This study aimed to determine the neutron dose equivalent to the thyroid gland and eye lens in brain tumor radiation therapy with 15- and 18-MV three-dimensional conformal methods (3D-CRT). A Monte Carlo simulation was performed using the Monte Carlo N-particle transport code to calculate neutron fluence and ambient dose equivalent (H*(10)). Afterward, these parameters were measured using a model NRD roentgen equivalent in man (REM) neutron detector (Thermo Electron Corporation, USA) equipped with Eberline’s ASP-2e rate meter. Finally, the organ neutron dose equivalent was obtained by applying depth corrections to the measured ambient dose equivalent at the distance of the organ center from the central beam axis. The ratio of the out-of-field photon dose equivalent, measured previously, to the neutron dose equivalent in the eye lens was high due to its proximity to the radiation field. In contrast, this ratio remained unexpectedly high in the thyroid gland that is far from the central beam axis (about 15 cm). The calculated neutron parameters agreed with the measurements. The present study findings indicate that external field photon dose is the main source of thyroid gland biological effects in radiotherapy of brain tumors. In addition, it is appropriate to apply the model NRD REM neutron detector for measuring neutron contamination from high-energy linear accelerators inside and outside the treatment field.
Neutron contamination as a source of out-of-field dose in radiotherapy is still of concern. High-energy treatment photons have the potential to overcome the binding energy of neutrons inside the nuclei. Fast neutrons emitting from the accelerator head can directly reach the patient’s bed. Considering that modern radiotherapy techniques can increase patient survival, concerns about unwanted doses and the lifetime risk of fatal cancer remain strong or even more prominent, especially in young adult patients. The current study addressed these concerns by quantifying the dose and risk of fatal cancer due to photo-neutrons for glioma patients undergoing 18-MV radiotherapy. In this study, an NRD model rem-meter detector was used to measure neutron ambient dose equivalent, H*(10), at the patient table. Then, the neutron equivalent dose received by each organ was estimated concerning the depth of each organ and by applying depth dose corrections to the measured H*(10). Finally, the effective dose and risk of secondary cancer were determined using NCRP 116 coefficients. Evidence revealed that among all organs, the breast (0.62 mSv/Gy) and gonads (0.58 mSv/Gy) are at risk of photoneutrons more than the other organs in such treatments. The neutron effective dose in the 18-MV conventional radiotherapy of the brain was 13.36 mSv. Among all organs, gonads (6.96 mSv), thyroid (1.86 mSv), and breasts (1.86 mSv) had more contribution to the effective dose, respectively. The total secondary cancer risk was estimated as 281.4 cases (per 1 million persons). The highest risk was related to the breast and gonads with 74.4 and, 34.8 cases per 1 million persons, respectively. Therefore, it is recommended that to prevent late complications (secondary cancer and genetic effects), these organs should be shielded from photoneutrons. This procedure not only improves the quality of the patient’s personal life but also the healthy childbearing in the community.
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