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Lisa Spanovich

Wedge Factor Calculation

522 Radiation Dose Calculations

Wedge Factor Calculation

The objective of this project is to obtain the transmission factor for a dynamic wedge. This
wedge factor will then be incorporated into a calculation of a patients treatment.

The generic formula used to find out the attenuation of the beam is the output with the material
in the path of the beam, divided by the output without the material in the beams path. Visually it
is shown as:

Transmission factor = Dose with the material in the beams path

Dose with no material in the beams path

Dose rate modification filters can be defined as anything that comes in the path of the beam.
These materials include block trays (solid or slotted), wedges, or compensation filters.1 The
purpose of a wedge is to tilt the isodose curve of the radiation beam, so that it can distribute a
more even dose to the patient.2 Radiation works best on a flat surface (for example, the flat
shape of a box), but it is known that typical body composition will never mimic that shape. In
order to smooth out the dose to a patients anatomy, we add compensators so that this material
can make up for the tissue that it is missing. Think of the curvature of a patients pelvic region.
There is denser, thicker tissue at the anterior portion of the pelvis, but posteriorly, there is mostly
a thinner density of adipose tissue at the buttocks region. How do we account for these different
densities? We will use wedges. The formula to obtain a wedge factor is as follows:

Wedge factor= Dose with a wedge in the beams path

Dose with no wedge in the beams path

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There are a few different ways that linear accelerators are able to skew the isodose curve of the
radiation beam. The first type of wedge, was a physical wedge. This wedge was an accessory
that would have to be physically taken in and out of the machine, depending on when it was
needed. These wedges typically came in 15, 30, 45, and 60 degree wedge angles. The type of
wedge that I used in this project is a dynamic wedge. A dynamic wedge is not a physical piece
of equipment, rather, it uses the collimator jaws to mimic the old fashioned physical wedge. The
wedge effect is produced by driving one of the collimator leaves across the field, thus gradually
increasing the field size. The side of the field where the movement begins will receive the most
dose (toe side of a physical wedge). The speed that the collimator moves determines the angle
of the sloping isodose curve.2

Method and Materials

This project was done on a Varian linear accelerator 2300IX. First, we set a 10 x 10 field size,
with a depth of 5 cm, using buildup or plastic water. There was a 4 cm buildup block placed on
a 2 cm buildup block that housed the chamber in the middle (1 cm depth), this gave us a total
depth of 5 cm to the chamber. The optical distance indictor was set to 100 SSD. When the 100
SSD was set, the lasers in the treatment room skimmed the top of the buildup which is another
indication that we were at the correct depth. For each of the energies measured, we delivered 100
monitor units (MU). A farmer-type ionization chamber was used. The brand of the chamber is
Exradin, and it is the A12 model. The chamber was connected to a Fluke electrometer. This
electrometer is what we used to obtain our measurements. We ran 3 rounds of 100 MU to warm
up the electrometer. After the electrometer was warmed up, we took 3 readings of an open 10 x
10 field, with 6x photons. Then we then took 3 reading of 16x photons. The results for both 6x
and 16x are shown in the following section.
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Image 1: the ionization chamber at 5 cm depth, using plastic water.

Image 2: the Fluke electrometer used to obtain our measurements.

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Results

Table 1: output readings for an open 10 x 10 field size

6x 16x
Reading 1 18.388 20.08

Reading 2 18.388 20.08

Reading 3 18.385 20.09

From this information, the averaged reading for a 6x open field, with a 10 x 10 field size is
18.387. The averaged reading for a 16x open field, with a 10x 10 field size is 20.083.

Per my Preceptor, Matthew Pacella, MS, DABR, FACR, due to the positioning of the chamber
and the way the collimator jaw moves while mimicking a wedge, we need to take two readings,
while measuring the dose going in both directions of the chamber. The first reading is the
collimator moving from right to left, the second reading is of the collimator moving from left to
right. The readings when the jaw opens from the right, and when the jaw opens from the left,
help to shape the beam, so it is not accurate to only obtain a reading in one direction.3 The
following tables show the measurements of 6x photons with a 30 wedge, 6x photons with a 45
wedge, 16x photons with a 30 wedge, and 16x photons with a 45 wedge, respectively.
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Table 2: Readings of 30 wedge in a 6x photon beam.

6x 6x Average
30 Wedge 30 Wedge
Y1 In: Coll 270 Y1 In: Coll 90
Reading 1 15.695 15.774 15.7345

Reading 2 15.696 15.774 15.735

Reading 3 15.695 15.775 15.735

The total averaged readings for a 30 wedge using a 6x photon beam is 15.735.

Table 3: Readings of 45 wedge in a 6x photon beam.

6x 6x Average
45 Wedge 45 Wedge
Y1 In: Coll 270 Y1 In: Coll 90
Reading 1 14.143 14.267 14.205

Reading 2 14.143 14.267 14.205

Reading 3 14.143 14.267 14.205

The total averaged reading for a 45 wedge using a 6x photon beam is 14.205.
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Table 4: Readings of 30 wedge in a 16x photon beam.

16x 16x Average

30 Wedge 30 Wedge
Y1 In: Coll 270 Y1 In: Coll 90
Reading 1 17.736 17.830 17.783

Reading 2 17.735 17.831 17.783

Reading 3 17.736 17.831 17.784

The total averaged reading for a 30 wedge using a 16x photon beam is 17.783.

Table 5: Readings of 45 wedge in a 16x photon beam.

16x 16x Average

45 Wedge 30 Wedge
Y1 In: Coll 270 Y1 In: Coll 90
Reading 1 16.312 16.466 16.389

Reading 2 16.312 16.466 16.389

Reading 3 16.311 16.466 16.389

The total averaged reading for a 45 wedge using a 16x photon beam is 16.389.

My Preceptor and I looked up the actual wedge factors for our machine, to see the variance from
our readings to the machines readings. The wedge factors we obtained and the wedge factors
from the beam data are shown below.
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Image 3: Wedge factors from measurements taken.

Discussion
From obtaining these measurements, the wedge factor for a 30 wedge using 6x beam is 0.856.
The wedge factor for a 45 wedge using a 6x beam is 0.772. The wedge factor for a 30 wedge
using a 16x beam is 0.885. The wedge factor for a 45 wedge using a 16x beam is 0.816. From
this information, I was able to make 2 conclusions. First, I noticed that when you compare the
same wedges to the higher and lower beam energies, you will notice that there is less attenuation
with the higher (16x) energy. This occurs because the higher energy radiation does not interact
with the material as much and blows through quicker. The wedge factor is higher for the
higher energy because more radiation is getting through. Secondly, when comparing the 30
wedge to the 45 wedge with the same energies, the 45 wedge attenuates more radiation than
the 30 wedge. This is simply because the different wedge angles are used to skew the isodose
curve at different angles, so thicker, more attenuating wedges are needed when there are great
tissue variances.
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Clinical Application

For this project, a prone 3 field rectum treatment was used. For the application, I will calculate
the monitor units for each treatment field, and compare the results with the treatment planning
software. I will also calculate the amount of underdose the patient would receive per treatment if
the wedge factor was not taken into account. The prescription is 1.8 Gy x 25 fractions.

The weighting of each field is as follows:

PA: 180 cGy x 0.37 = 66.6 cGy

RT Lat: 180 x 0.315 = 56.7 cGy

LT Lat: 180 x 0.315 = 56.7 cGy

Table 6: Treatment field information.

PA RT LAT LT LAT
Energy 16x 16x 16x
Field x 15 17.9 17.9
Field y 17.9 11.9 11.9
Eq Sq 16.3 14.3 14.3
WF --- 0.816 0.816
SSD 92.0 82.0 81.4
Depth 8 18 18.6
Weight % 37% 31.5% 31.5%
TAR 0.921 0.719 0.711
Scp 1.045 1.033 1.033
Inv Sq 1.057 1.057 1.057
Output 1 1 1
MU 65 89 90
TPS MU 66 92 94
% Difference 1.5% 3.3% 4.3%
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Image 4: Screen shot of Eclipse patient field information.

Image 5: Monitor unit calculation WITH wedges.

Image 6: Monitor unit calculation WITHOUT wedges.

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Image 7: PA field treatment plan

Image 8: Right Lateral field treatment plan

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Image 9: Left lateral field treatment plan

Image 10: MU differences wedge vs. non wedged.

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Comparing the treatment planning software with my hand calculation, all fields were less than
the recommended 5% variance. The PA field showed a 1.5% difference, the Rt Lateral field
showed a 3.3% difference, and the Lt Lateral showed a 4.3% difference.

Next, I calculated what the dose for each field would be if the wedge was omitted. Because a
wedge was not used on the PA field, there was no variance to the monitor units. However, the Rt
Lat field had a 19.1% difference, and the Lt Lat field had a 18.9% difference in monitor units.
This is a significant change in dose when wedges are utilized for a treatment plan.

Conclusion

After performing the hand calculation for this 3 field rectum patient, I realized the importance of
how different factors affect the dose that we deliver to a patient. When treating a patient with a
45 wedge, as my findings has shown, can change the dose by 19%, which is an extraordinary
amount. If a wedge factor is omitted, the dose to the patient will decrease by 19%. And if not
caught early enough in the treatment, it can cause problems. Forgetting to add a wedge factor is
just as bad as the radiation therapist forgetting to place the wedge. With the record and verify
system, it may not happen as often as in the past, but its still so important to diligently review
your information and make sure that your patient is receiving an accurate treatment.
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References

1. Washington CM. Leaver DT. Principles and Practice of Radiation Therapy: Physics,
Simulation, and Treatment Planning. St Louis, Missouri: Mosby Publishing; 1996.
2. Bentel GC. Radiation Therapy Planning. 2nd ed. New York, NY: McGraw-Hill;1996:52-
53.
3. Interview with Matthew Pacella, MS, DABR, FACR, at the James P Wilmot Cancer
Center at Strong Hospital, Rochester, NY. February 28th, 2017.