Search

Background: Widely used physical wedges in clinical radiotherapy lead to beam intensity attenuation as well as the beam hardening effect, which must be considered. Dynamic wedges devised to overcome the physical wedges (PWs) problems result in dosimetry complications due to jaw movement while the beam is on. This study was aimed to investigate the usability of physical wedge data instead of enhanced dynamic wedge due to the enhanced dynamic wedge (EDW) dosimetry measurement hardships of Varian 2100CD in inhomogeneous phantom by Monte Carlo code as a reliable method in radiation dosimetry. Materials and methods: A PW and EDW-equipped-linac head was simulated using BEAMnrc code. DOSXYZnrc was used for three-dimensional dosimetry calculation in the CIRS phantom. Results: Based on the isodose curves, EDW generated a less scattered as well as lower penumbra width compared to the PW. The depth dose variations of PWs and EDWs were more in soft tissue than the lung tissue. Beam profiles of PW and EDW indicated good coincidence in all points, except for the heel area. Conclusion: Results demonstrated that it is possible to apply PW data instead of EDW due to the dosimetry and commissioning hardships caused by EDW in inhomogeneous media.

Aim of Study: Physical wedges (PWs) are widely used in radiotherapy to obtain tilted isodose curves, but they alter beam quality. Dynamic wedges (DWs) using moving collimator overcome this problem, but measuring their beam data is not simple. The main aim of this study is to obtain all dosimetric parameters of DWs produced by Varian 2100CD with Monte Carlo simulation and compare them to those from PWs. Subjects and Methods: To simulate 6 MV photon beams equipped with PW and DW, BEAMnrc code was used. All dosimetric data were obtained with EDR2 films and two-dimensional diode array detector. Results: Good agreement between simulated and measured dosimetric data for PW and DW fields was obtained. Our results showed that percentage depth dose and beam profiles at nonwedged direction for DWs are the same as open fields and can be used to each other. Conclusion: From Monte Carlo simulations, it can be concluded that DWs in spite of PW do not have effect on beam quality and are good options for treatment planning system which cannot consider hardening effect produced by PWs. Furthermore, BEAMnrc is a powerful code to acquire all date required by DWs.

Background: Across the history of radiotherapy, wedges are generally used to modify the shape of isodose lines to achieve desired clinical dose coverage to the target and to reduce the hot spot as well. Aim: The main aim of this study was to analyse and compare the dosimetric properties of Varian’s physical and enhanced dynamic wedges, and their dosimetric impact on radiotherapy plan (3D-Conformal). Materials and Methods: All plans were generated and evaluated in Varian’s eclipse planning system. For comparing the isodose line alteration, the plans were prepared in water phantom with field of size 10 cmx 10 cm. Wedges of angle 15°, 30°, 45° and 60° were used for generating isodose lines in the current study. All wedge factors were measured in water phantom using FC65 farmer type chamber. Discussion: In the current study, the dosimetric characteristics of EDW and PW were analyzed and compared. For analyzing the impact of EDW and PW, 22 patients were taken into consideration, and 50 Gy dose was prescribed to PTV in 25 fractions. Conclusion: The analysis of EDW and PW shows slightly different dosimetric features. EDW gives better target’s coverage, less hyper dose and comparatively less MUs as compare to PW. Hence the use EDW in 3D-conformal radiotherapy plan is a prudent practice.

Dose inhomogeneity in treatment planning can be compensated using physical wedges. Enhanced dynamic wedges (EDW) were introduced by Varian to overcome some of the shortcomings of physical wedges. The objectives of this study were to measure EDW output factors for 6 MV and 20 MV photon energies for a Varian 2300CD. Secondly, to review the literature in terms of published enhanced dynamic wedge output factors (EDWOF) for different Varian models and thereby add credence to the case of the validity of reference databases. The enhanced dynamic wedge output factors were measured for the Varian 2300CD for both 6 MV and 20 MV photon energies. Twelve papers with published EDWOF for different Varian linac models were found in the literature. Comparing our results with the published mean, we found an excellent agreement for 6 MV EDWOF, with the percentage differences ranging from 0.01% to 0.57%, with a mean of 0.03%. The coefficient of variation of published EDWOF ranged from 0.17% to 0.85% and 0.1% to 0.9% for the for 6 MV and 18 MV photon energies, respectively. This paper provides the first published EDWOF for 20 MV photon energy. In addition, we have provided the first compendium of EDWOFs for different Varian linac models. The consistency of value across models and institution provide further support that a standard dataset of basic photon and electron dosimetry could be established as a guide for future commissioning, beam modeling, and quality assurance purposes. PACS numbers: 87.50, 87.55

The purpose of this work was to study the dosimetric properties of the enhanced dynamic wedge using a Seven29 ion chamber array. The PTW Seven29 ion chamber array and solid water phantoms were used for the study. Primarily, the solid water phantoms with the two-dimensional (2D) array were scanned using a computed tomography scanner at different depths. Using these scanned images, planning was performed for different wedge angles at 6 and 15 MV. A dose of 100 CGy was delivered in each case. For each delivery, the required monitoring units (MUs) were calculated. Using the same setup with a Varian Clinac iX, the calculated MU was delivered for different wedge angles. Subsequently, the different wedged dose distributions that had been obtained were analysed using Verisoft software. A shoulder-like region was observed in the profile; this region reduced as depth increased. The percentage deviation between the planned and measured doses at the shoulder region fell within the range of 0·9–4·3%. The standard deviation between planned and measured doses at shoulder region in the profile fell within 0·08±0·02 at different depths. The standard deviations between planned and measured wedge factors for different depths (2·5, 5, 10 and 15 cm) were 0·0021, 0·0007, 0·0050 and 0·0001 for 6 MV and 0·0024, 0·0191, 0·0013 and 0·0005 for 15 MV, respectively. On the basis of the studies that we performed, it can be concluded that the 2D ion chamber array is a good tool for enhanced dynamic wedge dosimetry.

Junctions of fields are known to be susceptible to developing cold or hot spots in the presence of even small geometrical misalignments. Reduction of these dose inhomogeneities can be accomplished through decreasing the dose gradients in the penumbra, but currently it cannot be done for enhanced dynamic wedges (EDW). An MLC‐based penumbra softener was developed in the developer mode of TrueBeam linacs to reduce dose gradients across the side border of EDWs. The movement of each leaf was individually synchronized with the movement of the dynamic Y jaw to soften the penumbra in the same manner along the entire field border, in spite of the presence of the dose gradient of the EDW. Junction homogeneity upon field misalignment for side‐matched EDWs was examined with the MV imager. The fluence inhomogeneities were reduced from about 30% per mm of shift of the field borders for the conventional EDW to about 2% per mm for the softened‐penumbra plan. The junction in a four‐field monoisocentric breast plan delivered to the Rando phantom was assessed with film. The dose inhomogeneities across the junction in the superior‐inferior direction were reduced from about 20% to 25% per mm for the conventional fields to about 5% per mm. The dose near the softened junction of the breast plan with no shifts did not deviate from the conventional plan by more than about 4%. The newly‐developed softened‐penumbra junction of EDW (and/or open) fields was shown to reduce sensitivity to misalignments without increasing complexity of the planning or delivery. This methodology needs to be adopted by the manufacturers for clinical use.

Intensity Modulated Radiotherapy (IMRT) is increasing its use r ecently due to its benefits of minimizing the dose on surrounding normal organs and being able to target a hi gh dose specifically to the tumor. The study aims to measure and evaluate the dose distribution according to its dynamic changes in Mapcheck.In order to verify the dose distribution by EDW angle(10 ˚,15˚,20˚,25˚,30˚,45˚,60˚), field size (asymmetric field) and depth changes (1.5 cm, 5.0 cm)using IMRT in Clinac i x, a solid phantom was placed on the Mapcheck and 100MU was exposed by 6 MV, 10MV X-ray. Using a 6MV, 10MV energy, the percentage depth dose according to a dynamic changes at a maximum dose depth (1.5 cm) and at 5.0 cm depth showed the value difference of maximum 0.6%, less than 1%, which was calculated by a treatment program device considering the maximum dose depth at the center as 100%, the percentage de pth dose was in the range between 2.4% and 7.2%. Also, the maximum value difference of a percentage de pth dose was 4.1% in Y2-OUT direction, and 1.7% in Y1-IN direction. When treating a patient using a wedge, it is considered that using an enhanced dynamic wedge is effective to reduce the scattered dose which i nduces unnecessary dose to the surroundings. In particular, when treating a patient at clinic, a treatment m ust be performed considering that the wedge dose in a toe direction is higher than the dose in a heel direction.

The purpose of this work is to study dose non-linearity in medical linear accelerators used in conventional radiotherapy and intensity-modulated radiation therapy. Open fields, as well as the enhanced dynamic wedge ones, were used to collect data for 6 MV and 15 MV photon beams obtained from the VARIAN linear accelerator. Beam stability was checked and confirmed for different dose rates, energies, and application of enhanced dynamic wedge by calculating the charge per monitor unit. Monitor unit error was calculated by the two-exposure method for open and enhanced dynamic wedge beams of 6 MV and 15 MV photons. A significant monitor unit error with maximum values of ±2.05931 monitor unit and ±2.44787 monitor unit for open and enhanced dynamic wedge beams, respectively, both energy and dose rate dependent, was observed both in the open photon beam and enhanced dynamic wedge fields. However, it exhibited certain irregular patterns at enhanced dynamic wedge angles. Dose monitor unit error exists only because of the overshoot phenomena and electronic delay in dose coincident and integrated circuits with a dependency on the dose rate and photon energy. Monitor unit errors are independent of the application of enhanced dynamic wedge. The existence of monitor unit error demands that the dose non-linearity of the linear accelerator dosimetry system be periodically tested, so as to avoid significant dosimetric errors.

Introduction. Enhanced dynamic wedges (EDW) are known to increase drastically the radiation therapy treatment efficiency. This paper has the aim to compare linear array measurements of EDW with the calculations of treatment planning system (TPS) and the electronic portal imaging device (EPID) for 15 MV photon energy. Materials and methods. The range of different field sizes and wedge angles (for 15 MV photon beam) were measured by the linear chamber array CA 24 in Blue water phantom. The measurement conditions were applied to the calculations of the commercial treatment planning system XIO CMS v.4.2.0 using convolution algorithm. EPID measurements were done on EPID-focus distance of 100 cm, and beam parameters being the same as for CA24 measurements. Results. Both depth doses and profiles were measured. EDW linear array measurements of profiles to XIO CMS TPS calculation differ around 0.5%. Profiles in non-wedged direction and open field profiles practically do not differ. Percentage depth doses (PDDs) for all EDW measurements show the difference of not more than 0.2%, while the open field PDD is almost the same as EDW PDD. Wedge factors for 60 deg wedge angle were also examined, and the difference is up to 4%. EPID to linear array differs up to 5%. Conclusions. The implementation of EDW in radiation therapy treatments provides clinicians with an effective tool for the conformal radiotherapy treatment planning. If modelling of EDW beam in TPS is done correctly, a very good agreement between measurements and calculation is obtained, but EPID cannot be used for reference measurements.

This work assessed the dosimetric performance of an amorphous silicon electronic portal imaging device (EPID) for measurement and quality assurance of enhanced dynamic wedge (EDW) profile and wedge factor. EPID measurements of EDW profiles were corrected for pixel sensitivity variation and spectral over-response relative to ion chamber and compared to ion-chamber and diode-array measurements. The dependence of EPID measurements on wedge direction and source to EPID distance was assessed. The long-term stability was investigated by weekly measurement of EDW profiles and wedge factors over a seven month interval. An empirical correction method was developed to improve EPID profile agreement with diode-array measurements. The EPID profiles differed from conventional measurements by up to 5%. Backscatter from the EPID housing was also found to affect measurements by up to 4%, resulting in changes in EPID measured profile with the direction of the moving jaw and source to EPID distance. EPID profile measurements varied by a maximum of 0.3% (1 SD) within the umbra, and wedge factors varied by 0.3% (1 SD) over the seven month interval. The correction function improved agreement between EPID and diode array to within 2% for all wedge angles and energies. Due to the ease of use and reproducibility of the EPID-measured EDW profiles the device is highly suited to regular measurement of EDW.

Dynamic wedges have been used in clinical practice for many years. Obvious superiority of dynamic over physical wedges is accompanied by the increased overhead involved in verifying the accuracy and reliability of their use. Contrary to very limited QA required to ensure proper functioning of the physical wedges, dynamic wedges, like any other dynamic treatment, require a robust QA program. This work expands upon previous suggestions and describes a comprehensive QA program for Varian enhanced dynamic wedges (EDWs) and presents the results of an 18‐month evaluation of these wedges. The QA program includes daily, monthly, and yearly tests and individual treatment QA at the onset of use of the EDWs. The results of the 18‐month evaluation show reproducibility in the wedge factors of better than 1% and in dose profiles of better than 2% on a monthly basis. Daily output measurements are generally within 2% of expected values. PACS numbers: 87.53.Xd, 87.56.Fc

The purpose of this study is to describe and evaluate a new analytical model for Varian enhanced dynamic wedge factors at off-center points. The new model was verified by comparing measured and calculated wedge factors for the standard set of wedge angles (i.e., 15 deg., 30 deg., 45 deg. and 60 deg.), different symmetric and asymmetric fields, and two different photon energies. The maximum difference between calculated and measured wedge factors is less than 2%. The average absolute difference is within 1%. The obtained results indicate that the suggested model can be useful for independent dose calculation with enhanced dynamic wedges.

Introduction: Using physical wedges (PWs) to modify dose distribution and more homogeneous target coverage is a well-established technique. However, there are many problems with PWs known as beam hardening, which made them problematic. This can be overcome by dynamic wedges which do not filter beam. Comparison of physical properties of physical and enhanced dynamic wedges (EDWs) restricted to homogeneous medium. Hence, the main aim of this study is to compare dosimetric properties of physical and EDWs at bladder inhomogeneous phantom as a most common case implementing wedges. Materials and Methods: An inhomogeneous pelvic phantom with homogeneities of uterus, femur, soft tissue, rectum, and bladder was designed. Eclipse treatment planning system with the aim of bladder target was used for calculations. All dose distributions were measured with EBT3 films. Results: Comparison between beam profiles of physical and EDWs at wedged and nonwedged directions shows a greater difference at near inhomogeneous soft tissue interface and also at heel side of wedges. Conclusion: Little difference observed between dose distribution of physical and EDWs shows neglectable effect of beam hardening produced by PW compared to EDW at inhomogeneous medium. Furthermore, EBT3 films present good feature to measure dose distributions at EDW fields.

The output factor for an enhanced dynamic wedge (EDW) field, like that for a dynamic wedge field, is a complex function of the field dimension in the wedge direction. The large change in output for different field sizes (varying more than 40% for a 60 degrees wedge angle) is due to rescaling of the golden segmented treatment table (GSTT), which specifies the cumulative monitor unit weighting as a function of moving jaw position. The rescaling of the GSTT results in increased output on the central axis with a decrease in the value of the final moving jaw position in the wedge plane. The output factor (in air or in water) on the central axis of an EDW field can be predicted to within 1% by multiplying the output factor (in air or in water) of an open field of the same size with the ratio of the normalized GSTT (NGSTT) value at 4.5 cm, which corresponds to a 10 cm x 10 cm square field, to the NGSTT value at the final moving jaw position for the EDW field. Once the NGSTT factor is separated from the output for EDW fields, the field-size-dependent wedge factor varies less than 1%. This approach allows a simple and accurate determination of the output factor for rectangular and asymmetric EDW fields. The equivalent square method for determining output for rectangular fields applies to EDW fields with the same precision as it does to open fields. The output for EDW fields strongly depends on the final moving jaw position. Every 5-mm change in the final moving jaw position causes 3.5-5.4% error in monitor unit calculation.

The article discusses how to use the standard utility program on Theraplan to create physical wedges which are equivalent to each of the enhanced dynamic wedges. The user must first create segmented treatment tables for each wedge, using a spreadsheet, and then convert these tables to equivalent thicknesses of an arbitrary wedge material. These thicknesses are then supplied to Theraplan. The paper discusses the agreement achieved between Theraplan and measured data, and the quality assurance procedures which should be adopted.

An EDW field is in principle a sum of fields with different sizes. The Helax TMS 3.1 dose planning system uses pre-existing open beam data and information specific to the geometry of the accelerator treatment head including flattening filter and collimators to generate open fields. These open fields are then summed using the Segmented Treatment Tables (STT) to generate the Enhanced Dynamic Wedge fields. Verification of predicted fields and output factors against measured data are discussed for different wedge angles, asymmetric fields and shaped fields.

Dynamic wedge distributions are produced by closing one jaw continuously while simultaneously controlling dose as each position of the jaw. This method of producing wedge distributions requires more frequent Quality Assurance checks, such as verification of wedge profile, wedge factor and verification of the accuracy of the digital position readout for the jaws used for dynamic wedge. “Hard” wedges require only the verification of wedge factor and the verification of reproducibility of mechanical position in the beam. This paper will discuss methods and equipment used for the Quality Assurance of Enhanced Dynamic Wedges.

This paper investigates the accuracy of the two available calculation algorithms of the Oncentra MasterPlan three‐dimensional treatment planning system (TPS) – the pencil beam method and collapsed‐cone convolution – in modeling the Varian enhanced dynamic wedge (EDW). Measurements were carried out for a dual high energy (6–15 MV) Varian DHX‐S linear accelerator using ionization chambers for beam axis measurements (wedge factors and depth doses), film dosimetry for off‐axis dose profiles measurements, and a diode matrix detector for two dimensional absolute dose distributions. Using both calculation algorithms, different configuration of symmetric and asymmetric fields varying the wedge's angle were tested. Accuracy of the treatment planning system was evaluated in terms of percentage differences between measured and calculated values for wedge factors, depth doses, and profiles. As far as the absolute dose distribution was concerned, the gamma index method (Low et al. (13) ) was used with 3% and 3 mm as acceptance criteria for dose difference and distance‐to‐agreement, respectively. Wedge factors and percentage depth doses were within 1% deviation between calculated and measured values. The comparison of measured and calculated dose profiles shows that the Van Dyk's acceptance criteria (Van Dyk et al. (14) ) are generally met; a disagreement can be noted for large wedge angles and field size limited to the low dose‐low gradient region only. The 2D absolute dose distribution analysis confirms the good accuracy of the two calculation algorithms in modeling the enhanced dynamic wedge. PACS number: 87.53.Bn, 87.55.kn, 87.56.ng

Purpose: A multi-leaf collimator (MLC) based dynamic wedge (MDW), which provide similar dose profile of physical wedge (PW) along x-jaw direction while significant monitor unit (MU) reduction, was developed and investigated for clinical use. Methods: A novel technique was used to create the wedge profile using MLC. A modification was applied to the DICOM-RT format file of the plan made with the PW to replace PW with MDW. The Varian enhanced dynamic wedge profile was used to produce MLC sequence, while the MU of the wedged field was recalculated using PW factor and fluence map. The profiles for all possible MDWs to substitute PWs were verified in 6/15 MV x-ray irradiations. New plans with MDWs were compared with the original plans in 5 rectal, 5 RT breast and 5 liver cases. Results: The wedge profile of the MDW fields were well matched with those of PWs inside the fields while less scatter than PW out of the fields. For plan comparisons of the clinical cases no significant dose discrepancy was observed between MDW plan and PW’s with the dose volume histograms. The maximum and mean doses in PTVs are agreed within 1.0%. The Result of OARs of MDW plans are slightly improved in the maximum doses (3.22 ∼ 150.4 cGy) and the mean doses (17.18 ∼ 85.52 cGy) on average for all cases while the prescribed doses are 45 Gy for rectal cases, 40 or 45 Gy for liver cases and 50 Gy for breast cases. The MUs of the fields which replace PW with MDW are reduced to 68% of those of PW. Conclusion: We developed a novel dynamic wedge technique with MLC that shows clinical advantage compared to PW.

Purpose: To study the dosimetric properties of Enhanced Dynamic Wedge (EDW) using PTW Seven29 ion chamber array Methods: PTW Seven29 ion chamber array and Solid Water phantoms for different depths were used for the study. The study was carried out in Varian Clinac ix with photon energies, 6MV & 15MV. Primarily the solid water phantoms with the 2D array were scanned using a CT scanner (GE Optima 580) at different depths. These scanned images were used for EDW planning in an Eclipse treatment planning system (version 10). Planning was done for different wedge angles and for different depths for 6MV & 15MV. A dose of 100 CGy was delivered in each cases. For each delivery, calculated the Monitoring Unit (MU) required. Same set-up was created before delivering the plans in Varian Clinac-ix. For each clinically relevant depth and for different wedge angles, the same MU was delivered as calculated. Different wedged dose distributions where reconstructed from the measured 2D array data using the in-house developed excel program. Results: It is observed that the shoulder like region in the profile which reduces as depth increases. For the same depth and energy, the percentage difference between planned and measured dose is lesser than 3%. For smaller wedge angles, the percentage difference is found to be greater than 3% for the largest wedge angle. Standard deviation between measured doses at shoulder region for planned and measured profiles is 0.08 and 0.02 respectively. Standard deviations between planned and measured wedge factors for different depths (2.5cm, 5cm, 10cm, and 15cm) are (0.0021, 0.0007, 0.0050, 0.0001) for 6MV and (0.0024, 0.0191, 0.0013, 0.0005) for 15MV respectively. Conclusion: The 2D Seven29 ion chamber array is a good tool for the Enhanced Dynamic Wedge (EDW) dosimetry.

Use of an enhanced dynamic wedge (EDW) changes the size of the irradiation field in real time because of the shift of the flexible aperture during irradiation. Therefore, when EDW is used, it is speculated that the scatter factors proposed by Khan et al. may differ from that obtained in an open irradiation field. The aim of the present study was to investigate whether the total scatter factors (S(cp)) can also be separated into the collimator scatter factors (S(c)) and phantom scatter factors (S(p)) when using EDW, and whether S(p) in an irregular irradiation field using EDW and one without the use of EDW can likewise be handled. Results indicated that the values of S(cp) and S(c) in a square or rectangular irradiation field using EDW tended to differ from those in an open irradiation field, whereas S(p) was almost the same, with a slight variation of about 0.5%, indicating that S(cp) could be separated into S(c) and S(p). However, for an irregular irradiation field, the variations in S(p) exceeded 1% in some cases irrespective of the use or non-use of EDW. Depending on the size and geometry of the irradiation field, it was within the range of the degree of uncertainty of 2.5% in the evaluation of output radiation dosage, which was described in AAPM Report 13. Therefore, the theory proposed by Khan et al. was found to be valid also for an irregular irradiation field using EDW, which could be handled in the same manner as in the irregular irradiation field without using EDW.

Practical aspects of the clinical implementation of enhanced dynamic wedges (EDW) replacing manual wedges are presented and discussed extensively. A comparison between measured and calculated data is also presented. Relative dose distributions and wedge factors were calculated with a commercially available treatment planning system and measured in a water-phantom and with an ionization chamber. Wedge factor calculations and measurements were also compared with an independent method of wedge factor calculations available from the literature. Aspects of the clinical implementation, such as safety and quality assurance, were evaluated. Measurements and calculations agreed very well and were slightly better than results of previous studies. Profiles and percentage depth doses (PDDs) agreed within 1% to 1.5% and within 0.5%, respectively. Measured and calculated wedge factors ratios agreed within 0.5% to 1%. Calculated and measured EDW dose distributions showed excellent agreement, both relative and absolute. However, for safe and practical use, specific aspects need to be taken into consideration. Once the treatment planning system is commissioned properly, the clinical implementation of EDW is rather straightforward.

Purpose: We have evaluated the response of the Gafchromic EBT3 film in low dose for 6 MV x-ray beams with two scanning modes, the reflection scanning mode and the transmission scanning mode. Methods: We irradiated the Gafcromic EBT3 film using a 60 degree enhanced dynamic wedge (EDW) with 6 MV x-ray beams from Clinac iX Linear accelerator (Varian Medical Systems, Palo Alto, CA). The irradiated Gafchromic EBT3 film was scanned with different scanning modes, the reflection scanning mode and the transmission scanning mode. The scanned Gafchromic EBT3 film was analyzed with MATLAB. Results: When 7.2 cGy was irradiated to the Gafchromic EBT3 film, the uncertainty was 0.54 cGy with reflection scanning mode and was 0.88 cGy with transmission scanning mode. When 24 cGy was irradiated to the Gafchromic EBT3 film, the uncertainty was similar to the case of 7.2 cGy irradiation showing 0.51 cGy of uncertainty with reflection scanning mode and 0.87 cGy of uncertainty with transmission scanning mode. The result suggests that the reflection mode should be used in Gafchromic EBT3 film for low irradiation. Conclusion: The result suggests that the reflection mode should be used in Gafchromic EBT3 film for low irradiation.

Purpose: To investigate causes of isocenter shifts in treatment planning and its clinical impact on patient treatment efficiency and safety. Methods/Materials: Treatment planning data of 340 patients under treatment over 8 weeks period were gathered to identify isocenter shifts according to site of the treatment, types of treatment plan or types of the machine used. Treatment plans included inversed and forward IMRT, as well as 3D plans. Treatment sites included pelvis, chest, abdomen, breasts, head and necks and extremities. Re-planning were performed without the isocenter shift for pelvis and chest plans, the dosimetric parameters such as PTV coverage, and dose sparing of OARs of these plans were analyzed and compared. Results/Discussions: Results showed that the isocenter shift was always necessary for some of sites such as breasts, two or more distinctive PTVs, or special cases such as large PTV treated with enhanced dynamic wedge. Many other cases, the re-planning results indicated 53% of the plans that the same quality of the plan can be achieved without the shift of the isocenter. Repositioning patients on a daily basis demanded unambiguous instructions for therapists for patient setups, and additional time to perform the shifts before treatment. Opportunities for error propagation exist during the communication and hand-over of such plans. Conclusion: Isocenter shifts demanded unambiguous instructions and times for therapists for daily patient setups, therefore it impacted both safety and efficiency of the patient treatment. Based on the analysis, the isocenter shifts were unavoidable for cases such as treatment of multiple sites, overcoming limitations of treatment machines, and/or sometime better dosimetry. However, we found many initially proposed shifts may have been eliminated either by careful planning or by improved CT simulation process such as detailed review of the images and localization of the PTV during simulation.

Purpose: The aim of this study was to compare few of the dosimetric characteristics of a physical and enhanced dynamic wedge from a dual energy (6 and 18 MV) linear accelerator.Materials and Methods: This study used the Varian Clinac‐DHX (S.No.3172) linear accelerator which is equipped with three different type of wedges. To compare the change in beam quality with physical and enhanced dynamic wedge half value layer (HVL) was measured using a 0.14 cc ion chamber covered with brass build up cap positioned at 2 meter distance from the source and the distance from the target to absorber distance was maintained as 1 meter. Transmission measurements were made for varying thickness of white polystyrene phantom placed on the couch. The surface dose with physical and enhanced dynamic wedges were measured using a parallel plate chamber at 85 and 100 cm source to surface distance (SSD), for 6 and 18 MV photons.Results: The HVL was estimated for 6 and 18 MV photons along the central axis and at off‐axis points for the field size of 20 × 20 cm2 with 45° upper physical wedge and compared with that of the enhanced dynamic wedge (EDW). For physical wedged field, at heel edge side HVL value was high compared with the measured that of EDW. It was noticed that, the HVL variation across the beam was significantly high for 6 MV X‐rays than for 18 MV X‐rays. The measured surface dose was found to be more at 85 cm FSD for all the fields. The lower energy photons (6 MV) were found to result in higher surface dose than the higher energy photons (18 MV). Conclusion: The three wedge systems produce significantly different surface doses that should be considered in properly choosing a wedge system for clinical use.

Dose uniformity within the treatment volume for tangent breast irradiation can be significantly improved through dynamic compensating collimation using all four independent jaws to define a superposition of sequentially reduced Enhanced dynamic wedge fields. The enhanced dynamic wedge angle is determined which optimizes dose uniformity in the central axis transverse plane, then the sequential reduction of the superior and inferior jaws is determined to optimize the sagittal dose uniformity. This technique could be applied under computer control through a record and verify system.

Measurement of Enhanced Dynamic Wedge parameters requires that the dose at a measurement point be integrated during the entire exposure as the moving jaw closes to form the dose distribution. This major difference from static fields, where dose rate measurements can be made using a single moving probe, requires major modification in measurement techniques to use devices which can measure multiple points within the field simultaneously. Each of these new tools introduce unique problems in dose measurement, which must be understood prior to their use. This paper discusses these tools.

Treatment planning for Enhanced Dynamic Wedge requires a knowledge of the dosimetric parameters of the treatment fields. These dosimetric parameters include depth doses, surface doses, buildup doses, peripheral doses, beam profiles, wedge angles and wedge factors. These parameters and their application to treatment planning are evaluated and compared with standard open field and metal wedge field dosimetric parameters.

Wedged fields are common in three dimensional conformal radiation therapy and require appropriate quality assurance (QA). Currently, our centre calculates the angle of enhanced dynamic wedge (EDW) deliveries with the PROFILER at a monthly frequency but Canadian guidelines on the recommended QA of enhanced dynamic wedges are not available yet. TG-142 recommendations include monthly validation of the central axis wedge factors with only annual verification of wedge profiles. Our monthly QA results have demonstrated a sensitivity of the calculated EDW angle to open beam symmetry. The goal of this work is to compare wedge angle and direct profile comparison as QA measures of EDW delivery and determine appropriate parameter tolerances. The impact of open field symmetry variations on EDW profiles was determined by varying beam symmetry with a test potentiometer and measuring the resulting EDW beam profile with the PROFILER. A calculated wedge angle and direct profile comparison were used to describe the deviations in EDW deliveries. The impact of the deviations on typical plans incorporating wedged fields was evaluated by constructing 'equivalent wedges' to the profile deviations using mixed 60 degree and open field beams and performing plan comparisons in Eclipse. Beam symmetry was observed to have a significant impact on wedge angle for small angle wedges, with a 1% symmetry tolerance allowing a 3.4 degree range of wedge angles for a nominal 10 degree wedge. Direct profile comparison allows a more consistent definition of a dose based tolerance range to be applied without angle dependent tolerances.

Purpose: The goal is to demonstrate mathematically and experimentally an efficient Enhanced Dynamic Wedge (EDW) treatment planning system (TPS) commissioning using the PINNACE TPS; only open and 60degree EDW data are required for beam modeling. Methods: A mathematical relationship is given in the Varian user manual in which the MU of a field consisting of both open and 60degree EDW beams can be converted to the MU for a different angle EDW field. TomoDose (Sun Nuclear Corp) was used to measure EDW profiles. The open‐field PDDs, profiles and output factors(OFs) were measured using an ion chamber in water and EDW profiles were measured using TomoDose in solid water at 5 depths for all field sizes (FSs)up to 30×(20,10)cm2 for 6/16MV.Only open and 60degree EDW PDDs, profiles and OFs were imported to the TPS for the EDW commissioning. Measured and calculated PDDs, profiles and wedge factors (WFs) for the other 6 EDW angles were compared. Results: The time needed to measure the commissioning data (open PDDs and profiles and 60degree EDW profiles) was approximately 3hrs. To validate replacement of the EDW PDDs with the open‐field PDDs, maximum differences between the open and EDW PDDs were 0.6%.For the majority of the EDWs and FS geometries, differences between measured and computed PDDs were within 2%; for cross profiles, differences between measured (TomoDose and ion chamber) and computed values were

The use of megavoltage X-ray sources of radiation, with their skin-sparing qualities in radiation therapy, has been proved useful in relieving patient discomfort and allowing higher tumor doses to be given with fewer restrictions due to radiation effects in the skin. The purpose of this study was to compare the dosimetric characteristics of a physical and enhanced dynamic wedge from a dual-energy (6 and 18 MV) linear accelerator such as surfaces doses with different source to surface distances (SSD), half value layer (HVL) in water and peripheral doses for both available energies. At short SSD such as 85 cm, higher surface doses are produced by the lower wedges by the short wedge-to-skin distance. For physical wedged field, at heel edge side HVL value was high (17 cm) compared with the measured that of EDW (15.1 cm). It was noticed that, the HVL variation across the beam was significantly higher for 6 MV X-rays than for 18 MV X-rays. The lower wedge has the maximum variation of peripheral dose compared to other wedges. The three wedge systems discussed in this work possess vastly different dosimetric characteristics. These differences will have a direct impact on the choice of the wedge system to be used for a particular treatment. Complete knowledge of the dosimetric characterisitics, including the surface and peripheral doses, is crucial in proper choice of particular wedge systems in clinical use.