Attenuation Project

Jina Lee

Wedge Transmission Factor Calculation

Objective

To determine the wedge factor of a 60 degree motorized wedge, and demonstrate the
effect on an output calculation in a clinical setting.

Purpose

Wedges are used in conformal treatments to manipulate the tilt of the isodose lines. This
is helpful when compensating for areas of variable thickness and spread the dose more
homogeneously to the target. Paired wedges will have often have the heels facing each other or
towards the same direction where tissue thickness decreases. The heel is the thickest portion of
the wedge that attenuates dose while the toe is the thinnest portion of the wedge that allows more
transmission of dose to the target. When this linac was first commissioned, the wedge factor was
acquired under calibration settings, or at 100 SAD, field size of 10.4 x 9.6, and at 10 cm depth.

Formula for wedge factor (WF) 1

Dose with wedge

WF=
Dose without wedge

Methods and Materials

To determine the wedge factor, a measurement must be made with an open field and a
wedged field. Elekta’s Synergy linear accelerator uses a motorized wedge system, meaning that a
physical 60 degree wedge is attached to the head of the gantry. During treatment planning, this
angle can be adjusted which translates into ratios of open and wedged fields and allowing
dosimetrists to mimic any angle from 0-60 degrees. For calculating the WF, the same setup and
measurement method during machine commissioning was used. A solid water phantom
equivalent to tissue was placed 100 SAD at a depth of 10 cm with a farmer ion chamber in place.
The ion chamber was connected to an electrometer that read the accumulated charge in
nanocolombs. The dose rate used was 520 MU/min, and readings were stopped at 100 MU. Each
measurements were taken for 6 MV and 15 MV photons, once with an open field of 10.4 x 9.6,
then twice with the wedge placed in field with collimator at 90 and 270 degrees.2 In theory, the
transmission of the beam at the central axis with a wedge should not change as the collimator
rotates about the isocenter. However, if there are shifts with the motorized wedge as the
collimator is rotating and does not perfectly align with the central axis as it did in its previous
positions, the thickness at the central axis can vary slightly. This is the primary reason why the
collimator is rotated 180 degrees apart when taking measurements. During commission of the
machine under this project’s study, this is how the wedge factor was calculated. However most
linacs are measured with each position defined to obtain individual WF at different positions.2

Results

Table 1: Readings of beams with an open 10.4 x 9.6 field at 10 cm depth

Energy Readings (nC)

6 MV 14.98 nC

15 MV 16.69 nC

Table 2: Readings of same beams with collimator at 90 and 270, each with a 60 degree wedge in.
Readings at each position are used to obtain an average value used to determine the WF.

Energy Reading Reading Average

(Collimator=90) (Collimator=270)
6 MV 4.084 4.027 (4.084+4.027)/2=
4.056
15 MV 4.709 4.658 (4.709+4.658)/2=
4.684

Table 3: Calculating the WF with the open field reading and the average wedge in field reading
 Energy WF calculation using WF
Table 1 &2
6 MV WF = 4.056/14.98 .271

15 MV WF = 4.684/16.69 .281

Discussion
The wedge factor for is .271 and .281 for a 6 MV and 15 MV beam, respectively. The energy did
not contribute to a significant change in the % of beam transmitted since the wedge factor is a
ratio of beam transmission. Wedge factor measurements may vary depending on variables that
directly affect output, such as temperature and pressure. With a 6 MV beam, the 60 degree
wedge attenuated the beam 72.9 %. With a 15 MV beam, the attenuation was 71.9%. Since
physical wedges in the head of the linac clearly show a high attenuation power, it is critical that
we not only correctly calculate the MU during planning, but also ensure that the wedge is
actually being utilized during treatment.

Clinical Application

Elekta Synergy is calibrated to give 1 cGy/MU with a 10.4 x 9.6 field size at d-max depth and at
100 SAD. Sc, Sp, TPR, and WF will be accounted for the clinical application (no ISL required
since calibrated at 100 SAD, not 100 SSD). Since output is 1cGy/MU at d-max depth but our
TPS uses TPR tables using 10 cm as our reference depth, the scaled output is .872 cGy/MU at a
reference depth of 10 cm. TPR tables used for this machine reflect this value (TPR = 1 and
output = .872 cGy/MU for 10 cm depth, or TMR = .872 and output = 1.0 cGy/MU at d-max
depth).

Prescription: 2400 cGy/6 fx to isocenter, IDL = 98.6%. At least 95% coverage to 100% of the
GTV_R_Kidney, OAR: Liver, spinal cord, contralateral kidney.

Technique: 15 MV Oblique fields (RAO, LPO) 140 degrees apart, with the posterior field using
100% 60 degree wedged field to compensate for missing area of tissue. Weighting of beams:
65% RAO, 35% LPO. Effective Depth = 8.76 for RAO, 9.93 for LPO. Equivalent square =
12x12 for both fields.

Image 1a: Beam orientation, machine, energy, and type

Image 1b: MU per beam, beam weighting

Image 1c: DRRs

Hand Calculations:

Image 2a: MU calculations for LPO and RAO beams, and comparison to TPS computed MU

The calculated MU for the wedged LPO field is 572 MU, while the MU for the open
RAO field is 290 MU. Although the wedged field is designed to only give 35% of the prescribed
dose, the MU is almost double the amount needed to deliver the dose from the RAO beam. This
difference in MU further shows the significance of wedges and how much they are able to
attenuate the dose.

Image 2b: Dose calculation and error % if wedge was not utilized during treatment

If there were errors with wedge interlocks or machine malfunctions that caused the
motorized wedges not to be actually utilized during treatment, the patient would potentially face
serious damage. Receiving 498 cGy is 3.56 x the original planned 140 cGy for this beam, and
this effect would cause the total dose to be 758 cGy for one fraction. This high dose trends
towards the SBRT dose/fraction category, and the 3D technique does not give adequate
conformity for such a high dose.
TPS parameters, calculations and dose distribution:

Image 3a: Field parameters including equivalent square, effective depth, output, dose, and MU
for RAO open field.

Image 3b: Field parameters including equivalent square, effective depth, output, dose, and MU
for LPO wedged field.
Note: The normalized dose (ND) at reference point takes into account output at 10 cm depth,
TPR at the central axis depth, and heterogeneity correction factor. Another method to account for
heterogeneity is using the effective depth, which directly condenses or expands length depending
on density of tissue in the beam’s path length. For hand calculations, the effective depth will be
used, as heterogeneity correction factors will not be known.

Image 3c: Dose distributions

Conclusion
Wedges can manipulate the shape of the isodose lines to compensate for missing tissue or
overlap of beams. In order to achieve this effect, the wedges attenuate the beam significantly.
Depending on the wedge angle, the transmission factor for wedges must be accounted for during
hand calculations. Ensuring that the wedge is in place during treatment is critical to prevent mis-
admistration. The advantage of dynamic wedges is the automation of treatment delivery and
reduced penumbra compared to the physical wedge.1 Many contemporary linacs use this feature,
or an intermediate feature such as the motorized wedge as discussed throughout this project.
While not completely obsolete, wedges and compensators are still intensity modulating devices
that have been superseded by IMRT optimization and control point manipulation for 3D
techniques.1
References

1. Gibbons JP, Khan FM. 11.4 Wedge Filters. In: Khan's The Physics of Radiation Therapy.
Philadelphia, PA: Wolters Kluwer; 2020:184-196.

2. Popple RA, Brezovich IA, Duan J, Shen S, Pareek PN, Ye S-J. Determination of field size-
dependent wedge factors from a few selected measurements. Journal of Applied Clinical
Medical Physics. 2005;6(1):51-60. doi:10.1120/jacmp.v6i1.2063