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Ian Zoller
March 4, 2017
Attenuation Project
Enhanced Dynamic Wedge Transmission Factor
Objective
To determine the transmission factor of a 20 enhanced dynamic wedge (EDW) used in
the field of a patients treatment.
Purpose
Linear accelerators at the James Cancer Hospital are calibrated using an SSD setup in
order to deliver a dose of 1 cGy/MU at the depth of maximum dose for a specified energy using
a 10 x 10 cm field size. Any factor that deviates from the calibration conditions must be
accounted for in monitor unit calculations in order to deliver a treatment with high accuracy.
With certain beam arrangements, a patients treatment plan may benefit from the use of wedges.
According to McDermott and Orton,1 wedges help to compensate for a lack of tissue or
irregularly sloping surfaces within the field. In addition to this, wedges help to correct for dose
nonuniformity and prevent hot spots at beam intersections.
Although wedges offer many benefits for treatment planning, inserting a wedge into the
beam decreases the output of the linear accelerator.2 To achieve the prescribed dose to a certain
depth within the patient, a correction factor must be applied when calculating monitor units. Due
to the unavailability of physical wedges at the James, a wedge factor for an EDW is used.
Methods
Measurements were taken using a 6 MV photon beam on a Varian Truebeam linear
accelerator. A farmer type ionization chamber was connected to a PC electrometer and placed in
solid water. An additional 2 cm of solid water was placed over the ionization chamber to ensure
that measurements were acquired outside of the dose buildup region. The distance from the
source to the solid water was set to 100 cm.
For each measurement, 100 MUs were delivered with a 600 MU/min dose rate using a 14
x 10 cm field size. According to Gibbons,3 wedge factors for Varian enhanced dynamic wedges
have a dependence on field size. This is due to the ionization chamber being exposed and
covered for different lengths of time depending on the size of the field. For this reason, a
patient-specific field size of 14 x 10 cm was used for each measurement. Using the setup
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described, two measurements were taken with an open field and two were taken with a 20
EDW.
Averages were calculated for both the open field and wedged field measurements and
used to calculate a wedge factor. The general formula for calculating attenuation factor is
described by McDermott and Orton1 and is adapted for a wedge factor below:
(Dd with wedge)
WF =
(Dd with open field)

Image 1: Farmer type ionization chamber used in measurements

Image 2: Shows overall setup of ionization chamber placed in solid water with 2 cm additional
solid water over top.
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Results
Open Field (nC) 20 EDW (nC)
Measurement 1 -18.312 -16.468
Measurement 2 -18.312 -16.476
AVG -18.312 -16.472
((Measurement 1 +
Measurement 2)/2)
Table 1: Readings from electrometer along with calculated averages.
Using the averages from Table 1 along with the wedge factor equation listed above, the
wedge factor can be calculated as follows:

(Dd with wedge)


WF =
(Dd with open field)
16.473 nC
WF =
18.312 nC
WF = 0.8995 or 0.900
Discussion
The calculated wedge factor for a 20 EDW using a 6 MV beam with a 14 x 10 cm field
size was measured to be 0.900. This means that approximately 10% of the beam is attenuated
when using this degree of wedge. This result makes sense due to the way an EDW works. As
the jaw is closing down to achieve the effect of the desired wedge angle, the ion chamber is
completely blocked for part of the beam-on time. Given this rational, I would expect that for
EDWs with greater wedge angles, the amount of the beam that is attenuated would be increased
due to the ionization chamber being blocked for a longer time period.
Clinical Application
Isocentric AP/PA hip prescribed a tumor dose of 400 cGy per fraction. The field size is
14 x 10 cm and the anterior field has a 20 EDW to account for the sloping patient contour. The
AP field is weighted 53% and the isocenter is at 6 cm depth.
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Image 3: Beams eye view of AP treatment field with 20 EDW running medially.

Image 4: Axial view at isocenter showing 6 cm depth from AP field.


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Due to the rectangular field size, an equivalent square is needed to find correction factors
for TPR and S CP .

Image 5: Calculation of equivalent square.


After finding the equivalent square, the monitor unit calculation of the AP field can be
completed. An inverse square factor is needed due to the treatment machine having been
commissioned using an SSD technique. The images below show the correction for the inverse
square law, the monitor unit calculation both with the EDW and without, and the calculation of
the percent difference.

Image 6: Correction for the inverse square law.

Image 7: MU calculation including the wedge factor for the AP field.


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Image 8: MU calculation excluding the wedge factor.

Image 9: Calculation of the percent difference.


According to McDermott and Orton,1 wedge related errors are one of the most common
problems in radiation therapy treatments. Due to this reason along with the ease of use with
EDWs, the James Cancer Hospital does not use physical wedges. Because of this, a wedge
factor would always be included by the treatment planning system. However, it is easy to see
how omitting a wedge factor in a monitor unit calculation would impact a patients treatment. In
this patients case, forgetting to add the factor to the calculation would underdose the patient by
10%, or approximately 21 cGy in just one fraction. In contrast, including the wedge factor in the
monitor unit calculation while omitting the wedge from the beam path would result in an
overdose of 10% along with and unexpected dose distribution.
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Image 10: Treatment plan summary indicating wedged AP field along with the MU calculated
in Eclipse.

Conclusion
Inclusion of a wedge in a treatment field deviates from the parameters used for
calibration of the linear accelerator. Inserting a wedge into a field opening causes attenuation of
the beam, which relates to an increase in the number of monitor units so that the prescribed
tumor dose may be delivered. Inclusion of a wedge factor - along with corrections for
parameters such as field size and depth - is imperative to delivering an accurate treatment. In the
clinical case presented, the error associated with forgetting a wedge factor in the monitor unit
calculation corresponds to a 10% underdose of the patient.
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References

1. McDermott PN, Orton CG. The Physics and Technology of Radiation Therapy. Madison,
WI: Medical Physics Publishing; 2010.
2. Khan FM. The Physics of Radiation Therapy. 4th ed. Philadelphia, PA: Lippincott
Williams & Wilkins; 2010.
3. Gibbons JP. Calculation of enhanced dynamic wedge factors for symmetric and
asymmetric photon fields. Med Phys. 1998;25(8): 1411-1418.
http://dx.doi.org/10.1118/1.598313