Using the difference between responses to neutrons of TLD-600 and TLD-700, three experimental devices were constructed and arranged to measure thermal neutron fluences, neutron spectra, and neutron doses inside the treatment room of a radiotherapy 18 MV Linear electron accelerator (Linac). Thermal neutron fluences were measured with TLD-600/TLD-700 pairs arranged in both a bare and a cadmium (Cd) foil covered methacrylate box. Neutron spectra were measured in 26 energy bins by introducing pairs of TLD-600/TLD-700 in air and into the middle of five polyethylene spheres with diameters of 3, 5, 8, 10, and 12 inches. A PC version of the BUNKI code was used to unfold the six measurements in each sphere to obtain the 26 energy bins. Neutron and photon doses were measured by introducing pairs of TLD-600/TLD-700 into the middle of a single 25-cm-diameter paraffin sphere. The three required neutron calibrations were carried out at the Nuclear Technology Laboratory of the Polytechnique University of Madrid (UPM), using an 241Am-Be neutron source with an alpha activity of 111 GBq and a yield of 6.6 x 10(6) neutrons s(-1). Three devices were needed for the necessary calibrations: a BF3 counter for the thermal neutron fluence calibration, a LUDLUM 42-5 Bonner spectrometer with five 0.95 g cm(-3) polyethylene spheres with a LiI(Eu) 4 x 4 mm2 scintillation counter for the neutron spectrometer calibration and a NEMO 9140 remmeter for the paraffin remmeter calibration. The Monte Carlo code MCNP 4C has been used in two ways: to calculate the neutron kerma contribution to two TLDs (type 600 and 700) both in air and inside the paraffin sphere, and to determine the neutron spectra at those Linac room zones where the neutron spectra were measured. Thermal neutron fluences of 2.9 x 10(4) +/- 8.6 x 10(3) cm(-2) s(-1), measured around the Linac head plane, and 2.3 x 10(4) +/- 2.3 x 10(3) cm(-2) s(-1), measured at the patient couch plane, are in agreement with previous independent measurements from other authors. The calculated and measured neutron spectra obtained in the treatment room showed three distinct regions: a peak around 0.1 MeV, a flat epithermal region and a thermal region with values similar to those mentioned above. Patient dose equivalents of 0.5 mSv and 5 mSv from neutrons and photons, respectively, were obtained per treatment Gray.

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Absorbed photoneutron dose to patients undergoing 18 MV x-ray therapy was studied using Monte Carlo simulations based on the MCNPX code. Two separate transport simulations were conducted, one for the photoneutron contribution and another for neutron capture gamma rays. The phantom model used was of a female patient receiving a four-field pelvic box treatment. Photoneutron doses were determinate to be higher for organs and tissues located inside the treatment field, especially those closest to the patient's skin. The maximum organ equivalent dose per x-ray treatment dose achieved within each treatment port was 719 microSv/Gy to the rectum (180 degrees field), 190 microSv/Gy to the intestine wall (0 degrees field), 51 microSv/Gy to the colon wall (90 degrees field), and 45 microSv/Gy to the skin (270 degrees field). The maximum neutron equivalent dose per x-ray treatment dose received by organs outside the treatment field was 65 microSv/Gy to the skin in the antero-posterior field. A mean value of 5 +/- 2 microSv/Gy was obtained for organs distant from the treatment field. Distant organ neutron equivalent doses are all of the same order of magnitude and constitute a good estimate of deep organ neutron equivalent doses. Using the risk assessment method of the ICRP-60 report, the greatest likelihood of fatal secondary cancer for a 70 Gy dose is estimated to be 0.02% for the pelvic postero-anterior field, the rectum being the organ representing the maximum contribution of 0.011%.