The production of secondary neutrons is an undesirable byproduct of proton therapy. It is important to quantify the contribution from secondary neutrons to patient dose received outside the treatment volume. The purpose of this study is to investigate the off-axis dose equivalent from secondary neutrons using the Monte Carlo radiation transport code FLUKA. The study is done using a simplified version of the beam delivery system used at ProCure Proton Therapy Center, Oklahoma City, OK. In this study, a particular set of treatment parameters were set to study the dose equivalent outside the treatment volume inside a phantom and in air at various depths and angles with respect to the primary beam axis. Three different proton beams with maximum energies of 78 MeV, 162 MeV and 226 MeV and 4 cm modulation width, a 5 cm diameter brass aperture, and a small snout located 38 cm from isocenter were used for the study. The FLUKA calculated secondary neutron dose equivalent to absorbed proton dose, Hn/Dp, decreased with distance from beam isocenter. The Hn/Dp ranged from 0.11 ? 0.01 mSv/Gy for a 78 MeV proton beam to 111.01 ? 1.99 mSv/Gy for a 226 MeV proton beam. Overall, Hn/Dp was observed to be higher in air than in the phantom, indicating the predominance of external neutrons produced in the nozzle rather than inside the body.Physic
