Neutron production from flattening filter free high energy medical linac: A Monte Carlo study

One of the problems arising from using a conventional linac at high energy (>8 MV) is the production of neutrons. One way to reduce neutron production is to remove the flattening filter (FF). The main purpose of this work was to study the effect of FF removal on neutron fluence and neutron dose equivalent inside the treatment room at different photon beam energies. Several simulations based on Monte Carlo techniques were carried out in order to calculate the neutron fluence at different locations in the treatment room from different linac energies with and without a FF. In addition, a step-and-shoot intensity modulated radiotherapy (SnS IMRT) for prostate cancer was modelled using the 15 MV photon beam with and without a FF on a water phantom to calculate the neutron dose received in a full treatment. The results obtained show a significant drop-off in neutrons fluence and dose equivalent when the FF was removed. For example, the neutron fluence was decreased by 54%, 76% and 75% for 10, 15 and 18 MV, respectively. This can decrease the neutron dose to the patient as well as reduce the shielding cost of the treatment room. The neutron dose equivalent of the SnS IMRT for prostate cancer was reduced significantly by 71.3% when the FF was removed. It can be concluded that the flattening filter removal from the head of the linac could reduce the risk of causing secondary cancers and the shielding cost of radiotherapy treatment rooms.