Neutron dose in and out of 18 MV photon fields

In radiation therapy, neutron contamination is an undesirable side effect of using high energy photons to treat patients. Neutron contamination requires adjustments to the shielding requirements of the linear accelerator vault and contributes to the risk of secondary malignancies in patients by delivering dose outside of the primary treatment field. Using MCNPX, an established Monte Carlo code, manufacturer blueprints, and the most up to date ICRP neutron dose conversion factors, the neutron spectra, neutron/photon dose ratio, and the neutron capture gamma ray dose were calculated at different depths and off axis distances in a tissue equivalent phantom. Results demonstrated that the neutron spectra and dose are dependent on field size, depth in the phantom, and off-axis distance. Simulations showed that because of the low neutron absorption cross section of the linear accelerator head materials, the contribution to overall patient dose from neutrons can be up to 1000 times the photon dose out of the treatment field and is also dependent on field size and depth. Beyond 45 cm off axis, the dependence of the neutron dose on field size is minimal. Neutron capture gamma ray dose is also field size dependent and is at a maximum at a depth of about 7 cm. It is important to remember that when treating with high energy photons, the dose from contamination neutrons must be considered as it is much greater than the photon dose.