Enhanced Dynamic Wedge Research Articles

Predictive quality assurance for linear accelerator target failure using statistical process control

The performance of a linear accelerator (Linac) depends on the integrity of its x-ray target. The sudden failure of its target not only breaks down the Linac but also could contribute significant disruptions to patient care. This work is to develop a predicative quality assurance (QA) method using Statistical Process Control (SPC) and AutoRegressive Integrated Moving Average (ARIMA) modeling to identify the risk of target failure before it occurs. In the past years, we observed two incidents of target failure among our Linacs. Retrospectively, we collected past daily QA data (from both open fields and enhanced dynamic wedge (EDW) measurements) and analyzed its historical trend using methods of SPC and ARIMA. SPC is a technique that monitors process performance based on statistical analysis. ARIMA is a time-series forecasting algorithm that can be used to estimate future values based on its past pattern. Both have been evaluated for predictive QA in radiotherapy. Application of SPC on open beam QA data would not yield an early warning signal to the pending target failures. However, when the same SPC methodology applies to EDW measurements, the control limits were breached a couple of weeks before the target failed. EDW mechanism introduces nonuniform magnification factors over its wedge-directed beam profiles and is responsible for the sensitivity of its profile to changing beam properties induced by a degrading target. Further extension of the warning period may be possible by using ARIMA modeling. Predicative QA for EDW daily data using SPC and ARIMA methods may provide an early QA warning to incoming Linac target failure.

Enhance dynamic wedge verification by using electronic portal imaging device

Objectives The purpose of this study was to verify the 80% enhanced dynamic wedge (EDW) beam profile using an electronic portal imaging device (EPID). Methods This study investigated symmetric and asymmetric field sizes using a 6 MV photon beam. Verification of the wedge output factor with an 80% beam profile was performed by comparing EPID measurements and treatment planning systems (TPS) calculations in both symmetric and asymmetric field sizes at different wedge angles (15, 30, 45, and 60 degrees). Results For the symmetric field size, the average difference between the measured and calculated beam profile was less than 2% (range 0.57-1.12%). For the asymmetric field size, the difference was also less than 2% (range 0.3-0.52%). Conclusion This study indicates that EPID can be used to verify the 80% enhanced dynamic wedge beam profile at different field sizes and wedge angles. The difference in beam profiles was less than 2% which is in accordance with AAPM TG no.142 recommendations.

Comparison of dosimetric characteristics of physical wedge and enhanced dynamic wedge in inhomogeneous medium using Monte Carlo simulations.

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. A PW and EDW-equipped-linac head was simulated using BEAMnrc code. DOSXYZnrc was used for three-dimensional dosimetry calculation in the CIRS phantom. 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. 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.

Impact of Respiratory Motion on Point Doses for Three Whole-breast Irradiation Techniques after Breast-conserving Surgery

For whole-breast irradiation after breast-conserving surgery, computed tomography simulation (CTS) and irradiation are generally performed during free breathing. In treatment planning, there are three techniques: field-in-field (FIF), physical wedge (PW), and enhanced dynamic wedge (EDW). The aim of this study was to investigate the impact of respiratory motion on doses for these three irradiation techniques. All doses were measured using an ionization chamber in a cylindrical phantom on a respiratory motion platform. Doses for each technique were measured with and without phantom motion. The dose without phantom motion was defined as the reference. The reference was compared to the dose with the phantom motion. The positions of the isocenter with respect to the ranges of phantom motion were set as exhale and intermediate. The phantom motion amplitude was set to 5 mm or 10 mm. The respiratory phase to initiate irradiation was varied as inhale, intermediate-inhale, exhale and intermediate-exhale. When the motion amplitude was 10 mm, the dose differences for the FIF, PW, and EDW techniques were 4.2%, 0.5%, and 0.8%, respectively, at the maximum. However, the dose difference for the FIF technique was -0.5% when the isocenter position was set to the intermediate phase of phantom motion. We found that the dose difference per fraction was reduced when the respiratory phase during CTS image acquisition was set to the intermediate phase. Meanwhile, the dose differences per fraction for the PW and EDW techniques were less affected by the respiratory motion.

The effect of an air gap on a 2D monolithic silicon detector for relative dosimetry

Purpose: to evaluate the impact of an air gap on the Magic Plate (MP512) response and optimize this gap for relative dosimetry in photon and electron beams. Materials and methods: MP512 is a 2D monolithic silicon detector manufactured on a p-type substrate. The array consists of 512 pixels with 0.5 × 0.5 mm2 size and 2 mm pitch with an overall dimension of 52 × 52 mm2. The signal ratio (SR) as a function of beam size and the percentage were measured with MP512 in 6 MV and 10 MV photon beams. The enhanced dynamic wedge (EDW) beam profile measurements were performed for 6 MV photon beams. In this work the signal ratio is defined as the ratio of central axis MP512 reading for field sizes ranging from 0.5 × 0.5 cm2 to 10 × 10 cm2 and for the reference square field of side 10 cm at a depth of 10 cm in solid water phantom. The measurements were performed with an air gap immediately above the detector array of 0.5, 1.0, 1.2, 2.0 and 2.6 mm, respectively. The PDD was measured for field sizes 2× 2 cm2, 5× 5 cm2 and 10× 10 cm2 by scanning the MP512 from the depth of 0.5 cm to 10 cm. The beam profiles were measured for Varian linac enhanced dynamic wedge (EDW) angles of 15̂, 45̂ and 60̂ for field size 5× 5 cm2. The PDD for 6, 12 and 20 MeV electron beams were performed for a standard applicator providing 10× 10 cm2 field size. Results: the signal ratio measured with MP512 reduces with increasing air gap above the detector. The strongest effect of the air gap size was observed for small fields of 0.5× 0.5 cm2 and 1× 1 cm2 while the effect was negligible within ± 2% (1 standard deviation) for field sizes larger than 4× 4 cm2. The signal ratio measured with MP512 with air gaps of 0.5 mm and 1.2 mm showed a good agreement with signal ratio measured with the EBT3 film (within ± 2%) and MOSkinTM for 6 MV and 10 MV, respectively. Similar results were observed for the PDD measurement for field size 5× 5 cm2 and 10× 10 cm2. The PDD measured with M512 was in good agreement with Markus Ionization chamber (IC) within ± 1.6% (1 standard deviation) for 6 MV and ± 1.5% (1 standard deviation) for 10 MV. The PDD discrepancy for 2× 2 cm2 was within ± 3% of the EBT3 for both photon energies. The EDW dose profile matched well with the EBT3 for the air gap of 0.5 mm within ± 2% (1 standard deviation) for all wedge angles. The PDD measured by electron beams demonstrated no significant effect of the air gap size above MP512 for all energies. The results showed similar variations (within ± 3%) compared to Markus IC for both 0.5 mm and 2.6 mm gap. Conclusion: the MP512 diode array was demonstrated to be suitable as an in-phantom dosimeter for QA in small radiation treatment fields. The study shows that air gap size has a significant effect on small field photon beam dosimetry due to a loss of electronic equilibrium. The small air gaps of 0.5 mm and 1.2 mm were the best air gaps for 6 MV and 10 MV, respectively. The effect of the air gap in electron beam fields is not significant due to the fact that an electronic equilibrium is fully established.

Dosimetric Comparison of Treatment Plans Using Physical Wedge and Enhanced Dynamic Wedge for the Planning of Breast Radiotherapy.

The aim of this study is to compare the physical wedge (PW) with enhanced dynamic wedge (EDW) to determine the difference in the dose distribution affecting the treated breast and the contralateral breast, lungs, heart, esophagus, spine, and surrounding skin in the radiotherapy of breast cancer. Computed tomography (CT) data sets of 30 breast cancer patients were selected from the database for the study. The treatment plans which were executed with PW were re-planned with EDW without changing the beam parameters. Keeping the wedge angles same, the analytic anisotropic algorithm (AAA) with heterogeneity correction was used for dose calculation in all plans. The prescription was 50 Gy in 25 fractions. The dose- volume histogram (DVH) of the planning target volume (PTV) and critical structures of both PW and EDW plans were analyzed. The analysis showed that the maximum dose within the target volume is higher in EDW plan compared to PW plan. However the PTV conformity index (CI) remained the same in both plans. For all the critical structures, the EDW technique offered less dose compared to PW technique. The effect of volume of the contralateral breast on the dose to contralateral breast and the effect of volume of PTV breast for patients with carcinoma left breast on the dose to heart were studied and analyzed for the two wedges. No correlation between volumes and dose parameters was found for the two techniques. The number of monitor units to deliver a particular dose with EDW field is less than that of PW field due to change in wedge factor. As EDW produces less scattered dose to structures outside the treatment field, the risk of a second malignancy can be reduced with this technique.

MLC-based penumbra softener of EDW borders to reduce junction inhomogeneities.

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.

Comparison of beam hardening effect of physical and enhanced dynamic wedges at bladder inhomogeneity using EBT3 film dosimeter.

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. 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. 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. 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.

Comparison of treatment planning techniques in treatment of carcinoma of left breast: Second cancer perspective

AimTo compare the secondary cancer risk (SCR) between different planning techniques for treatment of Ca. Left-Breast patient. Materials and methodsFive treatment plans; 3DCRT tangential fields with physical wedge (PW), enhanced dynamic wedges (EDW), electronic compensator (EC), IMRT tangential fields (ITF) and Volumetric modulated arc (VMAT) plan (partial arcs) with 6MV photon beams were generated for a carcinoma of Left breast patient of age 40 to a prescription dose of 50Gy in 25 fractions. The SCR was estimated using the organ equivalent dose (OED) concept with a linear-exponential, a plateau, and a linear dose-response model for OARs. Also, the low dose-bath volume (5Gy) was calculated for all the plans. ResultsFor contra lateral breast the SCR relative to PW were (linear, plateau, linear-exponential) (−26.0%, −35.0%, −39.0%) for VMAT, (−50.0%,−50.0%,−51.0%) for ITF, (−48.0%, −49.0%,−49.0%) for EC and (−33.0%, −24% , −25.0%) for EDW respectively. The relative SCR (plateau) for heart and left lung were (−66.0% & −73.0%) for VMAT, (−20.0% & −6.0%) for ITF, (−24.0% & −18.0%) for EC and ( −17.0% & −14.0%)for EDW. In contrast, for skin the relative SCR (linear - exponential) were 78.0%, −8.0%, −13.0% and −10.0% for VMAT, ITF, EC and EDW respectively. The 5Gy low dose volume relative to PW for VMAT was 201.45%, whereas the same for ITF, EC and EDW were 17.0%, −7.33% and −4.3%. ConclusionCompared to all plans, VMAT plan showed high conformity for CTV and superior heart and left lung sparing. But SCR for skin and the low dose bath volume were significantly high in VMAT. ITF plan showed relatively better sparing for contra lateral breast and heart. EC plan shows moderately good sparing for OARs while scoring least SCR value for skin next to EDW. EDW and PW plans were similar but later had high SCR for contra lateral-breast. Planning techniques like ITF and VMAT can be strongly considered for left breast, provided better skin sparing techniques and less dose spillage can be achieved.

SU‐F‐P‐34: Commission of Enhanced Dynamic Wedge of Varian Truebeam Linac System with Feature Study

Purpose:To evaluate an Enhanced Dynamic Wedge (EDW) as part of machine commission process with feature study.Methods:The EDW system in this study was from a Truebeam, which is the Linear accelerator manufactured by Varian Medical Systems. The EDW feature vectors includes selected elements. These elements were dosimetric output spots check, field size, wedge angles, dose rate, collimator orientation, and different energy settings. Point dose measurement was done by a PTW farmer chamber, and profiles were measured by Gafchromic EBT2 films positing at different depths of the Solidwater based on the study elements. The output spot measurements were done with PTW farmer chamber with Solidwater setting for all orientation and wedge angles in the EDW system. The profiles comparisons were done by IMRT measurement function in RIT software at version 6.3. And the films were scanned by Vidar scanner. Dosimetry calculation were done by using the same Solidwater scanned by GE LightSpeed CT in Eclipse Treatment Planning System (TPS). Then measurements were compared to simulation results in TPS.Results:The energy average percentage difference between chamber measurement and TPS was 0.16% with standard deviation (SD) at 0.93%. For selected features, the average percentage difference between film measurement and computation was 0.93% with SD at 1.55% in horizontal profiles, and 1.18% with SD at 0.98% at vertical profiles. The average gamma difference for film measurement and TPS computing results was at 0.924 with SD at 0.314.Conclusion:A feature vector was developed to describe the commission of EDW, and developing a complete set of features for sufficiency of commission of a LINAC function could provide optimal commission instance with acceptable confident level of clinical application of the machine. Given the institution specific vector pattern and big data process, it could provide wide range clinical outcome comparison information in application of EDW.

Estimated Risk of Radiation Induced Contra Lateral Breast Cancer Following Chest Wall Irradiation by Conformal Wedge Field and Forward Intensity Modulated Radiotherapy Technique for Post-Mastectomy Breast Cancer Patients

Background:Epidemiological studies have indicated an increasing incidence of radiation induced secondary cancer (SC) in breast cancer patients after radiotherapy (RT), most commonly in the contra-lateral breast (CLB). The present study was conducted to estimate the SC risk in the CLB following 3D conformal radiotherapy techniques (3DCRT) including wedge field and forward intensity modulated radiotherapy (fIMRT) based on the organ equivalent dose (OED).Material and Methods:RT plans treating the chest wall with conformal wedge field and fIMRT plans were created for 30 breast cancer patients. The risks of radiation induced cancer were estimated for the CLB using dose-response models: a linear model, a linear-plateau model and a bell-shaped model with full dose response accounting for fractionated RT on the basis of OED.Results:The plans were found to be ranked quite differently according to the choice of model; calculations based on a linear dose response model fIMRT predict statistically significant lower risk compared to the enhanced dynamic wedge (EDW) technique (p-0.0089) and a non-significant difference between fIMRT and physical wedge (PW) techniques (p-0.054). The widely used plateau dose response model based estimation showed significantly lower SC risk associated with fIMRT technique compared to both wedge field techniques (fIMRT vs EDW p-0.013, fIMRT vs PW p-0.04). The full dose response model showed a non-significant difference between all three techniques in the view of second CLB cancer. Finally the bell shaped model predicted interestingly that PW is associated with significantly higher risk compared to both fIMRT and EDW techniques (fIMRT vs PW p-0.0003, EDW vs PW p-0.0032).Conclusion:In conclusion, the SC risk estimations of the CLB revealed that there is a clear relation between risk associated with wedge field and fIMRT technique depending on the choice of model selected for risk comparison.

Technical Note: Initial characterization of the new EBT-XD Gafchromic film.

To assess the dosimetric accuracy and energy dependence of the new EBT-eXtended Dose (XD) Gafchromic film and to compare the lateral response artifact (LRA) between EBT-XD and EBT3 film. EBT3 and EBT-XD calibration curves were created by exposing films to known doses from 0 to 3000 cGy using a 6 MV beam. To assess the accuracy and dynamic range of EBT-XD, a 60° enhanced dynamic wedge (EDW) was used to deliver a dose range of approximately 200-2900 cGy. Comparison to treatment planning system (TPS) calculation was made using a gamma analysis with 2%/2 mm passing criteria. To assess and compare the LRA between EBT3 and EBT-XD, 21 × 21 cm(2) open fields delivered doses of 1000, 2000, and 3000 cGy to both types of film. Films were placed at the center of the scanner, and ratios of measured to TPS predicted doses were calculated at 50 and 80 mm lateral from the scanner center in order to quantitatively assess the LRA. To evaluate the energy dependence of EBT-XD film, seven known doses ranging from 400 to 3000 cGy were delivered using both 6 and 18 MV beams and the resulting optical densities (ODs) compared. The gamma passing rate was 99.1% for the 6 MV EDW delivery. EBT-XD film exhibited minimal LRA (<1%) up to 3000 cGy. In contrast, EBT3 demonstrated an under-response of 11.3% and 22.7% at lateral positions of 50 and 80 mm, respectively, for the 3000 cGy exposure. Differences between ODs of the EBT-XD films exposed to known doses from 6 to 18 MV beams were <0.8% suggesting minimal energy dependence throughout this energy range. The LRA of EBT-XD is greatly reduced when compared to EBT3. This in combination with its accuracy from 0 to 3000 cGy and minimal energy dependence from 6 to 18 MV makes EBT-XD film well suited for dosimetric measurements in high dose SRS/SBRT applications.

Enhanced dynamic wedge output factors for Varian 2300CD and the case for a reference database.

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

SU‐E‐T‐82: A Study On Enhanced Dynamic Wedge (EDW) Dosimetry Using 2D Seven29 Ion Chamber Array Detector

Purpose:To study the dosimetric properties of Enhanced Dynamic Wedge (EDW) using PTW Seven29 ion chamber arrayMethods: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 &amp; 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 &amp; 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.

SU‐E‐P‐24: Simplified EDW Profile Measurements Using Two Commonly Available Detector Arrays

Purpose:Enhanced dynamic wedge (EDW) profiles are needed as part of the commissioning of a treatment planning system. This work compares the acquisition of EDW profiles using a linear diode array (LDA) with two commonly used detector arrays available in the clinics, with the goal of identifying the simplest approach for these measurements.Methods:The measurements of EDW profiles were performed on a Varian TrueBeam linear accelerator for 6, 10, and 18 MV photon beams for all seven wedge angles at four depths. The measurements were done using the LDA 99 in Blue Phantom2 (IBA Dosimetry), and IC Profiler and MapCHECK2 (Sun Nuclear) in solid water phantoms. The water phantom was set up at 100 cm SSD, whereas the two other devices were set up at 75 cm due to the size limitations of the devices. The largest possible field size was used. The average and maximum percentage differences were examined within the central 90% of the field and in the penumbra.Results:Dose profiles measured with IC Profiler were in a good agreement with LDA 99 data. The average percentage difference within the field did not exceed 0.5% for all energies. MapCHECK2 measurements matched well with LDA 99 for 10 and 18 MV (within 0.3%) with discrepancies of up to 1.4% observed for the 6 MV beam. The maximum percentage differences for both devices in the penumbra exhibited larger variations than LDA 99 results due to differences in detector spacing and high dose gradient, as expected.Conclusion:Common linac QA devices such as IC Profiler or MapCHECK2 provide EDW beam profile data of reasonable accuracy as compared to measurements performed using a linear diode array in a water phantom, saving the expense and time involved in acquiring and setting up a LDA.

SU‐E‐T‐362: Enhanced Dynamic Wedge Output Factors for Varian 2300CD and the Case for a Reference Database

Purpose:Dose inhomogeneity in treatment planning can be compensated using physical wedges. Enhanced dynamic wedges (EDW) were introduced by Varian to overcome some of the short comings 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 adding credence to the case of the validity of reference databases.Methods: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.Results:The EDWOF for 6 MV varied from 0.980 for a 5×5 cm 10 degree wedge to 0.424 for 20×20 cm 60 degree wedge. Similarly for 20 MV, the EDWOF varied from 0.986 for 5×5 cm 10 degree wedge to 0.529 for 20×20 cm 60 degree wedge. EDWOF are highly dependent on field size. 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 18MV 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.Conclusion:The consistency of EDWOF across models and institution provide further support that, a standard data set of basic photon and electron dosimetry could be established, as a guide for future commissioning, beam modeling and quality assurance purposes.

SU-E-T-100: Designing a QA Tool for Enhance Dynamic Wedges Based On Dynalog Files

Purpose: A robust quality assurance (QA) program for computer controlled enhanced dynamic wedge (EDW) has been designed and tested. Calculations to perform such QA test is based upon the EDW dynamic log files generated during dose delivery. Methods: Varian record and verify system generates dynamic log (dynalog) files during dynamic dose delivery. The system generated dynalog files contain information such as date and time of treatment, energy, monitor units, wedge orientation, and type of treatment. It also contains the expected calculated segmented treatment tables (STT) and the actual delivered STT for the treatment delivery as a verification record. These files can be used to assess the integrity and precision of the treatment plan delivery. The plans were delivered with a 6 MV beam from a Varian linear accelerator. For available EDW angles (10°, 15°, 20°, 25°, 30°, 45°, and 60°) Varian STT values were used to manually calculate monitor units for each segment. It can also be used to calculate the EDW factors. Independent verification of fractional MUs per segment was performed against those generated from dynalog files. The EDW factors used to calculate MUs in TPS were dosimetrically verified in solid water phantom with semiflex chamber on central axis.more » Results: EDW factors were generated from the STT provided by Varian and verified against practical measurements. The measurements were in agreement of the order of 1 % to the calculated EDW data. Variation between the MUs per segment obtained from dynalog files and those manually calculated was found to be less than 2%. Conclusion: An efficient and easy tool to perform routine QA procedure of EDW is suggested. The method can be easily implemented in any institution without a need for expensive QA equipment. An error of the order of ≥2% can be easily detected.« less

SU‐E‐T‐322: The Evaluation of the Gafchromic EBT3 Film in Low Dose 6 MV X‐Ray Beams with Different Scanning Modes

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.

Dosimetric verification of enhanced dynamic wedges by a 2D ion chamber array

Wedge filters are commonly used to achieve dose uniformity in the target volume in radiotherapy and can be categorized as physical wedges (PWs) and enhanced dynamic wedges (EDWs). The EDW generates PW-like dose profiles while moving the upper jaw in the Y directions with a varying dose rate in the treatment beams. Task Group 53 of the AAPM (American Association of Physicists in Medicine) recommended that the dynamic wedge be verified before implementation in the radiation treatment planning (RTP) system. The aim of this study was to use the I’mRT MatriXX to verify the dose profiles of the EDWs manufactured by Varian. We used Pencil Beam Convolution algorithms (eclipse 8.6) for the calculation and I’mRT MatriXX with Plastic Water® phantom MULTICube for dose measurements. The gamma indices of the calculations and the measurements for the EDWs were 84.84% and 86.54% in 2%/2 mm tolerance, and 99.47% and 99.64% in 3%/3 mm tolerance for wedge angles of 15°, 30°, 45° and 60°, respectively. The dose distributions differed between the calculations using the system and the measurements in the penumbra and the outer beam regions of the wedge fields. We confirmed that the dosimetric verifications of the EDW were acceptable when using the criterion for external beam dose calculations of Task Group 53.

SU-D-137-04: Comparison of Treatment Planning Techniques in Treatment of Carcinoma of Left Breast: Second Cancer Risk Perspective

Purpose: To compare the secondary cancer risk (SCR) between different planning techniques for treatment of Ca. Lt.breast patients. Methods: Five treatment plans; 3DCRT tangential fields with physical wedge (PW), enhanced dynamic wedges (EDW), electronic compensator (EC), IMRT tangential fields (ITF) and Rapid-Arc (RA) plan (partial arcs) with 6 MV photon beams were generated for a carcinoma of Lt.breast patient of age 40 to a prescription dose of 50.4Gy in 28 fractions. The SCR was estimated using the organ equivalent dose (OED) concept with a linear exponential, a plateau, and a linear dose response model for OARs. Also, the low dose bath volume (5Gy) was calculated for all the plans. Results: For contralateral breast the SCR relative to PW were (linear, plateau, linear-exponential) (−25.89%, −99.985%, −85.96%) for RA, (−50.12%,−41.94%,−44.57%) for ITF, (−47.78%, −38.43%,−42.05%) for EC and (−32.70%,−26%,−28.31%) for EDW respectively. The relative SCR for heart and Lt-lung were (−89.99% & −89.38%) for RA, (−0.05% & 5.69%) for ITF, (−0.16% & 0.04%) for EC and ( −0.04% & 0.01%)for EDW. In contrast, for skin the relative SCR were 77.68%, −7.71%, −11.11% and −9.04% for RA, ITF, EC and EDW respectively. Also, the 5Gy low dose volume relative to PW for RA was 201.45%, whereas the same for ITF, EC and EDW were −8.41%, −7.33% and −4.2%. Conclusion: Compared to all plans, RA plan showed high conformity for CTV and superior heart, contralateral breast and left lung sparing. But SCR for skin and the low dose volume were significantly high in RA. ITF plan showed relatively better sparing for contralateral breast and heart at the same time has the least low dose bath volume. EC plan shows moderately good sparing for OARs while scoring least SCR value for skin. EDW and PW plans were similar but later had high SCR for contralateral breast.