In radiology, the photon fluence and the energy spectrum generated from an x-ray tube may depend on the anode tilt angle. In this contribution, a Monte Carlo investigation is performed to quantify this effect by modeling an x-ray tube based on published data Bujila R. et al (2020 Physica. Med. 75 44–54). The GATE simulation code is used for this purpose. The calculations have moreover confirmed this dependence; the tilt of the anode could be used to increase the photon fluence. The thermal analysis has shown that the hot spot size is dependent as well on the anode tilt angle. The thermal focus temperature (ΔT) decreases when the anode tilt angle increases. Finally, by moving the acquisition angle from 293°–337° to 248°–292° and changing the anode tilt angle from 8° to 28°, the photon fluence can be increased by 55%.