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Amanda Lisher
Attenuation Project
February 15, 2015
Wedge Transmission Factor
Objective: Demonstrate and understand how a photon beam is attenuated by a physical wedge
during radiation treatments, and apply this knowledge to accurate treatment planning.
Purpose: The goal of radiation therapy is to deliver the highest, most conformal dose to the site
of disease, while sparing surrounding normal tissue. In order to achieve this, dosimetrists use a
variety of beam-shaping devices, including custom shielding blocks, bolus tissue compensators,
and wedges. Wedges are designed to compensate for areas of the body that are naturally sloped.
[1]

They are also used to reduce areas of increased dose (hot spots) in areas where there are

drastic differences in tissue, such as the neck and breast, or areas where there is dose overlap
from two or more treatment fields. The beam attenuation achieved by using a wedge effectively
changes the slope of the isodose curve at treatment depth, creating a more even dose distribution.
[2]

Standard wedge angles are 15, 30, 45 and 60 degrees, based on the angle they create in the

isodose curve. Each thickness of wedge will attenuate the radiation beam to a different extent. It
is important to know how much radiation is being absorbed by the wedge, in order to
compensate for dose lost to the patient. For the purposes of this study, the beam attenuation of a
30 degree physical wedge was measured in order to calculate the necessary increase in monitor
units (MU) necessary to achieve the desired dose for a total liver treatment.
Methods and Materials: In order to calculate the increase in MU needed to compensate for
beam attenuation by the wedge, it is necessary to determine the wedge transmission factor (WF).
The WF represents the amount of radiation exiting the wedge that reaches the patient at a
specified depth and field size.[3] Determining the attenuation of objects in the path of the beam is
a relative measurement (Dr. Rick Holmes, personal interview conducted February 5, 2015). It is
a comparison of dose achieved with and without the object in place. The WF can be therefore be
calculated using the following equation: WF=Dose with wedge/Dose without wedge.[4] For this
study, data was measured on a Varian 23iX linear accelerator. A PTW model TN30013 farmer
chamber was placed at a depth of 4cm inside a polystyrene phantom. The field size was set at

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10x10cm, source to surface distance was set at 100cm. Using a 15 megavoltage (MV) beam, 100
MU were delivered three times with and three times without the 30 degree physical wedge in
place. Dose measurements were read with a CNMC model 11 dosimeter/electrometer.
Results:
Table 1: Dose measured with and without the 30 degree physical wedge in the path of the beam.
Dose with Wedge in Place
(nC)
100 MU, 15MV photon beam:

Dose without Wedge in Place


(nC)

11.29

17.73

11.28

17.74

11.29

17.72

Sum of Measurements:

33.86

53.19

Average Measurement
(Sum/3):

11.29

17.73

Table 2: Calculating the Wedge Transmission Factor (WF)


Average Reading with the Wedge/
Average Reading without the Wedge
11.29/17.73

Wedge Transmission Factor (WF)


0.637

Discussion: The WF for a 30 degree physical wedge using a 15MV photon beam is 0.637.
According to these measurements, a 30 degree wedge attenuates 36.3 percent of the photon
beam. As a result, only 63.7% of the primary beam is contributing to the therapeutic dose.
Ahmad, et al. have noted that the WF varies greatly for physical wedges depending on depth and
field size.[5] This difference is a result of beam hardening, as low-energy photons are most likely
to be absorbed by the wedge material, and is outside the scope of this report.
Clinical Application: Whole liver treatment. The plan is for 150cGy to be delivered daily, four
times each week, to a total palliative dose of 2250cGy. The treatment will be delivered through
RAO, LAO and LPO treatment fields. Both the LAO and RPO fields utilize 30 degree physical

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wedges. The monitor unit hand calculation for each treatment field, first with and then without
the WF included, is included below. In order to be thorough, all field calculations are shown.

Figure 1: MU calculations for RAO, LAO, LPO whole liver fields, including calculations with
and without WF and percent difference.

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For the LAO and RPO fields, the use of the 30 degree WF resulted in an average 36.55%
increase in MU. This data demonstrates that the liver would receive a significant underdose if the
WF were not accounted for in the calculation.

Figure 2: MU check worksheet

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Figure 3: Plan MU check worksheet

Conclusion: Ideally, during radiation therapy, the beam would penetrate a flat surface, delivering
an even dose across the entire field size. Unfortunately, the human body is not so
accommodating. There are several tools available to the medical dosimetrist to assist in shaping
the treatment beam, ensuring the highest therapeutic dose reaches the target while sparing
healthy tissue. However, each alteration in the primary beam results in changes in dose

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distribution that must be accounted for in treatment planning calculations. As this paper has
indicated, the use of a physical wedge will significantly reduce the amount of radiation reaching
the patient. As a result, treatment plan MU must be increased to compensate for this loss of dose
and ensure the prescribed amount of radiation is delivered.

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References
Stanton R, Stinson D. Treatment planning. In: Stanton R, Stinson D, eds. Applied Physics for
Radiation Oncology. Madison, WI: Medical Physics Publishing; 1996:215-246.
Coleman AM. Treatment procedures. In: Washington CM, Leaver D, eds. Principles and
Practice of Radiation Therapy. 3rd ed. St. Louis, MO: Mosby-Elsevier; 2010:158-179.
Armstrong J, Washington CM. Photon dosimetry concepts and calculations. In: Washington
CM, Leaver D, eds. Principles and Practice of Radiation Therapy. 3rd ed. St. Louis, MO:
Mosby-Elsevier; 2010:492-526.
Bentel GC. Dose determination for external beams. In: Bentel GC, ed. Radiation Therapy
Planning. 2nd ed. New York, NY: McGraw-Hill; 1996:32-58.
Ahmad M, Hussain A, Muhammad W, Rizvi SQA, Matiullah. Studying wedge factors and
beam profiles for physical and enhanced dynamic wedges. J Med Phys/Association of
Medical Physicists of India 2010;35(1):33-41. doi:10.4103/0971-6203.57116.