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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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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

1256

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

1256

1257

1257

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,

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

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

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,

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.

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

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

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

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

1258

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 ,

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

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.

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

1258

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.

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

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

1259

1259

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

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

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

EDW factors was performed by using the quantity diff%

defined as follows:

diff% = 100 1

WFi ,cal

WFi ,mes

10

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.

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

1260

1260

points for symmetric fields.

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

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

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

1261

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

MUY 2 MUY 1

= MUtotala1

.

GsY MF

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

P. K. Kijewski, L. M. Chin, and B. E. Bjarngard, Wedge shaped dose

distribution by computer-controlled collimator motion, Med. Phys. 5,

426429 1978.

2

D. D. Leavitt, M. Martin, J. H. Moeller, and W. L. Lee, Dynamic wedge

field techniques through computer-controlled collimator motion, Med.

Phys. 17, 8791 1990.

3

P. L. Petti and R. L. Siddon, Effective wedge angles with a universal

wedge, Phys. Med. Biol. 30, 985991 1985.

4

E. E. Klein, D. L. Low, A. S. Meigooni, and J. A. Purdy, Dosimetry and

clinical implementation of dynamic wedge, Int. J. Radiat. Oncol., Biol.,

Phys. 31, 583592 1995.

5

C. Liu, T. C. Zhu, and J. Palta, Characterizing output for dynamic

wedges, Med. Phys. 23, 12131218 1996.

6

M. Miften, M. Wiesmeyer, A. Beavis, K. Takahashi, and S. Broad,

Implementation of enhanced dynamic wedge in the focus RTP system,

Med. Dosim 25, 8186 2000.

7

P. W. Koken, S. Heukelom, and J. Cuijpers, On the practice of the

clinical implementation of enhanced dynamic wedges, Med. Dosim 28,

1319 2003.

8

C. Liu, S. Kim, D. L. Kahler, and J. Palta, Generalized monitor unit

calculation for the Varian enhanced dynamic wedge field, Med. Phys.

30, 18911896 2003.

9

S. Papatheodorou, S. Zefkili, and J.-C. Rosenwald, The equivalent

wedge implementation of the Varian enhanced dynamic wedge EDW

into a treatment planning system, Phys. Med. Biol. 44, 509524 1999.

10

J. P. Gibbons, Calculation of enhanced dynamic wedge factors for symmetric and asymmetric photon fields, Med. Phys. 25, 14111418 1998.

11

M. K. Yu, Analytical representation of enhanced dynamic wedge factors

for symmetric and asymmetric photon fields, Med. Phys. 29, 26062610

2002.

12

V. Y. Kuperman, A new analytical models for Varian enhanced dynamic

wedge factors, Phys. Med. Biol. 49, 28412851 2004.

13

K. L. Prado, S. M. Kirsner, R. J. Kudchadker, R. E. Steadham, and R. G.

Lane, Enhanced dynamic wedge factors at off-axis points in asymmetric

fields, J. Appl. Clin. Med. Phys. 4, 7584 2003.

14

W. Ansbacher and C. Neath, Comment on Analytical representation of

enhanced dynamic wedge factors for symmetric and asymmetric fields,

Med. Phys. 30, 722723 2003.

1

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