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Attenuation project: Wedge Transmission Factor

Student name: Joanne Li
Date: February 8, 2016
Attenuation Project: Wedge Transmission Factor
Background: Body surface and thickness in treatment field varies depending on the location of
the cancer. In order to optimized the isodose distribution with designed hot spot, a wedge filter
can be inserted in the path of the treatment beam to compensate the intensity of the beam. Wedge
filter is a common beam modification device in radiotherapy with compound angles to attenuate
the treatment beam progressively across the field.1 There are two classes of wedges: physical
wedge and non-physical wedge.2 The thick portion heel attenuates the beam greater than the
thin portion toe. No matter what kind of wedge is in use, it decreases the beam output in
different degrees by attenuating the treatment beam and altering beam quality. Therefore, wedge
transmission factor must be taken into account in treatment calculation. In our department, we
have physical wedges made of steel with angles of 15o, 30o, 45o, 60o available and Varians
Enhanced Dynamic Wedge. The wedge degree is not the angle of the actual wedge, but refers the
tilt of the isodose curve attenuated by the wedge respect to the central axis of a beam at a certain
depth.2 The physical wedge was not used at all since the Dynamic wedge was implemented in
our department. With the help of my preceptor Matt, I measured the wedge transmission factor of
a 15-degree physical wedge in a solid water phantom at 5 cm depth.
Aim: In my experiment, the transmission factor of a physical steel wedge with 15-degree angle
for a 6 MV photon beam was measured and compared with the effect of photon beam without
wedge filter. Monitor unit (MU) in a patient treatment was calculated by applying the wedge
factor resulted from the experiment.
Materials and Methods: In my experiment, a dense 15-degree physical wedge was mounted in
a bracket and inserted into the collimator head holder. The treatment beam was 6 MV photon
beam produced by a linear accelerator, Clinac Varian 21 EX machine at Strong Memorial
Hospital Radiation Oncology Department . A solid water phantom with 9 cm thickness was
placed in the treatment field. The set up for the treatment field is 5 cm depth, 100 cm source to

skin distance (SSD), a 10cm x10cm2 open field, and a water phantom aligned to the isocenter.
The collimator rotated from 90 degrees to 270 degrees with gantry in the initial position. An ion
chamber is placed in the water phantom 5 cm deep to the isocenter. 100 monitor unit (MU) was
delivered at 400 MU/min dose rate.
Wedge Factor Measurement: The calculation point is at the ion chamber reading point. The
wedge factor was calculated by using equation below.1
WF=

Dose rate withthe wedge

Dose rate without the wedge

100 cGy dose was delivered three times at each of three conditions: without wedge at 90 degrees
of collimator, with wedge at 90 degrees and 270 degrees of collimators. Dose outputs were
measured at the same point of the central axis of the beam at the same depth. Three sets of data
from each condition collected from the ion chamber reader outside of the treatment room.
Average of the readings was used in calculation of wedge transmission factor.
Table 1: Beam output with and without wedge for 6 MV beam at 5 cm depth, 10x10cm2 field
size

Reading

Open field output at 90-

Wedged beam output at

Wedged beam output at

degree collimator (nC)

18.362

90-degree collimator (nC)

12.843

270-degree collimator (nC)

12.888

#1
Reading

18.360

12.841

12.891

#2
Reading

18.359

12.843

12.889

#3
Average

(18.362+18.360+18.359

(12.843+12.841+12.843)/3 (12.888+12.891+12.889)/3

readings

)/3=18.360

=12.842

=12.889

The dose rate with wedge was taken from an average reading with 15-degree physical wedge at
90-degree and 270-degreee of the collimator.
(12.842+12.889)nC/2=12.866 (nC)
Applying measurement to the transmission factor calculation formula:

WF=

Dose rate withthe wedge

12.866 nC
=
=0.701
Dose rate without the wedge 18.360 nC

Discussion: The steel wedge factor for a 6 MV photon to a 10 x 10 cm2 and a fixed 100 cm SSD
treatment field at 5 cm depth is 0.701. Because the physical wedge has not been used for so long
time at our department, the physicist I worked with could not find the wedge factor reference
table for this Varian 21 EX treatment machine. However, we checked two other similar treatment
machines: Varian Clinac 600CD and Varian Clinac 2300 CD, with reference wedge factors 0.701
and 0.787 respectively. By comparing, we think the wedge factor we measured was consistent to
the wedge factors measured on the other same type of treatment machines. We were satisfied
with our experiment.
In my experiment, the wedge was aligned to perpendicular to the ion chamber and was
fixed centrally at the central axis of the beam. Wedge factors were measured at two positions
with 90-degree apart, which further confirmed the central alignment and right measurement point
of the wedge. Therefore, the reading for the measurement is maintained consistently. The
numbers used in final calculation were taken from average readings in each measurement. All
aimed to improve the accuracy of the experiment with more precise results.
My experiment agreed with the attenuation principle of a physical wedge that the beam
output was found to decrease with wedge in the path in comparing with beam output in an open
field.2 Table 1 represents this finding with all the measurement. Therefore, when a wedge is used
in radiotherapy, the dose calculation must be corrected with wedge factor.
Clinical application: In treatment of neck, head, or breast cancers with uneven body thickness,
wedges can be used to avoid too high dose section or hot spot in the thinner part of the body.
With the help of my preceptor Matt, we selected an example of thoracic spine treatment with an
AP beam. Due to the different thickness of the patients chest and the anatomy curve of the spine,
the dose will be unnecessary hotter near to the neck part. By adding a 15-degree wedge with
the heel portion towards the neck perpendicular with the beam, the hot spot was pulled off the
margin of the body, which creased a desirable even dose distribution in the body with the
isocenter at the target. As the treatment machine was calibrated at 1 cGy/MU, the output factor
was calculated by looking up in the effective field size table and percentage depth dose for 6 MV

beam table. With all other factors remained consistently, we then calculated the MU of each
treatment plan with and without a wedge. Figure 1 attached below lists the detail of the hand
calculation.
From the chart, MU without wedge was 348 Mu and 496 MU with a wedge. I listed the
formal calculation here.1
MU no wedge =

prescribed dose
300 cGy
=
=348 MU
cGy
1 cGy
%DDoutput factor
0.86730.9952
Mu
1 MU

MU with wedge =

prescribed dose
cGy
%DDoutput factorWF
Mu

300 cGy
1 cGy
0.86730.99520.701
1 MU

=496 MU

The deference between open field and with a wedge can be calculated as below.
%diff =

MU withwedge MU without 496 MU348 Mu

148 MU
=
100=
100=29.8
MU with wedge
496 MU
496 MU

If the wedge transmission factor was missed in the dose calculation with wedge in place, the MU
setting would be 29.8% less than desired dose. The target would receive less dose, and the cancer
will be undertreated.
Conclusion: My experiment represents an individual physical wedge has a transmission
factor in the path of treatment beam, and it decreased the beam output by comparing with the
MU settings without a wedge. Along with the slop of the wedge, beam intensity decreased
progressively across the field. We created an ideal treatment field with the isocenter at target
volume by adding a 15-degree wedge in my clinical example. However, one more wedges and/or
greater ankles of wedges could be used in a treatment depending on the treatment sites in order
to produce desirable dose distribution. We tried to keep all other variable factors the same in my
experiment to get a consistent measurement of wedge factor. We calculated the 15-dgree wedge
affected the monitor units of the beam by 29.8% in our example. This is a significant impact of
radiation dose. This finding from my experiment is also applied to all other angles of wedges
with associated wedge factors.2

As our goal in creating a treatment plan is to make as accurate as possible dose

distribution with most effective radiation treatment, any factors regardless minor or big must be
accounted into our consideration for more precise dose calculation. This experiment provided me
a great opportunity to see how the traditional wedge is set up in treatment machine and how it
affects patients treatment. By understanding the basic concept of wedge, it will be easier for
students to learn and apply the dynamic wedge in creating treatment plan.

Figure 1 MU calculation with and without 15-degree wedge

References

1. Bentel, GC. Radiation Therapy Planning. 2nd ed. Colombia: McGraw-Hill; 1996: 49-53,
137.
2. Khan FM. The Physics of Radiation Therapy. 4th ed. Philadelphia, PA: Lippincott
Williams and Wilkins; 2010: 181-185.