Reducing stray radiation dose for a pediatric patient receiving proton craniospinal irradiation

The aim of this study was to quantify stray radiation dose from neutrons emanating from a proton treatment unit and to evaluate methods of reducing this dose for a pediatric patient undergoing craniospinal irradiation. The organ equivalent doses and effective dose from stray radiation were estimated for a 30.6-Gy treatment using Monte Carlo simulations of a passive scattering treatment unit and a patient-specific voxelized anatomy. The treatment plan was based on computed tomography images of a 10-yr-old male patient. The contribution to stray radiation was evaluated for the standard nozzle and for the same nozzle but with modest modifications to suppress stray radiation. The modifications included enhancing the local shielding between the patient and the primary external neutron source and increasing the distance between them. The effective dose from stray radiation emanating from the standard nozzle was 322 mSv; enhancements to the nozzle reduced the effective dose by as much as 43%. These results add to the body of evidence that modest enhancements to the treatment unit can reduce substantially the effective dose from stray radiation.