Monte Carlo simulation of secondary radiation exposure from high-energy photon therapy using an anthropomorphic phantom

The development of intensity-modulated radiotherapy treatments delivering large amounts of monitor units (MUs) recently raised concern about higher risks for secondary malignancies. In this study, optimised combinations of several variance reduction techniques (VRTs) have been implemented in order to achieve a high precision in Monte Carlo (MC) radiation transport simulations and the calculation of in- and out-of-field photon and neutron dose-equivalent distributions in an anthropomorphic phantom using MCNPX, v.2.7. The computer model included a Varian Clinac 2100C treatment head and a high-resolution head phantom. By means of the applied VRTs, a relative uncertainty for the photon dose-equivalent distribution of <1 % in-field and 15 % in average over the rest of the phantom could be obtained. Neutron dose equivalent, caused by photonuclear reactions in the linear accelerator components at photon energies of approximately >8 MeV, has been calculated. Relative uncertainty, calculated for each voxel, could be kept below 5 % in average over all voxels of the phantom. Thus, a very detailed neutron dose distribution could be obtained. The achieved precision now allows a far better estimation of both photon and especially neutron doses out-of-field, where neutrons can become the predominant component of secondary radiation.