1 Katrina Lee February 2014 Attenuation Factor Wedge Transmission Factor Calculation Objective: To determine the transmission factor

for a wedge used in the path of a beam, and to demonstrate the incorporation of it in a monitor unit calculation. Purpose: Treatment machines used in radiation therapy are calibrated by department physicists. It is an important step in confirming that the machines will adequately deliver a prescribed treatment to a patient. Beam-modifiers, or filters, can be used to absorb radiation emitted from a treatment machine. Wedges are a common device that are used to attenuate a beam in a progressive manner across a field.1 The benefit of placing a wedge between the patient and the beam source, is that the dose will distribute differently causing the isodose lines to tilt. If a wedge is used in a treatment plan, it must be accounted for in the calculation because it attenuates the beam.2 A wedge transmission factor, or wedge factor (WF), is defined by the following:

WF =
Methods and Materials: A Varian 21 IX linear accelerator was used to measure the beam transmission using 6 megavoltage (MV) and 18 MV photon energies. The beams were set at 100 source to axis distance (SAD) with a 10x10 cm field size. The machine was set to 100 monitor units (MU) for each reading. The experiment was carried out by using 15 and 30 wedges to determine the transmission factor the linear accelerator. These wedges were placed in the path of the beam and measured, as shown in Figure 1.

Figure 1: 15 and 30 wedges (respectively) in the path of the beam A virtual water phantom was set on the treatment couch (set at 0) with the gantry and collimator set to 0 (Figure 2). Photons and electrons can be calibrated using a virtual water phantom, which is a dosimetric tissue equivalent material that will attenuate and scatter x-rays similarly. The phantom can calibrate machines within 0.5% of the actual dose.3

Figure 2: Virtual Water Phantom on couch

3 The beam output was measured with a Wellhofer FC-65 ionization chamber at a 10 cm depth. The readings were recorded with a Victoreen 525 electrometer (Figure 3).

Figure 3: Victoreen 525 electrometer connected and ready to read beam output Results:
Energy Readings w/ 15 left wedge 11.583 6 MV 11.576 11.578 15.311 18 MV 15.304 15.303 Readings w/out wedge 16.267 16.26 16.277 19.79 19.79 19.78 Readings w/ 30 in wedge 8.893 8.89 8.893 12.474 12.468 12.461

Table 1: Readings taken with and without the 15 and 30 wedges in the beam path

Energy 6 MV

Average of readings w/ 15 left wedge 11.579

Average of readings w/out wedges 16.268

Average of readings w/ 30 in wedge 8.892

18 MV

15.306

19.787

12.468

Table 2: The average of the trials with and without the wedges present for both energies. The average determined by adding the three values and dividing by 3.
Energy 6 MV 15 Wedge 18 MV 6 MV 30 Wedge 18 MV Reading with Wedge Reading w/out Wedge 11.579 16.268 15.306 19.787 8.892 16.268 12.468 19.787 Wedge Transmission Factor (WF) 0.712 0.774 0.547 0.63

Table 3: Calculation of the transmission factors by the formula: Discussion: The WF readings following the experiment show how much a wedge will affect a Varian 21 IX linear accelerator by attenuating a beam across a treatment field. The Victoreen electrometer measured the beam output for both energies three times each for an open field beam as well as beams containing either a 15 or 30 wedge. The beam output using 6 MV for a 30 wedge measured 8.893, 8.890, and 8.893 nanoCoulombs (nC). The beams were averaged by adding the output and dividing the number by three, resulting in 8.892 nC. For an 18 MV beam using a 30 wedge was measured 12.474, 12.468, and 12.461 nC. The measurements were averaged and found to be 12.468 nC. The WF was calculated by

5 plugging averages into the formula. The 30 wedge WF measured 0.547 and 0.630 for a 6 MV and 18 MV beam respectively. The beam output was measured using 6 MV and 18 MV x-rays with a 15 wedge. The 6 MV output measured 11.583, 11.576, and 11.578 nC. The average of the beams was calculated to be 11.579 nC. The 18 MV output measured 15.311, 15.304, 15.303 nC. The calculated average for the beam was 15.306 nC. The 15 wedge WF measured for a 6 MV and 18 MV beam to be 0.712 and 0.774 respectively. Clinical Application: A laryngeal tumor was planned using two-fields, a right and left lateral. The physician prescribed the patient to receive 3060 cGy over the course of 17 fractions. The plan was initially done without a wedge, and the coverage of the planned tumor volume (PTV) was not adequate for treatment. The isodose distribution is shown in Figure 4.

Figure 4: Two-field Laryngeal Treatment Plan - No wedge

6 In order to optimize the plan and get better PTV coverage, a 30 wedge was added to the right treatment field (1a Rt Lat). The plan was recalculated and the dose coverage was better, as shown in Figure 5.

Figure 5: Two-field Treatment Plan with 30 wedge Though the PTV coverage was better, adding another wedge to the opposing beam was discussed in the hope of better covering the PTV. A 15 left wedge was added to the left treatment field (1b Lt Lat) and recalculated (Figure 6).

Figure 6: Two-field Treatment Plan with 30 and 15 wedges With the two wedges incorporated into the plan, the PTV coverage was 100% when normalized to the 97% isodose line, 2968.2 cGy. The dose volume histogram, or DVH, is shown in Figure 7. The physician accepted the plan for treatment, and second checks needed to be completed.

Figure 7: Dose Volume Histogram for the accepted treatment plan The plan was exported into the MU check program and calculated via computer. Figure 8 shows the calculation of the treatment plan.

Figure 8: MU check To check the MU calculations by hand, shown in Figure 9, the respective values were plugged into the following equation. These values were determined by using the parameters set from the treatment plan.

MU =

10

Figure 9: MU hand calculations Conclusion: Beam-modifying devices are used to modify the beam distribution out of a treatment machine. Wedges distort a treatment beam, causing the isodose lines to tilt.2 This is a useful technique when trying to achieve a better dose distribution to the PTV or reduce a hot spot within a treatment field. Though wedges are accounted for in a treatment planning system, it is important to understand how they can change the dose distribution along a treatment field. They can be beneficial for a treatment plan, but the wedge orientation must be known throughout a department to deliver a successful treatment. If inserted improperly, it is a major error and at times reportable to the National Regulatory Commission, or NRC. Also, knowing how to incorporate a wedge factor into a monitor unit calculation is essential for a dosimetrist. These calculations help to effectively and accurately treat a patient with radiation.

11 References 1. Bentel G. Radiation Therapy Planning. 2nd ed. New York, NY: McGraw-Hill; 1996: 32-54. 2. Khan FM. The Physics of Radiation Therapy. 4th Ed. Baltimore, MD: Lippincott, Williams, and Wilkins; 2010: 181-189. 3. CNMC. Dosimetry Phantoms/ Plastic Slab Phantoms. http://www.cnmcco.com/dosimetry/PDFdocs/slabPhantoms/CNMC_virtualwater.pdf. Accessed Feb. 15, 2013.