in the
Image Panel. Move the pointer to see the location, magnification percentage
and color range in the cursor area. The slide bar at the bottom of the window
changes the magnification of the image. The higher the magnification, the
smaller the red dashed box. Increase magnification by dragging the bar to the
right.

26
The color channel spreader, spreads the color so that the selected image
region is displayed with a color saturation between 0% and 100%. This feature
magnifies differences in color. The color channel selector, selects the
combination of red, green and blue color channels for mapping the view of the
image region.

Statistics Panel shows the dose histogram and the image

statistics. Information is displayed for the entire image as
well as the image around the cursor. In addition,
information is displayed for any areas of interest marked
on the image. It displays the image statistics all the areas
in tabular form and of the full frame or a highlighted area
of interest in histogram form. Use the window at the
bottom of the panel to select the histogram displayed.
Move the cursor or
area of interest around to see the real time tracking of
or frame
columns. Pixel statistics (#, #) at the bottom of the panel indicates the location
of the cursor.

The two arrows, or number format buttons, can change the format of the
numbers displayed in the window. Depending on the image selected from the
Case Tree in the Case Data Selector, the table will present information related
to the color channel (film image) or dose for the color channel (dose map
image). Right click inside the table to:
o change the units and format of the column;
o copy the table;
o change the pixels of cursor region or 4) change the configuration of the
table.
The histogram shows the bar graph for
probability versus dose or color channel
response. To zoom in, click and drag a
region from top left to bottom right of the
preferred region. To pan out, click and
drag from bottom right to top left. Right
click and hold to drag the histogram across the data range. Right click inside
the graph to: 1) change the units and format for the color channel or
probability, 2) copy the table or chart, 3) set a new predefined data range or
4) change the configuration of the graph. The image histogram region drop-
down list selects the region of the
image displayed in the histogram.
Right click inside the window and
check
data of all frames (counts possible
overlap regions multiple times).
Uncheck the option to count overlap
regions only once. The histogram range
button lets the user toggle between full
histogram range (0-100%) and auto range (i.e.
the zero clusters at boundaries are removed).
The icon appears when full range is on and
becomes when switched to auto range.

the preferred range.

The color channel selector, lets the user

select the color channel for calculating the
histogram.
The color translation tool, lets the user select a color matrix or color translation

28
that is applied to the color pixel values before the histogram data is calculated.
Right clicking on the icon opens a pop-up window with other options.

The Profile Panel

shows the image
profile along the
user- defined path
in the
image. Click and
drag in the image
panel to create an
image path.
Alternatively click
the profile icon on
the toolbar and select the type of profile from
the menu. Click on the profile icon also to change the width of a profile path.
Right-click on the profile path itself to select the axis type from pixels, length or
normalized. If length is selected right-click again on the profile path to select the
measurement units The path profile shows in the Film Evaluation Panel as a line
graph of dose or color channel value versus position along the path.
Depending on what image is selected
under the Case Data Selector, the graph
presents information related to the color
channel value of a film image or the dose
value for a selected color channel of a
dose map. Right click inside the graph to:
1. Change the units of the graph,

2. Copy the graph or

3. Change the configuration of the

graph.
The Contour Panel displays the iso-line chart of the image for a given set of dose
or color channel values (see image on the
right). Right clicking inside the chart to copy the
image, to change the units or to configure the
chart. The legend displays the color palette
associated with different dose or color channel
values. Again, by right clicking, one can
change the units as well as add, copy, paste,
open and save a palette. Other options for
contour levels are:
1. Maximize Contour Level Range sets the
range to the minimum and maximum color
channel values or doses of the image.
2. Auto Maximize Contour Levels maximizes
the range automatically.
3. Number of Contour Levels changes the number of isodose levels.
4. Assign Default Contour Levels and Palette change the contour levels and
palette to the software default settings.
The Iso-map Panel displays the dose map or color
channel map of the image. Right clicking inside
the chart to copy the image or to configure the
chart. Similar to the isolines, the legend displays
the variances of dose positively and negatively for
the image displayed. Likewise, with the isolines
palette, right clicking in it will adjust the
configurable settings.

The Surface Tab displays analysis data in a 3D

surface. Options to change perspective,
elevation, rotation are also available.

30
The Report Tab configures and formats the case
report. The report can be written based on color
channel, size and content. The footer of each
report always lists the dose distribution
comparison functions gamma, DTA and dose
difference.

The Case Report can be magnified, saved and

printed by using the familiar icons under the
chart. If any of the charts displayed in the report
have been re-calculated or altered in any way
after the report was formatted the click on the
icon to update the contents of the report before
it is saved or printed.
CALIBRATION (Video: http://www.youtube.com/watch?v=AKqpsFKprf0)

The calibration process uses films irradiated with known doses to generate a
calibration table and calculate a set of calibration functions, one for each color
channel. These calibration functions correlate the dose values of the exposed
films with the color values in the scanned images. This section describes how to
demonstration purposes it uses files
downloaded with the FilmQA Pro installation file and installed in Program
Files/Ashland Advanced Materials or ISP Advanced Materials.
FilmQA Pro uses simple, asymptotic, rational calibration functions that behave
like film, i.e. the response asymptotes to constant value at high dose just the way
film darkens with increasing dose. The simplest and most widely applicable of
these rational functions requires definition of three coefficients so the specific
behavior of a batch of radiochromic film could be defined with as few as three
data points. In practice, we recommend a minimum of four points since with
this redundancy the application provides some statistics that can show which of
the calibration functions is best. In general, the dose points for a particular case
should be chosen in geometric progression say 0,
75, 150 and 300 cGy - rather than in arithmetic
progression. One or two more points could be
added if the dose range is much larger say 0 to
20 Gy but there is no advantage to the much
large numbers of data points sometimes tens in
number that are frequently used. Since relatively
few calibration films are necessary, the
recommended way is to use the One Scan
Protocol and scan the calibration films all together
in one image rather than separately.

32
Film Calibration (Ordinary) is used when all the calibration films are contained in
a single scan as for the One Scan Protocol. Film Calibration (Mosaic) is used
when the calibration films are contained in multiple images. Film Calibration
(mosaic) is no longer available in the default settings; however, it is available at
the library and can be accessed by the user who wants to do the Mosaic
calibration. More information on Film Calibration (mosaic) can be found in the

-down menu
choos .
Film Calibration (Ordinary):

1. Calibration
on
the first heading o N/
menu:

o
navigate to a folder and select a
image file to open;

o from
and select
a DICOM file to open;

o shortcut to recently used image files;

o
obtain an image from a Twain compliant
scanner

2.
the
FilmQAPro/Images/Example EBT3 Rapid Arc and open the calibration film
image. A thumbnail image appears in the empty data slot and the full image is
displayed in the center window.
3.
, from the Tool Bar located in the border to the left of the image
S be manipulated,
i.e. moved, sized and shaped. Be aware that in calibration the user is defining
the average response of the film and the ROI should cover an area of at least 20
cm2.

Draw a rectangular ROI at the center of one of the exposed film strips and
adjust its size. (Hint: the exposed areas in the sample images are 10 cm wide).
Panel to display a range
of image data including size and position of
the image was acquired, the scanner used, etc. Repeat the ROI selection for
each calibration strip.
Note: There are shortcuts to copy and resize ROIs. Highlight an ROI, hold down
left- clicking , the
user can choose from options to copy and paste multiple ROIs and/or save
them to file. Right click and there are more choices including an option to

34
select an ROI and size/shape all other ROIs in the same way.

4. The next step is to activate the calibration tool. At the end of the Film
Calibration (ordinary) branch of the Case Tree click Tool . The
calibration window containing the calibration tool opens on the right of the
screen.
Once all the images are imported, a calibration table and fitting function must
be generated. In the bottom right corner of the Film Evaluation Panel, the Color
Channel Value icon, appears. Clicking this icon
automatically loads the response values for the
selected ROIs into a table. (Note: The calibration table
could also be populated by typing response values
manually or by copying/pasting tabulated data from
another application).

After response values are loaded, right click in the

table to access an option menu to manipulate the
response data in the table.
o Color channel unit: 16-bit: response values
scaled from 0 (black) to 65535 (216-1, maximum brightness); %: response
values scaled from 0- 100, i.e. 16-bit response
value/65535; and OD (Optical Density): values
expressed as log10(16-bit response
value/65535)

o Color channel format: Adjusts the precision of

the response values.
o Copy table: Right click in table to copy/ paste
to another application.

o Copy color value calibration table image:

Generates image with calibration patch tablet
using calibration table and copies image to
the clipboard

o Paste universal data: Paste a selection of tables with calibration data

obtained from numerous radiochromic film lots

36
 o Insert or Delete Rows: Point and click to add or delete a row

o Delete all rows: Click to delete all the rows

o Options: Provides a menu of options to customize the calibration table

The dose values can be entered manually from the keyboard or copied and
pasted from a table of values. From the IMRT and RapidArc examples installed
the image
files. The dose values can be entered in any order, since, by default, once the
table is full, the dose values/responses are sorted in reverse order depending on
the responses in the red color (i.e. lower response values are associated with
higher dose). Right click the Color Channel Synchronization icon, just below
the table to select a choice for synchronizing the dose values with the response
values, or to turn off the dose-response synchronization. Note: Doses and/or
response values could also be entered by copying and pasting from a table.
There are files
Exposure.txt in each of
the folders: Example
EBT3
GafChromicPhantom
Lung SBRT 14Gy and
Example EBT3 Rapid Arc
containing the example images. For convenience, open the appropriate txt file
and copy and paste the doses into the calibration table.

The image below shows a completed calibration. The calibration film image
and user-selected ROIs are shown in the image panel (center section). The film
evaluation panel (right section) displays tabulated and graphical calibration
data for each color channel along with the user-selected fitting function and
coefficients relating measured film response to dose.
Data will not be fitted and no plot will be displayed unless there is exactly one
dose value for each row of response values. Note: A chart with data points, but
no fitted line for one or more of the channels means that no dose-response
correlation could be established for that fitting function. Also, if the chart
displays a fit with one or more singularities, choose another fitting function. The
user cannot use a function containing a singularity.

The fitting function matched to the plotted calibration curve is displayed in a

window just above the calibration table. There are several choices in addition to
the default, color reciprocal linear vs. dose function. Click on the right end of
the calibration function window to see all the choices.

o Color reciprocal linear vs. dose: X (D) =A + B / (D-C) where X (D) is

the response at dose D and A, B, and C are coefficients to be
determined. This function is used as the default.

38
 o Color rational (linear) vs. dose: X (D) = (A + BD) / (D+C) where X (D) is the
response at dose D and A, B, and C are coefficients to be determined.
o Color rational (quadratic) vs. dose: X (D) = P2 (D) / (D+E) where X (D) is the
response at dose D; P2 (D) = AD2 + BD +C and A, B, C, and E are
coefficients to be determined.
o Color rational (cubic) vs. dose: X (D) = P3 (D) / (D+F) where X (D) is the
response at dose D; P2 (D) = AD3 + BD2 + CD + E and A, B, C, E, and F are
coefficients to be determined.

Right click this icon to display or copy/paste the determined coefficients of

the selected fitting functions to another application. The fitting functions are
generally expressed as X (D) = fD and the inverse D = fX (D) where X (D) is the
response expressed as (16-bit value/65535) at dose D in Gy.

Use the Calibration Statistics icon just under the calibration table to display
the calibration statistics in the image panel. This is a table of dose consistency
values determined from the calibration doses values and the fitted values. It
provides help in selecting the fitting function best suited to the data points.
Lower values in the table signify better consistency among the color channels. In
this case, and most cases with doses <500 cGy, the best fitting function is the
rational (linear) function.

For a higher dose ranges, e.g. 0-10 Gy the color rational linear function: X (D) =
(A +BD) / (D+C) is often preferred. For even greater dose ranges up to 20, 30 Gy
or more, the rational quadratic or cubic functions are preferred.

The exponential universal calibration is a generic or pre-shaped function

determined by compounding calibration data from many production lots of EBT
type films. It may better represent the shape of the response curve of EBT type
films and in this way, make it better adapted to the characteristics of any one
lot than are the other fitting functions.

When the calibration is finished, there are a number of save options.

on the menu bar

case. Or save the calibration data by

right clicking on
Save Film Calibration Data as
green box in
the image to the right). The calibration
curve, calibration table, function and
scanned images of patches will be
stored to use in calculating a dose map
in this case or another case. When a
Calibration Treatment Object is reloaded the calibration can be edited.

red
box above). In this case only the calibration will be saved for use in calculating
a dose map, but for security, a fixed calibration cannot be edited or revised.

40
Scanner header information is required to save a fixed calibration function to
load calibration data saved as a Treatment
Case choose menu bar and

a Treatment Object or Fixed Calibration

then right- new

navigate to the folder containing the case

object file. A case may contain multiple
calibration objects, but if a case contains
more than one calibration object it will be
necessary to select the correct
dependency for any other objects in that case requiring a calibration, e.g. a
Dose Map Object. For instance, expand the Dose
dependence for that branch of the case tree.

Calibration cases and calibration data can be saved in many ways. The
Calibration Function Management icon located under the calibration
function window provides a shortcut to saving and utilizing a calibration in other
useful ways. Right-click the icon to access the menu:

o Save as a fixed calibration: Saves the calibration in a form that cannot be

edited or revised when later used.
o Save as FilmQA XR calibration: Saves calibration in a form that can be
used in the FilmQA XR application.
o Calibration function type management: Accesses the calibration function
library from which other existing calibration functions could be loaded.
o Add as universal calibration: Adds the calibration as a pre-shaped
function.

o Add calibration as color mapping: Adds the calibration function as a tool

to convert response values to dose. When this option is invoked, for
example in plotting a profile across an image in response space, the
 profile chart and table will be displayed as dose vs. position as opposed
to scanner response vs. position.
o Edit calibration function name: Customizes the name of the selected
calibration function
o Add unknown calibration function types: Provides a path to adding a
new calibration function to the calibration function library.
Other icons of interest involved with the calibration are:

o Under the Calibration Table

o Increases or decreases number of decimal points for response

data

o Refreshes the loading of ROI response data into calibration table

B Under the Data Chart.

o Selects whether the chart plots the calibration function or the

nd
1st, 2 , or 3rd derivative.

o Expands or compresses the dose range to either a discrete

range or the full color interval.

o Chooses which color channel data is displayed in the chart.

The selection does not affect the calibration. It only changes how
the calibration functions are displayed.

o Allows custom ranges for the dose and response axes.

42
DOSE MAP (Video: http://www.youtube.com/watch?v=pfcGM3yIHlU)

To measure or evaluate a dosimetry film, it is necessary to first scan the film and
apply an appropriate calibration function to convert the resulting image into
of
quantitative analysis tools to evaluate the dose maps.

To work with an exposed

application film: begin by
opening a Calibration Object
and developing a calibration
function. Alternatively, open a
saved case containing a
calibration object/calibration
function or load a Calibration
Object or Fixed Calibration from
file. For either of the last two,

Data
Selector window and from the drop-down menu, select
the
calibration file.
Note: The calibration function is scanner dependent as well as being
dependent on the film type and manufacturing lot. The film image being used
for dose map calculation must be acquired from the same scanner as the
calibration data and be the same acquisition type, e.g. reflection or
transmission mode and positive or negative image. In addition, the application
film must come from the same manufacturing lot as the calibration film.
To demonstrate the dose map calculation,
another case object will be added to the
example from the previous section,
Calibration. Specifically, the example adds
lm Calibration

under the Case Object Management

heading in the Case Data Selector
window. From the drop- down menu select
Dose Map (Single
dose map object appears in the case tree
Then
and
import the IMRT image by choosing
to
C:\Ashland Advanced Materials\FilmQA Pro 2016\Image\Example EBT3
RapidArc 2Gy and open open various

FilmQA Pro also recognizes

images in DICOM format files. To use
a DICOM fil
from

image may also be generated

directly by scanning an application
film.

triple-channel
dosimetry and automatically builds a dose map and a consistency map. When

44
the calculations are complete the dose map and consistency map are
displayed as thumbnail images under the dose map object branch. Triple-
channel dosimetry involves the solution of a non-linear optimization problem for
each pixel in an image. Since many images contain >500,000 pixels the creation
of triple-channel dose map may take more than 10 seconds depending on the
computer resources available. In the bottom right hand corner of the screen is a
little star icon. When the star is colored blue - - it indicates the application is
busy with calculations. The number beside the star is the number of calculation
processes under way.
The consistency map displays a representation of dose uncertainty defined as

((DR DB)2 + (DB DG)2 + (DG DR)2) where DR, DG and DB are the calculated
doses in the red, green and blue channels respectively. The optimization
problem used to calculate doses in multi-channel
dosimetry involves minimizing the consistency
function for each pixel in the image. Full frame
images on an A3 scanner can involve the solution
of a million optimization problems, or more. Using
triple channel dosimetry and the One Scan
Protocol see Lewis, et al., Med. Phys., 39(10),
2012, pp 6339 - consistency values better than 1%
of the maximum dose to the application film are
the standard.
In addition to triple-channel dosimetry, other dose
mapping methods and options are available. By right-clicking on -
map (singl appears.
o Rebuild: Recalculates dose and consistency maps using the selected
method.
o Dose mapping method: Allows the following options to be specified:
 o Dose map from single channel: Calculates dose for each channel
independently.

o Dose map using density reference channel: Dual channel dosimetry uses
the selected channel as the reference. The appropriate choice is to use
the channel where the slope of the dose response curve is least. Up to 30
Gy, at least, the blue channel has the lowest slope and is the best choice
for the reference channel. Dual channel dosimetry with blue channel as
reference is equivalent to doing dosimetry by dividing red channel
response by blue channel response or using the radio of the green ro blue
response.

o Dose map using triple channel uniformity optimization: Splits the

application image into dose-dependent and dose-independent fractions
thereby removing the effect of film non-uniformities and scanner artifacts
from the dose map - see Micke, et al., Med. Phys., 38(5), 2011, pp 2523.

o Recalibration using reference regions: Used to implement the One Scan

Protocol by removing scan-to-scan variability and making it possible to
get dosimetry results with a few minutes of radiochromic film exposure.

o Auto scale dose range: Scales the dose range of the dose map

46
 between the highest and lowest detected values.

o User defined dose range: Scales the dose range of the dose map
to the values - this is helpful when the film image contains
dark areas not related to dose - e.g. pen marks, scanner masks.

o Enforce same dose range for RGB: When checked, the dose range
is the same for all color channels.

o Uniformity Map: Click this line to calculate and display the uniformity map.
In triple channel dosimetry, the film image is split into dose- dependent
and dose-independent parts. The uniformity map is the dose-independent
part and
contains the film
and scanner
artifacts
removed from
the dose map.

o Consistency Map: Click this link to access options for displaying and
scaling the consistency map. In triple channel dosimetry the consistency
map is the remaining
error after the dose
independent
information is removed.
Lower consistency
means a better
calibration.
 o Filtering: Contains filters that could be applied to any image data before
calculating dose or uniformity maps.

o Fiducial Detection:
Contains options
and methods
useful in
recognizing the placement of fiducial markers.

Adds a duplicate
copy of the dose
map object to the
case tree. This
option is useful
when comparing
dose mapping
methods or other
data treatments.
o the
data in the dose map object as a treatment object that can be added to
another case.
o D the
case tree.
o Recover removed object: Recovers a dose map object deleted in error.
o image
o Save all images of the treatment case as: Saves the film images from all
case objects in the case tree.

48
 o Refresh treatment case tree: Refreshes all calculations in the case tree
after one or more parameters have been changed.
o Sort objects: Sorts the
case objects
according to a
number of options. This
feature is useful when
multiple objects of various types have been added to the case tree
without regard to their order.

o Twain Scanner: Reprises the configuration options for the Twain scanner
otherwise available through the Twain Configuration icon at the
bottom of the Case data selector window.

o Options: Accesses a variety of options to change the display of the Tool

Tip, the icons and button bars and allow types of image movement as
well as a selection of image types and resolutions. These options are
otherwise available through the Tool Tip icon at the bottom of the
Case data selector window.

single
channel, dual channel or triple channel dose maps as well as an option to scale
the dose map either automatically, or on a user-defined basis. When the dose
map is displayed in the center window (clicking any thumbnail image will
display that image in the window) the scale of the dose map image appears in
the right-hand window under any
(Note:
Rarely, the display in the center panel will fail to update when a different
thumbnail is selected. If so, toggle back and forth to other thumbnail images
until the update is triggered).
- well
unless the darkest areas in the image are not due to radiation exposure, but
rather occur because of ink marks on the film or from a mask used on the
scanner. In such a case the apparent dose-range of the image may be much
higher than the actual dose range to the film and lead to loss of precision in the
defined
dose
Enter the dose range values setting the upper value about 25% higher than the
expected
maximum dose to check that
the film. Click on
the maximum
value then enter
the new value,
the dose unit is correct, and the keyboard. Change the
minimum value
automatically the dose map will be recalculated with the new user-
selected dose range. Right-click any of the thumbnail images will reveal
a menu of options including
saving the image to file, copying the image to another location in
a
spreadsheet application, e.g. Excel.
When an image is displayed in the image panel (the center window), a
large variety of options and tools are available through the icons on the
left side of the Image Panel and the tabs
along the left side of the Image Evaluation
Panel (the right-hand window). The purpose
and operation of these features is described
in the Image Panel and Film Evaluation Panel
sections. To change the axis units or to copy the image from the image panel,
right-click on the axis of the image to change the
default) to length in mm or to hide the axis. Right-click in the same place to

50
 location.
As soon as a dose image loads and so long as a calibration curve is available in
the case, FilmQA and consistency maps.
The thumbnail dose and consistency map images appear below the
corresponding dose film in the case tree.
To save a copy of the patient treatment
film, right click on

Map nt

right).
FilmQA Pro saves images in various

The Treatment Case can be saved by

because all the data for all the Case Objects in the case is saved in one single
file, not as separate files. As referenced earlier, any single film image, Dose Map,
Consistency Map or Uniformity Map, etc. can be saved separately, or the all the
data contained in any Case Object can be saved as a Treatment Object.
PLAN TO DOSE COMPARISON (Video: http://www.youtube.com/watch?v=8V0dZJ_mchY)
In this section the comparison of an IMRT treatment plan to a dose map
calculated from a patient film is described. The description that follows uses the
image and data files provided along with the installation of the FilmQA
application. It builds on the example contained in the Calibration and Dose
Map Sections of this User Manual. Everything needed for the example is
contained in C:\Ashland Advanced Materials\FilmQA Pro 2016\Image
\Example EBT3 RapidArc 2Gy. The example assumes that the calibration films
and dose map film in the Example EBT3 RapidArc 2Gy folder have been used to
calculate a dose map using triple channel dosimetry.
selector

from the drop-down The

following items appear under the branch:
o Data - Treatment plan (empty): Location for the treatment plan.
o Data Dose map (read only): Location for dose map created in last
section.
o Data Dose map registered (empty read only): Not used.
o Data Comparison dose to plan (empty read only): Not used.
o Dependence Dose map (single scan): Right click and specify which
dose map to use if the case has multiple dose maps.
o Tool image comparer: Click on this tool to start the image comparer
the images from the treatment film and treatment plan are overlaid and
displayed in the Image Panel.

Since the example case contains a dose map, it is automatically loaded into
dose map (read onl the
thumbnail image in the display. If a case contains multiple dose maps the first
dose map in the case is automatically loaded. So if comparison of one of the
other dose maps to plan is required, right click on the line Dependence-dose

52
map (single scan) and select the Dose Map required from the drop-down list.
copying and
pasting image data from a spreadsheet. With the file to be copied on the
clipboar Paste CSV data
appears
enter the scaling ranges defining the physical size of the images and its color or
dose scaling range.

To a -Treatment
and select from the menu:
o Open treatment plan: Select this option to open a treatment plan from a
list of planning system-specific formats BrainLab, Pinnacle, Tomotherapy,
and Xio.
o stored in
tiff format.
o plan
from a 3D dose map in a DICOM format.
o operative.
o Paste CSV data as im a
 spreadsheet to be posted as CSV table. . In the panel that then appears
enter the scaling ranges defining the physical size of the image and its
color or dose scaling range.

C:\Ashland Advanced Materials\FilmQA

Pro 2016\Image\Example EBT3 RapidArc
2Gy and look for the Plan image.

Once the Treatment plan has loaded the Dose to plan comparison section of
the case tree appears as shown above. Inspection of
the thumbnail images reveals they are aligned
differently. Aligning the image is a two-step process The
first step is a rough alignment that could be done either
on the film image in the Dose Map Object, or on the
dose map image in the Image Comparer tool. The
second step is done only in the Image Comparer tool and precisely overlays the
dose map with the treatment plan using fiducial marks either as the pre-
punched holes in some versions of the film itself (e.g. EBT3P) or scribed onto the
patient film with pen by a user at the time the film was exposed. The fiducial
marks delineate the in-plane and transverse axes of the treatment system as
indicated by the projection of the light-field onto the film. When using a film with
pre-punched fiducial holes the marks are lined up with the crosshairs in the
lightfield, or the film is placed onto the registration pins of a Gafchromic Quick

54
Phantom and the registration marks on the outside of the phantom then are
aligned with the crosshairs.
Observe the thumbnail images. Depending on the orientation used for scanning
the dose map film the
image could be
rotated or flipped
relative to the
treatment plan.
Note: If the
thumbnail images
are indistinct, then click on the dose
map image and then the treatment plan image to display them at full size in the
Image Panel).

The fiducial marks may have been highlighted when the dose map was
calculated, or the highlighting could be added at this stage with the Fiducial
marker tool. Notice that the rough alignment of this image is now correct, Then
click the icon and Image fiducial type
fiducial Point the cursor at the black fiducial mark at the
top of the image near the center and click. The fiducial is
delineated with a mark indicating that it will be fitted in
horizontal direction (left-to-right).
For fine adjustment of the position relative to the scribe mark click on the fiducial

to highlight it like this the

position with the keyboard arrows. Repeat the process for the scribe marks
located at bottom-center and about 1/3 the way down the sides of the film. The
fiducial along the bottom edge will be delineated and fitted the same as at the
top. Along the sides the delineation changes to indicating the fiducials will
be fitted vertically (up-and-down).
the
position at which a fiducial mark is
being placed and chooses the type/
orientation of the mark accordingly. To
override the automatic selection,
highlight the fiducial mark and select
the type/orientation from the menu.

Note: The position of a fiducial mark is

determined by the geometric center
of the software marker, not the scribed
mark on the film.
plan
map (sometimes
referred to as the Client Image) overlaid on the treatment plan. Close inspection
of the display in the Image Panel at this stage reveals the fiducial marks on the
dose map are not aligned with the longitudinal and tranverse axes.
Note: If the case contains multiple dose maps, the correct one must be
th
line along the branch) and choose which
Dose Map to use from the drop-down list.

56
By default, a large
Region of Interest
(ROI) for quantitative
evaluation is pre-
selected. Click the
Frame Selector
icon to activate
the tool and adjust
the size, shape and
position of the ROI
frame. Note: Keep the ROI within the area of the dose map film and inside the
fiducial marks. The ROI can include all the low dose areas where the exposure is
principally due to scattered radiation. If desired these low doses can always be
excluded from the quantitative analysis by entering a threshold value in the
slot at the bottom of the Film Evaluation Panel or Analysis Window.
Note: If the Image Movement icon on the toolbar looks like this the tool is
active and will prevent the Frame Selector tool from being activated. Click the
Client Image Movement icon to turn the tool off - it should look like this and
then the Frame Selector can be activated.

To align the dose map and treatment plan using fiducial registration, click the
fiducial fit icon, on the toolbar to the left of the Image Panel. By selecting
the dose map is automatically
aligned with the in-plane and transverse axes and thereby with the treatment
plan.
To manually align the dose map and treatment plan, click the
Image Movement icon, on the toolbar to activate the tool. A little
arrow appearing in the icon indicates the tool is active - . Click
the icon below Image Movement icon to toggle between coarse

movement or fine movement . Right click either icon to adjust

the motion speed over an even greater range. Clicking the Image
movement icon, to activate the tool. Select fine movement
and right click the icon to choose a further adjust the motion speed. A setting of
2% or 5% is usually best. To display the rotational pole, click and select a
position. pole to center cross ice after a fiducial
alignment, but the pole could be positioned at other locations if preferred.

Fine adjustments are best controlled by using the rotation and translation
buttons appearing at the bottom of the Image
Panel when the Image movement tool is on. For
translational movement, click the arrows on the
large square button or turn the circular knob for
rotation. Alternatively click either button and use the
keyboard arrows. The display to the right of the
rotation knob shows the xy coordinates of the
rotation and the rotation angle. % will be most
useful. Larger values are associated with coarse
movement.

The Dose Map can be moved by click/drag of the overlay image, but the
adjustments can be better controlled by using the rotation and translation
buttons that appear at the bottom of the Image Window when the Image
movement tool is active. For translational movement click the arrows on the
large square button or turn the circular knob for rotation. Alternatively, the
motions can be controlled by clicking either of the large buttons and using the

58
keyboard arrows. For relative dosimetry the maximum dose value in the
treatment plan can be scale up or down. Use the spin arrows to
increase/decrease the maximum reference dose or type in a value
and press enter to accept the value. provides for various
quantitative comparisons of the measured dose distribution with the Treatment
Plan. Click on the Comparison Map selector icon to choose between the
gamma, distance-to-agreement, and differential delta functions.
This example focuses on the gamma analysis test - Low, et al, Med. Phys. 25, 656
(1998) - in one of
two ways (% relative error):
2
1. a + DTA2 . tolerance/distance) where DD = dose difference in %;
DTA is distance to agreement, tolerance is the dose threshold and
distance is the distance threshold; or
2
2. /tolerance2 + DTA2/distance2).

The test criteria are set by entering the tolerance and distance values into the
cells near the bottom of the Film Evaluation Panel. The default values are 2% at
2mm with the minimum threshold set at 0% (i.e. 0% of the maximum value in the
Treatment Plan).

Click on the icon to choose the type of gamma map

select between Gamma relative error, Gamma Normalized
or Gamma Angle.

Click on the icon and from the menu select whether the
required tolerance value is set relative to the maximum dose in the plan, relative
to the plan value for the pixel in question or relative to a user-defined value.
From the menu also select whether the search will continue to evaluate DTA out
to the radius specified by the distance criterion used for the gamma test, or
whether the search is stopped at the radius at
which a threshold
dose can be displayed either as % of the maximum
dose in the treatment plan or as an absolute dose
value in a selection of dose units. Click on the
icon to toggle between % dose and absolute dose.

By default, the gamma test is calculated as

dose tolerance relative to maximum dose at a distance criterion of 2mm and
with the search to the entire 2mm radius. The default dose threshold is zero, so

more, the spatial resolution of the Dose Map is almost always much greater than
the Treatment Plan. This means there are >1 measured pixels for every plan pixel.
To prevent gross overestimation of the gamma passing rate the plan pixels and
measured dose map must be put on the same basis for evaluation and
comparison. That is the measured dose map must be projected to the grid of
a Projection Map, i.e. the measured
dose map is recalculated by averaging individual pixels values grouped to
reproduce the spatial resolution of the plan.

60
In the example
case the gamma
test passing rate is
>95% for 2% dose
tolerance at 2mm.
Passing rates >95%
for the 2%/2mm
criteria are
common with film
evaluation, but with
passing rates that high, there is little sensitivity in using the passing rate to search
for a more optimal fit while using the coarse 2%/2mm evaluation criteria.
For instance, by using the fiducial marks on the film to register the dose
measurements with the Treatment Plan, human error in scribing those marks
affects the comparison of the dose distributions. This can be can be achieved
by Optimization Tool in Evaluation Panel.
automatically searches for an optimum fit between Dose film image and
Treatment film image. Even small changes <0.5 mm in the relative positions of
the distributions can have a large effect on the gamma passing rate. For the
example case, the gamma passing rate for 2%/2 mm is 97%.

Optimizing the dose distribution comparison involves fine movement of the

Projected Dose Map in the x and y directions and rotationally relative to the
treatment plan. The tools to do this are activated by the icon to the left of the
Image Window as previously described.

The maximum dose in the Treatment Plan is shown to right of the xy translation
button and on the far right of the panel are the x and y translations. Right click
on any of the values to set the units.
Note: For absolute dosimetry, do NOT adjust the maximum dose in the plan
image. Maximum dose could be adjusted when doing relative dosimetry.

Small position adjustments of x = - 0.3 mm; y = -0.6mm and rotation by -0.2°

move the passing rate from 95.11% to 96.4%. Clicking the icon assigns the
analysis map (gamma map in the example) as a Treatment Object within the
Dose to plan comparison Object. Note: If the analysis function values do not
update after changes click the icon to force an update. The icons under
the histogram in the Analysis Window control the range of values/step sizes
along the x axis of the chart (the gamma value axis in the example). Click
to change the way the histogram is displayed. The red color channel icon,
indicates data for the red color channel is displayed. Click to change the color
channel.

Right click anywhere in the chart to access another set of selections for the
chart display and control the values along x and y axes, format
the units, show a probability histogram or cumulative histogram
and change the number of data clusters for the histogram
display.

62
 ay mode and activate one of the
choices to display a histogram table in addition to the chart. And
remember that
image can be transferred into other Windows-based applications using
point/click and copy/paste commands.
Display options in the Film Evaluation Panel, or Analysis Window are
available along the left border. Eight tabs control the following type of
analysis data:
The Statistics Tab displays statistics of any film or user-defined area of interest
displayed in the Image Panel and has been described in a previous section.

The Profile Tab activates the display of a user-defined profile in the

Analysis Window. The initial display is the default profile diagonally top-left
to bottom-right across the Selection Frame. Right click the Profile icon
and select the profile settings listed below:
1. Line: User sets the position, length and orientation of the profile line.
2. Vertical line: User sets the position and length of a vertical line.
3. Horizontal line: User sets the position and length of a horizontal line.
4. Multiple lines: A freehand path of multiple lines can be defined.
5. Full vertical line: User sets the position of a vertical line across the entire
image.
 6. Full horizontal line: User sets the position of a horizontal line across the
entire image.
7. Circle: User defines a circular path.
8. Ellipse: User defines an elliptical path.
9. Options: Presents options for the way in which the profile
path is displayed.
10. Path range width: User defines the width of the profile
path.
11. Copy path: Path can be copied for pasting on another
image in the Image Panel.
12. Add current path to recent list: Saves the selected path to file for later
use.
13. Delete path: Allows the user to delete the path.

The default settings display a diagonal profile of 10 pixels wide for the treatment
Plan (thick line) overlaid with the
measured profile from the dose
map (thin line). The icons under
the Profile Chart control the
display of the profiles.
The icon controls whether
plan and measurement profiles
are displayed together or separately. A selection can be made to plot and
display the difference between the profiles.
The icon controls the range and units on the y axis (the dose axis). A selection
can be made to plot and display the dose profiles normalized to the maximum
value. Click the icon to display the path editor tools and the envelope slider.
These are helpful to make precise and repeatable adjustments. By turning the
buttons in the path editor tool, the profile path can be translated and rotated
and the path width and length can be altered. The envelope slider controls

64
translation along the x and y axes. There is an option to limit the profile path to
the envelope of the Selection Frame (Region of interest).

The Isolines Tab displays an overlay of the isodose lines between the treatment
plan and dose map. It is a very useful display when making manual adjustments
of the rotational and translational position of the measurements relative to the
plan.

Right click anywhere on the isolines chart to

show a menu of display choices for the
chart. These include the dose and length
units as well as choices for altering the
number of contour levels displayed and
their colors. To make changes to the
contour levels click the Palette Editor icon
or right-click the chart legend and select
the Edit contour levels and palette
command to open the Contour Level
Editor.
 o Click on to change the number of contour levels.

o Click on to edit the colors of the contour lines.

o Click in the Contour level column of the table to edit the doses
assigned to the contours. After specifying the dose levels, the
slider can be used to change the maximum and minimum dose
levels and the intermediate doses are scaled accordingly.

o Click the icon to set contour levels with the doses

automatically scaled.

o Use the to save or copy the Contour Level Palette or retrieve

a saved Contour Level Palette.

The Isomap Tab displays the isomap of the gamma function. A legend describes
the variances of the dose.

66
The Surface Tab displays the analysis data on a 3-D surface.

The Projection Map is critical to the proper calculation of the dose distribution
comparison functions. The dose map and treatment plan cannot be compared
without placing them in the same spatial domain. Because film is usually

always much greater than the treatment plan. This means there are >1
measured pixels for every plan pixel. To prevent gross overestimation of the
passing rates the plan and measured dose maps must be put on the same basis

for evaluation and comparison. That is, the measured dose map must be
map, i.e. the measured dose map is recalculated by averaging individual pixels
values grouped to reproduce the spatial resolution of the plan. The projection
map is displayed in the projection tab. The projection map can be exported
either as an image file or a CSV table to other applications. Icons along the left-
hand border of the window give
access to tools available in the Image
Panel and described in that section.

The Report Tab configures and

formats the case report. Use the Color
Channel icon, to select the
channel or channels for which data is
required. Next, use the menu in the
panel at the lower left corner of the
window to select the charts required
for the Case Report. Click on the Case
Report Format icon to select whether the Case Report will contain one chart
per page or select the number of charts to be tiled and printed on each page.
Then click the icon to update the report. It may take a few seconds before
the Report is formatted and displayed in the panel.
In addition to the data in the charts the report always lists the quantitative results
for all three dose distribution comparison functions gamma, DTA and dose
difference. Patient and Case Data contained in the Case Description Object is
recorded in the header of the Case Report. The Case Report can be magnified,
saved and printed by using the familiar icons under the chart. If any of the
charts displayed in the report have been re-calculated or altered in any way

after the report was formatted the click on the icon to update the contents
of the report before it is saved or printed.

68
ONE SCAN PROTOCOL

This efficient protocol was developed to simplify radiochromic film calibration

and to avoid the complications of the post-exposure growth of radiochromic
film response and the scan-to-scan variability of the scanner. The protocol
provides a time-saving method for evaluating radiotherapy treatment plans.

The protocol
combines
calibration and
measurement in a
single scan. It was
published in Medical
Physics, 39(10), pp
6339,
2012. Also by using
the One Scan
Protocol,
measurement results
can be obtained in
as little
as 10 minutes. To do
this, the application
and reference films should be exposed within a narrow time window. Since the
post- exposure growth in these two films is so very similar when they are exposed
minutes apart, it is no longer necessary to wait overnight or 24 hours before post
exposure changes have slowed and film can be scanned. If the time between
minutes,
before scanning to reduce the dose error to less than 1%. Now results can be
obtained on your schedule. Furthermore, the One Scan Protocol addresses the
accuracy and integrity of the measurement by eliminating variability due to the
scanner or environmental factors affecting the response of the film. The One
Scan Protocol requires an unexposed reference film, one reference film exposed
to a known dose of radiation in addition to the exposed application film. Note:
All films used for the One Scan Protocol must be from the same production lot
and from the same production lot as the films used for the primary calibration.
The illustration shows an application film is shown with two reference strips above
it. The upper strip is the unexposed film and the lower strip is the one exposed to
a known dose. As a rule, the exposed reference strip should receive a dose
close to the maximum dose expected in the application film.

To demonstrate the One Scan Protocol, we will use the images in the EBT3 Rapid
Arc example in The root is
Program Files/Ashland Advanced Materials/FilmQAPro/Images/Example EBT3
Rapid Arc. Click "Add new case object" at the bottom of the case tree and
select 'Film calibration (ordinary)' from the list. Navigate to the Example EBT3
Rapid Arc folder and open the file 0 69_2 138_3 368_8.tif. The file name
embeds the calibration dose values. The dose values are also available in the
file Exposures.txt in the same folder. The technique of having all calibration films
in a single image is called an One Scan calibration. It minimizes the number of
calibration images and uses film and your time efficiently. Because FilmQA Pro
uses asymptotic fitting functions that behave like film, i.e. the responses
approach constant values at high dose just as the darkening of the film gets
progressively smaller with each dose increment, fewer points are needed to
correlate the response of a specific film to dose.
One of the most useful fitting functions is X(D) = A + B/(D-C) where X(D) is the
response at dose D and A, B, and C are coefficients to be determined.
Responses are fitted separately for each color channel.

Since only three coefficients per channel need to be defined, as few as three
dose points are needed for the correlation. However, it is preferable to add one

70
or two more points to provide statistics showing the goodness of the fit, to
eliminate bad dose points and to select the best fitting function. To fit all the
calibration films in a single scan cut 1½ film.
Not only does this provide an easy reference to film orientation, but it also means
that a calibration with three or four exposures can be done with less than one sheet
o the rule, it works best to have the
doses in approximate geometric progression rather than in arithmetic progression.

Use the Frame Selector tool to

draw areas of interest in the center
of each strip. A frame can be easily
duplicated by holding down the

with the mouse. Calibration defines

the average response of the film so
the measurement areas should
be about 20-25 cm2. Activate
the Calibration Tool by clicking on the last line of the Film Calibration Object and

click the icon

in the lower right corner of the Calibration Window to populate the calibration
table with response values. Then click in the
dose column and enter the doses. Dose
values can be entered in random order as
the doses/responses are sorted/matched in
reverse order, i.e. the smallest dose is
matched to the largest response value. By
default, the red channel is used for the
synchronization. Click the color

synchronization icon to synchronize

responses of other color channels or to sort

matching order or turn off the
synchronization. As soon as all dose values
are entered the data points and fitting
functions are charted in the Calibration Window.

Use the Calibration Statistics icon to display a table of calibration statistics in

the Image Window. This table of consistency values determined from
the measured calibration doses and the fitted values and
helps in selecting the best fitting function
for the data points. Lower values in

the table signify a better fit. In most cases

with doses <500 cGy, the best fitting
function is the rational (linear) function. For
a higher dose ranges, e.g. 0-10 Gy, the color rational linear function is often
preferred.

72
The fitting functions and coefficients are expressed as a response, X(D), which is
a function of dose D and the inverse dose as a function of
response where response is expressed as %, i.e. the16-bit
value/65535, with dose given in cGy. Click the icon under
the calibration equation to copy and paste a table of the
coefficients for all color channels. To show the One Scan
Protocol, go to Program Files/Ashland Advanced
Materials/FilmQAPro/Images/Example EBT3 Rapid Arc and
load the file Dose Film 0_313_0.tif. Now highlight the fiducial
marks (indicated by the arrows in the figure) delineating the
axes of the treatment system and the isocenter. They are
the small black marks close to the center of each edge of
the film and correspond to the position of the cross hairs in

ma

whether a particular point is fitted in a vertical or horizontal direction.

Point the cursor and click on each fiducial mark to add highlight marks. The
fiducial fitting senses the center of the highlight marks, not the marks scribed on
the film. For precise adjustment; click on a highlight, press the Control key, and
use the keyboard arrows to move the mark.
When FilmQA Pro has finished calculating the dose map (using multi-channel
dosimetry), select the dose map and draw areas of interest at the center of the
values.
Look at the values for Frames 1 and 2. In Frame 1, they are close to zero in each
color channel; but for Frame 2, the values for the exposed reference film are all
close to 310 cGy when they should be 313 cGy. The differences between the
measured and actual values are the result of scan-to-scan variability either
from the scanner itself, or because the reference/application films were
scanned at a different ambient temperature than the calibration films. If the
user stopped at this point, the user would've have accepted a 1% offset in the
dose map.

74
 be
applied. Display the image of the application
and reference films in the Image Panel and
draw an area of interest on the unexposed
reference strip. Then right click the region to
designate it a calibration region and right
click again on the frame to type in and enter
the calibration value of zero. Notice that the
frame changes color from yellow to blue to

process for the exposed strip and enter the

value of 313 cGy. Now, right click on the line
Dose Map (Single Scan) and select Dose
Mapping Method then Recalibration using
reference regions and then Dose Linear
Scaling . To complete the recalibration, go back to Dose Map (Single Scan)
and select Rebuild Dose Map . The thumbnail images of the Dose and
Consistency Maps are refreshed.

Display the new dose map in the Image Window and look at the values in the
Statistics table. The exposed reference film is now exactly 313 cGy in each color
channel. For the unexposed film the tabulated values are not exactly zero, but
only because FilmQA Pro negative
calculated value is set to zero as shown by the histogram.

76
STAR SHOT ANALYSIS (Video: http://www.youtube.com/watch?v=CPtz-0dHbR8)
I. SCOPE

The protocol applies to Gafchromic EBT3 films exposed on a linear

accelerator and analyzed using FilmQA Pro software. It provides an
efficient method for evaluating the isocenter position of linear
accelerators using the star shot test. The exposed films are scanned on an

Epson® 10000XL or 11000XL scanner in either transmission of reflection

mode. Dose calibration of the film is not required as the analyses are
performed directly from the scanned images without transferal to dose
space. The method encompasses gantry, collimator and couch star shots.
II. EQUIPMENT AND MATERIALS

o EBT3 film per star shot test.

o Adhesive tape

o Two (2) plastics slabs larger than the film. Slabs sized 5x30x30 cm3
should be available in most clinics, but other sizes could be used at
the discretion of the physicist.
o Linear Accelerator
o Pencil or fine-tipped marker
o Ruler
o 48-bit RGB Epson* 10000XL, 11000XL, or 12000XL flatbed scanner,
preferably with transparency adapter
o Epson* Scan software
o FilmQA Pro software
III. PROCEDURE
A single sheet of film is to be exposed for each test. For EBT3 films use a
test.

*third-party owned trademark

 A. Gantry Star Shot

1. Tape a sheet of film at the center of the large face of one of the
plastic slabs with the edges of the film and the slab roughly parallel
to one another.

2. Place the second slab over the film and stand the two slabs on end
on the couch and under the gantry. If desired the slabs could be
fixed together with some adhesive tape, but it is not essential.

3. Using the laser lines and light field marker maneuver the slabs/film so
the film is in the transverse plane. The horizontal joint at the top of
the slab should be aligned using the light field marker. Make sure
this horizontal joint is parallel to the transverse field line and that the
slabs are placed so the longitudinal field line is close to the center
of the slabs.

4. Adjust the couch height so that the vertical center of the film is
close to isocenter and use a pencil or fine-tipped marker to scribe
lines on the edges of the slab to which the film is taped. The marks
will later be transferred to the film to indicate the position of
isocenter. Marks on the slabs can be removed later with eraser or
an alcohol wipe.

5. Close the collimator to produce a slit beam about 2-4 mm wide

parallel to the gantry rotation axis. Note: The beam width will
influence the analysis in the following ways. As the slit becomes
narrower more monitor units may be required to obtain the same
darkening of the film. Widening the slit may reduce the accuracy
and precision of the analysis because the lines will be less sharp.

6. Set the gantry at zero degrees and use a 6MV photon beam (of
other beam at the discretion of the Physicist) to expose the film with
150 MU. Then change the gantry angle in increments of 40° up to
160° expose the film with 150 MU at each position.

78
 Note: The ideal dose to the film for each beam is 100 200 cGy.
Adjustment of MU should be made to achieve the aim.

7. Separate the slabs. Take the one to which the film is attached and
use a fine-tip pen, a ruler and the marks on the slab (see Step 4)
transfer the transverse line indicating isocenter height to the edges
of the film. Remove the film from the slab and proceed to Scanning
and Star shot Image Analysis, Step D1. Note: The gantry star shot
should look similar to Figure 1 Because the exposure source was
closer to one end of the film than the other when each line was
exposed each of the beam lines is darker at one end than the
other.

Figure 1: Gantry star shot

B. Collimator Star Shot

1. Tape a sheet of film at the center of one of the plastic slabs with the
 edges of the film and the slab roughly parallel to one another.

2. Place the slab under the collimator with the film on top and the
long edge of the film roughly parallel to the longitudinal axis and
the center of the film roughly at isocenter.

3. Using the laser lines and light field markers adjust the couch height
and slab/film position so the film is level and at isocenter. Using a
fine-tipped marker scribe marks near the edges of the film to
indicate the position of the longitudinal and transverse cross hairs.

4. Close the collimator to produce a slit beam about 2-4 mm wide

parallel to the longitudinal rotation axis. Note: The beam width will
influence the analysis in the following ways. As the slit becomes
narrower more monitor units may be required to obtain the same
darkening of the film. Widening the slit may reduce the accuracy
and precision of the analysis because the lines will be less sharp.
Note: For the collimator star shot no build-up slab is used on top of
the film. In the absence of the build-up material the effect of
scattered radiation will be reduced, and exposed lines will be
sharper. The lack of a build-up layer will also reduce the dose/MU
by a factor >2 depending on the beam energy.

5. Set the gantry and collimator at zero degrees and using a 6MV
photon beam (or other beam at the discretion of the physicist)
expose the film with 300 MU. Then rotate the collimator in
increments of 30° up to 150° and expose the film with 300 MU at
each position.
Note that each exposure should be the same with an ideal dose to
the film of 100 200 cGy each time. Adjustment of MU should be
made to achieve this aim.

6. Remove the film from the slab and proceed to Scanning and Star
Shot Image Analysis, Step D1. Note: The couch star shot should look

80
 similar to Figure 2. As no build-up layer the dose/MU is lower than for
the gantry star shot and the darkening on the film is less.

Figure 2: Collimator star shot

C. Couch Star Shot

1. Tape a sheet of film at the center of one of the plastic slabs with the
edges of the film and the slab roughly parallel to one another.
2. Place the slab under the head of the linac with the film on top and
the long edge of the film roughly parallel to the longitudinal axis
and the center of the film roughly at isocenter.
3. Using the laser lines and light field markers adjust the couch height
and slab/film position so the film is level and at isocenter. Using a
fine-tipped marker scribe marks near the edges of the film to
indicate the position of the longitudinal and transverse crosshairs.
 4. Close the collimator to produce a slit beam about 2-4 mm wide
and parallel to the longitudinal axis. Note: The beam width will
influence the analysis in the following ways. As the slit becomes
narrower more monitor units may be required to obtain the same
darkening of the film. Widening the slit may reduce the accuracy
and precision of the analysis because the lines will be less sharp.
Note: For the couch star shot no build-up slab is used on top of the
film. In the absence of the build-up material the effect of scattered
radiation will be reduced, and exposed lines will be sharper. The
lack of a build-up layer will also reduce the dose/MU by a factor >2
depending on the beam energy.
5. Set the gantry and collimator at zero degrees and using a 6MV
photon beam (or other beam at the discretion of the physicist)
expose the film with 300 MU. Then rotate the couch in increments of
30° covering couch angles from -90° to +60° and expose the film
with 300 MU at each position. Note that each exposure should be
the same with an ideal dose to the film of 100 200 cGy each time.
Adjustment of MU should be made to achieve this aim.
6. Remove the film from the slab and proceed to Scanning and Star
Shot Image Analysis, Step D1. Note: The couch star shot should look
similar to Figure 2. As no build-up layer the dose/MU is lower than for
the gantry star shot and the darkening on the film is less.
D. Scanning and Star shot Image Analysis

82
1. Connect an Epson* 10000XL, 11000XL, or 12000XL scanner to the
computer, turn on the scanner and activate the FilmQA
software. The FilmQA Pro screen has three windows. The Case Data
Selector Window is to the left, the Image Window in the center and
Analysis Window to the right. Under the line
in the left-hand
see Figure 3

Figure 3: FilmQA Pro Opening screen

2. Select MLC Star shot Physics QA from the drop-down menu

*third-party owned trademark

 3. Expand the MLC Starshot Physics Case Object and right click on
Data starshot #1 (empty) . Click on Scan Image Starshot #1 .
Alternately an image could be loaded by selecting Open image
starshot #1 from file .

Opening Epson* Scan utility to scan an image

*third-party owned trademark

84
 4. Next, the Epson* Driver window appears. Choose the following
settings (see Figure 6A):

Mode: Professional Mode

Document type: Film

Film type: Positive Film

Image type: 48-bit color
Resolution: 72 dpi

If color correction icons are active (see red arrow in Fig. 4A), they must be de-
activated. Open the Configuration window (Fig.
. The icons should appear gray (green arrow, Fig. 4C).

Incorrect! Color
correction must be Correct! Color
turned off. correction is not
active
Open Configuration
window and check
color

Figure 4A Figure 4B Figure 4C

*third-party owned trademark

 5. Put the star shot film in the center of the scanner and scan it. The
analysis does not involve dosimetry, so no warm-up scans are
required, and the film can be placed in any orientation. Then using
the fiducial management tool select and place horizontal markers
on the fiducial marks scribed on the sides of the film and vertical
markers on the ends Figure 5. In the case of the gantry star shot
there are no pen marks at the ends. In that case, place the
software fiducials close to where the 0° beam line crosses the edge
of the film. To make fine adjustments highlight a fiducial mark, hold
down the Crtl key and use the keyboard arrows to move the mark
and center it. Figure 6 shows a gantry star shot image with the
software fiducials highlighting the scribed fiducial marks and the 0°
beam line.

Figure 5: Gantry starshot film image and selection of vertical fiducial mark

86
 Figure 6: Gantry starshot with software fiducial marks in place

6. s The fiducial marks

should automatically align with the axes in the display, but if they do not as
shown in Figure 7 click on the horizontally,
vertically and gned image is shown in Figure 8

Figure 7
 Figure 8

At this point the analysis is complete although small adjustments could be made
by refining the default settings as described in the following steps 7 and 8.

o The diameter of the analysis circles: In general, the larger circle should
extend almost to the end of the beam lines but be within fiducial marks. In
the gantry starshot the beam lines extend the film edge, so the larger
circle could be 15 cm, or more, in diameter. The smaller circle should be ¼
to ½ the diameter of the large circle. Smaller is generally better, but if too
small the maxima along the circular profile become less distinct as the
decreasing space between the beam lines.

o The width of the analysis circles: To a point, the method benefits from
having wider analysis lines because image pixel noise is dampened
through an averaging process. But for the larger analysis circle the wider
lines must not extend past the end of the beam lines or be wide enough
for the fiducial marks to interfere. For the smaller circle the analysis line
should not be broad enough to be close to the area where the beam
lines come together. A path width of about 10 20 pixels at scan
resolution of 72 dpi is ideal.

88
o The minimum angle between the beam lines: In general, the error in
determining the intersection of two lines is in inverse proportion to the
angle between them. So, the analysis can benefit by restricting the
analysis to only those lines crossing at more than a specified angle. The
nine beam lines in the gantry starshot are at 20° intervals so restriction to
an intersection angle >25° leaves 27 of the 36 beam intersection points in
the analysis. In the collimator starshot the six beam lines are at 30° intervals
and restricting the analysis to beam lines crossing at >30° leaves 9 of 15
intersection points for the analysis.
7. In the following gantry starshot example, the analysis circles have
radii of about 250 pixels (approx. 88 mm at 72 dpi) and 125 pixels
(approx. 44 mm) and an analysis path width of about 20 pixels
(approx. 7 mm). The result, depicted in Figure 9, shows the smallest
circle encompassing all intersection points has a radius of 1.3mm
and the centroid formed by the intersection points is 0.8mm from
isocenter. Adjust the diameter and width of the circles by using the
sliders at the bottom of the Image window.

Figure 9

8. As shown in figure below, right-click the icon underneath the

chart in the Analysis Window and select the option to restrict the
analysis to intersection angles >25°.
The result (Figure 10) shows that 27 of 35 intersection points were used. The radius
of the minimum circle encompassing all intersections is reduced to 0.7 mm. The
intersection-point centroid is still 0.8 mm from isocenter.

Figure 10

The blue arrows move the image clipping region in the desired direction
selected. These buttons (right) set the size and scale of the display chart and the
position of the information displayed (clipping region).

90
A summary of the starshot analysis (shown right) includes the smallest circle
enclosing all beam intersections,
the detected isocenter based on the
intersection of the beam lines and the
distance between the detected
isocenter, the isocenter determined
from the fiducial marks related to the
laser lines or light- field markers, and angles of the detected beam lines. To copy
icon .
E. Analysis Circle Profile
1. (see below) to display a profile along the
paths of the two analysis circles as well as the intersection points
determined by the analysis.

Click to display profiles

Profiling along the analysis paths and intersection points

 Profiling along the analysis
path verifies the quality of the
detected intersection points
between the beam lines and
analysis circles. The Star Shot
Peak Profile (left) shows the
color channel values along
both analysis path circles and
the locations of the detected
beam line points (minima
when darker otherwise
maxima).
Smoothness of the profile data can be increased by widening the
average range of the path circles. The detected results depend on
the radii of the chosen analysis path circles. Each circle has a range
used to average the pixel data. This tab will display the profile data
along the analysis circles and the detected minima points (center
of the beam lines). toggles
between normalized data and color channel value data. The
copies current chart settings to the reporting
tool.
F. Report

The Report feature of FilmQA Pro is accessed under the Report tab
along the border between the Analysis Window and Image Panel.
Cl
the Report Items section at the bottom left of the Analysis Window
choose the features to be displayed in the report. In this example, all
four items have been selected. Use the icons under the report to print
or save it to file.

92
 Figure 11
1. report data, click (automatically
updates). By right clicking, the option to manually update, can
be selected.
2. zooms the viewing size of the report page. The
option does NOT change the image resolution.
3. opens a pop-up window so the user can:
o Loads or saves report
settings.
o Shows or hides report
parameter controls.
o Selects fixed or floating
number of pages per page section. Default is set as float.
4. sends the report to a printer. Printer selection dialog will
appear.
5. saves the report as a portable document file, PDF, or as
an image file using one of the many graphic formats.
6. copies current chart settings to the reporting
tool.
7. selects the number of images displayed
on one page.
 8. changes the image size to display
more information.
9. Other Adjustments

After following the steps and instructions laid out, it is very unlikely the user will
have to use adjustments other than those described in the main section of this
protocol. However, in the rare event other adjustments are necessary, below is a
brief overview of adjustments to optimize the analysis.
The analysis tool operates by establishing response profiles along two specified
circular paths around the isocenter. While the user may select from a range of
response channels the red channel will provide the sharpest contrast for
radiochromic film images. The analysis tool searches along the circular paths to
find the centers of the beam lines exposed on the film. The search algorithm
seeks the response maxima where the paths cross the beam lines while avoiding
false maxima induced by measurement noise. In general, the larger analysis
circle should approach the maximum allowed by the length of the beam lines
exposed on the film and the smaller circle should be 40-60% of the diameter of
the larger one. In most cases the effect of measurement noise is reduced by
using relatively wider path widths with the provision not to include areas beyond
the length of the exposed beam lines nor encroach upon the area of higher
exposure where the beams cross near the isocenter.

o Right-click the icon in the bottom

right corner of the Image Window (see
right) to reveal a menu of analysis
options:
1. Number of regression points: To
find the center of the beams the
analysis paths are split into a
number of segments over which the response maxima are sought.
Default is 1½% (percent of the total analysis path length). The

94
 optimum is unlikely to be outside the range from 1-2%. Very short
paths are unlikely to be helpful since they may be shorter than the
beam width. Very long paths are unlikely to be helpful since they
may cover two or more beams.
2. Analysis color channel: Follow the protocol and the red channel is
all the user will need for radiochromic film. In an extreme case
where the response of radiochromic film is very high say at doses
>>10Gy the green channel response has a higher contrast and
may be preferred. The gray channel is available for non-
radiochromic film images.
3. Star shot lines are darker than background: Follow the protocol and
this is always the case for radiochromic film. If the user selected to
scan as a color negative in the Epson® Scan utility, the user would
are brighter than

4. Detection mode: the method used to detect the analysis path

extrema. Six detection choices are available: average all, closest to
found extremum point, search local extremum, most inner detected
point, refit detection range and center of extremum detection
range.
5. Extrema cut-off limit: the tolerance for extrema inclusion. Choices
are 0, 3, 5, 10, 15, 20, 30, 40, 50, 70 and 100%.

6. Profile start angle: The start of the circular analysis paths must not
coincide with the center of a beam line. The default is -26° since it is
very unlikely that a beam line will fall at that angle, but another
starting point could be selected.
 7. Options: (See Figure B-2)
o Show analysis path control: Hides the sliders used to specify the
diameter of the analysis circles and the analysis profile path width.
o Show sensitivity slider: Allows the number of regression points to be
adjusted with a slider - see the Section on this topic above.
o Show profile start angle: Displays/hides the starting angle.
o Show analysis path: Displays/hides the analysis paths.
o Show analysis points: Displays/hides the analysis points i.e.the
detected centers of the beams.

Figure B-2

96
FLATNESS AND SYMMETRY ANALYSIS

heading. A drop-down menu will

appear and gives the user several

There are two types of objects to

select:
any number of images
to be analyzed and uses the images
Symmetry
Physics QA
a single image that will be converted
into a dose map.

Next, acquire the image by either reading it

from a saved file or scanning it directly.

For the automated image registration, select

the and mark the positions on
the image (Shown right). The minimum number
to determine both x & y shift and rotation is
three fiducials. When all the fiducials are
marked,
The isocenter is
automatically fitted to the marked fiducials.
The flatness and symmetry tool automatically assigns the horizontal and vertical
analysis path lines. Use the analysis configuration tool, to make the analysis
include used analysis path lines. The detected results may depend on the
average width of the chosen analysis path lines (average perpendicular to the
path direction) and the color channel used to analyze the image data.

the profiles along the selected analysis path lines

(for this example, center cross) and a table with
the numerical analysis data according to the
selected analysis protocols for flatness, symmetry,
and penumbra.

The profile data can be normalized in different

ways. Use the Profile Normalization Tool , to
select the various normalization behaviors.

98
The maximum or CAX value can be normalized
between 0 and 1. If the base line of the profile is
disturbed (left and right values are different),
the base line can be equalized using a linear

the flatness region as well as the

penumbra areas are marked in the chart as
shown right.

When the analysis is completed,

summarize the results for the

record.
Enable items that should be
included in the report and add
information to identify the test in
the footer of the report.
PICKET FENCE ANALYSIS

heading. A drop- down menu will

appear and gives the user several

Physics
acquire the image by either reading
it from a saved file or scanning it
directly.

For automated image registration, select the fiducial tool, and mark the
fiducial positions on the image as shown right. Any number of fiducials can be
used to identify the isocenter. However, the minimum number to determine both
x, y shift and rotation is three fiducials. When all fiducials are marked, select the

tree.

The isocenter (blue/black

dashed lines) is
automatically fitted to the
marked fiducials as shown
right.

The picket fence analysis tools automatically detect the beam lines and displays
the detected beam line points at the analysis path lines as shown above in the

100
center section. The beam line detection uses the selected region of the interest
(green dashed rectangle) to analyze the image data. Select the frame icon
to make this region of interest editable. Click and drag the border lines so that
only beam lines are covered.

lysis path lines and the

detected extrema. The button allows the detection parameters to be
changed. Default settings are optimized for the use of EBT3 films. The most
important parameters are
the following:

o Analysis Color Channel: Signal used to generate profile. Red channel is

most sensitive for EBT3 film. Red/Blue ratio compensates for EBT3 film
thickness variations.

o Beams are darker then background: Beam lines are described by profile
minima otherwise maxima are used.

o Beam Alignment: Allows to synchronize beam lines (angle and distance)

o Detection Mode: Method used to detect extrema along the profile curve.

o Number of Analysis Lines: More lines stabilize the results but consume more
computer performance

o Analysis Path Width: Wider range delivers smoother profiles. Path range
cannot exceed visible beam line area.

Underneath the center registration image, the beam line statistics are
displayed. Information includes minimum, average, and maximum distance of
the detected beam lines as well as the minimum, average, and maximum of
the slant angle.
The next step is the MLC Design. For this example, the Varian Millennium 80 MLC
is used. Select the MLC Design using the icon.

Template
to input new data. When the MLC design is selected, the overlay is
displayed in the center section. Use the blue arrow keys to adjust the image
position relative to the MLC.

Adjustments are complete when the leaf borders on the film line up with the

102
overlaid MLC leaf borders (solid blue lines, dotted blue line are leaf center lines).
The space around the leaf center line is used to create profiles to detect the

analysis.

The upper part of the leaf analysis shows the profiles along the center lines for
the selected leaf and beam ranges (bottom row). One can only select leafs
located inside the region of interest determined by the center section (green
dashed rectangle) and for detected beams (red number labels). The leaf
openings are determined as intersections of the profiles with a threshold value
(red line in the upper chart). This detection threshold can be adjusted using the
buttons. The profile values might vary due to distortion of the
measurements. Another factor is the measurement actually determines dose
equivalent value. The distortion and dose equivalent value can bias the shape
of the scanned profile.
 profile
normalization options:
o Normalize global minimum and maximum to 0 and 1: Global extrema for
each leaf center profile are normalized to 0 and 1 to account for small
drifts across the image.

o Equalize all local minima and maxima to 0 and 1: Normalization changes

for each beam and leaf extrema pair and equalizes all profile sections. All
maxima are at 1 and all minima are at 0.

Truncate at smallest local minimum and maximum values and normalize to 0 and 1:
Truncate lower part of the profile at highest minimum and upper part of the profile at

104
lowest maximum and then normalize resulting profile to 0 and 1. This approach is very
advantageous especially when the leaf openings vary over a wide range (i.e. the dose
varies a lot between the leaf openings).

Use the button to select the normalization mode for the profiles the user
requires. Relative analyzed leaf width range (%): Width of the averaging region
around leaf center relative to leaf width used to generate the profile. Whenever
the profile data or analysis method is changed, FilmQA Pro calculates the leaf
opening width values for the selected beam and leaf index range as shown
below.

The color of the depicted opening depends on the width and bias of the
specific leaf opening. Threshold value for these color changes can be assigned
using the context menu of the chart.
 results
of the case. Enable items that should be included in the report and add
information to identify the test in the footer of the report.

106
EDITORS
The Bitmap Color Translation Editor is the first editor and allows the user to
create, edit and delete color translations to the image. The bitmap color
translation editor can be accessed under the statistics and profile panels.

the color
translation is applied. Right click inside the image to change the
color channel and image size.

M, which describes the image color translation. The new

color, Xnew, is calculated by: Xnew = set [X] + old

where X = red, green or blue

The column indicates the contributions to that particular color
channel to the translated color. The row indicates the contributions
of the original color to the translated color.
indicates the offset of the translated color.
available at the working panel. The user can view, select and delete color
translations on the -down list to select the
image being tested with the color translation
window
permits the user to create, view or
change the name of the color translation selected.

shows colors and its effect in

the
properties but changes how the test image is viewed only.) To turn off all effects

icon, enables/inhibits the color translator to be displayed on the test image.

begins a new translation and resets the matrix to default
values. The next icon does exactly what the picture represents. It is the redo and
undo icon, . The normalizes the color translation matrix. To
transpose and invert the matrix, select the . To select a color
translation, click on and select one saved on file. Adding or deleting a color
translation isas easy as selecting these icons, . If the user would
icons, .

The Color Translation Maps Editor plots the image from one color, Cold, to
another Cnew. The simplest example would be a case where the color translation
is linear (i.e. the matrix of coefficients and the new color components are only a
weighted linear combination of the old color values). In this particular instance,
the user would edit the matrix of coefficients through the Bitmap Color
Translation Editor.
1.
and choose the
preferred dose map (see Figure 1).

108
 Figure 1

2. Enter the name and description of the color map. If necessary, the color
icon can be changed (see below).
 3. Color translations can be mapped to any image. When such translations
are needed, one can access them via the
the Image Panel.

4. Translation
non- linear (non-
matrix) translations.

110
 the user to
view the image before and after the The lists all
translation is applied. Right click inside the the color translations available. One
panel to change the displayed color can view, select, and delete the color
channel and the image size. translations in this list.

Drop-down list of images Window to change the name,

to test and preview the
description of the color map
color translation editor
and to view its source

o allows the user to select the

Panel.

o Identifies when the color translator is enabled or de-activated.

o
translators.
CONFIGURATION

F an
array of tasks in radiochromic film dosimetry and QA tests. While not every
function in the library is activated and given default availability, it is very simple
to add inactive tools, treatment objects, plans readers, etc. to the active list as
demonstrated by the following example.

menu bar and select

management and
then Object type
management from
the context menus. A
window opens with a comprehensive list of Treatment Objects. Hover the cursor
over any item in the list to explain its purpose or action. Those shown on the right
side of the panel are activated; those to the left are inactive.

To add a treatment object to the active list, click on the object to highlight it.
Then click the icon between the two lists to transfer the object and finally

112
click . Reverse the process by clicking the icon to remove an item
from the active list. Two particularly useful Treatment Objects that might not be
activated are:

o Film Calibration from Multiple Bitmap no Background: This is the

calibration object with which multiple images may be opened or
scanned to perform film calibration.

o Image Comparison: With this object, it is possible to compare any two

images. The Dose-to-plan Comparison object is a special case of Image
Comparison in which one of the images is
the treatment plan.

After activating one of the Tools, Treatment

Objects, Plan Readers, Calibration Functions, etc.
the user can maintain it in the activated list each
time the application is opened by saving the
on the
menu bar and then Configuration and either
or As to save the current configuration.
To reset any of the Tools, Treatment Objects, Plan Readers, Calibration Functions,
etc. (return to the default
configuration), click on the
function management line
and Reset to default
The user can use any of the
programming languages in
the Microsoft .net
environment to write your own Tools, Treatment Objects, Plan Readers,
Calibration Functions, etc. and add them (*.dll) to the function library.
TROUBLESHOOTING

Installation Issues:

1. Make sure security programs or virus scanners are disabled prior to

installing.

2. If program does not load, check if .NET Framework 4.0 is installed. Client
version will NOT work. The full version must be installed.

3. When using Windows 7, make sure that .NETFramework 4.0 is installed. If

.NETFramework 4.0 is installed then check whether the write permission is
Windows 7 does NOT
enable write permission for program folders if the User Account Control is
on.

4. [*.msi
(Windows Installer Package)] on your computer. If the FilmQA Pro needs
to be reinstalled and the program is not located on your computer,
downloading FilmQA Pro off the site again will require another license key.
Scanning Issues:

1. If using EPSON* found in

the menu settings, remove insert inside top cover and rescan.
drop-down menu now.

2. Orientation plays an important factor especially during calibration.

Remember to keep the same orientation when scanning.

3. The
best
s panel differs between
scanners. The EPSON* to
the EPSON* 10000XL. For the EPSON* 10000XL, the dimensions of the
in). *third-party owned trademark

114
 4. Do not place the film in the calibration area of the scanner. The
calibration area is 2 cm (0.78 in) from the top.

Film Issues:

1. When using the EPSON* V700 Photo scanner, remove film after scanning is
complete. Unlike the EPSON* 10000XL, the lamp stays on and could affect
the film if in contact with light for longs periods of time.
Operating Issues:

1. has
generated a license request (LicenseRequestData_xxx_20120605.txt) and
submit it to advancedmaterialsorders@ashland.com. When the license
key is emailed back to the user, copy the file (BaseLicenseGrant_xxx.txt)
folder.

2. If using Windows XP and programs load but cannot add case objects,
install Microsoft Visual C++ 2010. Any version older than 2010 will NOT work.

3. If FilmQA Pro
c:\Program Files\Ashland Advanced Materials\FilmQA Pro 20** or
c:\Program Files\ISP Advanced Materials\FilmQA Pro 20**.

4. If
windows resources are exhausted. Check resources allocations first. If no
processes
under either c:\Program Files\Ashland Advanced Materials\Film QA Pro**
or c:\Program Files\ISP Advanced Materials\FilmQA Pro 20**. Also check
the available memory in your system using TaskManager →Performance
→Physical Memorty → Available should be >2 GB before the user starts
FilmQA Pro.

5. When calculating the calibration function, performing a background is

not necessary. In earlier versions of FilmQA Pro, background
 compensated for lateral scanner effects. However, the new multi-channel
technique to calculate dose values mitigates this effect in most cases.

6. If an exception error (change header name) occurs when saving a fixed

calibration, there is a problem with scanner information. Either the
scanners are different or the driver is corrupted. Reinstalling the scanner
drivers should correct the problem. If not, then save the calibration file as
a treatment object.

7. used,
the images may need to be cropped. Too many strips could result in no
of interest.

8. lower
resolution image formats (i.e. JPEG) is not recommended. Too much
information is lost with those images. For quantitative analysis, importing a
TIFF file is recommended.

9. Throughout FilmQA Pro, absolute dose is used. Relative dose is not ideal
and was not incorporated in to the software. Furthermore, MU, or monitor
unit, is not used because the measure of machine output is dependent
under particular conditions.

116
Appendix

Calibration Protocol for Radiochromic Film

I. PURPOSE

To define an efficient protocol for calibration of radiochromic dosimetry film.

II. SCOPE

The calibration protocol applies to Gafchromic EBT3 films at doses up to about

10 Gy. The resulting calibration is intended for use with a radiochromic film
dosimetry protocol. The calibration protocol requires a minimum time to elapse
between exposure of the films and scanning. The time is shortest, and the
protocol is most efficient when the calibration films are exposed within a narrow
time window. An explanation is given in Appendix C. The calibration exposures
may be done on a single film or multiple films. In either case it is assumed that
the doses delivered in the film plane are known. Note: The calibration is only
valid when applied to application films from the same production lot as the
calibration films.
III. INTRODUCTION

The efficiency of this protocol stems from the use of fitting functions that behave
similarly to film. For example, consider the rational function X(D,n) = a + b/(D-c)
where X(D,n) is the scanner response in the nth color channel measured for film
exposed to dose D and a, b, and c are constants. Figure 1 shows an example
for calibration data (seven dose points) from EBT3 film fit to this function. The
function behaves as film is expected to behave, i.e. as dose increases the
response values decrease because the film gets darker. The values asymptote
to almost constant values at very high dose.
 Figure 1
Contrast this to the behavior when the same data is fitted to polynomial
functions (in this case 4th order) as shown in Figure 2. Obviously, the polynomial
ike film color and more
transparent at high doses. Also, polynomial functions are unacceptable
because they oscillate between dose values. The fit with the polynomial
function could be improved with additional dose points, but it takes more time
problem.
Response

Figure 2

118
The benefit of using the type of rational function described above is that the
user can reduce the number of dose points required for calibration. Figure 3
shows the fit when four of the data points were removed. It is almost identical to
the fit in Figure 1 with seven data points. The function has three constants a, b,
and c and is fully defined with three data points two films exposed to known
doses plus one unexposed film.

Figure 3

IV. EQUIPMENT AND MATERIALS

o Gafchromic EBT3 radiochromic films
o Adhesive tape
o Radiation source usually a linear accelerator, but it could be a source
delivering photons between about 10kV and 25MV
o 48-bit RGB Epson* flatbed scanner, preferably model 10000XL, 11000XL, or
12000XL with transparency adapter
o Epson* Scanner Software
o Software
o The use of a phantom to provide electron equilibrium (e.g. water
equivalent plastic blocks) is optional.

*third-party owned trademark

V. PROCEDURE

anything between. If
multiple films are used, they must have the same lot number. When cutting strips
be certain that the orientation is known with respect to the sheet from which
they were obtained.

The radiation source is provided as the means for delivering known exposure
doses to the calibration and application films. For calibration exposure, it is
assumed the user can control the source to deliver the known doses to the film.
The protocol requires a minimum of two non-zero exposure doses, plus a dose of
zero. A greater number of exposure doses could be used, but this is not
necessary. The calibration will be valid for doses between zero and the highest
exposure dose for the calibration. The calibration will be valid for other EBT3 film
from the same production lot scanned on the same scanner as the calibration
films. The protocol requires the calibration films to be scanned together in a
single scan with the exposed areas all located along the central axis of the
scanner (see Figure 4). The exposures could be made on a single film, or on
separate films. In any event, the films should be sized to fit together on the
scanner.
The protocol requires a minimum time to elapse between exposure and
scanning. It is most efficient if the exposures are made within a narrow time
window, t. The elapsed time between the last film and film scanning must be a
minimum of 4t.
1. Position a calibration film in the center of the radiation field to be delivered
by the exposure source with the plane of the film perpendicular to the
beam. Frequently the film will be exposed in a phantom or between slabs of
plastic to achieve electron equilibrium, but this is not mandatory. The
essential requirement is that the user knows the exposure doses delivered in
the plane of the film.

120
2. Expose the calibration film to a known dose about 30% greater than the
highest dose expected for an application film. One way is to use a linear
accelerator to expose a 10 cm x 10 cm, but the choice is up to the user. The
goal is to create a large area of uniform exposure on the film. Note the time
of the exposure. Remove the film and keep it where it is not exposed to
light.
3. Repeat Step 1 using another film from the same production lot. Using the
same exposure source and exposure conditions and setup, expose the film
to a known dose about 20% of that used for the first film. Note the time of
exposure. The time window within which the calibration films are exposed is
related to the speed with which the scanning and calculations can be
completed. Your efficiency increases by minimizing the time window. If the
exposures are t min. apart, film scanning can be done 4t min. later, or any
time thereafter. Remove the film and keep it where it is not exposed to light.
4. While unnecessary, additional calibration films could be generated by
repeating Step 3 with different exposure doses.
5. From the
drop-
Calibration ( : The calibration will be valid for other films from
the same production lot scanned on the same scanner.

Figure 1
 6. Calibration
(Figure 2).
The Epson* Driver Window will appear. Choose the settings shown in Figure
3C. If the color correction icons are active (red arrow in Figure 3A), they
must be de-activated. Open the Configuration window (Figure 3B) and
(green arrow
below, right). Note: Resolution of 72 dpi is suggested.

Figure 2

*third-party owned trademark

122
 Incorrect! Color
correction must be Correct! Color
turned off. correction is not
active

Open Configuration
window and
color

Figure 3A Figure 3B Figure 3C

7. Place the calibration films and an unexposed film from the same lot on the
scanner as shown in Figure 4. The time between film exposure and scanning
is related to the time window within which the calibration strip and
application film were exposed. Your efficiency increases when the user
minimizes the time window. For exposures t min. apart, film scanning can be
done 4t min. later, or any time thereafter.
Start of scan
Calibration Region
Scan Direction
Position exposed areas of
the
film in the center (left-to-
right) of the scan
window with the
edge perpendicular to
the scan direction

Figure 4
8. Use the Frame Tool to mark areas of interest in the centers of the calibration
 strips (Figure 5).

Select areas of interest

in center of calibration
strips

Figure 5
9. the
in the
dose values into the calibration table.

icon

Figure 6A Figure 6B
10. as
fixed calibration as Treatment Obje (Figure 7)
and save the calibration. The fit of the dose-scanner response function is
valid and usable between zero and the highest dose exposed on the
calibration films. It is applicable to other films from the same production lot

124
on the same scanner.

Figure 7
An Efficient Protocol for Radiochromic Film Dosimetry (One Scan Protocol)

I. PURPOSE

To define a radiochromic film dosimetry protocol to measure radiation dose

distributions for comparison with a radiotherapy treatment plan.
II. SCOPE

The protocol applies to Gafchromic EBT3 films exposed on a linear accelerator.

The object is to provide a time-efficient method for evaluating radiotherapy
treatment plans. It requires an unexposed calibration film, at least one
calibration film exposed to a known dose of radiation and the exposed
application film to be evaluated. It also requires the calibration film(s) and the
application film to be exposed within a time window. An explanation is given in
Appendix C. The application film is usually required for validation of a treatment
plan and may be exposed as a single treatment field, or as a composite of
multiple treatment fields. In either case it is assumed that the planned radiation
dose distribution in the plane of the exposed application film is known.

III. EQUIPMENT AND MATERIALS

o Gafchromic EBT3 film

o Adhesive tape

o Phantom material to provide electron equilibrium, e.g. water equivalent

plastic blocks

o Linear Accelerator Treatment plan

o 48-bit RGB Epson* flatbed scanner, preferably model 10000XL,11000XL, or
12000XL with transparency adapter
o Epson* Scanner Software
o Software

*third-party owned trademark

126
IV. PROCEDURE

Films used in this protocol are of two sorts, strips and sheets. Strips are used for
calibration exposures and about 4 x 20.3 cm. These strips can be cut from sheets
of film taking care to keep track of orientation, so all films can be scanned in the
same orientation. Sheets are used for plan exposures and can be 20.3 x 25.4 cm
sheets or smaller sizes large enough to accept the plan exposures. If pieces are
cut from whole sheets keep track of film orientation so all films can be scanned
in the same orientation. The strips, intended for calibration exposures, are
referred to as calibration films. The sheets, intended for exposure of the
treatment plan, are referred to as application films.

The linear accelerator is provided as the source of radiation exposure for the
calibration and application films. For calibration exposure, it is assumed the user
knows the relationship between the number of monitor units delivered by the
accelerator and the dose delivered to the film placed at a known location in
the phantom.
1. Position the phantom on the couch as required for a particular case. The film
is to be located in a known plane at a known distance from the source and
surrounded by a known amount of the phantom material.

2. Place an application film from a known production lot in the phantom with
the center of the film located close to the center of the area to be exposed.
Use small pieces of adhesive tape to hold the film in place. If desired, mark
the edges of the film to show the axes of the accelerator as indicated by the
laser markers. Place phantom material above the film as required.

3. Expose the phantom/film to the chosen radiotherapy treatment plan and

note the time. Remove the application film from the phantom. Keep it where
it is not exposed to light.
4. Choose a calibration film strip from the same production lot as the
application film. Place it in the phantom with the center of the strip close to
the center of the exposure area. Fix the film with adhesive tape and place
phantom material above the film as required.

5. Expose the strip to a known dose between 10% and 30% greater than the
highest dose expected on the application film. One way is to expose a 10
cm x 10 cm open field, but the choice is up to the user with the goal of
creating a large area of uniform exposure on the film. The time window within
which the calibration strip and application film are exposed is related to the
speed with which the dose measurement and comparison to plan can be
completed. Your efficiency increases by minimizing the time window. If the
exposures are t min. apart, film scanning can be done 4t min. later, or any
time thereafter. An explanation is given in the Appendix C. Remove the
calibration film from the phantom. Keep it where it is not exposed to light.

6. From the
drop-
to the folder containing the file with the relevant
fixed calibration object, e.g. XXXXXXX.CaseObj, and open the file (assuming
the primary calibration has been done for the production lot of film using
FilmQA Pro and the data have been saved as a Calibration Object).

128
 Figure 1

7.

Figure 2
8. -
drop-down menu. The Epson® Driver
Window will appear. Choose the settings shown in Figure 3C. If the color
correction icons are active (red arrow in Figure 3A) they must be de-

en arrow below, right). Note:

Resolution of 72 dpi is suggested.

Incorrect! Color
correction must be Correct! Color
turned off. correction is not
active

Open Configuration
window and check
color

Figure 3A Figure 3B Figure 3C

9. Place the application film, the calibration film(s) and an unexposed

calibration film on the scanner as shown in Figure 4. The time between film
exposure and scanning is related to the time window within which the
calibration strip and application film were exposed. Your efficiency increases
when the user minimizes the time window. For exposures t min. apart, film
scanning can be done 4t min. later, or any time thereafter.

130
 Calibration Start of scan
area Keep first
2 cm clear of
film
Scan
Direction

Position the films in the

center (left-to-right) of the
scan window

Figure 4

10. Use the Frame Tool to select areas of interest in the centers of the calibration
strips.

Select areas of interest

in center of calibration

Figure 5
11. Right click the areas of interest (Figure 6A) to name the region types as

Figure 6A Figure 6B

Figure 6C

12.

(Figure 7B).

132
Figure 7A Figure 7B
13. Compare the measurements with the plan. Add a New Case Object

navigate to the right folder and open the treatment plan (Figure 8B). Now
click on the Image Comparer tool. The treatment plan and dose map
appear in the window.

Figure 8A Figure 8B

Use the tools along the left-hand border to select an area of interest around the
treatment plan and then align the dose map to the plan. This can be done by
either highlighting the fiducial marks defining the axes of the treatment system or
by moving the dose map manually. Select coarse or fine manual motion and
move the dose map directly with the cursor or use the tools at the bottom of the
frame to move step-by-step. Add and position a rotation pole to rotate the dose
map relative to the plan.
 Tabs to display
Tools to different maps
manipulate the and other types
dose map and of analysis data
plan

Tools to move
the dose map Tabs to access
relative to the different types
plan of analysis and
display types of
data
Figure 9
Tabs on the left edge of the right frame (Figure 9) change the display type in the
right window: Statistics, Profile, Isolines, Isomap, Map, Projection, or Report. Under
the display in the right window, select the type of display map (Differential,
distance-to-agreement, gamma) the tolerance and distance values, and the
color channel, etc.
-dose plot of
measurement (thin lines) versus the treatment plan (thick lines). Figure 11 is
another screenshot showing a gamma analysis agreement map. In the colored
areas, the differences between dose measurement in a particular color channel
and plan are outside the chosen criteria, in this case 2% at 2mm.

Figure 10 Figure 11

134
 Post-Exposure Change

Exposure of radiochromic film to ionizing radiation starts a solid-state

polymerization in crystals of the active component. Polymer grows within the
crystal matrix of the monomer. Interatomic distances in the polymer are shorter
than in the monomer causing the gap between the end of the growing polymer
chain and the next monomer molecule to increase as polymerization
progresses. Consequently, the rate of polymerization decreases with time. Based
on measurement, the response is linear with log(time-after-exposure) as shown in
the figure below. This means that an error in the dose-response function could
result if calibration films are scanned at different times-after-exposure. Since the
calibration protocol requires exposed films to be scanned together at the same
time the time-after-exposure for the films will be different. However, if the timing
difference is small, i.e. the films are exposed within a narrow time window, any
error caused by the timing difference will diminish rapidly as the ratio of the
timing difference to the time-after-exposure decreases.
Scanner Response

69cGy
163cGy

Log10(time-after-exposure, minutes)
From the data in Figure B-1, it is calculated that at time-after-exposure of 30
minutes, a 5-minute timing difference could contribute to a dose error of about
0.3%, while a 10-minute timing difference could contribute to a dose error about
0.6%. As time-after-exposure increases from 30 to 60 minutes the dose error
contributed by a given timing difference
decreases by a factor of two. To ensure
that time-after-exposure differences have a
small contribution to dose error i.e. (<0.5%),
film scanning should be delayed for a time
period at least 4X longer than the interval
between exposure of the first and last
calibration films.
For example, if exposures are within a 5-minute time window, scanning should
be delayed for 20 minutes, or done at any time thereafter.

136
Film Calibration (mosaic)

1. Film calibration
(mosaic) to expand the selection.

2. N/A
and choose Open image

to a folder to select
For the purpose of this demonstration,
use the set of images installed with
Files/
Ashland Advanced
Materials/FilmQAPro/Images/Example EBT2 IMRT.

o There are four calibration images in the folder. Open the first
calibration image. A thumbnail appears in the previously empty
data slot and a new empty slot appears. Repeat by clicking on the
empty slot and loading the next image and continue until all four
images have been opened. (Note: There is a shortcut to quickly
open all four image files simultaneously. Right- click the
heading and choose the first item

highlight the files and open them.)

 o After the images are loaded, the case tree shows four thumbnail
images. Further down the branch is a
thumbnail with the images tiled into a
mosaic. Click on the mosaic to display it in
the center window with ROIs designated in
the center of each image.

3. Enable the Selection Frame

Tool, from the Tool Bar
located in the border to the
left of image panel. The

allows the regions of interest

(ROI) to be manipulated, i.e.
moved, sized, or shaped. Be
aware that in calibration the user is defining the average response of the

film and the ROI should cover an area of at least 20 cm2. Adjust the sizes
of the ROIs. (Hint: The exposed areas in the sample images are 10 cm
the Film Evaluation Panel to
display a range of image data including size and position of the image
acquired, the scanner used,
etc. Repeat the ROI selection for each calibration strip. (Note: There are
ht an ROI,
key and then point and click to copy the ROI. By left clicking , the user
can choose from options to copy and paste multiple
them to file. Right click and there are more choices including an
option to select an ROI and size/shape all other ROIs in the same way.)

138
4. At the end of the Film Calibration (mosaic) branch of the Case Tree click
Tool Calibration Tool The calibration window containing the
calibration tool opens on the right of the screen.
Index
A M
B Menu Bar 7, 32
Beam Line Detection 95 Mosaic 131
Bitmap Color Translation Editor 101 N
C O
Calibration 28 OneScan Protocol 65, 118
23
Case Data Selector 17 Ordinary 29
Case Description 14 P 23
Client Image Movement 53 Padding 11
Color Translation Editor 11 Patient Data 14
Colors 106 Picket Fence 94
Configuration 22 Plan to Dose Comparison 48
Cursor Panel Profile Panel 25, 59
D Projection Panel 63
Data Q
Delta Map 11 R
Dependency 63 Region of Interest(ROI) 19, 30
Dose Map 15 S
E 39 Selection Frame Tool 19
F Star Shot 72
File 8 Statistics Panel 23
Film Evaluation Panel 7, 22, 33 Symmetry 92
Fitting 36 T
Flatness Function 92 Task 13
Fonts 12 Triple-Channel Dosimetry 41, 118
G Troubleshooting 106
Generating a Response Curve 29, 31
Getting Started 7 U
H V
Help 14 W
Histogram Range 24 X
I Y
Image Comparer Panel 48, 52 Z
Image Histogram Region 24
Image Panel 19
Info Panel 22
Installation 2
Introduction 1
J
K
L

140
 References

Lewis D, Micke A, Yu X, Chan MF. An efficient protocol for radiochromic film

dosimetry combining calibration and measurement in a single scan. Med Phys.
2012;39(10):6339 50

D. A. Low, W. B. Harms, S. Mutic, and J. A. Purdy, A technique for the

quantitative evaluation of dose distributions, Med. Phys. 25, 656 661 (1998)

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