1 Spencer Arnould DOS 522 Dose Calculations Attenuation Project 30-Degree Wedge 2/14/2013

Objective: The objective of this assignment is to determine the transmission factor for a 30degree wedge used in radiation treatment. I want to demonstrate how this factor is incorporated into a real monitor unit calculation. Purpose: For radiation treatment planning, there are many different things that can be incorporated into a monitor unit calculation. These objects (wedges, trays, blocks) are usually put in front of the beam as it moves towards the patient. As the radiation passes through the object, it attenuates the beam and causes less radiation to be acquired at the target. When looking at this type of wedge, we have to understand how and why this object is shaped the way it is. It is also particularly important in dose calculations because of the distribution across the entire plane of the wedge.1 This concept is most commonly described as thinner in some parts, and thicker in others (See image 1). For oblique fields, these wedges are very helpful in compensating for a missing wedge of tissue, which accounts for the curved surface.2 When using an object like this in a monitor unit calculation, we must account for a certain attenuation factor in order to get an adequate dose to the tumor. Image 1: 30-Degree Wedge

2 The formula for Transmission Factor (TF), is defined as a factor that expresses the ratio of the dose rate on the central axis with and without wedge being used.1 TF of the Wedge = Dose with wedge being used Dose without the wedge being used Method and Materials: Throughout this type of research, the data was gathered on a Varian 600CD linear accelerator. This machine produces a single energy of 6 megavoltage (MV) and cannot treat with any higher beam or electron energy. The data we compiled was from setting a 10x10 centimeter (cm) field size at 90 source-to-skin distance (SSD), and using 200 monitor units (MU) with a dose rate of 600 MU per minute. We delivered this dose into a Solid Water phantom at a depth of 10cm. An A12 thimble ion chamber was placed into the sleeve of the solid water block at this depth and also connected to an electrometer to measure charge (See image 2). We ran these tests three different times with and without the wedge placement to obtain an average measurement of the results. Image 2: Solid Water Blocks with A12 Thimble Ion Chamber

3 Table 1: These are the Readings Taken With and Without the 30-Degree Wedge Energy 6MV Readings Without Wedge 15.653 nC 15.649 nC 15.651 nC TOTAL AVERAGE 46.954 nC 15.651nC Readings With Wedge 8.745 nC 8.732 nC 8.755 nC 26.232 nC 8.744 nC

Table 2: This table calculates the transmission factor of the 30-degree wedge. Energy Readings With Wedge Readings Without Wedge 6MV 8.744 nC 15.651 nC = .558 Transmission Factor

Data Results: The results of the testing are shown in table 1 and table 2. The resulting transmission factor for a 30-degree wedge used on this machine is 0.588. This transmission factor is calculated to attenuate about 44% of the 6MV beam when it passes through the central axis of the wedge. These results that I have obtained appear to be reasonable since the 30 degree wedge (larger) progressively attenuates the beam across the entire field, which causes there to be less dose rate at the central axis.1 Application: Source to Axis Distance (SAD) right breast radiation treatment. The prescribed dose to this site was 2.67 Gray (Gy) per day for 16 treatments. This prescription was also written to the 100 percent isodose line and calculated with different beam weight. The medial field was given a weight of 1, while the lateral wedged field was given .93. This caused the medial field to give 1.383 Gy, and the lateral wedged field to give 1.287 Gy.

4 Monitor Unit Demonstration:

5 As you can see throughout these calculations, there is a large difference in the amount of monitor units delivered with the wedge and without the wedge. The difference in monitor units is indicated by a 44.2 % increase for the beam to get enough radiation dose through the central line of the wedge. Image 3: Right Breast Treatment Plan Indicating the WF used. This treatment plan indicates the different factors used in obtaining accurate dose readout. The wedge factor is clearly indicated and used for the lateral field.

6 Image 4: Example of the different treatment fields for 2 field right breast.

The lateral treatment field is shown on the right of Image 4, and you can easily see the 30 degree wedge applied into the field. Conclusion: Throughout this research I have attained a complete understanding towards the effects of using different attenuation factors and applying them to clinical use. Whether its a wedge, block, tray, or even compensators, these objects will always need to be additionally factored in towards getting accurate dose readout. This specific 30-degree wedge not only affects where the radiation is pushing through the field, but also how many monitor units it takes to account for the beam attenuation it takes up when treating the patient. I think that this project allowed us to fully establish and follow through an entire treatment case with regards to how attenuation factors can change the outcome of radiation.

7 References 1. Bentel GC. Dose determination for external beams. In: Bentel GC, ed. Radiation Therapy Planning. 2nd ed. United States: McGraw-Hill; 1996: 32-58. 2. Khan FM. Treatment planning II: Patient data, corrections, and set-up. In: Khan FM, ed. The Physics of Radiation Therapy. 3rd ed. Philadelphia, PA: Lippencott WilliamsWilkins; 228-271.