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Jenny Kouri
February 9, 2015
Transmission Factor Calculation
Wedge Transmission Factor Calculation
Objective: To identify the attenuation factor for a 30-degree wedge and to demonstrate this
transmission factor in a monitor unit calculations relative to an actual patient treatment plan.
Purpose: The dosimetric properties of a photon beam are defined by the attenuation altered by
beam.1 A beam modifier is a device that changes the shape of the planned treatment field or
distribution of the radiation at depth. Wedges, the most commonly used beam modifier, are used
to optimize the target volume dose distributions by reducing hot spots and providing a more
uniform dose. A wedge is generally composed of dense material, such as lead or steel, which can
be inserted in the direct pathway of the beam. The wedge tray is always at a distance of atleast
15 cm from the skin surface to prevent ejected electrons from contaminating the photon beam.
This distance will eliminate the dose buildup effect at the patients surface, known as skin
sparing. Wedges cause an alteration in the isodose curve distribution. The wedge angle refers
to the angle through which an isodose curve is tilted at the central axis of the beam at a specified
depth. The degree of tilt is dependent upon the slope of the wedge. The wedge angle does not
describe the angle of the actual wedge. For example, a 15-degree wedge produces a 15-degree
tilt but the wedge itself does not physically measure a 15-degree slope.2 A wedge transmission
factor, or wedge factor (WF), must be calculated to correct for the decrease in beam output when
utilizing a wedge. The WF at a depth, d, in a water phantom, for a field size (FS), along the
central axis of the beam can be described in the following ratio3:
WF (FS,d) = Dw (FS, d)
Do (FS, d)
Dw (FS,d) is the dose at a specified point d along the central axis in a specified FS with the
wedge in place. Do (FS,d) is the dose at the same point in an open field of equal dimensions for
the same time of number of monitor units (MU).3 The wedge factor is only correct for the center
of the wedge, because the measurement is taken through the center of the wedge. More radiation
will be absorbed through the thicker end or the heel and less will be attenuated through the
thinner end, known as the toe. The depth must be beyond the depth of maximum dose, usually 510 cm. The specification of depth is essential since the presence of scattered radiation causes the

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angle of isodose tilt to decrease with increasing depth in the phantom.2 The importance of
appropriate wedge usage is vital. During treatment, wedge misplacement may result with a
significant under dose or overdose of radiation. A medical event occurs when the total dose
delivered differs from the prescription dose by 20% or more. If this occurs, the medical event
must be recognized and reported.4
Methods and Materials: The comparison of the beam output with or without a physical 30degree wedge utilized 6 megavoltage (MV) and 18 MV beam energies produced by a Varian
Clinac IX Linear Accelerator installed at the VA Medical Center in Minneapolis, Minnesota. In
the current study, a Farmer Chamber, Model FC65-G, was installed within a solid water phantom
at a depth of 10 cm. To measure the accumulated charge, the farmer chamber was correlated to
the Precision Electrometer/Dosemeter, Model 525. This set up is shown below in Figure 1 and
Figure 2. The linear accelerator delivered 200 MU at a dose rate of 400 MU per minute to a field
size of 10 x 10 cm and a depth of 10 cm within the phantom at 100 cm, source to skin distance
(SSD). This depth was chosen to eliminate electron contamination, which occurs at depths
above the maximum dose at depth. WF was measured by taking the ratio of wedge and open
field ionization data. Data was collected for 3 trials for both beam energies without a wedge and
another three trials with a wedge. The 30-degree wedge was oriented out. The set-up is shown
in Figure 1 and 2.
Figure 1: Solid water phantom is displayed at 100 SSD with the farmer chamber placed at a
depth of 10 cm.

Figure 2: Set-up of solid water phantom in respect to the linear accelerator.

Results: Table 1: Trials recorded without and with 30-degree wedge in the pathway of the beam
for 6MV and 18 MV energies at a 10 x 10 cm field size. This table shows the average readings
for both the 6 MV AND 18 MV energies, with and without the 30-degree wedge.

Beam Energy

6 MV

1
2
3

Average
18 MV
Average

Readings Without

Readings With

Wedge (nC)
26.67
26.67
26.66
26.67
32.32
32.32
32.32
32.32

Wedge (nC)
14.61
14.62
14.62
14.62
20.40
20.40
20.40
20.40

Trial Number

1
2
3

Table 2: This chart shows the wedge transmission factor for 6 MV and 18 MV beam energies at
a 10 x 10 cm field size. The data is derived from the averages in Table 1.

Reading With Wedge

Beam Energy

Wedge Transmission Factor

Reading Without Wedge

14.62
6 MV

0.548
26.67
20.40

18 MV

0.631
32.32

Table 3: Calibrated wedge transmission factors at a 10 x 10 field size derived from the
Minneapolis VA Medical Center.

Computer Transmission Factor

6 MV

18 MV

0.540

0.621

Discussion: As a result of this study, the wedge transmission factor for a 6 MV beam is 0.548
and 0.631 for 18 MV. It is expected that 18 MV had a higher transmission factor than 6 MV due
to its greater beam energy. Therefore, more radiation is transmitted through the wedge as
opposed to being attenuated by the wedge. Less radiation is transmitted through the wedge in a 6
MV beam. Regardless of beam energy, wedge modifiers will decrease the beam output. There is
a 0.015% difference between the 6 MV calibrated wedge transmission factor and the
experimented factor. A 0.015% difference for the 18 MV beam energy was found as well.
Clinical Application: The prescription dose for a palliative lung treatment was 300cGy per
fraction, normalized to 95% of the point dose at isocenter for ten fractions. Anterior and

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posterior fields were utilized with mixed energies. The anterior field (2a) was composed of 6MV
beam energy. The second anterior field (2b) and the posterior field (2c) used 18MV beam
energy. Only the anterior fields involved a 30-degree wedge. The majority of the dose was
delivered posteriorly. 2a was weighted by 21% of the daily dose; 2b, 15%; and 2c, 64%. The
monitor units were calculated by the primary treatment planning system, Pinnacle3. These
results were verified within a +/-3% tolerance through the secondary calculation software,
MuCheck.

Figure 3: Monitor units are hand calculated for 2a-c beams with 30-degree wedge.

Figure 4: Monitor units are hand calculated for 2a-c beams without 30-degree wedge.

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Figure 5: Percentage difference between wedge and non-wedge MU calculations. These
catastrophic percentage differences surpass the 20% of prescribed dose that could result in a
medical event if wedges were misused.4, 5

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Figure 5: Pinnacle treatment plan of palliative left lung with wedging

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Figure 6: Pinnacle treatment plan of palliative left lung without wedging.

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Figure 7: VA Medical Center monitor unit calculation sheet for 6MV photons.

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Figure 8: VA Medical Center monitor unit calculation sheet for 18MV photons.

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Figure 9: Sagittal view of left lung with 30-degree wedge. It can be seen that the wedge
compensates for the sloped chest. This allows for dose to build up on a more even plane
resulting in a more uniform isodose distribution. Full PTV coverage is achieved with the applied
wedge.

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Figure 10: Sagittal view of left lung without 30-degree wedge. The PTV is not fully covered by
the 100% isodose line (red).

Conclusion: Modifiers characterize a beam. If changes are made from the original field,
calculations must be preformed to account for an accurate change of dose. When placed in the
path of a beam, wedges attenuate dose differently for different beam energies, such as 6 MV and
18 MV. An ultimate goal of treatment planning is ensuring that computerized treatment plans

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accurately reflect the dose received by patients. When a wedge is not correctly placed or
misplaced, a change in dose will be given to the patient bringing undue harm. As a member of
the radiation oncology team, it is important to be aware of what wedge is being utilized for
certain fields, to eliminate a medical event.

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References
1. Palta JR. Dosimetric Characteristics of Clinical Photon Beams [PowerPoint].
Gainesville, FL: University of Florida Department of Radiation Oncology.
http://www.aapm.org/meetings/09ss/documents/11Palta-PhotonBeamDosimetry.pdf.
Accessed February 9, 2015.
2. Washington CM, Leaver D. Principles and Practice of Radiation Therapy. 3rd ed. St.
Louis, MO: Mosby-Elsevier; 2010.
3. Ahmad M, Hussain A, Muhammad W, et al. Studying wedge factors and beam profiles
for physical and enhanced dynamic wedges. J Med Phys. 2010;35(1):33-41.
http://dx.doi.org/10.4103/0971-6203.57116.
4. United States Nuclear Regulatory Commission. 35.3045 Report and notification of a
medical event. http://www.nrc.gov/reading-rm/doc-collections/cfr/part035/part0353045.html. Accessed February 9, 2015.
5. Discussion with Jim Schmitz, Medical Dosimetrist at the Minneapolis VA Medical
Center. February 10, 2015.