May 1

Michael May

March 10th, 2017

Attenuation Factor Calculation

Calculation of a Hard Wedge Attenuation Factor

Objective: The goal of this exercise is to measure the attenuation factor of a 60
degree hard wedge and use that factor in a monitor unit calculation using real
patient data.

Purpose: When considering monitor unit calculations, it is important to remember

that anything placed in the path of the beam will affect the dose that reaches the
patient. Hard wedges are a device that is intentionally placed in the path of the
primary beam. Because of its properties, and how it can effect isodose distribution,
it allows the dosimetrist to move dose, reduce hot spots, and compensate for
anatomical changes to name a few. A wedge angle has nothing to do with the
physical appearance of the wedge but actually corresponds to the angle of the
isodose curve created at the central axis in tissue. By placing this device in the
field, an increase in monitor units needs to be delivered in order to maintain the
desired dose. By using the wedge factor, another name for the attenuation factor of
a wedge, we can easily calculate the new monitor unit value that needs to be
delivered when the wedge is placed in the path of the beam. The wedge factor
formula is:

Dos e withthe wedge

WF=
Dose without the wedge

It is important to note that when a wedge is placed, it is always going to require an

increase in monitor units in order to deliver the same dose.

Methods and Materials: Measurements were taken using a Varian Truebeam

model linear accelerator with an 18MV energy. The dose was measured by a TPW
TN300130 ion chamber and a Keithley 35040 electrometer both ADCL calibrated by
MD Anderson. Per the TG-51 protocol, all measuring devices should be calibrated
by an ADCL accredited lab in order to ensure consistency from one center to
another.1 The Keithley electrometer was set to deliver 300 volts to the ion chamber.
The ion chamber was placed inside blue water blocks which are plastic blocks that
simulate water for measurement. We placed 4 cm of blue water above the
chamber, the ion chamber was inserted into a 1 cm block and then 5cm of blue
water was placed below the chamber in order to account for backscatter. At the
treatment console, we set a dose rate of 400MU/min and 100MU to be delivered. It
is important to note that a 10 x 10 field size and 100cm SSD was set. This means
that 100MU should equal 100cGy @ Dmax. The 100MU was delivered and
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measured three times. A 60 degree wedge was then inserted with the heel in the
270 degree collimator direction to start with. This is important because we want the
thickness of the wedge to be consistent across the entire length of the ion chamber.
Three measurements were taken and then the wedge was flipped so the heel is in
the 90 degree collimator direction. The reason for doing measurements with the
wedge flipped is to average out the results in case the ion chamber is not perfectly
centered under the wedge. Nothing else was changed and three more
measurements were taken. It is important to take at least three measurements as it
is more statistically accurate.
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Image 1: Blue Water blocks with ion chamber inserted

Image 2: PTW TN30013 ion chamber

Results:

No Wedge 60 degree wedge 60 degree wedge

with heel @270 with heel @90
degree degree
Test 1 -15.728 nC -6.688 nC -6.706 nC
Test 2 -15.727 nC -6.688 nC -6.707 nC
Test 3 -15.732 nC -6.687 nC -6.707 nC
Avg. -15.729 nC -6.688 nc -6.707 nC
Table 1: Measurements taken in nanocoulombs. Averages of the three
measurements given in the bottom row.

The average of the two wedged fields is calculated by:

6.688+6.707
avg .= =6.698
2
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The wedge factor for a 60 degree beam using 18 MV can then be calculated using
the formula presented earlier:

6.698
WF= =.426
15.729

Discussion: As mentioned earlier, we are always going to need an increase in

monitor units when a wedge is placed in the field. This factor of .426 means that
when a 60 degree wedge is placed in the path of the beam, 42.6% of that beam will
get to the target. Another way to consider this value is that in order to deliver the
same dose with a 60 degree wedge as without, you would have to deliver more than
double the MUs. This makes sense because we are using a wedge to either control
hotspots by moving them elsewhere or to account for uneven body contours. A 60
degree wedge being the most extreme wedge used.

Clinical application: A 3 field sacroiliac was recently planned in clinic. A

prescription of 300 cGy x 10 fxs was prescribed. A field weighting of .226 was used
on the right lateral field. How many MUs will need to be delivered for this field?
The field size is 14.7cm x 14.9cm and the SSD is 82.6cm. We will use the general
formula from the Kahn textbook.2
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. Image 3: Plan document showing prescription, energy, SSD and field size
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Image 4: Hand calc performed using wedge factor measured

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Image 5: Hand calc performed without wedge factor, % difference

What this data shows is that if the wedge was used without monitor unit correction,
the patient would be grossly under dosed for a treatment. Conversely, if the plan
was setup for the wedge and it was forgotten, the patient could be grossly
overdosed by more than double.

Conclusion: Wedges are a great tool that treatment planners can use to adjust the
isodose distribution in a way that benefits the patient most. It is important to
consider the increased MUs required when using a hard wedge though.
Misadministration could be very costly if a wedge is not planned for properly or
planned and forgotten. This project has helped me understand how drastic a
change could be by using a wedge and the importance of understanding and using
transmission factors.
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References

1. Almond P, Biggs P, Coursey BM, Hanson WF, Huq MS,Nath R, Rogers DW.
AAPMs TG-51 protocol for clinical reference dosimetry of high-energy
photon and electron beams. Med. Phys. 1999;26(9):1847-1870.
2. Kahn F, Gibbons J. Khans The Physics of Radiation Therapy. 5th Ed.
Philadelphia, PA: Lippincott, Williams & Wilkins; 2014.