Comparative investigation of the detective quantum efficiency of direct and indirect conversion detector technologies in dedicated breast CT

PurposeTo investigate the dose saving potential of direct-converting CdTe photon-counting detector technology for dedicated breast CT.Materials and methodsWe analyzed the modulation transfer function (MTF), the noise power spectrum (NPS) and the detective quantum efficiency (DQE) of two detector technologies, suitable for breast CT (BCT): a flat-panel energy-integrating detector with a 70 μm and a 208 μm thick gadolinium oxysulfide (GOS) and a 150 μm thick cesium iodide (CsI) scintillator and a photon-counting detector with a 1000 μm thick CdTe sensor.ResultsThe measurements for GOS scintillator thicknesses of 70 μm and 208 μm delivered 10% pre-sampled MTF values of 6.6 mm⁻¹ and 3.2 mm⁻¹, and DQE(0) values of 23% and 61%. The 10% pre-sampled MTF value for the 150 μm thick CsI scintillator 6.9 mm⁻¹, and the DQE(0) value was 49%. The CdTe sensor reached a 10% pre-sampled MTF value of 8.5 mm⁻¹ and a DQE(0) value of 85%.ConclusionThe photon-counting CdTe detector technology allows for significant dose reduction compared to the energy-integrating scintillation detector technology used in BCT today. Our comparative evaluation indicates that a high potential dose saving may be possible for BCT by using CdTe detectors, without loss of spatial resolution.     

A Monte Carlo investigation of the spatial resolution performance of a small-animal PET scanner designed for mouse brain imaging studies

Our laboratory has developed PET detectors with depth-encoding accuracy of ∼2 mm based on finely pixelated crystals with a tapered geometry, readout at both ends with position-sensitive avalanche photodiodes (PSAPDs). These detectors are currently being used in our laboratory to build a one-ring high resolution PET scanner for mouse brain imaging studies. Due to the inactive areas around the PSAPDs, large gaps exist between the detector modules which can degrade the image spatial resolution obtained using analytical reconstruction with filtered backprojection (FBP). In this work, the Geant4-based GATE Monte Carlo package was used to assist in determining whether gantry rotation was necessary and to assess the expected spatial resolution of the system. The following factors were investigated: rotating vs. static gantry modes with and without compensation of missing data using the discrete cosine transform (DCT) method, two levels of depth-encoding, and positron annihilation effects for ¹⁸F. Our results indicate that while the static scanner produces poor quality FBP images with streak and ring artifacts, the image quality was greatly improved after compensation of missing data. The simulation indicates that the expected FWHM system spatial resolution is 0.70 ± 0.05 mm, which approaches the predicted limit of 0.5 mm FWHM due to positron range, photon non-colinearity and physical detector element size effects. We conclude that excellent reconstructed resolution without gantry rotation is possible even using FBP if the gaps are appropriately handled and that this design can approach the resolution limits set by positron annihilation physics.     

Imaging performance of phase-contrast breast computed tomography with synchrotron radiation and a CdTe photon-counting detector

PurposeWithin the SYRMA-CT collaboration based at the ELETTRA synchrotron radiation (SR) facility the authors investigated the imaging performance of the phase-contrast computed tomography (CT) system dedicated to monochromatic in vivo 3D imaging of the female breast, for breast cancer diagnosis.MethodsTest objects were imaged at 38 keV using monochromatic SR and a high-resolution CdTe photon-counting detector. Signal and noise performance were evaluated using modulation transfer function (MTF) and noise power spectrum. The analysis was performed on the images obtained with the application of a phase retrieval algorithm as well as on those obtained without phase retrieval. The contrast to noise ratio (CNR) and the capability of detecting test microcalcification clusters and soft masses were investigated.ResultsFor a voxel size of (60 μm)³, images without phase retrieval showed higher spatial resolution (6.7 mm⁻¹ at 10% MTF) than corresponding images with phase retrieval (2.5 mm⁻¹). Phase retrieval produced a reduction of the noise level and an increase of the CNR by more than one order of magnitude, compared to raw phase-contrast images. Microcalcifications with a diameter down to 130 μm could be detected in both types of images.ConclusionsThe investigation on test objects indicates that breast CT with a monochromatic SR source is technically feasible in terms of spatial resolution, image noise and contrast, for in vivo 3D imaging with a dose comparable to that of two-view mammography. Images obtained with the phase retrieval algorithm showed the best performance in the trade-off between spatial resolution and image noise.     

99mTc thyroid imaging system using multiple imaging plates

A system for taking static thyroid ^99mTc images was devised by using multiple imaging plates (IPs) and a low-energy high resolution collimator. System spatial resolution of the IP systems and the gamma camera was determined by referring to standards set by the National Electrical Manufacturers Association. Sensitivity was represented by using lower detection limits (LDLs). The sensitivity and resolution of IP systems using 16 IP probes connecting two collimators and 9 IPs were determined by using a 20 ml thyroid phantom, and compared with the sensitivity of gamma cameras. The sensitivity of the IP systems increased in proportion to the number of IPs. The sensitivity and resolution of a probe using 6 IPs and a high resolution collimator were equivalent to or superior to the gamma camera for taking static thyroid ^99mTc images. IP systems can be applied clinically as mobile static nuclear imaging devices. The performance of IP systems should be thoroughly investigated for combinations of various collimators and the number of IPs in order to verify their efficacy for imaging all organs.     

Comparison of 90Y SIRT predicted and delivered absorbed doses using a PSF conversion method

PurposeThe aims of this study were to develop and apply a method to correct for the differences in partial volume effects of pre-therapy Technetium-99 m (^99mTc)-MAA SPECT and post-therapy Yttrium-90 (⁹⁰Y) bremsstrahlung SPECT imaging in selective internal radiation therapy, and to use this method to improve quantitative comparison of predicted and delivered ⁹⁰Y absorbed doses.MethodsThe spatial resolution of ^99mTc SPECT data was converted to that of ⁹⁰Y SPECT data using a function calculated from ^99mTc and ⁹⁰Y point spread functions. This resolution conversion method (RCM) was first applied to ^99mTc and ⁹⁰Y SPECT phantom data to validate the method, and then to clinical data to assess the power of ^99mTc SPECT imaging to predict the therapeutic absorbed dose.ResultsThe maximum difference between absorbed doses to phantom spheres was 178%. This was reduced to 27% after the RCM was applied.The clinical data demonstrated differences within 38% for mean absorbed doses delivered to the normal liver, which were reduced to 20% after application of the RCM. Analysis of clinical data showed that therapeutic absorbed doses delivered to tumours greater than 100 cm³ were predicted to within 52%, although there were differences of up to 210% for smaller tumours, even after the RCM was applied.ConclusionsThe RCM was successfully verified using phantom data. Analysis of the clinical data established that the ^99mTc pre-therapy imaging was predictive of the ⁹⁰Y absorbed dose to the normal liver to within 20%, but had poor predictability for tumours smaller than 100 cm³.     

Study on measuring device arrangement of array-type CdTe detector for BNCT-SPECT

Aim

To design the measuring device arrangement of array-type CdTe detector for BNCT-SPECT.

Background

In a boron neutron capture therapy, a very serious unsolved problem exists, namely that the treatment effect for BNCT cannot be known during irradiation in real time. Therefore, we have been developing a so-called BNCT-SPECT with a CdTe detector, which can obtain a three-dimensional image for the BNCT treatment effect by measuring 478 keV gamma-rays emitted from the excited state of ⁷Li nucleus created by the ¹⁰B(n,α) reaction. However, no practical uses were realized at present, because BNCT-SPECT requires very severe conditions for spatial resolution, measuring time, statistical accuracy and energy resolution.

Materials and methods

The design study was performed with numerical simulations carried out by a 3-dimenaional transport code, MCNP5 considering the detector assembly, irradiation room and even arrangement of arrayed CdTe crystals.

Results

The estimated count rate of 478 keV gamma-rays was sufficiently large being more than the target value of over 1000 counts/h. However, the S/N ratio did not meet the target of S/N > 1. We confirmed that deterioration of the S/N ratio was caused by the influence of Compton scattering especially due to capture gamma-rays of hydrogen. Theoretical calculations were thereafter carried out to find out whether anti-Compton measurement in an array-type CdTe detector could decrease the noise due to Compton scatterings.

Conclusions

The calculation result showed that the anti-coincidence would possibly increase the S/N ratio. In the next phase, an arrayed detector with two CdTe crystals will be produced to test removal possibility of the anti-coincident event.     

碲化镉（CdTe）探测器的原理及医学应用

本文介绍了一种新型的化合物半导体探测器——CdTe探测器,它具有灵敏度高,探测效率高、能量分辨率好、可以在室温下使用,以及对湿度不敏感和体积小等优点,并介绍了该探测器在医学应用方面的前景。     

Tomographie sténopéïque au 99mTc-MIBI dans l’hyperparathyroïdie primaire

PurposeThis prospective study was conducted to determine the interest of ^99mTc-MIBI pinhole SPECT compared with conventional SPECT, planar scintigraphy and ultrasonography, for the preoperative localization of parathyroid lesions in primary hyperparathyroidism.MethodsFifty-one patients cured after surgery were studied. Pinhole SPECT was reconstructed with a dedicated OSEM algorithm. Scintigraphies were analyzed visually. A diagnostic confidence score (CS) was assigned to each procedure considering intensity and extrathyroidal location of suspected lesions and was defined as follows: 0 = negative, 1 = doubtful, 2 = moderately positive, 3 = positive.ResultsSurgery revealed 55 lesions. Sensitivity of ultrasonography, planar imaging, conventional SPECT and pinhole SPECT were respectively, 51, 76, 82 and 87%. Five glands were only detected by pinhole SPECT. Combination of ultrasonography, planar and pinhole SPECT showed the highest sensitivity (94.5%). The mean CS of the 55 pathologic glands was significantly higher with pinhole SPECT compared with planar imaging and conventional SPECT (p < 0.0001). Compared with planar imaging and conventional SPECT, pinhole SPECT increased CS for 42 and 53% of parathyroid lesions, respectively, and contributed to markedly reduce the number of uncertain results. Nevertheless, planar imaging and ultrasonography were useful to analyze thyroid morphology and to detect some ectopic glands.ConclusionThe use of pinhole SPECT increases sensitivity and CS of scintigraphy. Combination of ultrasonography, planar and pinhole SPECT appears the optimal preoperative imaging procedure in primary hyperparathyroidism.     

Multicenter evaluation of a synthetic single-crystal diamond detector for CyberKnife small field size output factors

PurposeThe aim of the present work was to evaluate small field size output factors (OFs) using the latest diamond detector commercially available, PTW-60019 microDiamond, over different CyberKnife systems. OFs were measured also by silicon detectors routinely used by each center, considered as reference.MethodsFive Italian CyberKnife centers performed OFs measurements for field sizes ranging from 5 to 60 mm, defined by fixed circular collimators (5 centers) and by Iris^™ variable aperture collimator (4 centers). Setup conditions were: 80 cm source to detector distance, and 1.5 cm depth in water. To speed up measurements two diamond detectors were used and their equivalence was evaluated. MonteCarlo (MC) correction factors for silicon detectors were used for comparing the OF measurements.ResultsConsidering OFs values averaged over all centers, diamond data resulted lower than uncorrected silicon diode ones. The agreement between diamond and MC corrected silicon values was within 0.6% for all fixed circular collimators. Relative differences between microDiamond and MC corrected silicon diodes data for Iris^™ collimator were lower than 1.0% for all apertures in the totality of centers. The two microDiamond detectors showed similar characteristics, in agreement with the technical specifications.ConclusionsExcellent agreement between microDiamond and MC corrected silicon diode detectors OFs was obtained for both collimation systems fixed cones and Iris^™, demonstrating the microDiamond could be a suitable detector for CyberKnife commissioning and routine checks. These results obtained in five centers suggest that for CyberKnife systems microDiamond can be used without corrections even at the smallest field size.     

Video-rate Scanning Confocal Microscopy and Microendoscopy

Confocal microscopy has become an invaluable tool in biology and the biomedical sciences, enabling rapid, high-sensitivity, and high-resolution optical sectioning of complex systems. Confocal microscopy is routinely used, for example, to study specific cellular targets¹, monitor dynamics in living cells^2-4, and visualize the three dimensional evolution of entire organisms^5,6. Extensions of confocal imaging systems, such as confocal microendoscopes, allow for high-resolution imaging in vivo⁷ and are currently being applied to disease imaging and diagnosis in clinical settings^8,9.Confocal microscopy provides three-dimensional resolution by creating so-called "optical sections" using straightforward geometrical optics. In a standard wide-field microscope, fluorescence generated from a sample is collected by an objective lens and relayed directly to a detector. While acceptable for imaging thin samples, thick samples become blurred by fluorescence generated above and below the objective focal plane. In contrast, confocal microscopy enables virtual, optical sectioning of samples, rejecting out-of-focus light to build high resolution three-dimensional representations of samples.Confocal microscopes achieve this feat by using a confocal aperture in the detection beam path. The fluorescence collected from a sample by the objective is relayed back through the scanning mirrors and through the primary dichroic mirror, a mirror carefully selected to reflect shorter wavelengths such as the laser excitation beam while passing the longer, Stokes-shifted fluorescence emission. This long-wavelength fluorescence signal is then passed to a pair of lenses on either side of a pinhole that is positioned at a plane exactly conjugate with the focal plane of the objective lens. Photons collected from the focal volume of the object are collimated by the objective lens and are focused by the confocal lenses through the pinhole. Fluorescence generated above or below the focal plane will therefore not be collimated properly, and will not pass through the confocal pinhole¹, creating an optical section in which only light from the microscope focus is visible. (Fig 1). Thus the pinhole effectively acts as a virtual aperture in the focal plane, confining the detected emission to only one limited spatial location.Modern commercial confocal microscopes offer users fully automated operation, making formerly complex imaging procedures relatively straightforward and accessible. Despite the flexibility and power of these systems, commercial confocal microscopes are not well suited for all confocal imaging tasks, such as many in vivo imaging applications. Without the ability to create customized imaging systems to meet their needs, important experiments can remain out of reach to many scientists.In this article, we provide a step-by-step method for the complete construction of a custom, video-rate confocal imaging system from basic components. The upright microscope will be constructed using a resonant galvanometric mirror to provide the fast scanning axis, while a standard speed resonant galvanometric mirror will scan the slow axis. To create a precise scanned beam in the objective lens focus, these mirrors will be positioned at the so-called telecentric planes using four relay lenses. Confocal detection will be accomplished using a standard, off-the-shelf photomultiplier tube (PMT), and the images will be captured and displayed using a Matrox framegrabber card and the included software.Download video file.^{(90M, mov)}     

188Re image performance assessment using small animal multi-pinhole SPECT/PET/CT system

PurposeThe goal of this study was to investigate the performance of a pre-clinical SPECT/PET/CT system for ¹⁸⁸Re imaging.MethodsPhantom experiments were performed aiming to assess the characteristics of two multi-pinhole collimators: ultra-high resolution collimator (UHRC) and high-energy ultra high resolution collimator (HE-URHC) for imaging ¹⁸⁸Re. The spatial resolution, image contrast and contrast-to-noise ratio (CNR) were investigated using micro-Jaszczak phantoms. Additionally, the quantification accuracy of ¹⁸⁸Re images was evaluated using two custom-designed phantoms. The ¹⁸⁸Re images were compared to those obtained with ^99mTc (gold standard); the acquired energy spectra were analyzed and Monte-Carlo simulations of the UHRC were performed. To verify our findings, a C57BL/6-mouse was injected with ¹⁸⁸Re-microspheres and scanned with both collimators.ResultsThe spatial resolution achieved in ¹⁸⁸Re images was comparable to that of ^99mTc. Acquisitions using HE-UHRC yielded ¹⁸⁸Re images with higher contrast and CNR than UHRC. Studies of quantitative accuracy of ¹⁸⁸Re images resulted in <10% errors for both collimators when the activity was calculated within a small VOI around the object of interest. Similar quantification accuracy was achieved for ^99mTc. However, ¹⁸⁸Re images showed much higher levels of noise in the background. Monte-Carlo simulations showed that ¹⁸⁸Re imaging with UHRC is severely affected by down-scattered photons from high-energy emissions. The mouse images showed similar biodistribution of ¹⁸⁸Re-microspheres for both collimators.ConclusionsVECTor/CT provided ¹⁸⁸Re images quantitatively accurate and with quality comparable to ^99mTc. However, due to large penetration of UHRC by high-energy photons, the use of the HE-UHRC for imaging ¹⁸⁸Re in VECTor/CT is recommended.     

A Monte Carlo study of the influence of focal spot size,intensity distribution,breast thickness and magnification on spatial resolution of an a-Se digital mammography system using the generalized MTF

In this study the generalized Modulation Transfer Function (GMTF) and the geometric sharpness (S_geo) were used (i) to study the effects of various focal spot sizes (0.04 mm–0.3 mm), x-ray intensity distributions (Gaussian and double Gaussian), breast thicknesses (2–7 cm) and magnifications M (1.0–2.0) on the spatial resolution of an a-Se digital mammography system, (ii) to identify suitable focal spots for magnification mammography and (iii) derive optimum magnifications. For the calculation of GMTF the required components were: focal spot MTF, obtained from theory, detector MTF, scatter MTF and scatter fraction obtained from Monte Carlo simulations. The results showed that focal spots with sizes up to 0.18 mm are suitable for magnification mammography offering a GMTF which is >50% and >20% at the respective object frequencies of 6.5 mm⁻¹ and 9 mm⁻¹. Focal spots with sizes < 0.16 mm and Gaussian. intensity distribution, or sizes ≤ 0.1 mm and double Gaussian, offer a system resolution which improves or does not deteriorate with magnification for most object frequencies. For larger focal spots, i.e. 0.16–0.18 mm for a Gaussian and 0.12–0.18 mm for a double Gaussian. intensity distribution, optimum magnifications exist which depend on the object frequency and breast thickness. System resolution (in terms of S_geo) is maximized at M = 1.8–2.0 (all breast thicknesses) for Gaussian intensity distribution, and at M = 1.4–1.6 (breast thicknesses ≤ 4 cm) and M = 1.6–1.8 (thicker breasts) for double Gaussian.     

Design and development of a dedicated portable gamma camera system for intra-operative imaging

PurposeWe developed a high performance portable gamma camera platform dedicated to identification of sentinel lymph nodes (SLNs) and radio-guided surgery for cancer patients. In this work, we present the performance characteristics of SURGEOSIGHT-I, the first version of this platform that can intra-operatively provide high-resolution images of the surveyed areas.MethodsAt the heart of this camera, there is a 43 × 43 array of pixelated sodium-activated cesium iodide (CsI(Na)) scintillation crystal with 1 × 1 mm² pixel size and 5 mm thickness coupled to a Hamamatsu H8500 flat-panel multi-anode (64 channels) photomultiplier tube. The probe is equipped with a hexagonal parallel-hole lead collimator with 1.2 mm holes. The detector, collimator, and the associated front-end electronics are encapsulated in a common housing referred to as head.ResultsOur results show a count rate of ∼41 kcps for 20% count loss. The extrinsic energy resolution was measured as 20.6% at 140 keV. The spatial resolution and the sensitivity of the system on the collimator surface was measured as 2.2 mm and 142 cps/MBq, respectively. In addition, the integral and differential uniformity, after uniformity correction, in useful field-of-view (UFOV) were measured 4.5% and 4.6%, respectively.ConclusionsThis system can be used for a number of clinical applications including SLN biopsy and radiopharmaceutical-guided surgery.     

Distal edge determination precision for a multi-slat prompt-gamma camera: A comprehensive simulation and optimization of the detection system

Multi-slat prompt-gamma camera is a promising tool for range monitoring during proton therapy. We report the results of a comprehensive simulation study analyzing the precision which is possible to reach with this camera in determination of the position of the distal edge of the Bragg peak. For the first time we include simulation of optical photons. The proton beam (single pencil beam, 130 MeV, 10 ns bunch period, total of 1·10⁸ protons) is interacting with a polymethyl methacrylate (PMMA) phantom, which is a cylinder of 200 mm in diameter and length. The prompt gamma rays generated in the phantom are collimated with a multi-slat collimator and detected using a combination of yttrium aluminum perovskite (YAP) scintillators, installed in the collimator apertures, and light sensors. Two scintillator packing schemes, with one and with two scintillator plates per aperture, are considered. The collimator configuration (the septal thickness, aperture and height), resulting in the best precision, is determined using two methods of detector optimization. Precision of 2.1 mm (full width at half maximum) in the edge position determination is demonstrated.     

Root length and biomass losses during sample preparation with different screen mesh sizes

Data are presented on the differences in root length density (RLD), dry matter (DM), and root diameter values determined on wheat and faba bean using sieves of different mesh size to separate roots from soil during sample preparation. Screens with 0.2, 1, and 2 mm (0.04, 1, and 4 mm²) aperture were used. Roots collected on the 2-mm sieve represented on average 55% of the weight and only 10% of the total length collected using a 0.2-mm sieve. With a 1-mm sieve 75% of weight was retained, but only 34% of the length. In the 0–20 cm soil layer average RLD and DM values ranged between 1.3 and 2.5 cm cm^-3 and 215 and 136 g m^-2 for faba bean and wheat respectively with 2 mm screens and 14.6 and 18.1 cm cm^-3 and 313 and 202 g m^-2 with 0.2 mm sieves. RLD was more affected than weight since losses from coarse screens were largely due to fine root fractions, although the 1-and 2-mm screens retained a small amount of fine roots that were long or attached to main structures. Variability was higher for measurements on coarser screens. The use of screens much coarser than the diameter of fine roots is not recommended for the study of surface-related phenomena in which root length quantification is necessary, while it may be acceptable for gross comparisons of root weight and spatial extent.     

An array of planar apertures for near-field fluorescence correlation spectroscopy

We have developed a method of performing near-field fluorescence correlation spectroscopy via an array of planarized circular apertures of 50 nm diameter. This technique provides 1 μs and 60 nm resolution on proximal samples, including live cells, without incorporating a scanning probe or pulsed lasers or requiring penetration of the sample into the aperture. Millions of apertures are created in an array within a thin film of aluminum on a coverslip and planarized to achieve no height distinction between the apertures and the surrounding metal. Supported lipid bilayers and plasma membranes from live cells adhere to the top of this substrate. We performed fluorescence correlation spectroscopy to demonstrate the sub-diffraction-limited illumination with these devices.     

Single-Fluorophore Diffusion in a Lipid Membrane over a Subwavelength Aperture

We use submicrometer apertures milled in an aluminium film to study the diffusion dynamics of β-Bodipy-FL-C₅-HPC (Bodipy-PC) fluorophores in a lipid dioleoylphosphatidylcholine (DOPC) multilayer. The observation volume is limited by the aperture diameter, well below the optical wavelength. This spatial resolution improvement comes together with an enhancement of the detected fluorescence per molecule as compared to an open sample, with a significant increase up to 3.5 times.     

Evaluation of a SiPM array coupled to a Gd3Al2Ga3O12:Ce (GAGG:Ce) discrete scintillator

PurposeIn this study, we present the results of the evaluation of the SensL ArraySL-4 photo-detector, coupled to a 6 × 6 GAGG:Ce scintillator array, with 2 × 2 × 5 mm³ crystal size elements for possible applications in medical imaging detectors with focus in PET applications. Experimental evaluation was carried out with ²²Na and ¹³⁷Cs radioactive sources and the parameters studied were energy resolution and peak to valley ratio.MethodsArraySL-4 is a commercially available, 4 × 4 array detector covering an active area of 13.4 mm². The GAGG:Ce scintillator array used in this study has 0.1 mm thickness BaSO₄ reflector material between the crystal elements. A symmetric resistive voltage division matrix was applied, which reduces the 16 outputs of the array to 4 position signals. A Field Programmable Gate Array was used for triggering and digital processing of the signal pulses acquired using free running Analog to Digital Converters.ResultsRaw images and horizontal profiles of the 6 × 6 GAGG:Ce scintillator array produced under 511 keV and 662 keV excitation are illustrated. Moreover, the energy spectra obtained with ²²Na and ¹³⁷Cs radioactive sources from a single 2 × 2 × 5 mm³ GAGG:Ce scintillator are shown. The peak to valley ratio and the mean energy resolution values are reported.ConclusionsThe acquired raw image of the GAGG:Ce crystal array under 511 keV excitation shows a clear visualization of all discrete scintillator elements with a mean peak to valley ratio equal to 40. The mean energy resolution was measured equal to 10.5% and 9% respectively under 511 keV and 662 keV irradiation.     

Development and characterization of optical readout well-type glass gas electron multiplier for dose imaging in clinical carbon beams

The use of carbon ion beams in cancer therapy (also known as hadron therapy) is steadily growing worldwide; therefore, the demand for more efficient dosimetry systems is also increasing because daily quality assurance (QA) measurements of hadron radiotherapy is one of the most complex and time consuming tasks. The aim of this study is to develop a two-dimensional dosimetry system that offers high spatial resolution, a large field of view, quick data response, and a linear dose–response relationship.We demonstrate the dose imaging performance of a novel digital dose imager using carbon ion beams for hadron therapy. The dose imager is based on a newly-developed gaseous detector, a well-type glass gas electron multiplier. The imager is successfully operated in a hadron therapy facility with clinical intensity beams for radiotherapy. It features a high spatial resolution of less than 1 mm and an almost linear dose–response relationship with no saturation and very low linear-energy-transfer dependence. Experimental results show that the dose imager has the potential to improve dosimetry accuracy for daily QA.