Jenny Huang

Attenuation Paper
March 4, 2018

Wedge Transmission Factor

Objective: To obtain measurements and calculations of wedge transmission factor through the
central axis of a 60° EDW and apply this transmission factor in a monitor unit calculation.
Purpose: In radiation oncology, a wedge filter is a beam modifying device which causes a
progressive decrease in intensity across the beam, resulting in a tilt of the isodose curves from its
normal position and also to improve the dose uniformity in the target volume.¹ The wedge filter
is also used to compensate for sloping body surface.² The degree of the tilt depends on the slope
of the wedge filter. The heel, the thick part of the wedge, attenuates the greatest amount of
radiation, so it will push the isodose line towards the surface. The toe, the thin part of the wedge,
produces less attenuation along the wedge. This attenuation must be accounted for in order to
deliver accurate dose to the target volume.
Dose with wedge
Wedge Transmission Factor (Wedge Factor) =
Dose without wedge

Methods and Materials: Enhanced dynamic wedge (EDW) does not employ a physical beam
modifier like a physical wedge. It works by the sweeping action of the jaw from open to closed
position while the beam is on. The motion of the jaw caused different part of the field to be
exposed to primary beam for different length of time.³ This motion also creates wedge dose
profile across the field.
Data was collected on a Varian 21 iX linear accelerator, using a 0.6 cm3 Farmer type ion
chamber, placed at water-equivalent depth of 10cm (see figure 1). The ion chamber was
connected to an electrometer, from which we recorded integrated nanocoulomb (nC) (see figure
2). Energies of 6 MV and 18MV were used with a field size of 10 x 10 cm2 and SSD of 90 cm.
100 MUs were delivered at a dose rate of 400 MU per minute to the 10cm depth. The readings
were 740Atm for the pressure and 24°C for the temperature. We recorded measurements on the
CAX for the 6 MV and 18 MV energies; 3 times with the 60° EDW Varian 21 iX and 3 times
without (see table 1 and 2). We then took the average of each to calculate our WF (See Table 3).
Figure 1. 0.6cm3 Farmer-type ion chamber placed at a depth of 10 cm of water-equivalent
phantom.

Figure 2. Dosimetry Electrometer Model 206 to measure the absorbed dose.

Results:

Table 1. The average reading with and without wedge for 6 MV, EDW 60, field size 10x10 cm

Reading (6MV) Reading with EDW 60 (nC) Reading without wedge (nC)
1 9.48 14.29
2 9.48 14.28
3 9.47 14.27
Average 9.48 14.28

Table 2. The average reading with and without wedge for, 18 MV, EDW 60, field size 10x10 cm

Reading (18 MV) Reading with EDW 60 (nC) Reading without wedge (nC)
1 12.69 17.39
2 12.7 17.38
3 12.7 17.38
Average 12.7 17.38

Table 3. The wedge factor for EDW 60 with 6 MV and 18 MV

Energy Dose with wedge Wedge Factor % of Beam Attenuated

Dose without wedge by the Wedge
6 MV 9.48 0.664 33.6%
14.28
18 MV 12.7 0.731 26.9%
17.38

Discussion: The 60° EDW wedge factor for the 6MV photon energy is 0.664 and for the 18MV
photon energy is 0.731. The result shows that the 60° EDW attenuates 33.6% of 6MV beam and
26.9% of 18MV beam when passing through the 60° EDW. The presence of the wedge decreases
the beam intensity and need to be taken into account in calculating the dose.
Clinical Application: A dose of 3750 cGy with 180 cGy fractions and 95% isodose line were
prescribed to treat L-spine wedge pair. The treatment will be delivered through AP no wedge
(beam weighting 20%), RPO with 60° EDW (beam weighting 40%) and LPO with 60° EDW
(beam weighting 40%).

The calculated monitor unit for each treatment field using an EDW 60 for RPO and LPO and no
wedge AP is shown below:

𝐷𝑜𝑠𝑒
MUAP = 𝐶𝑎𝑙𝑖𝑏.𝑓𝑎𝑐𝑡𝑜𝑟 𝑥 𝑆𝑐𝑝𝑥𝑇𝑀𝑅𝑥𝑊𝐹𝑥𝐼𝐷𝐿𝑥𝐼𝑆𝐿

250 𝑐𝐺𝑦 (20%)

= 100+3.5
(0.9573)(0.987)(0.8285)(1)(0.95)( )2
100

= 63 MU

𝐷𝑜𝑠𝑒
MURPO = 𝐶𝑎𝑙𝑖𝑏.𝑓𝑎𝑐𝑡𝑜𝑟 𝑥 𝑆𝑐𝑝𝑥𝑇𝑀𝑅𝑥𝑊𝐹𝑥𝐼𝐷𝐿𝑥𝐼𝑆𝐿

250 𝑐𝐺𝑦 (40%)

= 100+3.5
(0.9573)(1.019)(0.9615)(0.731)(0.95)( )2
100

= 143 MU

𝐷𝑜𝑠𝑒
MULPO = 𝐶𝑎𝑙𝑖𝑏.𝑓𝑎𝑐𝑡𝑜𝑟 𝑥 𝑆𝑐𝑝𝑥𝑇𝑀𝑅𝑥𝑊𝐹𝑥𝐼𝐷𝐿𝑥𝐼𝑆𝐿

250 𝑐𝐺𝑦 (40%)

= 100+3.5
(0.9573)(1.019)(0.9615)(0.731)(0.95)( )2
100

= 143 MU
The calculated monitor unit for each treatment field without EDW on all 3 fields:

𝐷𝑜𝑠𝑒
MUAP = 𝐶𝑎𝑙𝑖𝑏.𝑓𝑎𝑐𝑡𝑜𝑟 𝑥 𝑆𝑐𝑝𝑥𝑇𝑀𝑅𝑥𝑊𝐹𝑥𝐼𝐷𝐿𝑥𝐼𝑆𝐿

250 𝑐𝐺𝑦 (20%)

= 100+3.5
(0.9573)(0.987)(0.8285)(1)(0.95)( )2
100

= 63 MU

𝐷𝑜𝑠𝑒
MURPO = 𝐶𝑎𝑙𝑖𝑏.𝑓𝑎𝑐𝑡𝑜𝑟 𝑥 𝑆𝑐𝑝𝑥𝑇𝑀𝑅𝑥𝑊𝐹𝑥𝐼𝐷𝐿𝑥𝐼𝑆𝐿

250 𝑐𝐺𝑦 (40%)

= 100+3.5
(0.9573)(1.019)(0.9615)(1)(0.95)( )2
100

= 105 MU

𝐷𝑜𝑠𝑒
MULPO = 𝐶𝑎𝑙𝑖𝑏.𝑓𝑎𝑐𝑡𝑜𝑟 𝑥 𝑆𝑐𝑝𝑥𝑇𝑀𝑅𝑥𝑊𝐹𝑥𝐼𝐷𝐿𝑥𝐼𝑆𝐿

250 𝑐𝐺𝑦 (40%)

= 100+3.5
(0.9573)(1.019)(0.9615)(1)(0.95)( )2
100

= 105 MU

Percent difference in MU:

143−105
RPO = x 100% = 26.6%
143

143−105
LPO = x 100% = 26.6%
143

The use of 60° EDW resulted an increase about 26.6% in MU. If both wedge factors were not
accounted for in this calculation, patient will be under dose by 26.6% which is very significant.
Patient is missing more than a quarter of the prescribed dose.
The images shown below are the monitor unit calculation using Pinnacle treatment planning
system.
Table 4: The percent difference in MU calculation using EDW 60 between calculated MU
setting and treatment planning system (TPS)

Field AP RPO LPO

Calculated MU 63 143 MU 143 MU
Pinnacle TPS 60 139 134 MU
Percent Difference 4.8% 2.8% 6.3%

Conclusions:

This assignment demonstrates that all variables must be considered to obtain the correct
dose. Ignoring one of these variables may cause patient not receiving the proper dose due to
attenuation of the beam that is not being compensated for. Overdosing can cause injury and even
death to healthy organ. On the other hand, under dosing can cause uncontrollable tumor not
being treated properly.
References:
1. Khan F, Gibbons J. Khan's The Physics Of Radiation Therapy. 5th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2014
2. Abing, C. Beam Modifying Devices in Calculations. [SoftChalk]. La Crosse, WI: UW-L
Medical Dosimetry Program; 2018
3. Saminathan S, Manickam R, Supe SS. Comparison of dosimetric characteristics of
physical and enhanced dynamic wedges. Reports of Practical Oncology and
Radiotherapy. 2012;(17):4-12