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Yinan Wang
Attenuation Project
February 12, 2016

Attenuation Project: Wedge Transmission Factor


Objective: To determine the wedge transmission factors on Elekta LINAC and apply the
factors to monitor unit (MU) calculation for breast photon boost fields.
Introduction: Wedge is the most commonly used compensator in radiation therapy that
will alter the isodose distribution when placed in the path of a beam.1 Wedge is usually
used to compensate for slop of the patient body or in the form of wedge pairs to produce
a more uniform dose distribution. There are two different types of wedges: physical and
dynamic wedges. A physical wedge is a wedge shaped filter made of lead or steel with a
thick end (heel) and a thin end (toe). A dynamic wedge changes the isodose distribution
curve through the motion of one of collimating jaws while the beam is on. The speed of
the motion determines the angle of the wedge. The wedge angle is defined as the angle
between the slope of the isodose line and the normal of the beam central axis. A wedge
with bigger angle will result in more tilted isodose distribution and less MU output. In my
clinic site, Beaumont Health System, Elekta LINAC are used for treatment. Elekta
LINAC uses universal (omni) wedge, which has only one physical wedge with an angle
of 60 mounted above the jaws. By adjusting the combination of open and wedged fields,
0 to 60 wedge angles can be achieved.2
To calculate the MU output for each beam in a radiation therapy plan, the wedge filter
attenuation (wedge factor) must be taken into account.1 The wedge factor is defined as
the ratio of the dose with and without the wedge at a point on the central axis of the beam
at a depth deeper than Dmax.
(1)
Methods and Materials:
a) Wedge factor measurements

In this attenuation project, an Elekta LINAC was used to measure the 60 wedge
transmission factor using 6 MV photon energies with a 1010 field size and 100 cm SAD
setup. Solid water phantoms were placed on the treatment couch, with a farmer ionization
chamber and the phantom surface at a distance of 100 cm and 95 cm, respectively from
the LINAC source (as shown in Fig 1a). The chamber was connected to an electrometer
(Fig. 1b) at the console area outside the treatment room. At a collimator rotation of 90,
100 MU were delivered at 6 MV with and without the wedge. Each condition was
measured three times. To cancel out the asymmetry of wedge position, the collimator was
rotated to 270 and the same measurements described above were repeated. All readings
were averaged to reduce the random noise.

(a)

(b)
Figure 1. a) Phantom and chamber setup for wedge factor
measurements and b) electrometer for charge (dose) measurement.

b) Clinical Application
Wedge pairs are routinely used for breast photon boost radiation therapy, which limits the
irradiated volume to lumpectomy cavity while reducing the hotspot in the boost region. A
hypo breast treatment (266cGy 16 with additional 266cGy 4 boost treatments,
Canadian fractionation) is used here to demonstrated dose calculation with wedge filter.
As shown in Fig. 2, the heels of the wedges are away from the breast surface, to
compensate the reduced thickness of anterior breast.

Figure 2. A wedged pair beam setup for breast photon boost treatment
Figure 3 shows the beam parameters from the Treatment Planning System (TPS) for LT
Med ABC BOOST (5A) field and LT LAT ABC BOOST (6A) field. The equivalent field
size is calculated using the following equation:
(2)
where A and B are the field width and length, and a is the fraction (expressed as a
decimal) of the area of the open field which is blocked. Then f is used to look up Sc, Sp,
and TMR values.
Effective wedge factor for a mixed field (wedged plus non-wedged) at depth d and for
field size f is calculated using the following equation:

(3)
where MUw is the MU for wedged portion of the field, MUo is the MU for open portion
of the field, MUt is the total MU for the field, and W(d, f) is the wedge factor for the 60
universal wedge. The 6 MV beam is calibrated with D0 = 1cGy / MU at the depth of
dmax=1.5cm, with a 1010 field size at 100cm SSD. So the SAD factor = (101.5/100)2 =
1.03. The total MU needed to deliver the required dose at the prescription point is:
(4)

Figure 3. TPS print out for the beam parameters

Results:
a) Wedge factor measurements
Table 1. Readings taken for a 6MV beam with a 10x10 cm field size , 100 cm SAD, 5cm
depth.
Open Field

60 Wedge (nC)

(nC)

90 Collimator

270 Collimator

Reading #1

17.20

4.607

4.610

Reading #2

17.25

4.603

4.609

Reading #3

17.23

4.604

4.605

Average
Reading

17.227

4.606

Transmission Factor Calculation:


(5)
Table 2 lists the wedge factors measured at machine commission for different field sizes
and depths. The wedge factor for 1010 field size at 5cm depth is 0.267 and 0.264 for our
measurement and commission measurement, respectively. The difference is 1.3%.
Table 2. 6 MV Wedge factor W(d, f) table from Beaumont Health

Side of equivalent square f (cm)


Depth d (cm)

10

20

30

5.0

0.259

0.264

0.276

0.281

10.0

0.265

0.268

0.279

0.285

15.0

0.269

0.273

0.283

0.288

20.0

0.274

0.277

0.287

0.293

25.0

0.278

0.281

0.291

0.298

b) Clinical Application
The beam parameters in Fig. 3 are list in Table 3. The field sizes and percentage blocked
area are 7.97.4 cm2 with 21.9% blocked and 7.97.5 cm2 with 20.2% blocked,
respectively. The equivalent squares for both fields are 6.8 cm2. The doses prescribed to
the reference point for the two beams are 138.3 cGy and 127.7 cGy, respectively. The Scp
and TMR can be retrieved from the clinical hand-calc tables based on the effective field
size and effective depth. From Table 2, the open field wedge factors for field 5A and 6A
can be interpolated to be 0.262 and 0.264, respectively. The effective wedge factors can
be calculated using Eq. 3 as:
(6)

(7)

Monitor unit calculations were created with and without the wedge factor to show the
importance of the factor in the calculation. The monitor units for field 5A and 6A are:
(8)
(9)
which are 1.8% and 1.7% different from the TPS calculation. The accepted error is < 3%.
If wedge factors are not included into the calculation, then
(10)
(11)
Without taking wedge factors into account, the dose deliver will be 42% lower from the
prescription.

Table 3. Hand-calc MU calculation parameters for breast photon boost treatment


Field Number

5A

6A

MEDIAL

LATERAL

Machine

SL2

SL2

Energy

6MV

6MV

SSD (cm)

93.97

92.34

Depth: physical (cm)

6.03

7.66

Depth: effective (cm)

5.55

7.12

Blocked Eq. Square (cm)

6.8

6.8

Wedge

40W

40W

Tumor Dose (cGy)

138.3

127.7

100

100

0.972

0.972

TMR/TAR

.896

.848

Inverse Square Factor

1.03

1.03

Wedge Factor

0.425

0.427

Hand-calc MU

363.6

353.1

TPS Total Monitor Units

370.4

359.3

TPS wedge MU

288.6

279.9

TPS open MU

81.8

79.4

Field Name

% Isodose Line
Ref. Dose Rate cGy/mu)
Scp
Sc
Sp

Discussion: In this project, the wedge factor measured for a 6 MV beam with 10x10 cm2
field size at 5 cm depth is 0.267, which is close to the number measured during machine
commission. Wedge factors are used to find the MUs for two beams containing wedge.
Wedge factors are measured at the central axis, so they are independent of the orientation
of the collimator. However, if the reference point is not at the central axis, additional
wedge off axis factors have to be included.1 The wedge factor is much smaller at the toe
(larger value) than that at the heel (smaller value).

The wedge factor can significantly affect the MU calculation.1 For the example showed
above, the differences are about 42%. If the patient was treated using MU calculation
without considering the wedge factor, it will be a big misadministration and both the
patient and the relevant regulation agency (NRC) have to be noticed.
Conclusion:
Wedge can be used as tissue compensators or wedge pairs to alter the shape of isodose
curves. 1 We demonstrated the calculation process of the wedge factors for two clinical
beams. The hand-calc process for a breast photon boost treatment using wedged pair
beams has been described. The MU hand-calcs with and without wedge factors have been
presented and the differences and its clinical effect have been discussed. From this
project, I learned that the wedge attenuates the transmission of the beam. Its important to
incorporate the wedge transmission factor into the MU calculations in order to deliver
correct dose to the target volume.

References
1. Khan FM, Gibbons JP. The Physics of Radiation Therapy. 5th ed. Philadelphia, PA:
Lippincott Williams & Wilkins; 2014.
2. Phillips MH, Parsaei H, Cho PS. Dynamic and omni wedge implementation on an
Elekta SL linac. Med Phys. 2000;27(7):1623-1634.
http://dx.doi.org/10.1118/1.599029.