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@PHDTHESIS{Harris:177441,
      author       = {T. Harris$^*$},
      title        = {{A} {N}ovel {M}egavoltage {M}ultilayer {I}mager {I}mproves
                      {C}linical {B}eam’s-{E}ye-{V}iew {P}erformance},
      school       = {Universität Heidelberg},
      type         = {Dissertation},
      reportid     = {DKFZ-2021-02533},
      year         = {2021},
      note         = {Corresponding author J. Seco; Dissertation, Universität
                      Heidelberg, 2021},
      abstract     = {Megavoltage imaging offers unique clinical applications due
                      to providing a beam’s-eye-view of the actual radiation
                      delivery. However, poor electronic portal imaging device
                      (EPID) performance presently limits the clinical utility of
                      megavoltage imaging. This thesis describes the clinical
                      translation, implementation, and trial of a novel multilayer
                      imager (MLI) designed to address current EPID shortcomings,
                      as well as the development of an application using the
                      imager to track tumor location during treatment. The
                      prototype MLI was constructed, with standard imaging metrics
                      demonstrating a 5.7x increase in detective quantum
                      efficiency, as well as substantially improved contrast- and
                      signal-to-noise ratios compared to standard EPID.
                      Pre-clinical tests were performed on an anthropomorphic
                      phantom to verify improved performance despite anatomical
                      variations. Subsequently, we conducted a clinical trial of
                      six patients receiving radiation for liver metastases. A
                      beam’s-eye-view tumor tracking algorithm was utilized to
                      assess MLI performance compared to a standard single layer
                      imager. Tumor tracking using MLI was found to be
                      significantly more accurate and efficient at successfully
                      tracking on more frames. Further analysis revealed
                      correlation between noise reduction and improved tracking
                      performance. Given the MLI’s superior performance, for
                      clinical beam’s-eye applications we recommend noise
                      reduction strategies such as employing multiple detection
                      layers in the EPID.},
      cin          = {E041},
      cid          = {I:(DE-He78)E041-20160331},
      pnm          = {315 - Bildgebung und Radioonkologie (POF4-315)},
      pid          = {G:(DE-HGF)POF4-315},
      typ          = {PUB:(DE-HGF)11},
      url          = {https://inrepo02.dkfz.de/record/177441},
}