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Nick Hopkins
DOS 522 – Radiation Dose Calculations
Attenuation Project

Objective: The aim of this project is to determine the central axis transmission factor for a 45
degree enhanced dynamic wedge (EDW). This data will then be used to show how the wedge
factor (WF) affects the calculation of monitor units (MU).

Purpose: Whenever something is placed in the path of the radiation beam, some attenuation
occurs.1 If this attenuation is significant it needs to be accounted for in any dose calculations.
Insignificant attenuation such as that of blankets or patient drapes can be ignored. The use of
wedge factors in MU calculations is an important step towards getting the customized treatment
field for a patient back to the calibration conditions of the machine. Inherent in the calculation or
measurement of the various factors is a relationship to the calibration conditions. As an example
the formula for calculating a wedge factor can be seen in Figure 1.

Figure 1. Formula for calculating a wedge factor.2

𝐷𝑤𝑒𝑑𝑔𝑒
𝑊𝐹 =
𝐷𝑜𝑝𝑒𝑛

Physical wedges have a thicker end, “heel”, and a thinner end, “toe”. The purpose of the wedge
is the shape the normally flat isodose lines to a specified slope that is denoted in the angle name
of the wedge. In the case of an EDW this alteration in isodose is created using the motion of a
collimator jaw. This project will focus on the central axis dose as separate factors are needed for
the computation of dose at any point off the central axis.

Methods and Materials: Data was collected on a Varian 2100 EX linear accelerator using an
Exradin A12 ion chamber placed in solid water buildup and connected to a Keithley
electrometer. The solid water slabs were assembled so that there was at least 10cm of
backscatter. This was followed by a 2cm slab that contained a precisely milled hole that would
fit the ion chamber, centering the collection volume in all directions within the slab. Lastly 9cm
of buildup were added to the top so that a total of 10cm of solid water was between the source
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and the chamber volume. This setup was positioned so the chamber volume was at isocenter. The
gantry was left at 0° and the collimator rotated to 90°. This was done in order to position the jaw
motion to cross the measurement volume instead of travel along it. This methodology provides a
more accurate measurement. At the console a 10x10cm field was programmed with 100 MU and
a 600 MU/min dose rate. These parameters are used because they most closely resemble our
output calibration conditions. The one difference is the depth and this does not matter for these
measurements because the WF is a relative factor and as long as the open and wedged
measurements are taken at the same conditions the ratio will be the same. Charge readings were
recorded for three consecutive measurements for both 6MV and 15MV beams and for both an
open field and a wedged field, Table 1. The charge readings were averaged for each of the four
measurement scenarios and used to calculate the wedge factor.

Figure 2. Measurement setup, setup conditions, and ion chamber.

SAD (cm) 100

Depth (cm) 10
Field Size (cm) 10 x 10
MU 100
Dose Rate (MU/min) 600
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Results:
Table 1. Charge readings for 6MV and 15MV with and without a 45° EDW.
6MV Open EDW 45-IN 15MV Open EDW 45-IN
Rdg 1 (nC) 15.80 12.11 Rdg 1 (nC) 18.00 14.61
Rdg 2 (nC) 15.81 12.12 Rdg 2 (nC) 17.99 14.61
Rdg 3 (nC) 15.81 12.12 Rdg 3 (nC) 18.00 14.60
Avg (nC) 15.81 12.12 Avg (nC) 18.00 14.61

Figure 3. 45° EDW factor calculation for 6MV and 15MV

12.12 𝑛𝐶 14.61 𝑛𝐶
𝑊𝐹(6𝑀𝑉,45° 𝐸𝐷𝑊) = 15.81 𝑛𝐶 = 0.767 𝑊𝐹(15𝑀𝑉,45° 𝐸𝐷𝑊) = 18.00 𝑛𝐶 = 0.812

Discussion: The wedge factors measured for the 45 degree dynamic wedge for 6MV and 15MV
were 0.767 and 0.812 respectively. This data represents a transmission of 76.7% and
corresponding attenuation of 23.3% of a 6MV photon beam at the central axis, and a
transmission of 81.2% and corresponding attenuation of 18.8% of a 15MV photon beam at the
central axis. The higher energy spectrum of the 15MV beam means that fewer photons are
attenuated and a greater number are transmitted as seen in the difference between the 6MV and
15MV wedge factor. For dynamic wedges, though we talk about them in the same terms as
physical wedges, we are not actually measuring the transmission or attenuation of the beam
through the moving jaw. Instead we are measuring a factor that relates to the dosimetric
equivalent fluence to a traditional physical wedge.3 This fact however does not make it any less
important to the calculation of MU as wedge factors in particular can cause significant change,
and resulting errors dramatically overdose or under-dose a patient.

Clinical Application: A case that I have planned clinically using wedges was a left posterior rib
that was treated palliatively to 2000cGy in 5 fractions of 400cGy per fraction. The anatomical
location of the tumor was best treated with a wedged pair technique that involves two orthogonal
beams with symmetrically oriented wedges, the heels toward each other, Figure 8. This
technique uses the wedges to compensate for the overlapping entrance dose of each of the beams
making a more homogenous dose distribution, Figure 10. For this patient 15MV photons and 45
degree EDW provided the best treatment plan. In order to show the clinical significance of the
wedge factor I will perform MU calculations both with and without the inclusion of this factor
and show the percent difference between them.
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Figure 4. Formula for calculating treatment MU.

𝐷 × 𝑏𝑒𝑎𝑚 𝑤𝑒𝑖𝑔ℎ𝑡
𝑀𝑈 =
𝐷𝑟𝑒𝑓 × 𝑆𝑐 × 𝑆𝑝 × 𝑇𝑀𝑅 × 𝑾𝑭
Note: There is no inverse square factor because the output at my facility is calibrated isocentrically which would
reduce the factor to 1.000.4

Figure 5. MU calculation with a wedge.

400𝑐𝐺𝑦 × 0.482
𝑀𝑈𝐿𝑃𝑂 132 = = 260 𝑀𝑈
1𝑐𝐺𝑦/𝑀𝑈 × 1.001 × 1.001 × 0.911 × 𝟎. 𝟖𝟏𝟐
400𝑐𝐺𝑦 × 0.518
𝑀𝑈𝑅𝑃𝑂 222 = = 280 𝑀𝑈
1𝑐𝐺𝑦/𝑀𝑈 × 0.998 × 0.999 × 0.915 × 𝟎. 𝟖𝟏𝟐

Figure 6. MU calculation without a wedge.

400𝑐𝐺𝑦 × 0.482
𝑀𝑈𝐿𝑃𝑂 132 = = 211 𝑀𝑈
1𝑐𝐺𝑦/𝑀𝑈 × 1.001 × 1.001 × 0.911
400𝑐𝐺𝑦 × 0.518
𝑀𝑈𝑅𝑃𝑂 222 = = 227 𝑀𝑈
1𝑐𝐺𝑦/𝑀𝑈 × 0.998 × 0.999 × 0.915

The impact of this difference is that the patient would be overdosed by approximately 23% from
each field if the planned wedge were to be omitted from the treatment delivery. This can be
attributed to the wedge as all other factors remain the same between calculations.

Figure 7. The percent difference between MU calculations

𝑊𝑒𝑑𝑔𝑒 𝑀𝑈
%𝑑𝑖𝑓𝑓(𝑤𝑖𝑡ℎ𝑜𝑢𝑡 𝑤𝑒𝑑𝑔𝑒) = ( )−1
𝑂𝑝𝑒𝑛 𝑀𝑈

260 𝑀𝑈
%𝑑𝑖𝑓𝑓𝐿𝑃𝑂 132 = ( ) − 1 = 23.2%
211 𝑀𝑈
280 𝑀𝑈
%𝑑𝑖𝑓𝑓𝑅𝑃𝑂 222 = ( ) − 1 = 23.3%
227 𝑀𝑈
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Figure 8. Axial view of isodose lines for a wedged pair technique in a patient.

Figure 9. Axial view of isodose lines without wedges in a patient.

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Figure 10. Axial view of isodose lines for wedged and non-wedged fields in a water phantom.

Conclusion: The use of wedges in treatment fields can be very beneficial to achieving the
desired dosimetric results. As a dosimetry student I am still exploring all the ways that they can
be utilized to achieve the optimal treatment plan. In this clinical example they provide a way to
get a more homogenous dose distribution without using parallel opposed fields. This is helpful in
order to spare additional entrance dose to critical structures when treating a peripheral tumor.
The use of dynamic wedges in particular can be more convenient as it offers more wedge angles
and during treatment delivery no physical device needs to be added to a treatment field. As
demonstrated the inclusion of a wedge factor during monitor unit calculation and the use of the
planned wedge during treatment have significant impact. These errors could result in a
significant under-dose to the target or a potentially fatal overdose to the patient respectively.
Understanding these factors, and their relationship to dose calculations and what is happening in
the treatment room, is imperative to being a medical dosimetrist.
References:
1. Armstrong J, Washington CM. Photon dosimetry concepts and calculations. In: Washington
CM, Leaver D, eds. Principles and Practice of Radiation Therapy. 4th ed. St Louis, MO:
Elsevier-Mosby; 2016:480-512.
2. Gibbons JP, Antolak JA, Followill DS, et al. Monitor unit calculations for external photon
and electron beams: Report of the AAPM Therapy Physics Committee Task Group No. 71.
Med Phys. 2014;41(3):031501-1-031501-34. http://dx.doi.org/10.1118/1.4864244
3. Chang SX, Gibbons JP. Clinical implementation of non-physical wedges. Refresher course
presented at: 41st Annual Meeting of the American Association of Physicists in Medicine
(AAPM); July 25-29, 1999; Nashville, TN.
4. Abing C. Introduction to Dose Calculations; Week Four: SAD Calculation Techniques.
[SoftChalk]. La Crosse, WI: UW-L Medical Dosimetry Program; 2018.