Wedges vs.

Field-in-Field
JOSH BARRUS
Patient and Setup

 Synchronous metastatic colon adenocarcinoma to spine (Stage IV) and

anorectal SCC (unstaged)
 Positioning and Immobilization
 Supine
 F HR w/ pillow under head
 Knee sponge indexed
 Softouch pad
 Hands on chest
 3 Field Pelvis
 PA
 Rt. Lat
 Lt. Lat
 Metal rod in left hip
OAR’s

 Bladder—6500 cGy
 Femoral Head—5200 cGy
 Skin-5000/5500 cGy
 Small Bowel—4000 cGy
 Colon—4500 cGy
 Rectum—6000cGy
Plan without Wedges or Field-in-Field

 MLC used to shape fields to PTV

 Weighting adjusted to decrease hot spots
Rt. Lat PA Lt. Lat
Gantry 270 Gantry 180 Gantry 90
Collimator 90 Collimator 0 Collimator 90
Field-in-Field

 Use MLC to shape fields

 Weighting adjusted
 Reduced fields used to block hot spot
Rt. Lat Rt. Lat RF
Gantry 270 Gantry 270
Collimator 90 Collimator 0
Lt. Lat Lt. Lat
Gantry 90 Gantry 90
Collimator 90 Collimator 0
PA
Gantry 180
Collimator 0
Wedges

 Use MLC to shape field

 Weighting adjusted to even out dose laterally
 Wedges used to decrease posterior hot spot and create more
uniform PTV dose distribution
Wedge Anatomy

Heel
Toe Patient

Wedge: Device used to cause a decrease in intensity across a

radiation beam
 Wedge Angle and Hinge Angle

90ᵒ
𝑊𝑒𝑑𝑔𝑒 𝐴𝑛𝑔𝑙𝑒 = 𝐻𝑖𝑛𝑔𝑒 𝐴𝑛𝑔𝑙𝑒 −
2

𝐻𝑖𝑛𝑔𝑒 𝐴𝑛𝑔𝑙𝑒 = 180 − (𝑊𝑒𝑑𝑔𝑒 𝐴𝑛𝑔𝑙𝑒 × 2)

RadiologyKey.com, 2016

 Wedge Angle: Angle of the isodose lines at the central axis of a

beam at a specified depth, usually 10cm
 Hinge Angle: Angle between the central axes of two adjacent fields
Physical vs. Dynamic Wedges

 Physical Wedges
 Heavy—typically made of high Z materials such as lead or steel
 Orientation set manually by the therapist for each field
 Can only be used for specific wedge angles: 15, 30, 45, and 60
degrees
 Dynamic Wedges
Scott W. Hadley, Reciprocity Theory.
 Angles created by moving the Y jaws across the field while the umich.edu, 2005

beam is on
 Orientation determined by the collimator angle and which Y jaw is
moving to create the wedge effect
 Can create virtually any wedge angle
Rt. Lat PA Lt. Lat
Gantry 270 Gantry 180 Gantry 90
Collimator 90 Collimator 0 Collimator 90
EDW 45 OUT EDW 45 IN
Monitor Units

211

210

No Wedges or Field-in-Field Wedges

Field-in-Field
Field-In-Field
 Advantages
 Can target specific areas using
the MLC
 Blocks irregularly shaped hot
spots while maintaining dose
to cooler areas
 Does not increase dose to
other parts of plan (could also
be negative depending on
what you want)
 Disadvantages
 More fields=more time
 Will get you closer to
homogenous dose, but will not
fully eliminate hot spot
 Only takes dose away from hot
spots, cannot redistribute
higher dose to colder areas
Wedges
 Advantages
 Simultaneously decrease hot spot
and increase dose to cold spot
 Fewer fields=less time (for dynamic
wedges)
 Creates gradual slope of isodose
lines rather than stepping down
dose abruptly
 Disadvantages
 Can create hot spots on toe side
of field due to higher MU
 Can’t select specific portion of
field
 If using physical wedges, can be
more work for therapist and longer
treatment times
Why not both?
References

 Lindsey K. Wedges and plans with wedges. lecture presented at The

Ohio State University: June 11, 2020.
Thank You!