Systematic out-of-field secondary neutron spectrometry and dosimetry in pencil beam scanning proton therapy

Background and purpose: Systematic investigation of the energy and angular dependence of secondary neutron fluence energy distributions and ambient dose equivalents values (H*(10)) inside a pencil beam scanning proton therapy treatment room using a gantry. Materials and methods: Neutron fluence energy distributions were measured with an extended-range Bonner sphere spectrometer featuring 3 He proportional counters, at four positions at 0 degrees, 45 degrees, 90 degrees, and 135 degrees with respect to beam direction and at a distance of 2 m from the isocenter. The energy distribution of secondary neutrons was investigated for initial proton beam energies of 75 MeV, 140 MeV, and 200 MeV, respectively, using a 2D scanned irradiation field of 11 x 11 cm(2) delivered to a 30 x 30 x 30 cm(3) PMMA phantom. Additional measurements were performed at a proton energy of 118 MeV including a 5 cm range-shifter (PMMA), yielding a Bragg peak position similar to that of 75 MeV protons. Results: Ambient dose equivalent values from 0.3 mu Sv/Gy (75 MeV; 90 degrees) to 24 mu Sv/Gy (200 MeV; 0 degrees) were measured inside the treatment room at a distance of 2 m from the isocenter. H*(10) values were lower (by factors of up to 7.2 (at 45 degrees)) at 75 MeV compared to those at 118 MeV with the 5 cm range-shifter. At 0 degrees and 45 degrees, an evaporation peak was found in the measured neutron fluence energy distributions, at neutron energies around MeV, which contributes about 50% to total H*(10) values, for all investigated proton beam energies. Conclusions: This study showed a pronounced increase of secondary neutron H*(10) values inside the proton treatment room with increasing proton energy without beam modifiers. For example, in beam direction this increase was about a factor of 50 when protons of 75 MeV and 200 MeV were compared. The existence of a peak of secondary neutrons in the MeV region was demonstrated in beam direction (0 degrees). This peak is due to evaporation neutrons produced in the existing surrounding materials such as those used for the gantry. Therefore, any simulation of the secondary neutrons within a proton treatment room must take these materials into account. In addition, the results obtained here show that the use of a range-shifter increases the production of secondary neutrons inside the treatment room. Using a range-shifter, the higher neutron doses observed mainly result from the higher incident proton energy (118 MeV instead of 75 MeV when no range-shifter was used), due to higher neutron production cross-sections. (C) 2017 American Association of Physicists in Medicine