Monitor unit calculation for large wedged high-energy photon beams

With the modern high-energy linear accelerators, the following beam characteristics have to be taken into account in the monitor unit (MU) calculation of a wedged treatment: (i) the field size dependence of wedge factors; (ii) the changes in depth dose and maximum build-up depth (dmax) induced by wedges; and (iii) the field size dependence of dmax. The incorporation of a field size specific wedge factor in an MU calculation is straightforward. Effects (ii) and (iii) however, often cause confusion and inconsistency in the choices of the reference depth for wedge factors and the normalization depth for wedged depth dose, and consequently can lead to inconsistent MU calculation formalism with additional efforts of up to 7% in the delivered dose. In this note, we illustrate a derivation of an exact central axis MU calculation for wedged treatments, which correctly accounts for the effects mentioned above.