The recent development of large-area, flat-panel a-Si:H imaging arrays is generally expected to lead to real-time diagnostic and megavoltage X-ray projection imagers with film-cassette-like profiles. While such flat-panel imagers offer numerous advantages over existing fluoroscopic and radiographic imaging devices, the unique properties of the arrays also offer the prospect of detector configurations not previously possible with other real-time technologies. The thin, highly uniform profile of the arrays allows the creation of composite imaging devices in which a flat-panel detector overlies a second imaging detector. A dual-energy (diagnostic and megavoltage) composite imager consisting of a pair of stacked, flat-panel imagers would provide unique information helping to resolve the patient localization and verification problem in megavoltage radiotherapy. In PET or SPECT, attenuation corrections could be obtained by placing a flat-panel array for transmission measurements directly in front of the main emission detector. In this article, the concept of such real-time flat-panel composite imagers is proposed. Specific embodiments of this concept applied toward the resolution of outstanding problems in radiotherapy, PET and SPECT are outlined and calculations and data supporting the feasibility of the concept are presented.
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