SU-E-J-117: Verification Method for the Detection Accuracy of Automatic Winston Lutz Test




Winston Lutz test (WLT) has been a standard QA procedure performed prior to SRS treatment, to verify the mechanical iso-center setup accuracy upon different Gantry/Couch movements. Several detection algorithms exist,for analyzing the ball-radiation field alignment automatically. However, the accuracy of these algorithms have not been fully addressed. Here, we reveal the possible errors arise from each step in WLT, and verify the software detection accuracy with the Rectilinear Phantom Pointer (RLPP), a tool commonly used for aligning treatment plan coordinate with mechanical iso-center.


WLT was performed with the radio-opaque ball mounted on a MIS and irradiated onto EDR2 films. The films were scanned and processed with an in-house Matlab program for automatic iso-center detection. Tests were also performed to identify the errors arise from setup, film development and scanning process. The radioopaque ball was then mounted onto the RLPP, and offset laterally and longitudinally in 7 known positions (0, ±0.2, ±0.5, ±0.8 mm) manually for irradiations. The gantry and couch was set to zero degree for all irradiation. The same scanned images were processed repeatly to check the repeatability of the software.


Miminal discrepancies (mean=0.05mm) were detected with 2 films overlapped and irradiated but developed seperately. This reveals the error arise from film processer and scanner alone. Maximum setup errors were found to be around 0.2mm, by analyzing data collected from 10 irradiations over 2 months. For the known shift introduced using the RLPP, the results agree with the manual offset, and fit linearly (R2>0.99) when plotted relative to the first ball with zero shift.


We systematically reveal the possible errors arise from each step in WLT, and introduce a simple method to verify the detection accuracy of our in-house software using a clinically available tool.