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Aubrie Rice
Attenuation Project

Wedge Factor for a 20 Enhanced Dynamic Wedge (EDW)

Objective
To determine the wedge factor of a 20 degree enhanced dynamic wedge (EDW) and to apply this factor in
a monitor unit hand calculation for an actual patient plan.
Purpose
A radiation therapy linear accelerator is calibrated to have a certain output (cGy/MU) at a specified depth
(usually d-max) and field size. When an object is placed within the path of the beam, scattering and
absorption take place which is defined as attenuation. 1 This attenuation changes the resulting output of the
beam and it must be accounted for when calculating monitor units to deliver a prescribed dose. In order to
account for this attenuation, radiation therapy departments calculate factors for the objects that will be
placed within the path of the beam and measure these along the central axis of the beam. 2 In this specific
case, a wedge factor (denoted WF) is determined for an EDW. The following formula 2 is used to calculate
wedge factors:
WF = Dose at depth d with wedge
Dose at depth d without wedge
Unlike a physical wedge that is physically placed in the path of the beam by a radiation therapist, an
EDW is not physically placed in the beam path. Rather, it creates a wedged isodose distribution by the
sweeping action of the jaw from open to closed. The dose rate and jaw speed vary during the closing of
the jaw as a function of the energy, field size and wedge angle chosen. 3 As Saminathan et al3 found in
their study, an EDW wedge factor will decrease with increasing field size and increase with increasing
energy.
Methods and Materials
A Varian TrueBeam linear accelerator was used to perform data measurements. A Sun Nuclear PC
Electrometer (Image 1) was connected to a farmer-type ionization chamber (Image 2) to create a bias
voltage of 300 V. The ionization chamber was placed inside a predesigned cutout and aligned to the
central axis using the light field. Twenty centimeters of solid water was placed beneath the ionization
chamber and 2 centimeters of solid water was placed above the chamber for buildup (Image 3). A 100
SSD setup was used.
Since the wedge factor for an EDW is dependent on both energy and field size as mentioned in the study 3
above, the field size and energy for the patient plan of interest was used in determining the WF.2 An
energy of 6 MV was used with a 7 cm by 7 cm field size. Two readings were taken for each of the
following scenarios: with a 20 degree EDW and without an EDW. One hundred monitor units were
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delivered for each of the four readings. An average of the two readings for each scenario was then taken
and used to calculate the wedge factor.
Image 1: PC Electrometer

Image 2: Farmer chamber

Image 3: Full setup including solid water and farmer chamber

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Results:
Table 1: Readings taken with and without a 20 degree EDW for a 7 cm by 7 cm field size along with the
average of the two readings.
Energy With 20 EDW for 7 x 7 FS (nC) Open field for 7 x 7 FS (nC)
6 MV -16.518 Average: -17.666 Average:
-16.517 -16.5175 -17.671 -17.669

The wedge factor was then calculated using the formula listed in the purpose section:
WF = -16.5175
-17.669
WF = 0.935
Discussion
The calculated wedge factor for a 6 MV beam at a 7 cm by 7 cm field size for a 20 degree EDW was
0.935. This factor is a representation of how much of the beam was attenuated by the dynamic wedge.
This factor demonstrates that the 20 degree EDW attenuated 6.5% of the beam. This percentage would
increase with larger field sizes and decrease with higher energies.
Clinical Application
The following patient example (Image 4a and 4b) is of an AP/PA spine case. A total of 400 cGy per day
were delivered with a weight of .58 (AP) and .42 (PA). An energy of 6 MV was used. The AP field size
was a 7 cm by 7 cm and involved a 20 degree EDW. The plan was normalized to the 95% isodose line.
The monitor unit hand calculation for the AP field is shown below with the wedge factor (Image 5a) that
was calculated in the results section. Also included is a monitor unit hand calculation excluding the wedge
factor (Image 5b) and the calculated percent different between the two (Image 5c). Scatter factors and
TPRs were obtained from The James Cancer Hospitals photon data book.
Image 4a: Treatment plan for AP/PA spine
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Image 4b: Sagittal view of treatment plan showing EDW from AP beam

Image 5a: Monitor unit calculation for the AP field with the wedge factor

Image 5b: Monitor unit calculation without the wedge factor

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Image 5c: Calculated percent difference between with and without wedge factor calculations

The monitor unit calculation with the wedge factor determined 308 monitor units while the calculation
excluding the wedge factor determined 288 monitor units. The percent difference between these two
calculations is 6.5% (image 5c). The difference between the calculation including the wedge factor and
the treatment plan is 13 MU (a 4.4% difference). This difference is due to the fact that the treatment
planning system is accounting for tissue inhomogeneity. To get a more accurate hand calculation, I would
need to use an equivalent path length. In the megavoltage range where Compton effect is predominant,
attenuation of the beam is governed by electron density. An effective depth can then be used to calculate
transmission through non-water equivalent tissues such as lung, fat muscle and bone. 4 An effective depth
can be determined by the following equation4:
Effective depth = depth1 + depth2(density)
In this equation, depth1 is the water equivalent depth and depth2 is the non-water equivalent depth. Using
measurements from the example patient CT, I calculated the effective depth using the approximate
densities of both lung (0.30 g/cc) and bone (1.5 g/cc). 4
Effective depth = 0.5cm (1.5g/cc) + 2.5cm (0.3g/cc) + 4 cm = 5.5 cm
I then used this equivalent depth to do another monitor unit calculation for the AP beam (Image 6a, 6b,
and 6c).

Image 6a: Monitor unit calculation using equivalent depth with wedge factor.
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Image 6b: Monitor unit calculation using equivalent depth without the wedge factor.

Image 6c: Calculated percent difference between with and without wedge factor calculations using
equivalent depth.

The calculated percent difference between the monitor unit hand calculations with and without the wedge
factors using equivalent path length was 6.5% This percent difference would mean a 6.5% overdose if the
field was calculated for a wedge but the wedge was not applied to the field and also a 6.5% underdose if
the patient was calculated without a wedge but treated with the wedge applied to the field. In this case,
since we have an EDW and not a physical wedge, a fault like this is much less likely to happen. But if for
some reason the machine faulted and the jaw did not sweep when a wedge was planned or did sweep
when a wedge was not planned, the resulting dose for each of those scenarios is calculated below for the
example patient (Image 6d).

Image 6d:
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Conclusion
These example calculations show the importance of correcting for attenuation in patient plans and
applying this factor in these calculations. With a physical wedge for example, not accounting for it in a
monitor unit calculation but using it in the patients treatment could lead to an underdose. If the opposite
were to happen and a wedge was left out of the field when calculated for, this would lead to an overdose.
These hand calculations are important to know as future medical dosimetrists, not only so we can perform
monitor unit second checks, but also so we know how to calculate the dose received if a situation like this
were to happen.
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References
1. McDermott PN, Orton CG. X-ray production II: basic physics and properties of resulting x-rays.
The Physics & Technology of Radiation Therapy. Madison, WI: Medical Physics Publishing;
2010:Chapter 5.
2. McDermott PN, Orton CG. Dose distributions in two and three field dimensions. The Physics &
Technology of Radiation Therapy. Madison, WI: Medical Physics Publishing; 2010:Chapter 14.
3. Saminathan S, Manickam R, Supe SS. Comparison of dosimetric characteristics of physical and
enhanced dynamic wedges. Rep Pract Oncol Radiother. 2011;17(1):4-12.
4. Eiler D. Tissue inhomogeneities. Lecture Presented: Columbus, OH: OSU Radiation Therapy
Program; 2016.