Calculating dose and output factors for wedged photon radiotherapy fields using a convolution/superposition method

We have developed a convolution/superposition method to calculate dose distributions in photon treatment fields with beam modifiers such as physical wedges. The dose component due to wedge generated radiation was accounted for by using an extended phantom model, which integrated a wedge, an air gap, and a patient phantom as the calculation phantom. The inhomogeneities in the extended phantom and the effect of beam hardening by the wedge were both corrected for in the convolution dose calculation. The calculated dose was verified by Monte Carlo simulation of the same extended phantom. A new dual photon source model was also used in the convolution method to account for both primary photons from the target and extra-focal photons from the primary collimator and flattening filter. Thus, realistic photon energy fluence distributions in the extended phantom were used for the dose calculation. The calculated dose distributions and the wedge factors agreed with the measured data within 2% for a variety of treatment fields including asymmetric fields. Our results showed that the wedge-generated radiation could contribute a significant fraction of the total dose in patients. This dose component depends on a specific field configuration, thus wedge factor changes with photon energy, wedge angle, field size, depth, and patient phantom SSD. The variation of the wedge factor can be predicted accurately by our convolution approach with the extended phantom model, which allows for more accurate dose or monitor unit computation for photon fields with beam modifiers.