U-frame Acrylic Head Frame Transmission Factor Attenuation Project

Objective: To determine the amount of radiation dose attenuated by a U-frame acrylic head
holder by measuring dose and creating a factor for calculation.

Purpose: A radiation oncologist prescribes a therapeutic dose to a known tumor volume. Based
on these known volumes a treatment plan is created using software that calculates dose to
densities through the use of algorithms.1 A foreign object or immobilization device placed in
between the treatment volume and the beam will attenuate dose which must be accounted for.

The wedge transmission factor is measured at central axis and is calculated with the following
equation2:

WF= dose with wedge

dose without wedge

For this experiment we will use:

Transmission factor = Dose with head frame
Dose without head frame

Methods and Materials: The data was collected at William Beaumont Hospital on an Elekta
SL3 linear accelerator. The dose was measure using a Markus Chamber which is a plane parallel
chamber with a volume of 0.6cm3. The physicist decided to use this chamber rather than a
farmers chamber due to its smaller size and the limited area to measure on the acrylic head
holder. We set up a stack of Solid-water phantoms on the treatment table. Solid-water is a tissue
equivalent and much easier to set up than a water phantom. It comes in the form of sheets or
slabs and may be machined to allow a plane-parallel chamber to be inserted into the slab.2 A
5cm slab of solid water was placed on the treatment table first to create full back scatter
conditions. McDermott says much after 5cm to infinity the backscatter changes very little.3 The
plane parallel chamber was placed into a machined slab followed by an additional 5cm of solid
water to reproduce the depth within the patient. The SSD was set to 100 and the field size was
set to 10x10cm. We measured the dose at 5cm depth with a 6MV beam energy by delivering 100
MU three times. Three trials were sufficient as there was little variance in the readings. Three
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readings were recorded with the head holder in the beam and three readings were recorded
without the head holder in the beam. The dose was measured on an Electrometer manufactured
by Inovision Radiation Measurements, Model: 35040; Serial number: 99286. The Markus
chamber was connected to a triaxle cable and connected to the spectrometer which allowed us to
receive our readings in nano-coulombs.

Images 1 and 2. Set up of Solid water with the machined center for the Markus chamber. An
additional 5cm of solid water set on top of chamber and SSD was set to 100 for a 10X10 field.
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Images 3 and 4. Markus chamber and serial number.

Images 5 and 6. Field parameters.

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Images 7 and 8. Set up with acrylic head frame in place.

Image 9. Thickness of head frame measured with calipers. 1.2cm

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Discussion: We found that the transmission factor is .958 for the 6MV photon energy used in
this study. The acrylic head frame attenuates about 4% of the beam when it is placed in the
treatment field. This result is expected due to its physical similarity to a Lucite blocking tray
which also attenuates 4% of the beam.4

Results:
Table 1. Readings of open field and open field with acrylic head frame in place.
10x10 open field (nC) 10x10 with head frame (nC)
0.6038 0.5787
0.6035 0.5786
0.6037 0.5780
AVG: 0.60366 AVG: 0.5784
Transmission factor = Dose with head frame
Dose without head frame
Transmission factor = 0.5784/0.60366 = 0.985

Figure 1.
MU= Dose(cGy) .
(TAR)(Cal Out)(ISL)(Rel Exp)(Transmission)(Wedge)
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Monitor Unit Calculation without Transmission Factor

AP1: 76.5 =163.8MU
(.889)(.976)(1.03)(1.003)(.521)
AP2: 76.5 =116.5MU
(.889)(.976)(1.03)(1.003)(.732)
PA: 147 =173.4MU
(.841)(.976)(1.03)(1.002)

Monitor Unit Calculation with Transmission Factor. PA field only.

PA: 147 =181.13
(.841)(.976)(1.03)(1.002)(.958)

Figure 2. Percent difference of Monitor Unit calculations.

PA: 181.13 - 173.4 x 100% = 4.26%
181.13

Clinical Application: APPA clavicle with dose delivered mid-plane. The AP field is weighted
slightly heavier, has an additional field, and a wedge. The daily dose is 300cGy delivered with a
6MV photon beam. The monitor unit calculations remain unchanged for the AP portals. The
acrylic head frame only affects the delivery of the PA beam. The PA calculation yielded a
difference of 4.26%. This difference was found by adding the computed transmission factor in
this study to the calculation. There is an increase in MU due to the acrylic head frame being
within the field and attenuation some of the beam. More MU is needed to overcome this amount
of attenuation to deliver the prescribed dose. If this device was completely in the treatment field
it would change the prescribed dose of this portal by 4.26%. There is only a fraction of the
device in the field and physics took the attenuation into account. The amount of dose attenuated
was minimal and at that point the plan was exceeding the prescribed dose by 110%. The tumor
volume was still receiving 100% of the prescribed dose at that point.
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Figure 2. Hand calculation performed at hospital and checked by the physics department.
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Figure 3: Treatment planning system plan report. No transmission factor to correct for acrylic
head frame
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Figure 4: Treatment fields and blocking.

Figure 5: Treatment planning system displaying dose attenuated by acrylic head frame and the
effects of dose distribution.
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Conclusion: It is important to notice when there is an immobilization device in the way of the
treatment volume to be certain that the correct dose is being delivered to the volume. The
transmission factor expresses the ratio of dose rates on the central axis with and without the
acrylic head frame in place.5 This study produced a factor that may be used in the future if a
device is intercepting a field. The physics department took measurements and corrected for the
location of this device. The study provided a verification of the corrected factor used in the
treatment calculation. A patient could be under dosed if a transmission factor is not used in
treatment planning. All factors must be used when calculating dose to produce the most accurate
plan for the patient.
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References

1. Khan FM, Gibbons JP. The Physics of Radiation Oncology. 5th Philadelphia, PA:
Lippincott Williams & Wilkins; 2014:160.
2. McDermott PN, Orton CG. The Physics and Technology of Radiation Therapy.
Madison, WI: Medical Physics Publishing; 2010:14-24
3. Interview with Patrick McDermott, Medical Physicist at William Beaumont Hospital.
February 20, 2017.
4. William Beaumont Hospital Dosimetric Calculation. Elekta Precise SL3 linear
accelerator. 6MV x-rays. SL3 SAD calcs. September 2002.
5. Bentel GC. Radiation Therapy Planning. New York, NY: McGraw-Hill; 1993:73-74.