SU-F-T-547: Off-Isocenter Winston-Lutz Test for Stereotactic Radiosurgery/stereotactic Body Radiotherapy.

PURPOSE To perform a quantitative study to verify that the mechanical field center coincides with the radiation field center when both are off from the isocenter during the single-isocenter technique in linear accelerator-based SRS/SBRT procedure to treat multiple lesions. METHODS We developed an innovative method to measure this accuracy, called the off-isocenter Winston-Lutz test, and here we provide a practical clinical guideline to implement this technique. We used ImagePro V.6 to analyze images of a Winston-Lutz phantom obtained using a Varian 21EX linear accelerator with an electronic portal imaging device, set up as for single-isocenter SRS/SBRT for multiple lesions. We investigated asymmetry field centers that were 3 cm and 5 cm away from the isocenter, as well as performing the standard Winston-Lutz test. We used a special beam configuration to acquire images while avoiding collision, and we investigated both jaw and multileaf collimation. RESULTS For the jaw collimator setting, at 3 cm off-isocenter, the mechanical field deviated from the radiation field by about 2.5 mm; at 5 cm, the deviation was above 3 mm, up to 4.27 mm. For the multileaf collimator setting, at 3 cm off-isocenter, the deviation was below 1 mm; at 5 cm, the deviation was above 1 mm, up to 1.72 mm, which is 72% higher than the tolerance threshold. CONCLUSION These results indicated that the further the asymmetry field center is from the machine isocenter, the larger the deviation of the mechanical field from the radiation field, and the distance between the center of the asymmetry field and the isocenter should not exceed 3 cm in of our clinic. We recommend that every clinic that uses linear accelerator, multileaf collimator-based SRS/SBRT perform the off-isocenter Winston-Lutz test in addition to the standard Winston-Lutz test and use their own deviation data to design the treatment plan.