Commissioning Varian enhanced dynamic wedge in the PINNACLE treatment planning system using Gafchromic EBT film

In external photon beam therapies, the technique of dynamic wedge is a well established method for dose inhomogeneity compensation. The introduction of the enhanced dynamic wedge (EDW) on Varian LINACs considerably improved the pre-existing techniques. In the process of commissioning a Varian LINAC into a PINNACLE3 treatment planning system (TPS), the user is required to import quite a few measurements of EDW profiles and percentage depth doses (PDDs). Standard measurement devices like ionization chambers in a water phantom are not the most indicated ones for this situation where each measurement point is obtained by integrating during the entire exposure: Measurements would result to be a very laborious and time consuming operation, most of the times not practically possible. The goal of the present work is to introduce an alternative and hands-on procedure to perform the measurements using a combination of GafchromicTM EBT films, irradiated sideways in one single shot for both profiles and PDDs, and a single standard ionization chamber. The scanned profiles obtained at different depths have easily been imported in the TPS; for the PDD measurements, a correction was proven necessary to account for a "self-shielding" effect introduced by the presence of the films themselves, when irradiated sideways, resulting in an underestimation of the dose at deeper depths. A correction curve was derived comparing TPS open field validated measurements with the curves extracted from GafchromicTM EBT films. Finally, the curve was applied to all the wedged fields PDD measurements and could minimize the errors. The comparison for the 15 MV photon beam between the measured and the calculated 48 profiles and 12 PDDs (field sizes from 5 x 5 to 20 x 20 cm2, wedge angles ranging from 15 degrees to 60 degrees) was acceptable. The confidence limit (CL) was used as fit indicator, as suggested by the ESTRO Booklet No. 7: For the investigated PDDs the maximum value was 6.40 in the build up region and 2.83 beyond the maximum dose point; regarding cross beam profiles, the CLs were below 3 for 85% of the points within the field and for 96% of the points outside the field; in the penumbra region, a more appropriate parameter to evaluate the agreement between calculated and measured doses is the distance to agreement; only 73% of the profiles had CLs below 15, but for the remaining ones, distance-to-agreement values were within 3 mm. A hundred ionization chamber point dose measurements (for square and elongated fields at different depth and for points in field and out of field) were performed in a water phantom and 98 of them confirmed the TPS calculations with differences lower than 3% and considerably lower in most of the cases. This article gives valuable guidance and insight to other physicists attempting to approach EDW commissioning in the PINNACLE TPS software using Gafchromic EBT films.