Multicentre investigation of neutron contamination at cardiac implantable electronic device (CIED) location due to high-energy photon beams using passive detectors and Monte Carlo simulations

Radiotherapy treatments involving LINACs operating at accelerating potentials >10 MV generate (photo)neutrons which deliver dose to patients also outside the target volume. This effect is particularly relevant for patients with cardiac implantable electronic devices (CIEDs), which can be damaged by the therapeutic irradiation. In the last few years, there has been a rising interest in this issue, and it seems that damage to CIEDs is primarily associated with the thermal component of the photoneutron field. In particular, a recent study led by Politecnico di Milano considered CIEDs from various manufacturers and showed that some of these devices can be damaged after an irradiation with a thermal neutron fluence of about 10(9) cm(-2). The present work results from a collaboration among Politecnico di Milano, the University of Pisa, the University of Trieste and three Italian hospitals located in Lucca, Trieste and Varese, respectively, and it is primarily aimed at evaluating the thermal neutron fluence in CIED region for some high-energy treatments delivered at 15 and 18 MV and to determine whether it is comparable to the critical value given above, which has been experimentally determined to be potentially harmful for CIEDs. Thermal neutron fluence was measured through CR-39 detectors and TLDs, which were housed inside a BOMAB-like phantom mimicking the patient's trunk. The experimental sessions involved two models of LINAC, Varian Clinac DHX (Varese hospital) and Elekta Synergy (Lucca and Trieste hospitals). The experimental results show that the treatments considered in this study can lead to a thermal neutron fluence in the cardiac region comparable to the critical value. Furthermore, detailed Monte Carlo geometries for the facilities involved in this project were developed with the MCNP code (v. 6.2), and they were tested by comparing simulation results to measurements considering some benchmark irradiation plans. Bubble detectors were also employed for fast neutron fluence measurements to be compared to simulation outputs. These computational models stand out as promising tools for the investigations required in this work, and they can be used for further studies also extending their use to analogous facilities hosting the same models of LINACs.