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Helen Nguyen

Spring 2019

DOS 522 Radiation Dose Calculations

Attenuation Project

Objective:

The objective of this project is to find the wedge transmission factor for a 60-degree physical
wedge.

Purpose:

A wedge has a heel and toe side, which represent the thicker and thinner side respectively.
Wedges are used to decrease the intensity across the beam, which results in a tilt of the isodose
lines.1 Wedges can be physical or nonphysical. Whether the wedge is physical or nonphysical, it
will decrease the output of the machine.1 Because of this, a wedge transmission factor needs to
be accounted for in treatment calculations to ensure that it is accurate. A wedge transmission
factor, or wedge factor, is a ratio of doses with and without the wedge, at a certain point along
the central axis of the beam.1 The purpose of this study will be to find the wedge transmission
factor of a 60-degree physical wedge.

Figure 1. Equation to find wedge factor.

𝐷𝑜𝑠𝑒 𝑤𝑖𝑡ℎ 𝑤𝑒𝑑𝑔𝑒

𝑊𝑒𝑑𝑔𝑒 𝐹𝑎𝑐𝑡𝑜𝑟 (𝑊𝐹) =
𝐷𝑜𝑠𝑒 𝑤𝑖𝑡ℎ𝑜𝑢𝑡 𝑤𝑒𝑑𝑔𝑒

Methods and Materials:

A Varian TrueBeam linear accelerator was used to deliver 6 MV and 15 MV photon beams with
and without a 60-degree wedge. A water phantom was used to build up dose and an ion chamber
connected to a PTW Unidose electrometer was used to measure the output of the beam. The
gantry and collimator were both set to 0°. The field size was set to 10x10cm at 100 source to
skin distance, using 100 MU and 600 MU/min dose rate. Before taking the measurements, 1,000
MU were delivered to warm up the ion chamber to deliver more accurate readings.
Measurements were then taken for 6 MV and 15 MV beams with and without the 60-degree
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wedge. Each measurement was taken three times, then averaged, to further ensure accuracy. The
wedge factor was then calculated using the measurements taken.

Figure 2. PTW Ionization Chamber

Figure 3. Water phantom

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Figure 4. PTW Unidose Electrometer

Figure 5. 60-degree wedge mounted on Truebeam Linac

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Results:

Table 1. Electrometer readings at 6 MV

6 MV Reading without wedge Reading with 60-degree wedge

1.745 nC .682 nC

1.744 nC .681 nC

1.744 nC .681 nC

Average (1.745 nC + 1.744 nC + 1.744 nC) (.682 nC + .681 nC + .681 nC)

reading 3 3
= 𝟏. 𝟕𝟒𝟒 𝒏𝑪 =. 𝟔𝟖𝟏 𝒏𝑪

Table 2. Electrometer readings at 15 MV

15 MV Reading without wedge Reading with 60-degree wedge

1.810 nC 1.262 nC

1.810 nC 1.263 nC

1.809 nC 1.263 nC

Average (1.810 nC + 1.810 nC + 1.809 nC) (1.262 nC + 1.263 nC + 1.263 nC)

reading 3 3

= 𝟏. 𝟖𝟏𝟎 𝒏𝑪 = 𝟏. 𝟐𝟔𝟑 𝒏𝑪
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Figure 6. Wedge factor calculation for 60-degree wedge with 6 MV

.681 𝑛𝐶
𝑊𝑒𝑑𝑔𝑒 𝐹𝑎𝑐𝑡𝑜𝑟 (6 𝑀𝑉, 60°) = = .390
1.744 𝑛𝐶

Figure 7. Wedge factor calculation for 60-degree wedge with 10 MV

1.263 𝑛𝐶
𝑊𝑒𝑑𝑔𝑒 𝐹𝑎𝑐𝑡𝑜𝑟 (15 𝑀𝑉, 60°) = = .698
1.810 𝑛𝐶

Discussion:

The wedge factor is used to determine how much the wedge will attenuate the beam. The wedge
factor for a 6 MV beam delivered from a TrueBeam linear accelerator with a 60-degree physical
wedge was found to be .390. This means that the wedge transmission is 39.0% of the beam and
the beam is attenuated 61% along the central axis. The wedge factor for the 15 MV beam was
found to be .698, which means the wedge transmission is 69.8%, resulting in a 30.2% attention
of the beam. The wedge factor is an important variable when calculating monitor units, equation
shown in figure 8.

Figure 8. Monitor Unit Equation

𝐷𝑜𝑠𝑒
𝑀𝑈 =
𝐷𝑟𝑒𝑓 ∗ 𝑆𝑐 ∗ 𝑆𝑝 ∗ 𝑇𝑀𝑅 ∗ 𝐼𝐷𝐿 ∗ 𝑂𝐴𝑅 ∗ 𝐼𝑆𝐹 ∗ 𝑇𝐹 ∗ 𝑊𝐹

The variables in this equation are: Dref = calibration reference dose (cGy/MU), Sc = collimator
scatter factor, Sp = phantom scatter factor, TMR = tissue maximum ratio, IDL = isodose line
(normalization), ISF = inverse square factor, OAR = off axis ratio, TF = tray factor, and WF =
wedge.
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Wedge factor is in the denominator, which means it is inversely related to the monitor units.
With a lower wedge factor, the monitor units increase. This makes sense since the wedges
attenuate the beam, thus forcing the linear accelerator use more monitor units to deliver the dose
needed.

Clinical Application:

In the example showed in Figure 11 and Figure 12, a pelvis is being treated with 3 fields. Both
Figures are being treated with three fields, one AP and two laterals. On Figure 11, the LT Lateral
field has a 60-degree wedge, with the heel on the posterior side and toe pointing anteriorly, while
the AP and RT Lateral fields have no wedges. On this plan, the hot spot is 113.3% and falls on
the posterior right side of the patient. The PTV (shown in navy), is missing coverage anteriorly.
On Figure 12, a 60-degree wedge is added to the RT Lateral field with the heel on the posterior
side and toe pointing anteriorly. This brought down the hotspot to 107.7% and helped to push
dose anteriorly, creating a more homogenous plan and helped the overall coverage of the PTV.
The calculated monitor units for the RT Lateral field with the 60-degree wedge is 139.4 MU,
shown in Figure 9. The calculated monitor units for the RT Lateral field without a wedge is
97.59 MU, shown in Figure 10. This a large difference in monitor units, proving the wedge
factor is critical.

Figure 9. Monitor Unit Calculation for RT Lateral Field with 60-degree Wedge

400 ∗ .23
𝑀𝑈 (𝑅𝑇 𝐿𝑎𝑡, 60°) = = 139.4
1 ∗ 1.004 ∗ 1 ∗ .710 ∗ 1 ∗ 1 ∗ 1.312 ∗ 1 ∗ .698

Figure 10. Monitor Unit Calculation for RT Lateral Field without Wedge

400 ∗ .23
𝑀𝑈 (𝑅𝑇 𝐿𝑎𝑡, 𝑛𝑜 𝑤𝑒𝑑𝑔𝑒) = = 97.59
1 ∗ 1.004 ∗ 1 ∗ .710 ∗ 1 ∗ 1 ∗ 1.312 ∗ 1
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Figure 11. Rt Lateral Field Without Wedge

Figure 12. RT Lateral Field with 60-degree wedge

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Conclusion:

This project illustrates the significance of wedges, their ability to attenuation the beam, and their
role in the calculation of monitor units. Wedges can be used to benefit the patient to create a
more homogenous plan. However, it is crucial that the wedge factor be accounted for since it can
drastically effect the monitor unit calculations. It is also important to make sure the correct
wedge is placed as it can considerably underdose or overdose the patient. Wedges, when
accounted for and used correctly, can be a great addition to certain plans to help manipulate the
isodose lines and create an improved plan for the patient.
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References:

1. Khan FM. The Physics of Radiation Therapy. 5th ed. Philadelphia, PA: Lippincott
Williams and Wilkins; 2014: 175-176.