In radiation therapy treatment planning, wedges and compensators are tools used to shape the dose

distribution of radiation beams to conform to the target volume while sparing healthy tissues. Therefore,
both wedges and compensators are beam modifying devices.

A compensator serves as a tool to modify the radiation beam, aiming to create a smoother skin surface
while maintaining skin sparing.1 It is particularly useful for addressing tissue variations within the
treatment area. Total body irradiation (TBI) serves as an example of its application in compensating for
such tissue heterogeneity. Additionally, compensators can rectify dose irregularities caused by reduced
scatter near the edges of the treatment field, as seen in Mantle fields. Another clinical instance where
compensators prove beneficial is when patients exhibit tissue heterogeneity within the treatment area,
such as air pockets or varying tissue densities. Here, a compensator adjusts the beam intensity
accordingly, ensuring a more uniform dose distribution across the target volume.

Conversely, a wedge serves as a tool to alter the radiation beam progressively by reducing its intensity
across the field, leading to a “tilting” effect of the isodose lines. 2 This is achieved through differential
attenuation, where the thicker end of the wedge absorbs more radiation than the thinner end. In cases
where a tumor resides close to critical structures, the implementation of a wedge may be necessary to
ensure the tumor receives sufficient radiation while minimizing exposure to adjacent healthy organs. The
wedge physically shapes the beam to accomplish this objective. Figure 1 demonstrates the difference
between a wedge and a compensator.3

a b

Figure 1: A schematic diagram illustrating the difference between a compensator (a) and a wedge (b)

There are scenarios where a wedge may function both as a wedge and a compensator simultaneously.
This occurs when the wedge's physical shape alters the beam's intensity across the field while also
compensating for tissue density variations within the same area. For example, when a patient has a
tumor adjacent to a lung with varying density due to air pockets. In this case, a wedge may be used to
both shape the beam to match the tumor's geometry and compensate for the lung's density variations
simultaneously. The thicker portion of the wedge may attenuate the beam to deliver a higher dose to the
tumor, while the thinner portion compensates for the lung's lower density to maintain a more uniform
dose distribution.

References:

1- Gibbons JP, Khan FM. Dose distribution and scatter analysis. The Physics of Radiation Therapy. 6th ed.
Philadelphia, PA. Wolters Kluwer; 2020: 203-241.
2- Gibbons JP, Khan FM. Dose distribution and scatter analysis. The Physics of Radiation Therapy. 6th ed.
Philadelphia, PA. Wolters Kluwer; 2020: 178-202.
3- George P. Isodose curves RADIATION ONCOLOGY. Slide Share.
https://www.slideshare.net/paulpampz04/isodose-curves-26644276. Updated September 28, 2013.
Accessed April 5, 2024