1

Wael Mekhael
January 28th, 2015
Attenuation Coefficient Project
Wedge Transmission Factor Calculation for 45 Degree wedge.
Objective:
What is a wedge? What happen to beam intensity if a hard wedge put in path of the beam? Does
patient get more or less dose if a wedge is omitted by mistake? Do we need more or less monitor
units (MU) if a wedge is used? To know the answers for these questions, we need to determine
the transmission factor for the hard wedge, and demonstrate how it is applied to monitor unit
calculations.

Purpose:
Wedges are made of dense material as lead; wedges are beam shaping devices that placed in the
path of the beam, produces a sloping isodose curve, wedges used to account for missing tissue
and beam direction, the presence of a wedge filter decreases the output of the machine.1 In
general there are many different factors that are taken into consideration when determining the
dose delivered to the patient. If we did not include these factors in our calculations, the dose we
intend to give to the patient and the dose actually delivered can be significantly different. In
particular, a wedge factor can have a considerable impact on dose, as wedge attenuates the
radiation beam progressively across a field. Each wedge has a physical angle that tilts the dose
that the patient is going to received.2 Wedge factor has to be calculated to ensure the delivery of
the correct amount of dose to the patient.
The wedge factor (WF) is the ratio of doses with and without the wedge, at a
point in phantom along the central axis of the beam. If the wedge factor is
known it is possible to calculate the amount of beam necessary to deliver the
desired dose.

Wedge Factor = Dose with wedge / Dose without the wedge

Wedge factor is a function of the wedge angle, beam energy, field size and
shape. Wedge angle is the angle through which an isodose curve is titled at
the central ray of a beam at a specified depth; a greater angle requires a
greater thickness. Beam energy attenuation will be a function of the energy
spectrum. The Field size and shape for a physical wedge affects wedge
factor, wedge factor increases with field size due to increasing scatter from
wedge as size increases.
For a physical wedge, the wedge factor tends to follow the profile of the
wedge, the wedge effect on beam quality, attenuating the lower-energy
photons, beam hardening, making the %DD more penetrating than for a
plain field. More pronounced at lower energies (4-6MV) where Compton
scatter predominates.
Methods and materials:
Each center calibrates their machines differently. At Wyckoff medical center
measurements are taken from Siemens Prius treatment machine at 10 cm
depth, 100 MU, 100 cm SAD and a 10 x 10 field size using 6MV and 15MV
photon energy. A farmer ionization chamber is used along with a solid water
phantom for the measurements.

Results:
Please look at table below for the ion chamber readings in Nano coulombs (nC)

Energy

6MV

Avg.

Readings without

Readings with

45 degree wedge

45 degree

in nC
2.264

wedge in nC
0.732

2.263

0.731

2.265

0.733

2.264

0.732

15MV

Avg.

2.644

1.059

2.645

1.058

2.643

1.060

2.644

1.059

WF = Dose with wedge / Dose without the wedge

WF (for 6MV) = 0.323

WF (for 6MV) = 0.732 / 2.264 = 0.323

WF (for

WF ( for 15MV) = 0.400

15MV) = 1.059 / 2.644 = 0.400

Discussion:
The above table shows the different wedge factors for the 45 degree wedge
using 6MV and 15MV photon energies. For higher energies the wedge factor
is more, as higher energies transmit more radiation and wedge is blocking
less radiation.

Clinical Application:

As we treating patient with rectum cancer, we will apply the wedge

factor to this patient and calculate the difference in MU`s. for this
patient we used right lateral and left lateral fields with 45 degree
wedge, the prescription was 4500 cGy, 25 fractions of 180 cGy each
fraction. The right lateral was given 48 cGy, using 15MV energy.

MU (with 45 degree wedge) = Prescribed dose / Cal f x TMR x TF x WF

= 48 / 0.955 x 0.706 x 0.400 = 178 MU

MU (with 45 degree wedge) = 178 MU

MU (without 45 degree wedge) = 48/ 0.955 x 0.706 = 71 MU

MU (without 45 degree wedge) = 71 MU

MU (without 45 degree wedge) / MU (with 45 degree

wedge) = 71/178 = 40%
In our case using 45 degree wedge increased MU by
40%
As we can see we need more MU with the wedge as we need more
MU to cover for the wedge blocking, meaning if we forget to account
for the wedge factor the patient will get underdose, because we will
be giving 71 mu to a patient that should get 178 MU, and if we
account for the wedge factor but the wedge is omitted at time of
treatment by mistake, the patient will get much more dose than

prescribed, meaning we giving patient 178 MU while he should get

only 71 MU, which may lead to patient complications or patient
death.

Conclusion

Placing a wedge in the path of the beam decreases the output of the machine.3 Wedge factor must
be taken into account in treatment calculations. Using wedges means more MU needed, not
putting the wedge factor in our consideration or forgetting the wedge at time of treatment can
significantly affect the dose given to the patient.

References:
1- Discussion with Larry Farina. Medical dosimetrist at Wyckoff Medical Center. February
9, 2015
2- Bentel G. Radiation Therapy Planning. 2nd ed. New York, New York: McGraw-Hill;
1996

3- Khan FM. The Physics of Radiation Therapy. Fourth Edition. Baltimore, MD: Lippincott
Williams and Wilkins; 2010