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Teri Burrier
March 1, 2018
Transmission Project
Wedge Transmission Project
Objective: The objective of this project is to determine the transmission factor for a physical 30-
degree wedge and also use this factor in a patient treatment monitor unit calculation.
Purpose: The purpose of this study is to more closely understand the effect that a wedge will
have when placed in the path of a treatment beam. A physical wedge is typically made of dense
material such as lead or steel and when it is placed in the path of a beam it will cause the dose
delivered to the underlying tissue to change.1 This concept is very important to understand
because it will have a direct effect on the dose being delivered. In order for the correct dose to
be delivered after the addition of a wedge, the MU calculation must be modified. This
modification will be in the form of a wedge transmission factor that must be added to the
calculation. The wedge factor used for the calculation will change based on the energy of the
beam being used and will be the focus of this study. By measuring the output of a 6x and 18x
beam with and without the 30-degree wedge in place, the transmission factors will be able to be
determined.
The wedge transmission factor is found using the following formula:
Wedge Factor = Dose with the wedge in place ÷ Dose without the wedge
This factor will be used in calculating the MU for the given field in order to find the correct
monitor units needed to deliver the desired dose to the prescription depth.
Method: For this study, output was measured on a Varian Trilogy linear accelerator. Beam
output was first acquired for 6x photons with and without the placement of the 30-degree
physical wedge. To begin the study, a thick piece of solid water was placed on the treatment
table and was used as a backscatter piece. Next, a 2cm buildup was added that included a
circular space for the insertion of the farmer chamber, which would be used to collect the
readings. When the farmer chamber is placed within the hole, the center of the chamber is at a
depth of 1cm. Finally, a 0.5cm buildup was added to the top to make the final depth to the
chamber 1.5cm, which is the depth of dmax for 6x photons.
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Images 1a and 1b: The farmer chamber used for measuring dose output, as well as the solid
water set-up used for this portion of the study.

For the readings, a 10x10 field size was used, a distance of 100 SAD (98.5 SSD to top of
buildup), and 100 monitor units were delivered with and without the physical 30-degree wedge
in place to determine the difference in dose. The wedge was placed in the lt/rt position for this
study and each reading was taken three times to ensure accuracy.

Table 1: Readings with and without the 30-degree wedge in place for 6x beam.

6x / 10x10fs Reading 1 Reading 2 Reading 3 Average

No 30◦ Wedge 20.18 20.18 20.19 20.18
With 30◦ Wedge 10.82 10.82 10.81 10.82

To determine the wedge factor, the earlier formula is used which is, wedge factor = dose with the
wedge in place ÷ dose without the wedge. This becomes: 10.82 ÷ 20.18 = .536. Thus, the
wedge factor for a 30◦ wedge in the lt/rt position is .536.
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The second portion of the study measured beam output with and without the 30◦ wedge
using 18x photons. All aspects of the study were kept the same except an additional piece of
solid water buildup material was used to place the farmer chamber at dmax, which is 3.5cm for
18x photons compared to 1.5cm for the 6x beam. This resulted in a 96.5 SSD to the top of the
solid water buildup.

Image 2: Solid water phantom used for 18x beam

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Table 2: Readings with and without the 30-degree wedge for 18x beam

18x / 10x10fs Reading 1 Reading 2 Reading 3 Average

No 30◦ Wedge 21.87 21.84 21.85 21.85
With 30◦ Wedge 13.57 13.57 13.56 13.57

13.57 ÷ 21.85 = .621 wedge factor for 18x 10x10fs

Comparison

Table 3: Calculation of wedge factor for 6x and 18x beam

Energy With Wedge No Wedge Wedge Factor

6x 10.82 ÷ 20.18 = .536
18x 13.57 ÷ 21.85 = .621

Findings: The study shows that the wedge factor increases with an increase in beam energy.
The wedge factor increased by 0.085 with the switch to 18x from 6x. The correct wedge factor
will need to be applied for all field calculations that contain a wedge in order to get the
appropriate mu. An example of the difference in mu for an 18x field with and without a wedge
factor used is found below:
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The calculations show that a field with a wedge will require additional monitor units to
deliver the desired dose to the isocenter. This increase in monitor units is necessary due to the
beam hardening effect the wedge has.2 The beam is hardened as a result of the lower energy x-
rays that are no longer able to reach the patient due to the wedge being placed in the path of the
beam. The subsequent x-ray beam is “harder” due to the higher average energy beam that
results. This causes less dose to reach the patient and would cause the patient to be under dosed
if not taken into account when doing the dose calculation. The calculations below emphasize the
importance of using a wedge factor when appropriate in monitor unit calculations.
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Clinical Application: Below is an example of a plan done using physical 30-degree wedges on
the lateral beams. Also shown are the monitor units determined by the treatment planning
system and the field information from the treatment plan report:

Image 3a: Plan with 30-degree wedge on lateral beams and mu from treatment planning system
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Image 3b: Plan report showing cGy and monitor units for left lateral beam using a 30-degree
wedge.
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Image 3c: Plan report showing cGy and monitor units for right lateral beam using a 30-degree
wedge.

An independent second check was done to compare the monitor unit calculations done by the
treatment planning system. The hand calculation form used in our clinic is included below and
demonstrates that there is a less than 1% difference between the treatment planning mu and the
second check hand calc.
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Image 4: Independent hand calculation

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Conclusion: This study showed that the addition of a wedge can have a large impact on the mu
needed to deliver the prescribed dose to the isocenter. Wedge factors were measured for both 6x
and 18x beams and it was determined that the wedge factor increases with beam energy. These
findings will affect my clinical training because I now have a better understanding of how the
addition of a wedge will affect the monitor units being delivered. Having this knowledge is
important because dosimetrists need to understand what is happening with each change they
make to a plan and understand if the resulting change to mu makes sense.
A wedge factor needs to be included in all dose calculations for wedged fields in order
for the dose calculations to be accurate. If a wedge factor is omitted from the calculation, but a
wedge is used in a plan, it will result in the patient being under dosed. Because the wedge factor
increases with beam energy, the error in dose being delivered is greater for lower energy beams,
which is directly related to less beam transmission through the wedge. If a wedge factor is used
in the calculation of a field, but the wedge is forgotten on the treatment day, it will result in an
overdose for the patient. Correct patient treatments depend on the vigilance of all staff. This
study demonstrates the importance of determining wedge factors and incorporating them into
dose calculations when appropriate, so a treatment error does not occur.
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References

1. Khan, FM. The Physics of Radiation Therapy. 5thed. Philadelphia, PA: Lippincott Williams
& Wilkins; 2014. ISBN: 978-1451182453.

2. Geraily G, Sharafi N, Shirazi A, Esfehani M, Masoudifar M, Rajab BE. Comparison of beam

hardening effect of physical and enhanced dynamic wedges at bladder inhomogeneity using
EBT3 film dosimeter. J Cancer Res Ther. 2017;13:97-101.