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John Keefe
March 22nd, 2020
DOS 522 Radiation Dose Calculations
UW-La Crosse
Wedge Transmission Factor Calculation
Objective: To determine the attenuation of a photon beam through a wedge by measuring the
individual wedges transmission factor. The wedge factor (WF) is then applied to a real treatment
scenario for the purpose of calculating monitor units (MU) and determining the effect of the
wedge on treatment MU.

Purpose: The goal of radiation therapy is to deliver dose to a specific target while sparing the
surrounding tissue. This may be achieved by the use of beam modifiers, devices that change the
shape of the treatment field or distribution of radiation at depth1, one such beam modifier is a
wedge. Wedge techniques have altered with advancement in technology, “hard” wedges are
physical wedges placed by a radiation therapist on the outside of the machine, these are
becoming more obsolete in therapy. The more commonly used Enhanced Dynamic Wedges
(EDW) are either created by a varying collimator jaw positions or in the case of an Elekta
Infinity Linear Accelerator a 60° universal wedge within the head of the linear accelerator.
When a wedge is introduced into a beams path, attenuation of the beam occurs and for this
reason a wedge attenuation factor is needed in MU calculations. The wedge attenuation factor is
defined as the ratio of the dose in the wedged field to the dose in the open field.1 A wedge
attenuation factor (WF) is dependent on multiple factors including energy, field size, and depth.

Methods and Material: The data was collected using an Elekta Infinity Linear Accelerator, a
SuperMAX electrometer and a Farmer-type Ion chamber. A 10cmx10cm field was set with a
SAD of 100 at a depth of 10cm in a solid water phantom. Three measurements were taken using
an energy of 6 MV, 100 MU delivered with an open 10x10 field. These measurements were
repeated with the same setup with the 60° universal wedge. The purpose of three measurements
with and without a wedge were to check for consistence, these were then averaged.
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Results:

Energy Readings without wedge (nC) Reading with 60° wedge (nC)
6 MV 14.04 3.555
  14.04 3.558
  14.05 3.556
  Average = 14.043 Average = 3.556
Dose w/ Device in Beam
WF Dose w/o Device in Beam =

WF 3.556 = = 0.253
14.043

Wedge Attenuation Factor (WF) for other wedges other than 60° were determined by
interpolation per physics staff.

  nC WF
60° wedge 3.556 0.253
30° wedge 8.7975* 0.626
15° wedge 11.419* 0.813
  * = interpolated  

10x10
TMR 0.792
Sc 1.0
Sp 1.0

Dose
MU = Sc x Sp x TMR x ISF x WF

Discussion: A wedge factor is needed on a field that utilizes a wedge. The factor is needed
because of the attenuation of the beam when the wedge is placed in the beams path. The wedge
factors for the machine used in this project and a 6MV beam are 60° wedge = 0.252, 30° wedge
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= 0.626, and 15° wedge = 0.813. The 30° wedge and 15° wedge data were gathered through
interpolation from the original 60° wedge measurements.

Clinical Application: The use of a wedge is common in a patient’s 3D planning. One instance
would be a right breast patient treated with tangential fields. The patient will be receiving
266cGy per fraction for 16 fractions. For this purpose, the fields will be weighted 55% on the
Lateral Tangent and 45% on the Medial Tangent. This patient will be utilizing 30° on both the
lateral and medial fields. Additional information was taken at a 100SAD, depth of 10cm and the
equivalent field size will be 10x10, this information was used to find the TMR, Sc & Sp. For
demonstration purposes a calculation with an excluded wedge factor by mistake was also
performed.

Lateral Tangent – 266cGy x 0.55 = 146cGy

Medial Tangent – 266cGy x 0.45 = 120cGy

Dose
MU =
Sc x Sp x TMR x ISF x WF

Lateral Tangent
146cGy
1 x 1 x 0.792 x 1.03 x 0.626

146cGy
= 286MU
0.51
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Medial Tangent
120cGy
1 x 1 x 0.792 x 1.03 x 0.626

120cGy = 235MU
0.51
As stated before if the wedge factor (0.626) was excluded the MU’s calculated would differ
drastically. For this, the same MU formula will be used however excluding the 0.626 WF.
Below you can see the difference in MU.

  W/ WF W/O WF
LATERAL 286 MU 179 MU
MEDIAL 235 MU 147 MU

Conclusion: The calculations above show the impact of a wedge on a beam. To provide the
proper dose at the intended point, whether that be a calc point or isocenter, the MU’s must be
higher because of the attenuation of the beam. Also shown above the impact that can occur if a
WF is not included in the calculation, this can lead to an underdosed treatment. There are many
benefits in using an Enhanced Dynamic Wedge including the automation of treatment delivery
compared to a physical wedge needing insertion by the therapist. Consequently, more elaborate
QA procedures may be required for nonphysical wedges to prevent the occurrence of a treatment
error.2

1. Washington CM, Leaver D. Principles and Practice of Radiation Therapy, 4th ed. St.
Louis, MI: Mosby; 2016
2. Khan FM, Gibbons JP. The Physics of Radiation Therapy, 5th ed. Philadelphia, PA:
Lippincott Williams & Wilkins; 2014