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Lee Culp February 3, 2014 Transmission Factor Calculation 15o Wedge Transmission Factor Calculation Objective: To determine and calculate the transmission factor for a 15o Wedge Toe In. Also to demonstrate the effect this transmission factor has on the monitor unit calculation, as well as the effect on a chest patient. Purpose: Radiation Therapy treatment machines are each calibrated to a specific standard, regulated very closely according to specific protocols set forth by the American Association of Physicists in Medicine (AAPM). The specific reference where these protocols are found is AAPM's TG-51 protocol for clinical reference dosimetry of high-energy photon and electron beam. For a reference field output, standard calibration is required and set forth by the protocol. The reference field would be 10 x10 centimeter (cm), at a 100cm source to skin distance (SSD), at a 10cm depth in a water phantom. To adjust this for individual patients, beam-modifying filters such as wedges, blocks, and Multi-Leaf Collimators (MLC's) are inserted in the pathway of the beam. This allows for delivery of conformal dose and sparing of normal tissue. A wedge is a piece of dense material, usually lead, which attenuates the beam progressively across the field. The thinner side of the wedge attenuates the beam less than the thicker side, resulting in tilted isodose curves.1 This attenuation has to be accounted for when calculating and delivering an accurate dose to a target when the wedge is involved. The factor that corrects for this attenuation of the device is called Cattn, and is defined by the following equation:2

Cattn = Dose with device in radiation beam

Dose without device in radiation beam Specifically, the 15o Wedge Transmission Factor calculation is as follows: 15o Wedge Transmission Factor = Dose with the 15o Wedge in the beam path Dose without the 15o Wedge in the beam path Methods and Material: The information was measured on a Varian Trilogy linear accelerator using both a 6 megavoltage (MV) and a 16 MV photon energy beams; with a 10 x 10 cm field

size, a 100 SSD, with 6cm of backscatter, to a depth of 10cm to "Plastic Water" blocks (See Image 1). 100 monitor units (MU) at a dose rate of 400MU per minute was delivered. An Exradon model A12 thimble ionization chamber was used and placed in a pre-drilled hole in one of the Plastic Water blocks at a depth of 10cm. The ionization chamber was then connected to a Fluke Advanced Therapy Dosimeter Electrometer to measure the individual and accumulated charge for each trial. Three 100MU trials were measured for each energy; 6MV and 16MV with the reference geometry listed above, at a collimator rotation of 90o. The collimator was placed at a 90o angle because we wanted to get a reading along the slope of the wedge, not perpendicular to it. Therefore, we avoided a fluctuation in reading across the slope from toe-to-heel, or vice versa. In theory, the reading should remain consistent parallel to the slope. Once this data was obtained, a 15o wedge - Toe In - was inserted into the beam path, and another three 100MU trials were measured for each energy. After this was completed, in accordance with TG 106, we rotated the collimator 180o to 270o and measured three additional 100MU trials with the wedge in the beam path. Once the detector is centered in the beam, one must acquire readings at one wedge orientation and then repeat the measurements with the wedge reversed 180 deg. The wedge factor is taken as the average of the two wedge orientation readings divided by the open field reading at a single collimator angle.3 Image 1: Setup of Plastic Water blocks with thimble chamber in place at a depth of 10cm.

Results: Table 1: Readings (in nanoCoulombs (nC)) taken without and with the Wedge in the beam path, with collimator at 90o and 270o.
Energy Readings without Wedge (nC) 6 MV 13.702 13.708 13.709 9.707 9.7 9.699 9.695 9.691 9.694 16 MV 16.029 16.024 16.024 12.204 12.204 12.207 12.206 12.202 12.205

Readings with Wedge (nC) - Coll @ 90

Readings with Wedge (nC) - Coll @ 270

Table 2: Calculating the average (avg.) of the trials for both 6 MV and 16 MV photon energies, as well as the readings with and without the 15o Wedge: at 90o and 270o. To obtain the average one must add all three readings in each column, and then divide the total by 3.

Energy Readings without Wedge (nC)

6 MV 13.702 13.708 13.709 41.119/3=13.7 nC avg. 9.707 9.7 9.699 29.106/3=9.7 nC avg. 9.695 9.691 9.694 29.08/3=9.7 nC avg.

16 MV 16.029 16.024 16.024 48.077/3 = 16.03 nC avg. 12.204 12.204 12.207 36.615/3=12.205 nC avg. 12.206 12.202 12.205 36.613/3=12.205 nC avg.

Readings with Wedge (nC) - Coll @ 90

Readings with Wedge (nC) - Coll @ 270

Table 3: Calculating the Transmission Factor (TF) using the averages from Table 2 for both 6 MV and 16 MV photon energies, as well as the readings with and without the 15o Wedge. Since there is no difference in readings between Collimator settings for 90o and 270o, the 270o readings going forward in this discussion will be eliminated.

Energy Reading w/Wedge Reading w/o Wedge

6 MV 9.7/13.7 =

16 MV
12.205/16.03 =

Transmission Factor

0.708

0.716

Discussion: The TF for the 6MV photon beam is 0.708 and the TF for the 16MV photon beam is 0.716. This demonstrates that the 15o wedge attenuates 29.2% of the 6MV beam, and 28.4% of the 16MV beam. The presence of a wedge filter decreases the output of the machine, which must be taken into account in treatment planning.4 The wedge is expected to influence and attenuate the beam to give the desired isodose curves. The photons of the greater energy (16MV) interacted less with the wedge, and consequently resulted in a reduced amount of attenuation and a larger TF. Clinical Application: Right Hip/Femur. The daily prescription dose is 300cGy, equally weighted to be delivered through both the Anterior and Posterior fields. The MU calculation is as follows for both fields, with visual inclusion of the WF in the Anterior field, and exclusion of the WF in the Posterior field:

Image 1: Example of a MU calculation with and without Wedge; Hand calculation. (6 MV) Monitor Unit Calculation with Wedge: AP MU with 15o wedge: MU = ___ _______Dose____________ (Ccal) (OF)(TMR)(SAD Factor)(WF) MU = ________ _______150cGy_______________ (1.0MU/cGy)(1.015)(0.748)(101.5/100)2(0.708) AP MU with 15o Wedge = 271 MU PA Open: MU = __ _______Dose_________ (Ccal) (OF)(TMR)(SAD Factor) MU = _____________150cGy____________ (1.0MU/cGy)(1.015)(0.748)(101.5/100)2 PA MU open = 192 MU Percent Diff in MU* WF-Open x 100% = % Diff WF 271-192 x 100% = 29% 271
*% indicates an increase in MU necessary to deliver the correct dose to the target volume with a wedge in the path of the beam

For the Anterior and Posterior fields, the use of the wedge resulted in a 29% increase in MU. This demonstrates that the patient would be over-dosed by 29% if the wedge was omitted accidently from treatment, if it were in-fact included in the MU calculation.

Image 2: Example of a MU calculation with and without Wedge; from RadCalc. (6 MV)

Image 3: Example of Anterior field with Wedge. (6 MV)

Image 4: Example of Anterior field without wedge. (6 MV)

Conclusion: This project establishes how essential it is to consider and include changes to the beams path, in order to deliver to correct dose to the target volume. One such consideration is the effect the wedge factor has on the beam; without the wedge in the beams path the patient will be overdosed 29%. If the wedge is accidently included in the field the patient will be underdosed as well, due to the attenuation of the beam not correctly accounted for. Also, this project exhibits that the transmission factor of a photon beam fluctuates with beam energy, as seen in Table 1.

8 References 1. Bentel GC. Dose determination for external beams. In: Radiation Therapy Planning. 1st ed. New York, NY: McGraw-Hill; 1992:72-73. 2. Stanton R, Stinson D. Photon beam dosimetry. In: Applied Physics for Radiation Oncology. Madison, Wisconsin: Medical Physics Publishing; 1996. 3. Das I, Cheng C, Watts R, et al. Accelerator beam data commissioning equipment and procedures: Report of the TG-106 of the Therapy Physics Committee of the AAPM, Med. Phys. 2008; 35(9):41864215. doi: 10.1118/1.2969070. Accessed February 4, 2014. 4. Khan F. The Physics of Radiation Therapy. 4th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2010:183.