Unexpected dose and the biological effect of neutron contamination in linear accelerators

Employing High-energy photons in medical linear accelerators can lead to neutron contamination. The relative biological effect of neutrons is 20 times higher than photons. Consequently, its damage to the biological tissue is much higher and unobtrusive. In this study, we calculated neutron equivalent dose in a medical linear accelerator by the FLUKA Monte Carlo code system. The results show that using smaller treatment fields increases the neutron contamination dose in out-of-field areas. Furthermore, the areas outside the treatment field receive several times higher neutron dose than the photon dose. Most of the neutron dose distribution is at the surface of the human body. So it could increase the secondary cancer risk, including skin cancer.