A study of Winston-Lutz test on two different electronic portal imaging devices and with low energy imaging

Stereotactic radiosurgery requires sub-millimetre accuracy in patient positioning and target localization. Therefore, verification of the linear accelerator (linac) isocentre and the laser alignment to the isocentre is performed in some clinics prior to the treatment using the Winston-Lutz (W-L) test with films and more recently with images obtained using the electronic portal imaging devices (EPID). The W-L test is performed by acquiring EPID images of a radio-opaque ball of 6 mm diameter (the W-L phantom) placed at the isocentre of the linac at various gantry and table angles, with a predefined small square or circular radiation beam. In this study, the W-L test was performed on two linacs having EPIDs of different size and resolution, viz, a TrueBeam™ linac with aS1000 EPID of size 40 × 30 cm(2) with 1024 × 768 pixel resolution and an EDGE™ linac having an EPID of size 43 × 43 cm(2) with pixel resolution of 1280 × 1280. In order to determine the displacement of the radio-opaque ball centre from the radiation beam centre of the W-L test, an in-house MATLAB™ image processing code was developed using morphological operations. The displacement in radiation beam centre at each gantry and couch position was obtained by determining the distance between the radiation field centre and the radio-opaque ball centre for every image. Since the MATLAB code was based on image processing that was dependent on the image contrast and resolution, the W-L test was also compared for images obtained with different beam energies. The W-L tests were performed for 6 and 8 MV beams on the TrueBeam™ linac and for 2.5 and 6 MV beams on the EDGE™ linac with a higher resolution EPID. It was observed that the images obtained with the EPID of higher resolution resulted in same accuracy in the determination of the displacement between the centres of the radio-opaque ball and the radiation beam, and significant difference was not observed with images acquired with different energies. It is concluded that the software based on morphological operations provided an accurate estimation of the displacement of the ball centre from the radiation beam center.