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Overview
An introduction to enhanced dynamic
wedges (EDWs)
Comparing EDWs to physical wedges
why bother switching?
EDW dosimetry
Using RadCalc and Pinnacle to perform
calculations
EDW introduction
What is a wedge?
A wedge is a device used to modify how
radiation is delivered to the patient
Wedges make one side of the beam deliver
more radiation than the other
Wedges are used when there is less tissue
on one side of the beam (breast, neck) or a
patient is treated with two beams that are
tilted towards each other
Physical wedge
EDW properties
Maximum field size: X=40 cm, Y=30 cm
for all wedge angles
Allowed wedge angles: 10, 15, 20, 25,
30, 45, and 60
Either Y jaw can move across the field to
create a wedge, but it can only go 10 cm
past the center (this is why the maximum Y
size is 30 cm)
EDW example
Y1
Y1
Y1
Y1
Y2
Y2
Y2
Y2
MU = 0
100
125
150
EDW screenshots
EDW delivery
EDW delivery
EDW delivery
Advantages of EDWs
Therapists will not have to walk into the
treatment room to add or change wedges
Management will make more money, as
more efficient treatments mean more
patients per day
Dosimetrists will be able to choose more
wedge angles with larger field sizes to
produce better plans
Disadvantages of EDWs
Wedges can only be delivered by the Y
jaws, which is perpendicular to the MLC
Field in field or physical wedge techniques
work best with breast treatments
Disadvantages of EDWs
Surface doses are ~2% higher than open
fields, and ~10% higher than physical
wedges
Using a dynamic treatment means that
breathing or other patient motion may alter
dose
EDW dosimetry
60 wedges, 10 cm depth
EDW statistics
Partial treatments
EDW calculations
RadCalc introduction
RadCalc will completely replace the in-house MU
check programs developed by John McGary and
David Bellezza
Plans are transferred from Pinnacle to RadCalc in
one click
Any mistake made in Pinnacle will be made in
RadCalc due to its automatic transmission
RadCalc keeps an electronic database of all MU
calculations
RadCalc screenshot
2% - Machine calibration
2% - Pinnacle calculations
2% - Patient setup errors
2% - Intrafractional motion
3% - Machine daily output fluctuations
3% - Interfractional motion
Average tumor dose uncertainty over the course of
a full treatment 5% (???)
Conclusions
EDWs have a wide range of advantages
over physical wedges
MU checks must change to RadCalc
Patients will receive better, faster treatments
and less total body dose with EDWs
The End