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Yinan Wang

Attenuation Project

February 12, 2016

Objective: To determine the wedge transmission factors on Elekta LINAC and apply the

factors to monitor unit (MU) calculation for breast photon boost fields.

Introduction: Wedge is the most commonly used compensator in radiation therapy that

will alter the isodose distribution when placed in the path of a beam.1 Wedge is usually

used to compensate for slop of the patient body or in the form of wedge pairs to produce

a more uniform dose distribution. There are two different types of wedges: physical and

dynamic wedges. A physical wedge is a wedge shaped filter made of lead or steel with a

thick end (heel) and a thin end (toe). A dynamic wedge changes the isodose distribution

curve through the motion of one of collimating jaws while the beam is on. The speed of

the motion determines the angle of the wedge. The wedge angle is defined as the angle

between the slope of the isodose line and the normal of the beam central axis. A wedge

with bigger angle will result in more tilted isodose distribution and less MU output. In my

clinic site, Beaumont Health System, Elekta LINAC are used for treatment. Elekta

LINAC uses universal (omni) wedge, which has only one physical wedge with an angle

of 60 mounted above the jaws. By adjusting the combination of open and wedged fields,

0 to 60 wedge angles can be achieved.2

To calculate the MU output for each beam in a radiation therapy plan, the wedge filter

attenuation (wedge factor) must be taken into account.1 The wedge factor is defined as

the ratio of the dose with and without the wedge at a point on the central axis of the beam

at a depth deeper than Dmax.

(1)

Methods and Materials:

a) Wedge factor measurements

In this attenuation project, an Elekta LINAC was used to measure the 60 wedge

transmission factor using 6 MV photon energies with a 1010 field size and 100 cm SAD

setup. Solid water phantoms were placed on the treatment couch, with a farmer ionization

chamber and the phantom surface at a distance of 100 cm and 95 cm, respectively from

the LINAC source (as shown in Fig 1a). The chamber was connected to an electrometer

(Fig. 1b) at the console area outside the treatment room. At a collimator rotation of 90,

100 MU were delivered at 6 MV with and without the wedge. Each condition was

measured three times. To cancel out the asymmetry of wedge position, the collimator was

rotated to 270 and the same measurements described above were repeated. All readings

were averaged to reduce the random noise.

(a)

(b)

Figure 1. a) Phantom and chamber setup for wedge factor

measurements and b) electrometer for charge (dose) measurement.

b) Clinical Application

Wedge pairs are routinely used for breast photon boost radiation therapy, which limits the

irradiated volume to lumpectomy cavity while reducing the hotspot in the boost region. A

hypo breast treatment (266cGy 16 with additional 266cGy 4 boost treatments,

Canadian fractionation) is used here to demonstrated dose calculation with wedge filter.

As shown in Fig. 2, the heels of the wedges are away from the breast surface, to

compensate the reduced thickness of anterior breast.

Figure 2. A wedged pair beam setup for breast photon boost treatment

Figure 3 shows the beam parameters from the Treatment Planning System (TPS) for LT

Med ABC BOOST (5A) field and LT LAT ABC BOOST (6A) field. The equivalent field

size is calculated using the following equation:

(2)

where A and B are the field width and length, and a is the fraction (expressed as a

decimal) of the area of the open field which is blocked. Then f is used to look up Sc, Sp,

and TMR values.

Effective wedge factor for a mixed field (wedged plus non-wedged) at depth d and for

field size f is calculated using the following equation:

(3)

where MUw is the MU for wedged portion of the field, MUo is the MU for open portion

of the field, MUt is the total MU for the field, and W(d, f) is the wedge factor for the 60

universal wedge. The 6 MV beam is calibrated with D0 = 1cGy / MU at the depth of

dmax=1.5cm, with a 1010 field size at 100cm SSD. So the SAD factor = (101.5/100)2 =

1.03. The total MU needed to deliver the required dose at the prescription point is:

(4)

Results:

a) Wedge factor measurements

Table 1. Readings taken for a 6MV beam with a 10x10 cm field size , 100 cm SAD, 5cm

depth.

Open Field

60 Wedge (nC)

(nC)

90 Collimator

270 Collimator

Reading #1

17.20

4.607

4.610

Reading #2

17.25

4.603

4.609

Reading #3

17.23

4.604

4.605

Average

Reading

17.227

4.606

(5)

Table 2 lists the wedge factors measured at machine commission for different field sizes

and depths. The wedge factor for 1010 field size at 5cm depth is 0.267 and 0.264 for our

measurement and commission measurement, respectively. The difference is 1.3%.

Table 2. 6 MV Wedge factor W(d, f) table from Beaumont Health

Depth d (cm)

10

20

30

5.0

0.259

0.264

0.276

0.281

10.0

0.265

0.268

0.279

0.285

15.0

0.269

0.273

0.283

0.288

20.0

0.274

0.277

0.287

0.293

25.0

0.278

0.281

0.291

0.298

b) Clinical Application

The beam parameters in Fig. 3 are list in Table 3. The field sizes and percentage blocked

area are 7.97.4 cm2 with 21.9% blocked and 7.97.5 cm2 with 20.2% blocked,

respectively. The equivalent squares for both fields are 6.8 cm2. The doses prescribed to

the reference point for the two beams are 138.3 cGy and 127.7 cGy, respectively. The Scp

and TMR can be retrieved from the clinical hand-calc tables based on the effective field

size and effective depth. From Table 2, the open field wedge factors for field 5A and 6A

can be interpolated to be 0.262 and 0.264, respectively. The effective wedge factors can

be calculated using Eq. 3 as:

(6)

(7)

Monitor unit calculations were created with and without the wedge factor to show the

importance of the factor in the calculation. The monitor units for field 5A and 6A are:

(8)

(9)

which are 1.8% and 1.7% different from the TPS calculation. The accepted error is < 3%.

If wedge factors are not included into the calculation, then

(10)

(11)

Without taking wedge factors into account, the dose deliver will be 42% lower from the

prescription.

Field Number

5A

6A

MEDIAL

LATERAL

Machine

SL2

SL2

Energy

6MV

6MV

SSD (cm)

93.97

92.34

6.03

7.66

5.55

7.12

6.8

6.8

Wedge

40W

40W

138.3

127.7

100

100

0.972

0.972

TMR/TAR

.896

.848

1.03

1.03

Wedge Factor

0.425

0.427

Hand-calc MU

363.6

353.1

370.4

359.3

TPS wedge MU

288.6

279.9

TPS open MU

81.8

79.4

Field Name

% Isodose Line

Ref. Dose Rate cGy/mu)

Scp

Sc

Sp

Discussion: In this project, the wedge factor measured for a 6 MV beam with 10x10 cm2

field size at 5 cm depth is 0.267, which is close to the number measured during machine

commission. Wedge factors are used to find the MUs for two beams containing wedge.

Wedge factors are measured at the central axis, so they are independent of the orientation

of the collimator. However, if the reference point is not at the central axis, additional

wedge off axis factors have to be included.1 The wedge factor is much smaller at the toe

(larger value) than that at the heel (smaller value).

The wedge factor can significantly affect the MU calculation.1 For the example showed

above, the differences are about 42%. If the patient was treated using MU calculation

without considering the wedge factor, it will be a big misadministration and both the

patient and the relevant regulation agency (NRC) have to be noticed.

Conclusion:

Wedge can be used as tissue compensators or wedge pairs to alter the shape of isodose

curves. 1 We demonstrated the calculation process of the wedge factors for two clinical

beams. The hand-calc process for a breast photon boost treatment using wedged pair

beams has been described. The MU hand-calcs with and without wedge factors have been

presented and the differences and its clinical effect have been discussed. From this

project, I learned that the wedge attenuates the transmission of the beam. Its important to

incorporate the wedge transmission factor into the MU calculations in order to deliver

correct dose to the target volume.

References

1. Khan FM, Gibbons JP. The Physics of Radiation Therapy. 5th ed. Philadelphia, PA:

Lippincott Williams & Wilkins; 2014.

2. Phillips MH, Parsaei H, Cho PS. Dynamic and omni wedge implementation on an

Elekta SL linac. Med Phys. 2000;27(7):1623-1634.

http://dx.doi.org/10.1118/1.599029.

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