Alyssa Olson

February 9, 2016
Attenuation Factor Calculation
Wedge Factor Calculation
Objective: To determine the wedge transmission factor for a 45-degree wedge and its impact on
radiation beam attenuation.
Purpose: Radiation isodose distribution data has been historically collected using uniformlyshaped phantoms. Because the human body is curvaceous in nature, there are times when the
radiation dose distribution is less than ideal. In addition, overlapping or intersecting radiation
beams in the body may create areas of undesirable hot spots.1 In order to compensate for
irregular surfaces and problematic dose distribution, a wedge may be placed in the path of the
beam which specifically attenuates the radiation based on the wedge composition.2 Physical or
hard wedges are typically made of lead or steel.3 The thin aspect of the wedge is referred to as
the toe and allows more radiation to be transmitted through the filter. Conversely, the thicker
aspect of the wedgeor heel, attenuates more of the radiation beam, reducing the intensity of
photons reaching the patient.2-3 This modified transmission ultimately causes a decrease in the
beams dose rate along the central axis.3 Each wedge is mounted on an individual frame which
can be connected to the head of the machine. Wedges are named with varying degrees and
orientations. The wedge degree refers to the tilt of a specific isodose line at a predetermined
depth along the central axis, rather than its physical composition. Therefore, the isodose line and
radiation dose will be tilted downwards towards the toe end of the wedge (Figure 1).3

Figure 1: Isodose Tilt Effect with a Wedge

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The wedge transmission factor (WF) is a comparison of dose to a wedged field to that of an open
field.2 This factor represents the amount of dose transmitted through the wedge. The WF can be
determined using the following equation:
WF =

Dose Wedge
Dose Open Field

Methods and Materials: All measurements with regard to the 45-degree wedge factor were
acquired using a Varian Trilogy linear accelerator. A pin point 31014 ion chamber was placed at
a depth of 10 cm in tissue equivalent solid water blocks (Gammex, Madison, WI) via a hollow
hole. The ion chamber was connected to a Sun Nuclear electrometer, which had a bias voltage of
+300 volts (V). An additional 11 cm of solid water was placed under the ion chamber to reduce
the backscatter contribution (Figure 2). The field size was set to 10 cm by 10 cm at an SSD of
100 cm. Data was gathered for two different photon energies: 6 MV and 15 MV. Four separate
tests were performed: 6 MV with no wedge, 6 MV with a 45-degree wedge, 15 MV with no
wedge, and 15 MV with a 45-degree wedge. One hundred monitor units (MU) were delivered to
the ion chamber for each test and the charge was measured and recorded in nanocoulombs (nC).
Each test was completed four times and an average (avg) charge was calculated.

Figure 2. Solid Water Phantom with Pin Point Ion Chamber

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Results: The results of each test were recorded as shown in Table 1. An average reading was
obtained for each test by using the following equation:
Average Reading =

(Reading1 + Reading2 + Reading3 + Reading4)

4

Table 1. Collected Charge Data (nC) for 6 MV and 15 MV Photons with

and without a 45-Degree Wedgea
Photon Energy
6 MV

6MV

15 MV

15 MV

No Wedge

45-Wedge

No Wedge

45-Wedge

Reading 1

0.2535 nC

0.1246 nC

0.2994 nC

0.1565 nC

Reading 2

0.2541 nC

0.1239 nC

0.2986 nC

0.1563 nC

Reading 3

0.2543 nC

0.1249 nC

0.2993 nC

0.1569 nC

Reading 4

0.2534 nC

0.1245 nC

0.2993 nC

0.1563 nC

Average Reading

0.2538 nC

0.1245 nC

0.2992 nC

0.1565 nC

Field size was set at 10 x 10 cm, and 100 cm SSD. Ion chamber depth was at 10 cm.

The WF was calculated by taking the ratio of average reading with a wedge over the average
reading with an open field of the same energy.3 This was completed for both photon energies
tested and recorded in Table 2.

Table 2. Calculation of Wedge Factor Using Average Energy Readings

Photon Energy
6 MV

15 MV

Calculation Equation
Avg. Reading Wedge
Avg. Reading Open Field
Wedge Transmission Factora
a

0.1245 nC

0.2538 nC

0.4905

0.1565 nC

0.2992 nC

0.5231

Wedge transmission factors were determined using the calculation equation

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Discussion: The WF values of 0.4905 and 0.5231 for 6 MV and 15 MV respectively imply that
approximately 50 percent of the radiation beam is attenuated by the 45-degree wedge. These
values are only specific to the 45-degree hard wedge along the central axis. Due to the halving
of beam intensity or dose rate the MU of the wedged field would have to double. This is
demonstrated using the equation below in Figure 3.
Monitor Units =

Dose(cGy)
cGy
Dose Rate( MU ) x WF

Figure 3. Monitor Unit Calculation With and Without a Wedge

Wedge
Open
Monitor Units =

1(cGy)
cGy
1( MU ) x 0.5

Monitor Units = 2 MU

Monitor Units =

1(cGy)
cGy
1( MU ) x 1.0

Monitor Units = 1 MU

With respect to the differences between the two energies tested, a relationship can be identified
between beam quality and penetration power.4 In general, as photon energy increases, the
penetration power and tendency to scatter forward also increases. In addition, wedges provide
additional hardening of the beam, by attenuating lower energy photons. Therefore, the 15 MV
photon beam will allow a greater percentage of the beam through the wedge in comparison to the
6 MV beam because of its increased penetration power and beam hardening.
Clinical Application: Clinical application of the WF can be observed in the following patient
example. The radiation oncologist wants to treat a patients rectum in the prone position using 4field box technique, 15 MV photons, 180 cGy per fraction, at 100 cm SAD. The machine is
calibrated to 100 cm SSD, 10 cm x 10 cm, and Dmax, where 1 cGy = 1 MU. The MU equation
used to calculate the planned MU from Table 3 is as follows:3
MU =

Dose (cGy)
cGy
DR ( MU ) Sc Sp TMR WF ISF

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Table 3. Plan Parameters for Prone Rectum Patient

Dose (cGy)
Dose Rate Ref (cGy/MU)
Eq. Square (cm2)
Depth (cm)
Sc (cGy/MU)
Sp (cGy/MU)
TMR
WF
ISF

PA Field
74.8
1.0
15
8.3
1.026
1.024
0.918
1.0
(102.9/100)2

AP Field
18.4
1.0
15
17.9
1.027
1.024
0.723
1.0
(102.9/100)2

Rt Lat
45.2
1.0
14
18.7
1.027
1.013
0.710
0.5231
(102.9/100)2

Lt Lat
44.9
1.0
14
18.9
1.026
1.013
0.704
0.5231
(102.9/100)2

Hand calculations were performed using the information in Table 3. This plan used a 45-degree
wedge on both lateral fields.

74.8 cGy

PA Field MU =
1.0

cGy
102.9
1.026 1.024 0.918 1.0 (
)^2
MU
100
PA Field = 73 MU

AP Field MU =

18.4 cGy
cGy
102.9
1.0 MU 1.027 1.024 0.723 1.0 ( 100 )^2
AP Field = 23 MU

Rt Lat MU =

45.2 cGy
cGy
102.9
1.0 MU 1.027 1.013 0.710 . ( 100 )^2
Rt Lat Field = 110 MU

Lt Lat MU =

44.9 cGy
cGy
102.9
1.0 MU 1.026 1.013 0.704 . ( 100 )^2
Lt Lat Field = 111 MU

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Hand calculations were also performed using the same lateral fields without a wedge as a
comparison of the monitor unit outcome.
Lt Lat MU =

44.9 cGy
cGy
102.9
1.0 MU 1.026 1.013 0.704 . ( 100 )^2
Lt Lat Field = 58 MU

Rt Lat MU =

45.2 cGy
cGy
102.9
1.0 MU 1.027 1.013 0.710 . ( 100 )^2
Rt Lat Field = 58 MU

This calculation demonstrates the impact of a using a wedge as it approximately doubles the MU
when a 45-degree wedge is used in the treatment field in comparison to an open beam.
Figure 4. MU calculations were generated for the prone rectum plan using the AAA algorithm in
Eclipse treatment planning system. Notice the use of 45-degree wedges on the lateral fields.

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Figure 5 provides a visual comparison of the 45-degree wedges impact on the isodose
distribution using the prone rectum plan. Due to the natural curvature of the buttocks and
reduced tissue thickness to the target, hot spots developed towards the posterior surface. To
account for this effect, the heel of the wedge was positioned on the posterior aspect of the
patient. This reduced the beam intensity on the posterior side and enhanced the beam uniformity.
Figure 5. Comparison of Isodose Distribution in a Wedged Plan versus an Open Plan

Conclusion: Wedges are an essential beam modifying device used in treatment planning. They
modify the intensity of the radiation beam by attenuating more photons at the heel versus the toe.
Adding a wedge into the beam can significantly impact several properties of the beam including
an increased number of field MUs, a decreased dose rate, and an altered dose distribution.
Specific care must be taken when planning with wedges. An accidental omission of a wedge
during planning will cause an under dose to the patient. Conversely, an omission of a wedge
during treatment delivery will cause an over dose to the patient.

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References:
1. Coleman AM. Treatment procedures. In: Washington CM, Leaver D, eds. Principles and
Practice of Radiation Therapy. 4th ed. St Louis, MO: Elsevier-Mosby; 2016:chap 8.
2. Bentel GC. Radiation Therapy Planning. 2nd ed. New York, NY: McGraw-Hill; 1996.
3. Kahn FM, Gibbons JP. Kahns The Physics of Radiation Therapy. 5th ed. Philadelphia,
PA: Lippincott Williams & Wilkins; 2014.
4. Mackie RT, Liu HH, McCullough EC. Treatment planning algorithms: model-based
photon dose calculations. In: Kahn FM, ed. Treatment Planning in Radiation Oncology.
2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2007:chap 6.