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Christopher Maurino

March 22, 2020

Radiation Dose Calculations – DOS 522

Attenuation Project

25-Degree Enhanced Dynamic Wedge Transmission Factor

Objective:

The objective of this project is to understand the principle of attenuation of the radiation

beam as it passes through an object and to calculate the transmission factor appropriately, which

will be used in a patient treatment calculation.

Purpose:

Any object in the path of a radiation beam causes the radiation beam to lose energy as it

transverses the matter in that object.1 As a result, physical wedges were developed in order to

attenuate the radiation beam in order to optimize the dose given to the target and optimize dose

distribution by tilting the isodose lines in a desired orientation.2 Physical wedges are high density

pieces of metal that have a thick portion on one side, called the heel, and tapers to a thin portion

on the other side, call the toe. The toe of the wedge attenuates less of the radiation; therefore,

more radiation passes through the toe and results with the wedge changing the orientation of the

dose distribution, depending on the thickness of the heel. With the development of multileaf

collimators (MLC’s) in modern linear accelerators, Enhanced Dynamic Wedges (EDW) were

created. EDW use the MLC’s to slowly move across the treatment field in order to alter the dose

distribution the same way a physical wedge would (P. Archer CMD, personal communication,

February 12, 2020). Each angled wedge or corresponding EDW alters the isodose lines

differently, therefore, each has a different wedge transmission factor. This paper aims to find the
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Wedge Transmission Factor (WF) for a 25-Degree EDW by finding the dose rate with the wedge

field divided by the dose rate without the wedge.

Methods

The dose was measured on a Varian TrueBeam Edge utilizing the Exradin A12 ion chamber

connected to a Innovision Model-35040 electrometer with and without the 25-degree EDW. The

set-up for the experiment used solid water and was standard for the machines, 90 SSD, 100 SAD,

10 cm depth with 10 cm of back scatter, as shown in image 1 and image 2. The field that was

analyzed was a single antero-posterior (AP) field from a plan that I created for treatment using a

6 MV photon beam. The field size was 13.0 x 12.4 cm with a blocked field of 12.5 x 7.0 cm field

with a collimator angle at 90 degrees. The dose rate that was given was 445 monitor units (MU).

The machine was calibrated to 0.8 cGy/ monitor unit at 10 cm depth, 100 SAD on a 10x 10 field.

Image 1: Solid water set up, 90 SSD, 100 SAD with 10 cm depth and 10 cm backscatter.
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Image 2: Solid water set up, gantry angle 0 degrees, collimator angle 90 degrees couch angle 0
degrees.

Results

Three measurements were taken with the EDW and without the EDW after delivering 445

monitor units, results are displayed in table 1. The mean charge of the EDW field was -56.53 nC

and the mean charge without the EDW was -68.546 nC. As described above, our wedge

transmission factor (WF) is Dose with wedge/Dose without wedge. Therefore, our WF is -

56.53/-68.546 = 0.825. The equivalent square for the treatment field was approximately 13 cm
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and the equivalent square for the blocked treatment field was approximately 9 cm (see image 3

for calculations). Dose to the ion chamber was 21% higher without the EDW compared to with

the EDW, 281 cGy to 232 cGy, respectively (see image 3 for calculations). The beam data table

used for hand calculations was provided in our DOS-522 class and was produced by Varian

Clinac 21X (S/N 2081) for 6 MV Tissue Maximum Ratio Dosimetry.3 Finally, image 4 shows

the hand MU calculation of the AP field of the treatment that we simulated in this experiment.

The MU calculated is 441 MU while the treatment planning system provides 445 MU, a

difference of 0.9%.

Reading 1 Reading 2 Reading 3 Mean

With EDW -56.53 nC -56.51 nC -56.55 nC -56.53 nC

Without EDW -68.59 nC -68.54 nC -68.51 nC -68.546 nC

Table 1: Readings from the

electrometer for an AP
field with 445 monitor
units with and without the
Enhanced Dynamic Wedge
(EDW) at collimator angle
of 90 degrees.

Image 3: Hand calculations

for equivalent squares and
dose delivered to the ion
chamber for the
experimented treatment
field.
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Image 4: Hand MU calculation vs. treatment planning system.

Discussion

Wedges are invaluable to radiation therapy because of the ability to change the dose distribution

of the radiation that the patient receives. Wedges can be used to avoid high doses to unwanted

areas, or they can be used as compensators for when the patient has to receive dose to variable

depths. They are a great asset to have in a Dosimetrists toolbox when trying to create a treatment

plan. The advent of the EDW eliminates errors from happening in the clinic and has improved

the efficiency compared to physical wedges. For instance, physical wedges must be placed in the

machine, and if forgotten, the patient would be treated to a much high dose. As calculated in this

experiment, the patient would receive 21% more dose if there was no wedge; as we can see from

the two dose distributions in images 5 and 6. These images are shown from the treatment

planning system dose distribution of an AP field with a 25-degree EDW and without the wedge

after giving 445 monitor units. However, with the EDW, radiation therapists are not required to

enter the room and add a physical wedge.4 When an EDW is used, the computer system
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automatically engages the wedge, thus, it cannot be forgotten. Therefore, in order for the patient

to receive the higher dose of forgetting the wedge, there must be a malfunction with the machine

or operating system, which would be very unlikely. In addition, EDW are more efficient than

physical wedges provided that EDW have a much lower wedge transmission factor (WF). For

example, this experiment showed that the WF of a 25-degree wedge was 0.825, while in the

beam tables that were provided to us in our class, the WF for a 15-degree wedge and 30-degree

wedge is 0.708 and 0.551, respectfully.3 That means that in order to give the same amount of

dose, you have to give approximately 50% more monitor units when using a 30- degree physical

wedge compared to the 25-degree EDW. As a result, by using a EDW, the patient is exposed to

less scatter radiation and treated more efficiently.

Image 5: Dose distribution of AP field of humerus with 25-degree EDW giving 445 MU.
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Image 6: Dose distribution of AP field of humerus without 25-degree EDW giving 445 MU.

Conclusion

Every object that is placed in the path of a radiation beam, attenuates that beam. Wedges are

used to purposefully attenuate the beam in order to achieve an optimized dose distribution in

order to efficiently treat the patient. In this experiment, we found that a 25-degree EDW had a

WF of 0.825. This experiment has shown that the WF is an important component of a dose

calculation since omitting the WF would increase the patient’s exposure to radiation by 21%.

Finally, there are two main advantages of the EDW compared to physical wedges. Firstly, an

EDW does not require a therapist to physically add the wedge, resulting in the reducing clinical

errors. Secondly, the EDW is more efficient because the EDW requires less monitor units in

order to provide the same amount of dose.

Acknowledgements

Thank you, Charlie Matrosic (physics Ph.D student at the University of Michigan), for being my

mentor and taking the time to set up this experiment with me.
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References:

1. OzRadOnc. http://ozradonc.wikidot.com/photon-attenuation. Accessed March 21, 2020.

2. Ahmad M, Hussain A, Muhammad W, Rizvi SQA, Matiullah. Studying wedge factors

and beam profiles for physical and enhanced dynamic wedges. Journal of medical

physics. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2825002/. Published January

2010. Accessed March 21, 2020.

3. Beam Data Tables. UW System Authentication Redirector.

https://uwlac.instructure.com/courses/278253/pages/all-weeks-

resources?module_item_id=4766589. Accessed March 22, 2020.

4. Khan FM, Gibbons JP. The Physics of Radiation Therapy, 5th ed. Philadelphia, PA:

Lippincott Williams & Wilkins; 2014