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Analytical representation for Varian EDW factors at off-center points

Vadim Y. Kuperman
Citation: Medical Physics 32, 1256 (2005); doi: 10.1118/1.1872532
View online: http://dx.doi.org/10.1118/1.1872532
View Table of Contents: http://scitation.aip.org/content/aapm/journal/medphys/32/5?ver=pdfcov
Published by the American Association of Physicists in Medicine
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Analytical representation for Varian EDW factors at off-center points


Vadim Y. Kuperman
James A. Haley Veterans Hospital, Tampa, Florida 33612

Received 25 October 2004; revised 24 January 2005; accepted for publication 25 January 2005;
published 13 April 2005
The purpose of this study is to describe and evaluate a new analytical model for Varian enhanced
dynamic wedge factors at off-center points. The new model was verified by comparing measured
and calculated wedge factors for the standard set of wedge angles i.e., 15, 30, 45 and 60,
different symmetric and asymmetric fields, and two different photon energies. The maximum difference between calculated and measured wedge factors is less than 2%. The average absolute
difference is within 1%. The obtained results indicate that the suggested model can be useful for
independent dose calculation with enhanced dynamic wedges. 2005 American Association of
Physicists in Medicine. DOI: 10.1118/1.1872532
Key words: radiotherapy, enhanced dynamic wedges, off-axis wedge factors
I. INTRODUCTION
By moving jaws during radiation treatment, modern clinical
accelerators can produce dose distributions similar to those
produced using physical hard wedges.1,2 The ability to generate a wedged dose distribution by varying jaw position is
commonly referred to as dynamic wedge. The latter has at
least three important advantages over a hard wedge. First,
dynamic wedges produce no additional scatter and, as a result, do not cause increased dose outside of the treatment
field. Second, in contrast to physical wedges used on
Siemens and Varian linear accelerators, the use of dynamic
wedges requires no physical involvement on the part of radiation therapist i.e., lifting wedges, inserting and removing
them from the head of the linear accelerator. The resulting
effect is decreased treatment time. Third, an additional, practical advantage of dynamic wedges over hard wedges is the
absence of the beam-hardening effect. The latter often makes
it difficult to adequately model hard wedges with available
treatment planning systems.
In order to dynamically generate wedged dose distribution, Varian utilizes segmented treatment tables STTs. Each
STT specifies the number of delivered monitor units MU as
a function of the moving jaw position. Since 1996 Varian has
used an approach in which a treatment STT for a given x-ray
energy, wedge angle, and field size is calculated with the
help of the so-called golden STT table, Gs. The latter is
specified for each photon energy and is designed to generate
a 60 deg wedge for the maximum field size of 30 cm. In the
approach used by Varian a desired wedge angle is produced
by combining dose distribution for a 60 deg wedge with that
produced by an open, static field.3 This approach is referred
to as the enhanced dynamic wedge EDW.
Implementation of Varian dynamic wedges has been extensively studied.2,411 Enhanced dynamic wedge factors at
the center of a radiation field can be described
analytically.911 One model, referred to below as the fractional MU approximation FMA, is based on the assumption
that an EDW factor equals the fraction of the total MU delivered while the point of calculation is within the unblocked
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Med. Phys. 32 5, May 2005

field.9,10 The reported agreement between the measured and


calculated wedge factors is within 2%4% for most symmetric and asymmetric fields. Recently, Yu11 suggested a modification of FMA. It should also be mentioned that Gibbons10
earlier developed a more complicated analytical model for
EDW factors. Although according to earlier studies,10,11
compared to FMA their models appear to reduce the discrepancies between the measured and calculated wedge factors at
the center of field, our study12 found that FMA actually performs no worse than the models by Gibbons and Yu.
While satisfactory agreement between calculated and
measured center-of-field EDW factors has been reported, the
above-mentioned analytical models generally fail to accurately predict wedge factors at off-center points see Sec.
III. Recently, Prado et al.13 described a new model for EDW
factors. This model requires that six parameters be determined for each photon energy: three parameters for centerof-field EDW factors and three more parameters for offcenter factors. In the six-parameter model an EDW factor is
given by the product of three terms: treatment STT, centerof-field correction factor, and off-axis correction factor.13
The purpose of this study is to describe a much simpler
model that accurately estimates EDW factors at off-center
points for symmetric and asymmetric fields. The new model
is a further development of our analytical representation for
center-of-field EDW factors.12 It should be emphasized that
the new model includes only two fitting parameters for each
photon energy see Sec. II. Because of its simplicity the
suggested approach is expected to become a useful tool for
independent dose calculations and for commissioning Varian
EDW for a treatment planning system.
The study is organized as follows: review of EDW generation on a Varian linear accelerator and the proposed model
for EDW factors are presented in Sec. II; measured and calculated wedge factors are compared in Sec. III; and the obtained results are discussed in Sec. IV.

0094-2405/2005/325/1256/6/$22.50

2005 Am. Assoc. Phys. Med.

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Vadim Y. Kuperman: Varian EDW factors at off-center points

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II. THEORY
II.A. Generation of EDW on a Varian linac

As mentioned previously, implementation of EDW requires generation of radiation while one of the jaws is moving. It should be mentioned that both dose rate and jaw speed
are varied during EDW treatment. The generated dose distribution depends on the relationship between the delivered
number of monitor units MU, the position of the moving
upper jaw, Y, and chosen wedge angle, . The function
MU , Y is defined by the treatment STT table as follows:
MU,Y = MUtotalSTT,Y,

where MUtotal is the total number of delivered MU. To ensure


that MUtotal is delivered when the moving jaw reaches its
final position Y MF, the STT in Eq. 1 is normalized so that
STT , Y MF = 1.
A normalized treatment STT for an arbitrary wedge angle
is described by the equation
AGS0 + BGSY
,
STT,Y =
AGS0 + BGSY MF

where GS denotes the golden non-normalized STT table


defined for a 60 deg wedge; GS0 is the value of the golden
STT at Y = 0 when the moving jaw just crosses the collimators axis of rotation. The coefficients A and B in Eq. 2 are
defined according to Petti and Siddon3 as
tan
A = 1
,
tan 60

tan
B =
.
tan 60

Below we will use a coordinate system for which the


moving jaw position is positive on the fixed-jaw side. In this
coordinate system GS can be approximated by using the following equation:10
GsY = a0 + a1 exp b1Y,

where parameters a0 , a1, and b1 are uniquely defined by the


photon energy and a1 , b1 0. It should be noted that for the
Varian C and E-series linacs the following conditions are
satisfied: a moving jaw position ranges from 20 to 10 cm
and b for any field size Y MF = Y FIX 0.5 cm, where Y FIX
denotes the position of the fixed jaw.

FIG. 1. Dynamic wedge treatment.

FMA is based on the assumption that the additional dose


delivered in the second phase exactly compensates for the
decrease in dose at the point of measurement during the first
phase of jaw motion. As a result, the wedge factor is described by the equation
WFY =

MU,Y
= STT,Y.
MUtotal

This model works remarkably well less than 1%2% error


for center-of-field EDW factors in the case of small and symmetric fields; however, for large and/or asymmetric fields the
published data10 for 6 and 18 MV photons indicate errors up
to 4%.
II.C. New model

In order to understand the rationale behind the new


model, let us take a closer look at a typical normalized treatment table for a 60 deg wedge Fig. 2 and 10 10 cm2 field.
The dashed line shows arbitrary MU0 delivered just before
the moving jaw crosses the beam axis; Y 1 and Y 2 are two

II.B. Fractional MU approximation

As mentioned above, EDW factors can be calculated analytically by using the FMA model.9,10 To elucidate the rationale behind FMA it is useful to follow the reasoning of
Gibbons10 and divide the delivery of EDW into phase 1 and
phase 2 which occur before and after the moving jaw crosses
the point of measurement Y, respectively Fig. 1. Due to
decreased scatter during phase 1, the point of measurement
receives a smaller dose as compared to the open field dose
delivered with the same MUY. Conversely, during phase 2
some additional dose to the observation point is delivered
due to scatter from the unblocked part of the field and due to
a small transmission of x-rays through the moving jaw.
Medical Physics, Vol. 32, No. 5, May 2005

FIG. 2. Typical treatment STT as a function of the moving jaw position.

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Vadim Y. Kuperman: Varian EDW factors at off-center points

small segments with the average coordinates Y 1 0 and Y 2


0, respectively, defined in the isocenter plane. It is assumed that the segments are symmetrically located with respect to the axis of the beam. Other notations are MU1
= MU0 MUY 1 and MU2 = MUY 2 MU0.
In the case when MU1 = MU2, the increased contribution to dose at Y = 0 from segment Y 2 will exactly compensate for the decrease in dose at the center of field due to the
decreased contribution from segment Y 1 if the transmission
through the moving jaw can be neglected. In reality, since
MU dependence on jaw position is not linear, MU1
MU2. In fact, based on the Gibbons approximation see
Eq. 4 one can show that MU1 MU2 see the Appendix; therefore, the net effect is an increase in the absorbed
dose relative to the case when MU1 = MU2. Based on similar arguments, we previously assumed that Eq. 5 underestimated center-of-field EDW factors12 and introduced a
model which has the following properties: a it generates
EDW factors greater than those calculated with the help of
Eq. 5 and b it reduces to Eq. 5 in the limit of small
fields. Our aim here is to extend our model for center-of-field
EDW factors to describe EDW factors at off-center points.
As in Ref. 12 we start with a modification of Eq. 5
WFY = STT,Y ,

where Y Y , l is yet unknown function of Y and field length


l = Y FIX Y MI. The rationale behind 6 is to develop a modification of FMA by shifting the calculation point from the
point of measurement as it was previously suggested by Yu.11
The current model is based on the new assumption that in
addition to being dependent on Y and field length, the point
of calculation Y also depends on the distance between the
point of measurement Y and the center-of-field: Y c = Y FIX
+ Y MI / 2. We use Taylor expansion
Y = Y + + Y FIX Y MI + Y c Y + Y FIX Y MI2
+ Y c Y + ,
2

where , , , , and are unknown coefficients. Since Eq.


5 accurately represents wedge factors for small fields,10,12
we want Eq. 7 to be reduced to Eq. 5 for small fields. To
ensure this we require that Y approaches Y as field size
approaches zero. From Eq. 7 it then follows that = 0. To
further simplify our model we will keep only first three nonzero terms in Eq. 7. As a result Eq. 6 becomes
WFY = STT,Y + l + Y c Y.

II.C.1. Center-of-field wedge factors


In the case when the point of measurement is at the center
of field i.e., Y = Y c, Eq. 8 is reduced to Eq.11 from Ref.
12. Note that in this case Eq. 8 is also similar to that recently suggested by Ansbacher and Neath.14 The important
difference between Eq. 8 and the model from Ref. 14 is
that in the latter model the point of calculation is shifted
from the point of measurement by aY FIX, where a is a coefficient. One weakness of this model is that the shift aY FIX
does not generally approach zero as field size decreases.
Medical Physics, Vol. 32, No. 5, May 2005

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Consequently, this model is not reduced to FMA for small


fields. Another weakness of the model from Ref. 14 is that
for Y FIX = 0 regardless of the field size, it predicts the same
EDW factors as those calculated with the help of FMA which
is known to be inaccurate for large and/or asymmetric fields.

II.C.2. EDW factors at off-center points


In our model described by Eq. 8, the shift between the
point of measurement and point of calculation is l + Y c
Y. It is clear that the shift can be negative or positive
depending on the coefficients and and the difference
Y c Y. Based on the behavior of STT as a function of Y see
Eqs. 24, one can show that a negative shift leads to an
EDW factor that is smaller than the corresponding factor
calculated with the help of FMA. Conversely, a positive shift
results in a wedge factor that is greater than the wedge factor
computed by using FMA.
According to our numerical calculations see Sec. III the
best agreement between measured and calculated wedge factors is achieved for positive and . Consequently, a negative shift l + Y c Y 0 can occur only for large enough
difference Y Y c 0 when the additional dose delivered at
the point of measurement during the second phase and the
effect of transmission through the moving jaw cannot compensate for a decrease in dose during phase 1. Thus, for large
enough Y Y c 0 i.e., for the wedge toe, the current model
predicts EDW factors which are generally smaller than those
calculated with the help of FMA. Conversely, since on the
wedge heel and at center of field the net shift is positive, the
corresponding EDW factors from the current model are
greater than those calculated by using FMA.
III. RESULTS
III.A. Methods

Measurements were performed at the VA Hospital in


Tampa on a recently installed Varian 23EX linear accelerator
with 6 and 18 MV photons. EDW factors were calculated as
ratios of average ionization readings obtained with wedged
fields to those obtained with open fields.
Center-of-field EDW factors for a 60 degree wedge were
obtained with the help of Scanditronix-Wellhofer dosimetry
system Memphis, TN and CC-13 chamber with an active
volume of 0.1 cm3. Center-of-field wedge factors for 15, 30,
and 45 degree wedges were measured in a solid water phantom by using a PTW M23343 parallel plate chamber PTW
Freiburg, Germany with a nominal volume of 0.05 cm3.
Each time the utilized ion chamber was carefully positioned
in the center of the radiation field. The produced ionization
in the chamber was measured with the help of Keithley K602
electrometer Keithley Instruments Inc., Cleveland, OH.
The maximum difference between the corresponding EDW
factors obtained with the two different chambers was 0.4%
for details see Ref. 12.
Center-of-field, 60 degree WFs measured with the CC-13
chamber in water were also compared with the corresponding wedge factors obtained by using a linear diode array

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Vadim Y. Kuperman: Varian EDW factors at off-center points

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TABLE I. Comparison between WFs measured with the help of diodes and WFs obtained by using the CC-13 ion
chamber in water. All measurements were performed with the dose rate of 400 MU/ min. In the case of diodes,
a 10 cm slab of solid water was placed on the surface of the profiler. The distance between the target and
profilers surface was 100 cm.
Jaw positions cm
Energy MeV

Wedge angle

Y MI

Y FIX

WFdiode

WFchamber

diff%

6
6
6

60
60
60

2.5
5
10

2.5
10
10

0.832
0.830
0.426

0.827
0.838
0.421

0.6
1.0
1.2

18
18
18

60
60
60

2.5
5
10

2.5
10
10

0.868
0.867
0.518

0.867
0.876
0.515

0.1
1.0
0.6

Profiler, Sun Nuclear Co., Melburne, FL. The difference


between the EDW factors for 6 and 18 MV photons obtained
with the help of diodes and those measured by using the
CC-13 chamber was within 1.2% Table I.
Off-center wedge factors for different field sizes were obtained by using the above-mentioned diode array with 0.5 cm
spacing between diodes. In our measurements we normally
used a nominal dose rate of 400 MU/ min. In order to establish experimentally if there is a dependence of diodes on
dose rate during EDW delivery, off-center and center-of-field
EDW factors for a 60 degree wedge and 20 20 cm2 field
size were measured for five different dose rates: 200, 300,
400, 500, and 600 MU/ min. In all measurements with different dose rates, a solid water slab of 10 cm was placed on
the surface of the profiler and SSD was 90 cm. EDW factors
within the central 80% of the radiation field varied as a function of dose rate by less than 2% for 6 MV photons. Variations in WFs with dose rate for 18 MV photons were less
than 1.1%.
III.B. Calculation of and

In this study we used our own data as well as the published WFs7,8 to determine the value of that provided the
best fit to the measured center-of-field EDW factors for a 60
degree wedge. The optimum value of was found by minimizing the cost function
S=

i
i
WF60,cal
2 .
i WF60,mes

i
i
In Eq. 9 WF60,mes
and WF60,cal
denote the measured and
calculated center-of-field wedge factors, respectively; different fields are identified by the index i. The best fits to the
measured wedge factors for 6 and 18 MV photons were
achieved for = 7.7 103 and = 3.7 103. The value of
for 6 MV photons from the current study is slightly greater
than the value of 7.1 103 from our previous study.12 The
difference is due to the fact that while in Ref. 12 only measured data from our institution were used to determine , in
the current study we also used published EDW factors from
Refs. 7,8.
After the optimum value of was found, we utilized Eq.
8 to fit measured profiles for a 60 degree wedge and 20

Medical Physics, Vol. 32, No. 5, May 2005

20 cm2 field. The best least-square fits to the measured


data for 6 and 18 MV photons were produced with
= 1.028 101 and = 7.69 102, respectively.
III.C. Comparison of the calculated and measured
wedge factors

The comparison between the measured and calculated


EDW factors was performed by using the quantity diff%
defined as follows:

diff% = 100 1

WFi ,cal
WFi ,mes

10

III.C.1. Center-of-field wedge factors


The agreement between the measured and calculated
center-of-field wedge factors for different symmetric fields,
different wedge angles, and two photon energies has been
previously investigated.12 The measured and calculated WFs
at center of field differ by less than 1% for different symmetric and asymmetric fields.12 It should be noted that in this
study we use a slightly greater value of for 6 MV photons
see Sec. III B. The new value of 7.7 103 resulted in less
than 0.2% change in EDW factors compared to those calculated by using the old value of 7.1 103. For more information about the agreement between the measured and calculated EDW at center-of-field including dependence on depth
and SSD the reader is referred to Ref. 12.

III.C.2. Off-center wedge factors


Off-center EDW factors were measured by using the
above-mentioned diode array. For each radiation field centerof-field EDW factors were also determined with the help of
ion chamber. As discussed previously see Table I, we observed small differences between center-of-field EDW factors obtained with the help of diodes WFdiode and those
determined by using ion chamber WFchamber. Using
WFchamber as the standard, WFdiode at each measurement point
was multiplied by a correction factor. The latter was given by
the ratio WFchamber / WFdiode at the center of radiation field.
In order to avoid the penumbra region with steep gradients, the comparison between the measured and calculated

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Vadim Y. Kuperman: Varian EDW factors at off-center points

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TABLE II. Comparison between measured and calculated WFs at off-center


points for symmetric fields.

FIG. 3. The diff% versus off-axis distance for 6 MV photons a and 18


MV photons b, and a 60 deg wedge: Acurrent model, Bfractional MU
approximation, CYus model.

EDW factors was restricted to the central 80% of the radiation field in all cases. Measured off-center factors were obtained by using a 10 cm slab of solid water placed on the
surface of the profiler. The distance between the target and
profilers surface was 100 cm. Figures 3a and 3b shows
diff% as a function of off-axis distance for 6 and 18 MV, 60
degree wedge, and symmetric field of 20 20 cm2. The letter
A in these figures describes the comparison between the
measured EDW factors and the calculated factors obtained
with the help of Eq. 8. Letters B and C in the same
figures describe the agreement between the measured wedge
factors and factors calculated with the help of the FMA and
the model by Yu,11 respectively. Comparison between measured and calculated WFs at off-center points for different
symmetric and asymmetric fields, wedge angles, and photon
energies are shown in Tables II and III. More specifically, the
latter tables contain maximum and average absolute diff%
obtained by using Eq. 10. Note that averaging was performed over the central 80% of the field.
IV. DISCUSSION
In this study we have suggested a new analytical model
for EDW factors at off-center points. The new model described by Eq. 8 is a modification of the fractional MU
approximation and is applicable for any wedge angle and
Medical Physics, Vol. 32, No. 5, May 2005

Energy MeV

Wedge angle

Field size cm2

diff%max

diff%

6
6
6
6
6
6

15
30
45
60
60
60

20 20
20 20
20 20
55
10 10
20 20

0.5
0.5
1.0
1.5
0.8
1.8

0.3
0.2
0.5
0.5
0.5
0.5

18
18
18
18
18
18

15
30
45
60
60
60

20 20
20 20
20 20
55
10 10
20 20

0.6
0.3
0.7
1.1
0.3
0.9

0.3
0.1
0.3
0.4
0.1
0.4

photon energy. The model includes two fitting parameters


that can be determined by using the following data: a
center-of-field wedge factors for different field sizes and b
off-center wedge factors for at least one field size e.g., 20
20 cm2.
Comparison between measured and calculated data for
different wedge angles and field sizes was used to verify the
new model. The center-of-field comparison demonstrates
better than 1% agreement between the measured and calculated EDW factors for the standard set of wedge angles of
15, 30, 45, and 60 degree see Ref. 12. The comparison
between measured and calculated EDW factors at off-center
points Tables II and III also demonstrates good agreement.
For all examined fields the average absolute deviations between measured and calculated factors are within 1%. The
maximum absolute deviations are within 2%. The discrepancies between the measured and calculated factors exceeding
1%1.5% were typically observed for only a few points closest to Y MI. In contrast, much larger deviations from the measured data up to 10%11% were observed for FMA. The
latter, in general, underestimates EDW factors for Y Y c and
overestimates them for Y Y c see Figs. 3a and 3b.
The proposed model should be compared with another
modification of the fractional MU approximation recently
suggested by Yu.11 In the model by Yu the calculation point
is shifted from the point of measurement by a positive conTABLE III. Comparison between measured and calculated WFs at off-center
points for asymmetric fields.
Jaw positions cm
Energy MeV Wedge angle

Y MI

Y FIX

diff%max diff%

6
6
6

60
60
60

5
0
5

10
10
10

0.8
1.2
0.7

0.3
0.6
0.4

18
18
18

60
60
60

5
0
5

10
10
10

1.8
0.7
1.3

0.6
0.3
0.6

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Vadim Y. Kuperman: Varian EDW factors at off-center points

stant. Our recent study12 has shown that the latter model
provides only marginal improvement for center-of-field calculations as compared to FMA. Notice that unlike Yus
model, for small fields symmetric and asymmetric Eq. 8
essentially leads to the same calculated wedge factors at
center-of-field points as FMA. This is because the effective
point of calculation Y = Y c + l in Eq. 8 becomes very close
to Y c for small l = Y FIX Y MI. Conversely, as l increases, the
difference between Y and Y c also increases, leading to noticeable changes in the calculated wedge factors.12 It should
be mentioned that like FMA, Yus model can significantly
underestimate EDW factors at off-center points with Y Y c,
and overestimate wedge factors for Y Y c see Figs. 3a and
3b.
As mentioned previously, Prado et al.13 recently described
a model for EDW factors at off-axis points which uses six
fitting parameters. Briefly, in their model an EDW factor is
given by the product of three terms: treatment STT table and
two additional corrections terms. The first term has an exponential dependence on the field size and contains three coefficients. The coefficients are obtained from the fit to the
center-of-field wedge factors. The second correction term is
given by the ratio of the off-axis and center-of-field wedge
intensities. The off-axis intensity function is described by a
quadratic polynomial. The latter also includes three coefficients that are obtained from the fit to the 60 degree wedge
profile over the central 80% of the field. The results from the
current study and those from Ref. 13 indicate that the new
model and Prados model both produce 1%2% agreement
with the measured EDW factors. Thus, it appears that the
main advantage of the new model over Prados model is a
much simpler structure e.g., only two fitting parameters instead of six, which makes it much easier to implement.
It has been previously established that the percent-depth
doses for EDW are close to those for open fields.4 This is
consistent with our results from the previous study.12 The
latter demonstrates no significant dependence of center-offield EDW factors on depth ranging from 5 to 20 cm and
SSD ranging from 80 to 100 cm. Consequently, good agreement between calculated and measured center-of-field EDW
factors at the depth of 10 cm Ref. 12 is sufficient to conclude that the suggested model can accurately predict centerof-field EDW factors at clinically important depths and
SSDs. However, it should be emphasized that a detailed
comparison between measured and calculated off-center
EDW factors for different depths and SSDs has yet to be
performed.

APPENDIX
Our aim here is to show that in the case of two arbitrary
chosen segments symmetrically located with respect to the
beams axis, the inequality MUY 1 MUY 2 holds for a
60 degree wedge see Sec. II C.
From Eqs. 14 it follows that for a 60 degree EDW
Medical Physics, Vol. 32, No. 5, May 2005

1261

MUY 1 = MUtotal
= MUtotal

MUY 2 = MUtotal
= MUtotal

Gs0 GsY 1
GsY MF
a1 a1 exp b1Y 1
,
GsY MF
GsY 2 Gs0
GsY MF
a1 exp b1Y 2 a1
.
GsY MF

A1

By using Eq. A1 we obtain


MUY 2 MUY 1
= MUtotala1

exp b1Y 2 + exp b1Y 1 2


.
GsY MF

Since we consider symmetrical segments, then Y 2 = Y 1 and


we can write
x + 1/x 2
,
A2
MUY 2 MUY 1 = MUtotala1
GsY MF
where x = exp b1Y 2. It should be mentioned that according
to Ref. 10 a1 and b1 0. If we now recall that the inequality
x + 1 / x 2 holds for any positive x1 i.e., Y 20 and that
the golden STTs are positive, then, from Eq. A2, it follows
that MUY 2 MUY 1.
a

Electronic mail: vadimkuperman@yahoo.com


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