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Kevin Kocos
March 8, 2017
60 Degree Wedge Transmission Factor Calculation
Objective: To determine the wedge transmission factor (WF) for a 60 degree wedge in a 6
megavolt (MV) radiation beam and to incorporate this into a patient plan to obtain the correct
monitor unit (MU) calculation.
Purpose: There are many options in regards to beam modification methods for radiation fields.
External physical wedges are commonly made with a dense material such as lead and manually
inserted into the head of treatment machine.1 The application of the wedge into the treatment
field alters the isodose distribution within the patient to achieve acceptable radiation parameters
for the consideration of the disease being treated.
Certain treatment issues may arise when radiation beams have overlapping coverage
within a patient. When this occurs it can cause undesired areas of high or low dose that must be
taken into account to achieve the desired effect.2 The degree of dose variation within overlapping
beams depends on the hinge angle. The hinge angle refers to the angle of intersection between
the central axis of 2 radiation beams. Wedges can help to reduce the dose in fields that have a
hinge angle that is less than 180 degrees. The thick end of the wedge, also known as the heel, is
most commonly applied to the overlapping areas due to the fact that it will attenuate the greatest
amount of radiation.2,3
Wedges are commonly found in 15 degrees, 30 degrees, 45 degrees and 60 degree
measurements and can be placed in any one of 4 positions including in, out, right and left.3,4 It
must be noted however, that the wedge angle refers to the degree angle of tilt in the isodose
curve and not the angle of the actual wedge. In order to properly account for the MU applied to
the treatment field one must account for the WF of each beam. The WF can be expressed as the
ratio of the dose rate in a field with the wedge to the dose of the rate of the same field without the
wedge. It is more specifically defined in the following equation: 4
(,,,)
WF =
(,,)
D= Dose
a = wedge angle
s = field size
E = beam energy
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Methods and Materials: Measurements of the transmission factor of the 60 degree wedge were
performed using a 6 megavolt (MV) radiation beam on the Varian Clinac iX Linear Accelerator.
The measurements were performed on a plastic solid water phantom in which a Farmer
Chamber, model FC65-G, was placed at 10 centimeter (cm) depth into a precut hole. The solid
water phantom has various sized blocks that allow radiation readings to be taken with the same
attenuation as water. All of the readings were taken at 100 cm source to axis distance (SAD)
with a 10 x 10 cm field size. The chamber was then connected to a Victoreen Precision
Electrometer/Dosimeter Model 530 which measured the charges produced in nanocoulombs
(nC). Six trials were performed to 100 MU at a dose rate of 400 MU per minute. The first 3
trials were measured using the previously mentioned setup while the final 3 trials were
performed with the a 60 degree wedge placed in the in position to determine the wedge
transmission factor.

Image 1: Measurement set up with solid water phantom with the Farmer chamber placed inside.
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Image 2: 60 degree wedge placed in the in position

Results:
Table 1 shows the results of the readings from the dosimeter from the 6MV beam onto the solid
water phantom with and without the 60 degree wedge. Average readings were obtained by
taking the sum of all 3 trials and dividing that answer by 3.

Trials Readings without 60 Readings with 60


degree wedge (nC) degree wedge (nC)

1st Trial 15.670 6.290

2nd Trial 15.664 6.286

3rd Trial 15.668 6.286

Average Readings 15.667 6.287


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Table 2: Calculation of WF for the 60 degree wedge for a 6 MV Beam

Reading w/ 60 deg wedge Wedge Transmission Factor


Reading w/ out 60 deg wedge

.
= 0.401
.

Table 3: Calculation of Percent attenuation of 60 degree wedge on a 6MV radiation beam

Equation for % attenuation Percent attenuation of 6MV


of beam Beam

. 59.9%
( )
.

Table 4: Displays the Calibrated Wedge Transmission Factor currently used at the Minneapolis
Veterans Affair Medical Clinic (MVAMC) for a 6 MV Beam

Calibrated WF - 6 MV Beam
MVAMC

0.397
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Table 5: Demonstrates the calculation of percent difference between current calibrated factor of
6 MV beam at the MVAMC with a 60 degree wedge and my current readings

Percent Difference Calculation Percent Difference

. 0.99%
1( )
.

Discussion: The WF in this study was found to be 0.401 for a 6 MV beam that is applied to a 60
degree wedge on the Varian Clinac iX Linear Accelerator. This would show that the wedge is
attenuating 59.9% of the photon beam. This is a substantial WF and can be expected due to the
fact this is the largest wedge that is used in the MVAMC. The wedge calibration that is currently
used in our clinic at the MVAMC is 0.397. This accounts for approximately a 0.99% percent
difference in readings.
Clinical Application: The use of 60 degree wedges was demonstrated on a brain tumor with a
volume of 42.77 cm3. A prescription to the PTV was 5000 cGy over 25 fractions of 200 cGy per
session. Two trial comparisons were made, both of the trials utilizing an anterior beam at 0
degrees and a left lateral beam at 90 degrees. Both trials normalized the prescription dose to
95% and weighted the beams at 43% for the anterior beam and 57% for the left lateral beam.
The first trial was performed with no wedges while the second trial utilized a wedge pair
technique with 60 degree wedges on both of the beams. The following hand calculations below
will show the determination of MU needed to get the proper amount of dose to the PTV in both
the plans with and without wedges. It should be noted the significant increase in MU needed for
the plan with a 60 degree wedge pair due to the large attenuation by the wedge. The transverse
images of the treatment fields will also demonstrate how the wedge pair serves to push the
isodose lines across the PTV so that coverage of the 100% isodose line covered 97% of the PTV.
In the plan without wedges, only 73% of the PTV was covered by the 100% isodose lines.
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MU Hand Calculations for plan with no wedges


MU =

TD = Target Dose
k = Calibration dose per MU
Sc = Collimator Scatter Factor
Sp = Phantom Scatter Factor
TMR = Tissue Maximum Ratio

1a anterior beam 6MV with no wedges:


.
= 109 MU
. . . .

1b left lateral beam 6MV with no wedges:


.
= 135 MU

. . . .

MU Hand Calculations for plan with wedges


MU =

1a anterior beam 6MV with 60 degree wedge
.
= 267 MU
. . . . .

1b left lateral beam with 60 degree wedge


.
= 332 MU

. . . . .
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Calculation of percent difference of MU for each beam


1a anterior beam

= 59.17% difference

1b left lateral beam

= 58.8% difference

Transverse View of trial comparison for wedge pair technique vs. 2 field with no wedges

Image 3: Wedge Pair Image 4: 2 field with no wedges


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Image 5: Pinnacle Planning System Beam Summary for 2 field plan with no wedges
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Image 6: MuCheck for 2 field plan with no wedges


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Image 7: Hand calculation sheet for 2 field plan with no wedges


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Image 8: Pinnacle treatment summary for plan with wedge pair technique
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Image 9: MuCheck for 2 field plan with wedge pair technique


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Image 10: Hand calculation sheet for 2 field plan with wedge pair technique
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Conclusion: Each patient in radiation therapy requires individual planning considerations


depending on the progression of disease, surrounding organs at risk, variance in anatomy and
many others. This exercise has demonstrated that beam filters such as wedges can serve to
manipulate isodose lines to dramatically alter their shape across areas of interest. In order to
effectively and safely implement these tools, the dosimetrist must be able to accurately account
for the change in the MUs caused by the wedges.2 In addition to the change in MUs, each
member of the oncology must be able to recognize and carry out the correct placement of the
wedges which also has significant impact in delivering the correct dose to the correct location.
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References
1. Khan FM, Gibbons JP. The Physics of Radiation Therapy. 5th ed. Philadelphia, PA: Lippincott
Williams and Wilkins. 2014.
2. Washington CM, Leaver D. Principles and Practice of Radiation Therapy. 4th ed. St. Louis,
MO. Elsevier Mosby. 2016.
3. Bentel GC. Dose determination for external beams. Radiation Therapy Planning. 2nd ed. New
York: McGraw-Hill; 1996.
4. Saminathan S, Manickam R, Supe S. Comparison of dosimetric characteristic of physical and
enhanced dynamic wedges. Rep pract oncol radiother. 2012; 17(1): 4-12.
http://doi.org/10.1016/j.rpor.2011.06.007.