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Benjamin Smith
Transmission Factor Calculation

EDW45 Transmission Factor Calculation

Objective: To determine the transmission factor for a 45° enhanced dynamic wedge (EDW45),
and illustrate how this transmission factor affects a monitor unit (MU) calculation.

Purpose: In order to deliver a custom treatment for each specific patient, certain calibrations
have to be measured in order to achieve accurate calculations. These calibrations use a standard
reference field of 10x10cm at a 100cm source to skin distance (SSD) at a 10cm depth in a water
phantom. To accurately calculate the monitor units needed for each treatment field, all factors
need to be included in the calculation. This includes a wedge transmission factor, and more
specifically in this case, a 45° enhanced dynamic wedge (EDW45) factor. This wedge factor
attenuates the photon beam in a unique way when utilized for a given field. It causes a continual
decrease in the intensity across the photon beam which results in a tilted isodose curve, with the
degree of tilt correlating to the selected wedge angle.1 As mentioned previously, this attenuation
needs to be accounted for in order to deliver an accurate dose to the target volume.

The general formula for the Wedge Factor (WF), is defined by the following equation:1

WF = Dose with wedge at a point in phantom along central axis of the beam
Dose without wedge at a point in phantom along central axis of the beam

Methods and Materials: The data was measured on a Varian 2100 linear accelerator using 6
megavoltage (MV) with a 10x10cm field size at 100cm SSD. For each measurement, 100 MU
were delivered at a dose rate of 600 MU per minute at a depth of 10cm in “solid water” blocks.
Solid water has equivalent density to that of tissue. For the setup, a thimble ionization chamber
was used to measure the dose. One of the solid water blocks has a pre-cut hole into which the
chamber is placed. 5cm of solid water is placed below the chamber and 9cm of solid water is
placed on top of the chamber. Since the precut block has 1cm thickness, this gives a total of
10cm solid water above the chamber. 100cm SSD was set at the top of the solid water. An
electrometer was connected to the thimble chamber that was read in the control room. Three
trials were implemented with each delivering 100MUs using 6MV energy to establish a control.
After this, another three trials were tested with the same factors of 100MUs delivered using 6MV
energy but with the added 45° EDW in the beam’s path.
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Image 1: Set-up of Solid Water blocks with thimble chamber in place

Image 2: 100 SSD set on Solid Water blocks

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Image 3: Electrometer used to measure charge

Image 4: Treatment console parameters with EDW45

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Results:
Table 1: Readings taken without and with the EDW45 in the beam path.

Energy Readings without Readings with

EDW45 EDW45
6MV 13.76 10.65
6MV 13.77 10.65
6MV 13.77 10.64

Table 2: Calculating the average of the 3 trials without and with the EDW45. After adding all
the measurements together and dividing the sum by 3, the average is obtained.

Energy Readings without Readings with

EDW45 EDW45
6MV 13.76 +13.77 + 10.65+10.65+10.64=
13.77= 31.94/3= 10.647 avg
41.3/3=13.767 avg

Table 3: Calculating the transmission factor using the averages obtained from the readings
without and with the EDW45 for 6MV energy.

Energy Reading w/EDW45 Wedge Transmission

Reading w/o Factor
EDW45
6MV 10.647/13.767= 0.773

Discussion: The Wedge Factor (WF) for 6MV energy is 0.773. From this data, it can be
determined that the EDW45 attenuates 22.7% of the 6MV beam. This will be further illustrated
using some clinical applications.

Clinical Application: Isocentric right neck treatment. This treatment case used a 3 field
technique with equal weighting to deliver a total of 370cGy per fraction. This equates to
123.33cGy being delivered through each field. The treatment field for this application purpose is
the 1.1a RAO R Neck field. Two monitor unit calculations for this field will follow with one
incorporating the wedge factor and the other omitting the wedge factor.
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For the 1.1a RAO R Neck field, the use of the wedge factor resulted in a 22.7 increase in MU
needed to account for its attenuation. If the wedge factor was not apart of the calculations, the
patient would have been underdosed by 22.7% which is significant.

Image 5a: Actual treatment plan of the case being measured. It illustrates the EDW45 being
accounted for in its calculation of MU.

Image 5b: This shows the actual depth used for the calculation as well as the planned SSD
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Image 6a: Blocked area of the 1.1a RAO R Neck Field with the target volume displayed.

Conclusion: With technology always advancing with dosimetric planning and customizing
treatments specific for each patient, all factors need to be accounted for when calculating the
MUs needed to accurately deliver the prescribed dose. Utilizing an EDW45 is one such factor
that much be incorporated in the dose calculations. If the EDW45 was used but not accounted
for, the patient would be underdosed and not receive the correct prescribed dose. This project
illustrates the importance of including all factors, including EDW, into the MU calculation.
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References

1: Khan FM, Gibbons JP. The Physics of Radiation Therapy. Philadelphia:

Lippincott Williams & Wilkins; 2014