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Bret Conrad February 18, 2013 Attenuation Project 45 Degree Hard Wedge Transmission Factor

Objective: The objective of this project is to determine the transmission factor of a 45 degree hard wedge, use that factor in a monitor unit calculation, and find an example in a real patient where the factor is used. Purpose: Radiation therapy planning isnt always as simple as one square field to treat a tumor. Our treatment volumes are usually odd shapes and sometimes cover different tissue densities in the body. For this reason, sometimes we have to add beam modifying devices to shape the isodose lines in the body. The most common beam modifying device is a wedge shaped piece of metal, usually lead, put in the path of the beam (Figure 1).1 The purpose of a wedge is to cause a progressive decrease in intensity across the beam which results in a tilted isodose curve.2 Since this wedge is physically put on the machine in the beams path, that means the output of the machine is going to decrease. This is why the wedge transmission factor was created. If the monitor units were calculated without this factor, the patient would be mistreated. To find the wedge transmission factor, you take the ratio of doses with the wedge and the doses without the wedge. Methods and Materials: To find the data for the wedge transmission factor, the data was gathered on a Varian 2100 linear accelerator. With assistance from the Physicist, the machine was set for the testing. The Source-Axis Distance (SAD) technique was used for the findings. The field size was consistently set at 10 centimeters (cm) x 10cm during the entire procedure. The machine was tested using 2 different energies, that being 6 Megavoltage (MV) and 23 MV. As for the phantom, Plastic Water was used because it has a similar density as tissue. The measurements for the 6 MV beams were taken at 1.5 cm depth in the phantom, with a Source to Skin Distance (SSD) of 98.5. The measurements for the 23 MV beams were taken at a depth of 3 cm in the phantom, with an SSD of 97. A Physikalisch-Technische Werkstatten (PTW) Farmer ion chamber was connected to an Inovision Electrometer to collect and read the dose received. After all of the tools were in place, 3 trials were done for 4 different studies, including one at 6 MV without the 45 degree wedge, one at 6 MV with the 45 degree wedge, one at 23 MV without

the 45 degree wedge, and one at 23 MV with the 45 degree wedge. These measurements were gathered by delivering 100 monitor units to the ion chamber. Results: The results of all 12 readings were then charted and the average of the 3 trials were calculated (Table 1). The wedge transmission factor was then calculated for each beam energy by taking the average with the wedge and dividing it by the average energy without the wedge (Table 2). 6 MV w/o Wedge 19.104 19.083 19.100 Avg= 19.096 6 MV with Wedge 9.109 9.088 9.071 Avg= 9.089 23 MV w/o Wedge 20.120 20.093 20.106 Avg= 20.106 23 MV with Wedge 10.222 10.211 10.213 Avg= 10.215

Table 1: Table of Readings for each Trial taken off Electrometer (nC)

6MV 9.089/19.096= 0.476

23MV 10.215/ 20.106= 0.508

Table 2: Table of Wedge Transmission Factor for each energy Discussion: As seen by the results, the wedge transmission factor for the 6 MV beam was 0.476 and the wedge transmission factor for the 23 MV beam was 0.508. This concludes that in the 6 MV beam 47.6% of the beam reaches the ion chamber, meaning 52.4% of the beam was attenuated. The measurement was taken at the isocenter, so these numbers were calculated in the middle of the wedge. As for the 23 MV beam, 50.8% of the beam penetrated the wedge to the ion chamber, meaning 49.2% of the beam was attenuated by the wedge. To ensure that our calculations were measured correctly, we can look at these percentages and make sure they are logical. Our work agrees with Armstrong and Washington,3 stating that the wedge transmission factor is specific for each beam energy used. The higher the energy that we use, the more penetrating power it will have. Therefore, we would assume the higher energy beam would have a higher wedge transmission factor, which it does.

Clinical Application: To show the relevance of this factor, I applied it to an actual patient monitor unit calculation. The patient was receiving treatment to the right lung from two different

angles that both used 45 degree hard wedges. For this example, I only used the factors that have already been discussed in the class. The patient received 250 centigray (cGy) per day, with each field delivering 125 cGy. The numbers used were found on the actual patients calculation sheet (Figure 2). I then performed the monitor unit calculations by hand, first with the wedge factor (Figure 3) and then without the wedge factor (Figure 4). We can see that both fields are changed drastically when the wedge factor is included, and when it is not. For the Anterior-Posterior (AP) beam, our monitor units with the wedge factor are 350 and the monitor units without it are 167. This means that if the wedge is inserted in the machine and this factor is not used, the patient would only receive 48% of the dose necessary to meet the prescription. The Superior Anterior Oblique (SAO) field is showing the same statistics, when the wedge factor is included it delivers 376 monitor units, but without the factor only would deliver 179 monitor units. This also means that only 48% of the dose needed with the wedge in the path of the beam would be delivered.

Conclusion: It seems to be pretty obvious that wedge transmission factors are extremely important in radiation oncology. Under dosing a patient could cause not enough dose to get to the tumor, therefore reducing the likeliness of a cure. Throughout this project, it was interesting to see the behind the scenes work that the physicists do. All of the calculations and measurements they take are so critical in the whole process. Wedges are a very important tool used in radiation oncology, but it is only effective if it is used properly. Hopefully, you have learned why it is necessary to use the wedge transmission factor whenever a wedge is being used.


Figure 1: 45 Degree Hard Wedge for Linear Accelerator

Figure 2: Monitor Unit Calculation Sheet for Patient

Figure 3: Hand Monitor Unit Calculation WITH Wedge Transmission Factor

Figure 4: Hand Monitor Unit Calculation WITHOUT Wedge Transmission Factor

References 1. Bentel GC. Dose determination for external beams. Radiation Therapy Planning. 2nd ed. New York, NY: McGraw-Hill; 1996: 49. 2. Khan FM. Treatment planning I: isodose distributions. The Physics of Radiation Therapy. 4th ed. Baltimore, MD: Lippincott Williams and Wilkins; 2010: 181. 3. Armstrong J, Washington CM. Photon dosimetry concepts and calculations. Principles and Practices of Radiation Therapy. 3rd ed. St. Louis, MO: Mosby Elsevier; 2010: 502.