Purpose: Wedge-shaped isodoses are desired in a number of clinical situations. Physical wedge filters have provided nominal angled isodoses with dosimetric consequences of beam hardening, increased peripheral dosing, nonidealized gradients at deep depths, along with the practical consequences of filter handling and placement problems. Dynamic wedging uses a combination of a moving jaw and changing dose rate to achieve angled isodoses, The clinical implementation of dynamic wedge and an accompanying quality assurance program are discussed in detail. Methods and Materials: The accelerator at our facility has two photon energies (6 MV and 18 MV), currently with dynamic wedge angles of 15 degrees, 30 degrees, 45 degrees and 60 degrees, The segmented treatment tables (STT) that drive the jaw in concert with a changing dose rate are unique for field sizes ranging from 4.0 cm to 20.0 cm in 0.5 cm steps, resulting in 256 STTs. Transmission wedge factors were measured for each STT with an ion chamber, Isodose profiles were accumulated with film after dose conversion, For treatment-planning purposes, d(max) orthogonal dose profiles were measured for open and dynamic fields, Physical filters were assigned empirically via the ratio of open and wedge profiles. Results: A nonlinear relationship with wedge factor and field size was found, The factors were found to be independent of the stationary field setting or second order blocking. Dynamic wedging provided more consistent gradients across the field compared with physical filters, Percent depth doses were found to be closer to open field, The created physical filters provided planned isodoses that closely resembled measured isodoses, Comparative isodose plans show improvement with dynamic wedging. Conclusions: Dynamic wedging has practical and dosimetric advantages over physical filters, Table collisions with physical filters are alleviated. Treatment planning has been solved with an empirical solution. Dynamic wedge is a positive replacement for physical filters, and a first step for commercial introduction of dynamic conformal therapy.
