The physics of imaging with metal/phosphor (Gd2O2S:Tb on brass) screen
s at megavoltage energies has been investigated using Monte Carlo simu
lation. It has been found that pair production is a significant contri
butor to energy deposition for Bremsstrahlung beams with energies grea
ter than 6 MV. The effects of different thicknesses of phosphor and me
tal have been studied, and it is shown that the metal plays a signific
ant role in establishing electronic equilibrium in the phosphor. The t
ransport of optical photons through the phosphor has been modeled, and
was found that only 10% to 20% of the light created in the phosphor e
scapes from the surface, with much of the loss being due to total inte
rnal reflection at the surface. Calculated results have been compared
with experimental measurements of screen brightness for different phos
phor and metal thicknesses. The SNR of a video electronic portal imagi
ng device (VEPID) has been calculated as a function of x-ray and optic
al photon detection efficiency. The non-Poisson distribution of energy
deposition in the phosphor is an important contributor to the SNR. Th
e results of this paper should serve as a useful guide to the engineer
ing design of future electronic portal imaging systems.