ARTICLE IN PRESS

Applied Radiation and Isotopes 65 (2007) 599–604

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Investigation of photoneutron dose equivalent from high-energy

photons in radiotherapy
Jao-Perng Lina, Wei-Chung Liub, Chun-Chih Linc,
a
Department of Radiological Technology, Yuanpei Institute of Science and Technology, No. 306, Yuan Pei Road, Hsinchu 300, Taiwan
b
Department of Radiological Technology, Tzu-Chi College of Technology, No. 880, Sec. 2, Chien-Kuo Road, Hualien 970, Taiwan
c
General Education Center/Graduate Institute of Natural Healing Science, Nanhua University, No. 32, Chung Keng Li, Dalin, Chia-Yi 622, Taiwan
Received 16 April 2006; received in revised form 4 January 2007; accepted 16 January 2007

Abstract

Spatial distribution of photoneutron dose equivalent during radiotherapy at different beam size, depth, and distance from a 15 MV
linear accelerator was investigated with bubble detectors in a water phantom. The photoneutron dose equivalent was mainly from fast
neutrons, and decreased with distance at a fixed field and with depth. Besides, photoneutron dose equivalent was slightly affected by
beam size due to the variation of tungsten area exposed in the beam direction and photoneutrons occurred at the jaws. Fast
photoneutron dose equivalent of shallow critical organs was represented still considerably outside the beam size.
r 2007 Elsevier Ltd. All rights reserved.

Keywords: Neutron; Photoneutron; Dose equivalent; Accelerator; Bubble detector; Radiotherapy

1. Introduction former is about 2 orders of magnitude higher than that of

Cancer has been chief cause of death in recent world,
which makes medical linear accelerators (LINACs) a vital
tool in radiotherapy. With the advance of intensity-
modulated radiotherapy technology (IMRT) in recent
years, optimal dose distribution can be achieved in clinical
treatment by using high-energy photon beams in deep
tumor therapy (e.g. cervical and prostate tumors) or dose
offset (Spicka et al., 1989) in gullet cancer therapy.
However, during radiotherapy with high-energy accel-
erators, it is difficult to avoid photoneutron emission from
the treatment head shielding, composed by materials with
high atomic numbers (e.g. Al, Au, Fe and W). These
particles are produced via (photon,n) reactions, or by
electrons via (e,e0 n) reactions (McCall et al., 1984; NCRP
No. 79, 1984; Turner, 1995). The cross sections of
photonuclear and electronuclear reactions are described
in the literature (Scott et al., 1955; Berman and Dietrich,
1998) indicating that the maximum probability of the
Corresponding author. Tel.: +886 9 72019645; fax: +886 5 2427195.
E-mail addresses: jplin@mail.yust.edu.tw (J.-P. Lin),
liuw@tccn.edu.tw (W.-C. Liu), cclin@mail.nhu.edu.tw (C.-C. Lin).
the latter in the energy range of LINAC operation.
Direct neutrons collide with the walls, establishing a
nearly uniform scattered and thermal neutron fluence. As
the beam energies increase (410 MeV), the undesirable
photoneutron doses also increases (Armstrong and Col-
born, 1992; Badwharmet al., 1995; Hall, 1996) and thus
enhances the risk of second malignancies (Hall, 1996).
Besides, the contributed dose is noticeable when concern-
ing about neighboring critical organs, e.g. the dose of
gonads in radiotherapy of intestinal cancer.
Presently, researches of photoneutron in literatures
mostly lay stress on spatial distribution of neutrons in
therapeutic chambers (Sohrabi and Mostofizadeh, 1999;
Lin et al., 2001; Zanini et al., 2001; Konefat et al., 2005).
However, actual accepted neutron dose of the workers
around the therapeutic chamber as well as the internal
distribution of the patients is seldom probed (d’Errico
et al., 1998a; Adnani, 2002). In order to optimize treatment
conditions and avoid unnecessary radiation injury in
patient care, the dose from photoneutron investigation is
imperative to provide support for the field of health physics
and medical physics to accurately estimate received dose of
the patients.

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doi:10.1016/j.apradiso.2007.01.017
 ARTICLE IN PRESS
600 J.-P. Lin et al. / Applied Radiation and Isotopes 65 (2007) 599–604
Many detectors are available for the evaluation of
photoneutron contamination from medical linear accel-
erators (Swanson, 1978). Among them, the bubble detector
is especially a convenient tool for neutron detection (Ing
et al., 1997), which earned the inventor, Glaser, the Nobel
Prize in 1960 (Glaser, 1952). In the bubble chamber, the
superheated droplet (typically chlorofluorocarbons) main-
tains its liquid state above its normal boiling point and
suspends in a viscous polymer emulsion (Lo, 1987; Roy
and Roy, 2003). When energetic particles pass through the
liquid, the chamber pressure is abruptly reduced to
nucleate superheated droplets into vapor bubbles along
the particle paths (Fig. 1). The neutron dose is proportional
to the number of bubbles, which can be readily estimated
with an automatic bubble reader or bubbles in the polymer
can readily be counted by eye. In addition, photons
generated from the LINAC have low linear energy transfer
(LET) and thus will not contribute an ample energy (Green
et al., 2005) to the nucleation of bubbles since the
nucleation length is only about 100 nm (Tu et al., 1997).
Such a property is favorable for discriminating neutron
dose from that of the photons. Considering different
energies of neutrons existing in the radiation field, specific
bubble detectors should be chosen to distinguish fast from
thermal neutrons (Ing et al., 1997).
Among the bubble detectors, BD-PND and BDT bubble
detectors, which are temperature compensated over the
range of 20–37 1C, are commonly used as neutron
dosimeters. The BD-PND is designed for fast neutron
(200 keV–15 MeV) detection corresponding to 0.01–50 mSv
with a threshold around 100 keV, and insensitive to
thermal neutrons; while the BDT senses mainly thermal
neutrons to respond the dose of 0.01–1 mSv. In general
diagnosis and therapy under a radiation field, contribu-
tions of fast and thermal neutrons are both necessary to be
Fig. 1. Response of BD-PND bubble detectors before (a) and after (b)
neutron irradiation. Superheated liquid in viscous polymers transforms
into bubbles while energetic neutrons pass through the detectors.
considered. Therefore, we combined both BD-PND and
BDT bubble detectors in this research to estimate the
spectrum and the amount of generated photoneutrons as
well as spatial distribution of the dose equivalent of
photoneutrons in a water phantom, which may provide
actual accepted doses of the patients during radiotherapy.
2. Experimental
2.1. Materials and methods
Bubble detectors, BD-PND and BDT (with a sensitivity
of 0.43–6 and 19–20 bubble/mrem, respectively), obtained
from Bubble Technology Industries (Canada) were utilized
to investigate fast and thermal neutron doses, respectively.
A 15 MV linear accelerator (Siemens Primus, Germany;
quality factor ¼ 20, neutron source strength ¼ 2.0 
1011 neutron/Gy (Chibani and Ma, 2003)) installed in the
Radiotherapy Department of the Changhua Christian
Hospital was assembled with tungsten target, shielding
and flattening filter to provide high-energy photons. The
spectrum of photon-induced neutrons is similar to that of
252
Cf neutron source (Peurrung, 2000; Green et al., 2005),
which was employed for calibrating the bubble detectors.
The bubble detectors were positioned in the water phantom
and oriented with a monitoring computer.
In order to evaluate photoneutron doses of the healthy
tissues and its neighboring area of the patients, parameters
including irradiation field, depth under water (the sub-
cutaneous depth), and distance away from the beam axis
(the off-axis distance) were considered in this experiment
(Fig. 2). On the axis of the 15 MV photon beam, the
photoneutron dose equivalent (PNDE) of the water
phantom was measured five times with the bubble detectors
at the depth of 0, 5, 10, 15, 20, 25 and 30 cm under various
Fig. 2. Illustration of placed positions of bubble detectors in the water
phantom. The top face was confronting the 15 MV photon beam.
 ARTICLE IN PRESS
J.-P. Lin et al. / Applied Radiation and Isotopes 65 (2007) 599–604
irradiation beam size (10  10 cm2 or 40  40 cm2 (the
largest field)). Besides, under the beam size of 10  10 cm2
and the depth of 0 and 10 cm, the bubble detectors were
positioned at various distance (3, 5, 10, 15 and 20 cm) from
the beam axis. For each position, five measurements were
done. More than 1 h of standing was allowed after each
measurement to stabilize the bubble detectors for next
detection. Furthermore, to obtain actual dose equivalent
caused by each Gy of photons at the detection point, the
MU (monitor unit) value of the LINAC was varied with
detecting position of the bubble detectors inside the
phantom. After 10 min of standing following each expo-
sure, bubbles generated in the detectors were estimated
with a BDR-III automatic reader (Bubble Technology
Industries, 2006). By proper compression, the bubbles were
vanished and the detectors are capable of reusing
immediately. The obtained data were diagramed for
further analysis.
3. Results and discussion
Photoneutrons generated in the accelerator head shield-
ing are mainly produced from two mechanisms: evapora-
tion contribution and direct process. The evaporation
neutrons are in the majority of the photoneutrons and their
spectra are described by Eq. (1), where E and T denote the
energy and nuclear temperature of the neutrons from a
certain nucleus (NCRP No. 79, 1984; Tosi et al., 1991),
respectively,
 
dN n E E
¼ 2 exp . (1)
dE T T
Considering the relative contribution of the components
described above, the total spectrum of an isotropic neutron
source can be mathematically illustrated by Eq. (2) (Tosi et
al., 1991), where EM denotes the maximum energy of the
photons, and the numeral 7.34 denotes the average binding
energy (7.34 MeV) of neutrons emitted from the tungsten
dN n 0:8929E expðE=TÞ
¼
dE T2
0:1071 ln½E M =ðE þ 7:34Þ
þ R E M 7:34 . ð2Þ
0 ln½E M =ðE þ 7:34Þ dE
The corresponding nuclear temperature for the produc-
tion of neutrons in tungsten is 0.5 MeV (NCRP No. 79,
1984). By introducing EM ( ¼ 15 MeV) and T ( ¼ 0.5 MeV)
into Eq. (2), the photoneutron spectrum can then be
expressed as
 
dN n 15
¼ 3:5716E expð2EÞ þ 0:044366 ln . (3)
dE E þ 7:34
Accordingly, the mean and maximum energy of neutrons
before crossing the head of 15 MV LINAC is 1.15 MeV and
about 7.6 MeV (Swanson, 1980; Facure et al., 2005),
respectively. In addition, the most probable energy in the
spectrum is 0.5 MeV (ascribed to the evaporation term).
601
Under the beam size of either 10  10 cm2 or 40  40 cm2,
both the dose equivalents in water caused by fast neutrons
and thermal neutrons decrease with irradiation depths at
the isocenter axis as illustrated in Fig. 3. Furthermore,
PNDEs from fast neutrons are similar at depths shallower
than 10 cm under both fields. However, they decay slightly
faster under the beam size of 40  40 cm2 than those under
10  10 cm2 as the depth further increases. This may be
ascribed to higher amount of tungsten in the beam
direction under smaller field size (10  10 cm2), which
increases the neutron production.
On the other hand, the thermal PNDEs under
40  40 cm2 and 10  10 cm2 are similar (Fig. 3). However,
the thermal PNDEs on the axis under larger beam size are
slightly less than those under the smaller one at depths
shallower than 15 cm. The slight difference may arise from
more thermal neutrons occurring at the jaws under smaller
beam size, which contributes higher thermal PNDE to the
shallower region.
By nonlinear curve fitting, the PNDE of fast and thermal
neutrons under the above fields may be symbolized as f(r),
a function of the depth, r, on the beam axis. The function
f(r) reveals composite effect of the decay of photon flux
after flattening, the decay of neutron fluence/energy
by scatter or collision with the nuclei of collimator and
jaws, as well as the deceleration of fast neutrons in the
water phantom. Furthermore, the PNDE function f(r)
for fast neutrons may be approximately represented as
ff(r)1600( ¼ 14.0r3+249.9r21577.9r+4079.8) and ff(r)100
( ¼ 21.1r3+327.9r21789.5r+4262) under the beam size
of 40  40 cm2 and 10  10 cm2, respectively, where the
subscripts f and the numerals (100 and 1600) denote fast
neutron and beam size. Similarly, PNDEs from thermal
neutrons under the beam size of 10  10 cm2 and
40  40 cm2 are represented as ft(r)100 ( ¼ 0.8278r3+
23.82r2212.0r+656.9) and ft(r)1600 ( ¼ 1.84r3+35.8r2
240.2r+623.3), respectively, where the subscripts t denote
thermal neutron. It is observable that the dose equivalent
from fast neutrons is about five times higher than that from
thermal neutrons as shown in Fig. 3. Obviously, fast
photoneutron emission is dominant in the photonuclear
reaction initiated by the 15 MV photon beam, and
contributes the major part of photoneutron contamination
during the operation of high-energy clinical LINAC.
According to PNDE curves of fast neutrons in Fig. 3,
accumulated PNDE, D(r), along the axis between depth a
and b may be calculated by Eq. (4), to estimate total dose
equivalent inside a specific region
Z b
DðrÞ ¼ 2p rf ðrÞ dr. (4)
a
As illustrated in Fig. 4, fast PNDEs at the depth of 0 and
10 cm under the field of 10  10 cm2 are both decreased
abruptly with off-axis distance inside the beam size while
are moderately decreased outside the beam size. This
approximately conforms to the inverse proportionality of
the direct neutron fluence to the square distance as derived
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602 J.-P. Lin et al. / Applied Radiation and Isotopes 65 (2007) 599–604

3500 BD-PND, beam size=10x10 cm2

BDT, beam size=10x10 cm2
BD-PND, beam size=40x40 cm2
3000 BDT, beam size=40x40 cm2
BDT, beam size=40x40 cm2
BD-PND, beam size=10x10 cm2
2500 BD-PND, beam size=40x40 cm2
BDT, beam size=10x10 cm2
f(r) (µSv/Gy)

2000

1500

1000

500

0
0 5 10 15 20 25 30
r (cm)

Fig. 3. Photoneutron dose equivalents f(r) (mSv/Gy) measured with BD-PND and BDT bubble detectors at the depth (r) of 0, 5, 10, 15, 20, 25 and 30 cm
on axis of the photon beam under the field of 10  10 cm2 and 40  40 cm2, respectively, were represented as ff(r)100 and ff(r)1600. Similarly, PNDEs from
thermal neutrons under the field of 10  10 cm2 and 40  40 cm2 were represented as ft(r)100 and ft(r)1600, respectively. The PNDE functions were described
as follows: ff(r)100 ¼ 21.1r3+327.9r21789.5r+4262, R2 ¼ 0.998; ff(r)1600 ¼ 14.0r3+249.9r21577.9r+4079.8, R2 ¼ 0.994; ft(r)100 ¼ 0.8278r3+
23.82r2212.0r+656.9, R2 ¼ 0.994; ft(r)1600 ¼ 1.84r3+35.8r2240.2r+623.3, R2 ¼ 0.992.

3000 axis distance, shallow critical organs are still exposing to

BD-PND, r=0 considerable fast photoneutron fluence even outside the
2500 BDT, r=0 beam size.
BD-PND, r=10 Thermal PNDE at the phantom surface declines
BDT, r=10 abruptly (542.2–164.0 mSv/Gy) to less than 271.2 mSv/Gy
2000 and remains constant as off-axis distance is longer than
PNDE(µSv/Gy)

5 cm; however, it decreases gradually (181.6–71.6 mSv/Gy)

1500
1000
500
0
0 5 10 15
Distance (cm)
Fig. 4. Variations of photoneutron dose equivalent (PNDE; mSv/Gy) with
off-axis distance of the photon beam at the depth (r) of 0 and 10 cm under
10  10 cm2 of beam size.
by McGinley (1998). Besides, fast PNDE at the surface is
two times higher than at 10 cm deep of the same distance,
while their difference decreases as the distance is longer
than 10 cm. Furthermore, at 10 cm deep and as the off-axis
distance is farther than 10 cm, fast PNDE decreases to
o58.6 mSv/Gy; however, it is still noticeable (860.2 mSv/Gy)
at the phantom surface of the same off-axis distance.
Therefore, although fast PNDE decays quickly with off-
with increasing distance at 10 cm deep of the phantom.
Additionally, thermal PNDE at the surface maintains a
steady level when off-axis distance is farther than 5 cm;
nevertheless, it is still 1.9 times higher than that at 10 cm
deep. Either at the surface or 10 cm deep, fast PNDE is
found apparently higher than the thermal inside the beam
size indicating that the fast neutrons still dominate the
PNDE when considering different off-axis distances.
20 25 However, the effect of beam size on thermal PNDE is
found less important than that on fast PNDE.
Standard deviation in this research may be ascribed to
temperature fluctuation, error in bubble counting, inaccu-
rate detector positioning, and detector saturation under
high neutron fluence; however, the obtained standard
deviation is less than 15% revealing that bubble detectors
used in this research are acceptable.
During radiotherapy of nasal and prostate cancers, for
example, treatment dose of the patient is 70 Gy.
According to Fig. 3, the surface doses of critical organs
(e.g. eyes and gonad) from fast and thermal neutrons inside
the 10  10 cm2 of beam size are 27887327 mSv/Gy and
466794 mSv/Gy, respectively. Besides, at 10 cm deep inside
the beam size, fast and thermal PNDEs are respectively,
 ARTICLE IN PRESS
J.-P. Lin et al. / Applied Radiation and Isotopes 65 (2007) 599–604
Table 1
The comparison of organ absorbed neutron doses from the Monte Carlo
simulation for a 18 MV X-ray therapy under an 18  18 cm2 antero-
posterior pelvic field with those at relative position in the water phantom
under a 10  10 cm2 beam of 15 MV X-rays in this research
Tissue or organ Organ absorbed Converted absorbed
neutron dose (mGy/ neutron dose at
Gy) in the Monte relative position in
Carlo simulationa this study
Uterus 3.4270.06 72.8710.3
Intestine wall 10.1170.01 107.1712.4
Stomach wall 0.3770.12 4.770.4
Rectum 0.3770.05 4.770.4
a
Barquero et al. (2005).
12097160 mSv/Gy and 223739 mSv/Gy. Therefore, at the
end of a treatment course, PNDE at the surface of critical
organs would be totally 0.23 Sv, while that at 10 cm deep
would be 0.10 Sv.
At the phantom surface, in light of Fig. 4, fast and
thermal PNDEs of the nearby critical organs outside the
10  10 cm2 of beam size are respectively, 11697116 mSv/
Gy and 250732 mSv/Gy, while those at 10 cm deep region
are 58.678.31 mSv/Gy and 71.675.9 mSv/Gy each. Ac-
cordingly, after a complete course of treatment, total
PNDEs of the critical organs at surface and 10 cm deep
outside the 10  10 cm2 beam size would be 0.10 and
0.009 Sv, respectively.
On the other hand, total neutron dose equivalent on the
axis measured by d’Errico et al. under 10  10 cm2 of 18, 15
and 10 MV X-ray beams (d’Errico et al., 1998a, b, 2001) is
respectively, 1.6–1.9, 0.55–0.58 and 0.42–0.46 times com-
pared with our results (Fig. 3) at relative depths.
Furthermore, the total neutron dose equivalent of 18, 15
and 10 MV X-ray beams at 1 cm deep and less than 20 cm
off the axis is respectively, 1.80–1.95, 0.63–0.64 and
0.34–0.50 times as measured in this research (Fig. 4).
To compare our results under a 10  10 cm2 beam size
with organ absorbed neutron doses calculated by Monte
Carlo simulation for 18 MV X-ray LINAC-based radio-
therapy under an 18  18 cm2 antero-posterior pelvic field
(Barquero et al., 2005), a quality factor, 20, for the 15 MV
Siemens Primus LINAC is utilized (Chibani and Ma,
2003). The converted absorbed dose from our results at
surface on the axis is about 46 times higher than that of the
skin (3.5470.01 mGy/Gy) in the Monte Carlo simulation.
Compared with the absorbed dose at the other tissues/
organs in the simulation, the results at relative position in
this research are about 1 order higher as listed in Table 1.
The above difference may be attributed to smaller beam
size, lower LINAC energy and the quality factor used for
the conversion of absorbed dose (Ongaro et al., 2000).
4. Conclusion
The average and maximum energy of neutrons from the
head of 15 MV LINAC is 1.15 MeV and about 7.6 MeV.
603
Fast neutrons were found, either at the surface or deep
region (10 cm) of the water phantom, the major photo-
neutron contamination during the operation of the 15 MV
medical LINAC. Both fast and thermal PNDEs are
declining with increasing depth on the axis, which can be
represented as functions of depth. The fast PNDE decays
slightly faster under 40  40 cm2 than that under 10 
10 cm2 on the axis, which may be ascribed to higher
amount of tungsten in the beam direction under smaller
beam size. The thermal PNDEs under 40  40 cm2 and
10  10 cm2 are similar, while the latter are slightly higher
at depths shallower than 15 cm. With increasing off-axis
distance, fast PNDE decays quickly while shallow critical
organs are still exposed to considerable fast-neutron
fluence even outside the beam size. The effect of beam size
on thermal PNDE is less important than that on fast
PNDE.
The neutron dose equivalent on the axis under
10  10 cm2 of 18, 15 and 10 MV X-ray beams measured
by d’Errico et al. (1998a,b, 2001) is, respectively, 1.6–1.9,
0.55–0.58 and 0.42–0.46 times of total PNDE at relative
depth in this study. Besides, the converted absorbed doses
in this research under a 10  10 cm2 of beam size are about
1 order higher compared with the organ absorbed neutron
doses estimated by Monte Carlo simulation for 18 MV
X-ray radiotherapy under an 18  18 cm2 antero-posterior
pelvic field.
Acknowledgments
The authors are grateful to Dr. S.Y. Lin, Mr. Y.C. Lai
and co-workers of Changhua Christian Hospital for their
enthusiastic help as well as the funding supported by Far
Eastern Memorial Hospital.
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