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Stephanie Olson
February 13, 2015
Transmission Factor Calculation
Wedge Transmission Factor Calculation
Objective: To determine the wedge transmission factor for a 15 degree wedge and
perform a monitor unit calculation using this transmission factor.
Purpose: Linear accelerators used in radiation oncology have a defined set of calibration
output factors which are measured under specific conditions. These conditions include a
reference field set to a depth of 10 cm in a water phantom using a 10 x 10 cm field size at
a source to skin distance (SSD) of 100 cm. Due to the anatomical contours specific to
each patient, beam modifying devices are used to assist in creating more uniform dose
distributions. Beam modifying devices can include tissue compensators, lead blocks
attached to a tray and wedges. The most commonly used beam modifying device is the
wedge. Wedges are a lead attenuator which helps to shift the isodose curves depending
on where the heel and toe are place within the beam. The heel, or thicker part of the
wedge, attenuates the beam more resulting in less dose to that part of the beam while the
toe, or thinner part of the wedge, attenuates the beam less resulting in greater dose to that
portion of the beam.1 To account for the attenuation caused when a wedge is inserted into
the beam path, a transmission factor (TF) must be calculated to ensure the proper dose is
being delivered. The TF equation is as follows:
TF = dose with the object in the beam path
dose without the object in the beam path
More specifically, the wedge TF can be explained using the following equation:
TF = dose with the 15o wedge in the beam path
dose without the 15o wedge in the beam path
Methods and Materials: To measure the wedge TF for a 15 degree wedge, a Varian
Trilogy linear accelerator using 6 megavoltage (MV) and 10 MV photon energies using a
10 x 10 cm field size was used. Each measurement obtained was taken using 100
monitor units (MU) at a dose rate of 400 MU per minute. Measurements were taken
using a Sun Nuclear Daily QA 3 Dose Measurement Device. A 5 cm slab of solid water

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was placed on top of the Sun Nuclear QA 3 device and set to 100 SSD (Figure 1).
Measurements were recorded using the Daily QA 3 software located on a computer in the
console area.
Results: Measurements were recorded, averages were calculated, and TF was found in
the tables below:
Table 1. Measurements taken without and with the 15 degree wedge in beam path.
Energy

Measurement without wedge

Measurement with wedge

6 MV
6 MV
6 MV
10 MV
10 MV
10 MV

(cGy)
79.98
79.97
80.07
90.48
90.79
90.67

(cGy)
55.71
55.80
55.71
67.46
67.36
67.46

Table 2. Calculations for the average of the three trials for 6 MV and 10 MV energies,
without and with the 15 degree wedge. The average is found by adding the
measurements in each column for the specified energy and dividing by three.
Energy

Measurement without wedge

Measurement with wedge

6 MV

(cGy)
79.98

(cGy)
55.71

79.97

55.80

+ 80.07

+ 55.71

240.023=80.01
90.48

167.223=55.74
67.46

10 MV

90.79

67.36

+ 90.67

+ 67.46

271.943=90.65

202.283=67.43

Table 3. Calculations for the TF using the average measurements without and with the
15 degree wedge for 6 MV and 10 MV energies.

6 MV

TF = dose with the 15o wedge in the beam path

dose without the 15o wedge in the beam path
TF = 55.74

.697

10 MV

80.01
TF = 67.43

.744

Energy

TF

90.65
Discussion: The transmission factor for the 15 degree wedge calculated from the 6 MV
measurements was 0.697. This data shows that the 15 degree wedge attenuates
approximately 30.3% of the 6 MV beam. The transmission factor for the 15 degree
wedge calculated from the 10 MV measurements was 0.744 or attenuates approximately
25.6% of the beam. From these measurements, we can see that the 6 MV beam
attenuates more of the beam than the 10 MV beam due to more interactions occurring
with the wedge from the 6 MV beam. More attenuation with the wedge results in a lower
TF which would be expected due to higher interaction with the wedge.
Clinical Application: A clinical example using a 15 degree wedge was for a palliative
bone metastasis patient who was treated to the left arm. A total prescribed dose of 2000
cGy using five fractions of 400 cGy each was used for this plan. The field configuration
consisted of an anterior-posterior (AP) and posterior-anterior (PA) treatment beams using
no multi-leaf collimator blocking. The collimator was set to a field width of 6.1 cm and
field length of 17.3 cm. The AP field contained a 15 degree wedge while the PA field did
not (Figure 2). The AP beam was weighted at 56.9% and the PA beam was weighted at
43.1%. To calculate the amount of MU needed with the wedge in place, the following
equation can be used:
MU =

dose
.
dose rate * TMR * Sc * Sp * WF * Inv Sq

Thus, for the clinical example given above, the MU calculation for the AP beam with the
wedge is equal to:
MU =

400 cGy * 0.569

1 cGy/MU * 0.922 * .997 * .994 * 0.697
= 357 MU

To calculate the MU needed for the AP beam without the wedge, the following equation
can be used:
MU =

dose
dose rate * TMR * Sc * Sp * Inv Sq

Thus, for the clinical example given above, the MU calculation for the AP beam without
the wedge is equal to:
MU =

400 cGy * 0.569

1 cGy/MU * 0.922 * .997 * .994

= 249 MU
To then calculate the percent difference in MU between the calculations with the 15
degree wedge versus the calculation without the 15 degree wedge, the following equation
can be used:
% diff. in MU = (MU calculation with wedge) - (MU calculation without wedge)
MU calculation with wedge

* 100

Thus, for the clinical example given above, the percent difference in MU is equal to:
% diff. in MU = 357 MU 249 MU
357 MU
= 30.3%

* 100

From this calculation in percent difference, results show that the use of a 15 degree
wedge causes an increase of 30.3% in MU for the AP beam. Without the use of the 15
degree wedge, the patient would be under dosed by 30.3%.
Conclusion: A wedge is a beam attenuator that helps to better conform dose to a tumor.
Wedges cause progressive change in beam intensity across the beam from the toe of the
wedge to the heel.2 This attenuation of the beam must be accounted for in monitor unit
calculations and if omitted, a patient can be significantly under dosed. The wedge
transmission factor is specific to each beam and dependent on the beam energy and
wedge angle.

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References
1. Bentel G. Radiation Therapy Planning. 2nd ed. New York, NY:McGrawHill;1996:49.
2. Khan F. Khans Lectures Handbook of the Physics of Radiation Therapy.
Baltimore, MD:Lippincott Williams & Wilkins; 2011:156.

Figures

Figure 1. Set up of Sun Nuclear Daily QA 3 dose measurement device with 5 cm slab of
solid water set at 100 SSD.

Figure 2. Field configuration: AP beam with 15 degree wedge; PA beam without 15

degree wedge.