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Daniel Frieling

February 26, 2018

Attenuation Factor Calculation

Calculation of an F-Headrest Attenuation Factor

Objective:

To determine the attenuation factor when treating through a solid F-headrest and use this in a
patient monitor unit calculation.

Purpose:

The goal of radiation therapy is to deliver a dose to a specific area in the patient’s body. In order
to do this, a dosimetrist must account for everything that is in the path of the treatment beam.
This includes wedges, trays, and various immobilization devices. Given the properties of
radiation, it is known that as a photon beam passes through any material it loses intensity. This is
called attenuation. Attenuation is defined in Webster’s dictionary as “a lessening in amount,
force, magnitude, or value.”2 In order to determine this, a transmission factor must be applied to
the dose calculation formula. A transmission factor is simply a ratio of the dose distributed with
the object in the beam’s path over the dose without the object. This equation calculates the
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attenuation of the beam as it passes through different objects. It can be clearly seen in the
formula below.

𝑫𝒐𝒔𝒆 𝒘𝒊𝒕𝒉 𝒐𝒃𝒋𝒆𝒄𝒕 𝒊𝒏 𝒑𝒂𝒕𝒉

𝑻𝒓𝒂𝒏𝒔𝒎𝒊𝒔𝒔𝒊𝒐𝒏 𝑭𝒂𝒄𝒕𝒐𝒓 =
𝑫𝒐𝒔𝒆 𝒘𝒊𝒕𝒉𝒐𝒖𝒕 𝒐𝒃𝒋𝒆𝒄𝒕 𝒊𝒏 𝒑𝒂𝒕𝒉

In most radiation procedures, the patient is lying supine on a flat treatment table. Their head is
typically resting on a plastic or foam headrest. This is done to immobilize the patient’s head and
provide a level of comfort throughout the procedure. Headrests are designed to hold the patient’s
body in various different positions.

These positions typically correlate with either a number or letter. This makes documentation
regarding the patient’s setup easier to comprehend. Some elevate the patients head. Others are
utilized to accentuate the patient’s neck area for certain treatments. The purpose of this report is
to examine how a patient headrest affects the dose provided and assess how this factor could
change a patient’s treatment.
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Materials & Methods:

This project was performed on a Novalis 600c treatment machine.

A field size of 10 x 10 was set with a depth of 5cm. This was done using sheets of plastic water
for buildup. For each measurement taken, 100 monitor units (MU) were distributed. A farmer
type ionization chamber was utilized. The chamber was then connected to a Fluke electrometer.
This was used to obtain the measurements.
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After the electrometer was sufficiently warmed up, three measurements were taken with nothing
in the beam’s path. This was followed by three more measurements with the “F” headrest placed
in the field light.

For all of the readings, 6 MV beams were used with a dose rate of 480 MU/min.

Results:

Table 1: Output readings for a 10 x 10 open field

Reading Result (nC)

Reading One 21.61
Reading Two 21.60
Reading Three 21.62

From this information I averaged the readings to achieve a final result of 21.61 nC. This will be
used to determine my transmission factor later in the results.
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Table 2: Output readings for a 10 x 10 field with the beam passing through the headrest

Reading Result (nC)

Reading One 20.96
Reading Two 20.97
Reading Three 20.95
These readings were averaged as well to achieve a final result of 20.96 nC. This will be used in
in the transmission factor calculation.

Actually calculating the transmission factor is fairly straight forward. The formula mentioned
before is utilized and the values are simply plugged in.

𝑫𝒐𝒔𝒆 𝒘𝒊𝒕𝒉 𝒐𝒃𝒋𝒆𝒄𝒕 𝒊𝒏 𝒑𝒂𝒕𝒉

𝑻𝒓𝒂𝒏𝒔𝒎𝒊𝒔𝒔𝒊𝒐𝒏 𝑭𝒂𝒄𝒕𝒐𝒓 =
𝑫𝒐𝒔𝒆 𝒘𝒊𝒕𝒉𝒐𝒖𝒕 𝒐𝒃𝒋𝒆𝒄𝒕 𝒊𝒏 𝒑𝒂𝒕𝒉

𝟐𝟎. 𝟗𝟔 𝒏𝑪
𝑻𝒓𝒂𝒏𝒔𝒎𝒊𝒔𝒔𝒊𝒐𝒏 𝑭𝒂𝒄𝒕𝒐𝒓 =
𝟐𝟏. 𝟔𝟏 𝒏𝑪

𝑻𝒓𝒂𝒏𝒔𝒎𝒊𝒔𝒔𝒊𝒐𝒏 𝑭𝒂𝒄𝒕𝒐𝒓 = . 𝟗𝟕𝟎

Discussion:

All of the information presented to this point makes logical sense. The readings that were
received with an open field were higher than the readings with the headrest in the beam’s path.
This demonstrates the attenuation that takes place as the beam passes through the headrest. In
essence, the headrest absorbed a portion of the beams intensity resulting in a lower reading. A
transmission factor of .970 tells us that 3% of the beam was attenuated by the foam headrest.4 In
the end, this is not a large portion of the beam. However, it does need to be factored in when
calculating the monitor units of a patient. The formula to calculate monitor units for an SAD
setup is as follows:

𝑫𝒐𝒔𝒆
𝑴𝑼 =
[(𝑪𝒂𝒍)(𝑺𝒄𝒑)(𝑻𝑨𝑹)(𝑰𝒏𝒗𝑺𝒒)(𝑻𝑭)]

This equation will be used extensively in the “clinical application” section to follow.
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Clinical Application:

As has been discussed earlier, conceptually, the physics of a transmission factor makes perfect
sense. This can be best visualized, however, through the use of a clinical example. For this, I will
use a brain treatment. I will calculate the monitor units for each treatment field and then compare
the results with the treatment planning software. The patient in question has been prescribed a
dose of 30 Gy over 10 treatments resulting in a daily dose of 300 cGy.

Patient Treatment Parameters:

Right Lateral Left Lateral

Energy 6 MV 6 MV
Gantry 90.0 270.0
Field X 10.0 10.0
Field Y 10.0 10.0
SSD 89.1 cm 94.4 cm
Depth 10.9 cm 5.6 cm
Weight % .500 .500
TPR .753 .913
Scp 1.0 1.0
Inv. Square 1.0 1.0
MU 199 MU 164 MU
Treatment Planning System 204 MU 168 MU
Difference (%) 2.5% 2.4%
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From the parameters listed above, we can calculate the monitor units for this treatment plan.

Right Lateral MU Calculation:

𝑫𝒐𝒔𝒆
𝑴𝑼 =
[(𝑪𝒂𝒍)(𝑺𝒄𝒑)(𝑻𝑷𝑹)(𝑰𝒏𝒗𝑺𝒒)]

𝟑𝟎𝟎 𝒄𝑮𝒚 (𝟎 . 𝟓)
𝑹𝒕 𝑳𝒂𝒕 𝑴𝑼 =
[(𝟏. 𝟎 𝒄𝑮𝒚/𝑴𝑼)(𝟏. 𝟎)(. 𝟕𝟓𝟑)(𝟏. 𝟎)]

𝟏𝟓𝟎 𝒄𝑮𝒚
𝑹𝒕 𝑳𝒂𝒕 𝑴𝑼 =
[. 𝟕𝟓𝟑]

𝑹𝒕 𝑳𝒂𝒕 𝑴𝑼 = 𝟏𝟗𝟗. 𝟐 𝒐𝒓 𝟏𝟗𝟗 𝑴𝑼

Left Lateral MU Calculation:

𝑫𝒐𝒔𝒆
𝑴𝑼 =
[(𝑪𝒂𝒍)(𝑺𝒄𝒑)(𝑻𝑷𝑹)(𝑰𝒏𝒗𝑺𝒒)]

𝟑𝟎𝟎 𝒄𝑮𝒚 (𝟎 . 𝟓)
𝑳𝒕 𝑳𝒂𝒕 𝑴𝑼 =
[(𝟏. 𝟎 𝒄𝑮𝒚/𝑴𝑼)(𝟏. 𝟎)(. 𝟗𝟏𝟑)(𝟏. 𝟎)]

𝟏𝟓𝟎 𝒄𝑮𝒚
𝑳𝒕 𝑳𝒂𝒕 𝑴𝑼 =
[. 𝟗𝟏𝟑]

𝑳𝒕 𝑳𝒂𝒕 𝑴𝑼 = 𝟏𝟔𝟒. 𝟑 𝒐𝒓 𝟏𝟔𝟒 𝑴𝑼

For these calculations, machine parameters were utilized. Given that this patient is being treated
with a field size of 10 x 10, the Scp is 1.0. The patient is also being treated with an SAD
technique. This means the distance from the source (machine head) to isocenter is 100 cm. The
Novalis treatment machine was calibrated at 100 cm SAD. This leaves us with an InvSq equal to
1.0. The TPR’s for these formulas were found by referencing the Novalis calculation book. By
plugging in the field size and depth treated for each field, a correct TPR was found.
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TPR Data Sheets:

The difference between the hand calculataed and treatment planning system monitor units is
relatively small. It is roughly 2.5% for each field. This is most likely due to the variance in
tissues encountered by the field. The planning system is able to more accurately determine the
output required with this data.

The main purpose of this study is to demonstrate the affect that a transmission factor has on
monitor unit calculations. In order to exhibit this, the factor calculated earlier will be applied to
this patient’s calc.

Right Lateral MU Calculation With Transmission Factor:

𝑫𝒐𝒔𝒆
𝑴𝑼 =
[(𝑪𝒂𝒍)(𝑺𝒄𝒑)(𝑻𝑷𝑹)(𝑰𝒏𝒗𝑺𝒒)(𝑻𝑭)]
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𝟑𝟎𝟎 𝒄𝑮𝒚(𝟎. 𝟓)
𝑹𝑻 𝑳𝒂𝒕 𝑴𝑼 =
[(𝟏. 𝟎 𝒄𝑮𝒚/𝑴𝑼)(𝟏. 𝟎)(. 𝟕𝟓𝟑)(𝟏. 𝟎)(. 𝟗𝟕𝟎)]

𝟏𝟓𝟎 𝒄𝑮𝒚
𝑹𝑻 𝑳𝒂𝒕 𝑴𝑼 =
[. 𝟕𝟑𝟎]

𝑹𝑻 𝑳𝒂𝒕 𝑴𝑼 = 𝟐𝟎𝟓. 𝟒𝟕 𝒐𝒓 𝟐𝟎𝟓 𝑴𝑼

Left Lateral MU Calculation With Transmission Factor:

𝑫𝒐𝒔𝒆
𝑴𝑼 =
[(𝑪𝒂𝒍)(𝑺𝒄𝒑)(𝑻𝑷𝑹)(𝑰𝒏𝒗𝑺𝒒)(𝑻𝑭)]

𝟑𝟎𝟎 𝒄𝑮𝒚(𝟎. 𝟓)
𝑳𝑻 𝑳𝒂𝒕 𝑴𝑼 =
[(𝟏. 𝟎 𝒄𝑮𝒚/𝑴𝑼)(𝟏. 𝟎)(. 𝟗𝟏𝟑)(𝟏. 𝟎)(. 𝟗𝟕𝟎)]

𝟏𝟓𝟎 𝒄𝑮𝒚
𝑳𝑻 𝑳𝒂𝒕 𝑴𝑼 =
[. 𝟖𝟖𝟓𝟔]

𝑳𝑻 𝑳𝒂𝒕 𝑴𝑼 = 𝟏𝟔𝟗. 𝟒 𝒐𝒓 𝟏𝟔𝟗 𝑴𝑼

Conclusion:

Comparing these results, an observable increase in monitor units can be noticed. The right lateral
field increased from 199 MU to 205 MU. The left lateral field saw a similar increase from 164
MU to 169 MU. The question can be asked; why does this increase take place? The answer is
relatively simple. For each plan, the machine is tasked with delivering a prescribed dose to a
particular area in the patient’s body. The output of the machine, measured in monitor units, is the
energy necessary to complete this task.5 With the “F” headrest in the beam’s path, there is more
matter for the dose to travel through before reaching its intended destination. Thus, the
machine’s output must be increased to adjust for this scenario. A transmission factor is a variable
in the monitor unit calculation that accounts for this output difference. This sufficiently fulfills
the purpose of this study to demonstrate and explain the effect of a transmission factor on a
monitor unit calculation.
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Patient Beam Orientation:

Treatment Field Parameters:

Dose Prescription:
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References:

1. NL-Tec. Silverman Head Rests. http://www.nl-tec.com.au/Silverman-Head-Rests .

Accessed: 2/28/18
2. Merriam-Webster. Attenuation. https://www.merriam-webster.com/dictionary/attenuation
. Accessed: 2/28/18
3. Civco. Timo Headrests. http://civcort.com/ro/head-neck/timo-headrests/timo-headrests-
HN10.htm . Accessed: 2/28/18
4. Khan FM. A System of Dosimetric Calculations. The Physics of Radiation Therapy. 4th
ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2010.
5. Interview with Matthew Pacella, MS, DABR, FACR, at the James P Wilmot Cancer
Center at Strong Hospital, Rochester, NY. February 26, 2018.