Quantitative assessment of quality of digitized portal images: receiver operating characteristic analysis applied to imaging in radiation therapy.

An objective and quantitative method for the evaluation of the quality of megavoltage portal images was developed by applying receiver operating characteristic analysis. On the basis of therapeutic use of portal images, setup errors were employed as "signals" in this experimental study that compared the original portal films with digitized images. Six readers observed 104 portal images of a chest phantom, half of which were "abnormal" (ie, had setup errors). Digital images (2,048 x 2,048 matrix) were enhanced by means of histogram equalization and then printed with a laser printer for observation. The readers showed a higher discrimination capacity with the digitally enhanced images, although a statistically significant improvement was not demonstrated. The present method of assessment of image quality proved to be both simple and clinically reasonable.