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Purpose: Radiotherapy escalating dose rates above 50Gys -1 , might offer a great potential in treating tumours while further sparing healthy tissue. However, these ultra-high intensities of FLASH-RT lead to new challenges with regard to dosimetry and beam monitoring. FLASH experiments at HIT (Heidelberg Ion Beam Therapy Center) and at GSI (GSI Helmholtz Centre for Heavy Ion Research) have shown a significant loss of signal in the beam monitoring system due to recombination effects. To enable accurate beam monitoring, this work investigates the recombination loss of different fill gases in the plane parallel ionisation chambers (ICs)., Methods: Therefore, saturation curves at high intensities were measured for the currently used fill gases Ar/CO 2 (80/20) and pure He and also for He/CO 2 mixtures as alternative fill gases. Furthermore, breakdown voltages and ion mobilities were measured in ICs filled with He/CO 2 mixtures. A numerical model for volume recombination in plane parallel ionisation chambers was developed and implemented in Python. This includes a novel simulation method of the space charge effect from the charge carriers in the detector volume and predicts a significant effect on the electric field for high intensity beams., Results: Even at high intensities the He/CO 2 mixtures allow operation of the ICs at an electric field strength of 2 kVcm -1 or more which reduces recombination to negligible levels at intensities larger than 3 × 10 10 12 C-ions per second. Our measurements show that added fractions of CO 2 to He decrease the ion mobility in the fill gas but significantly increase the breakdown voltage in the ICs compared to pure He., (Copyright © 2022 Associazione Italiana di Fisica Medica e Sanitaria. Published by Elsevier Ltd. All rights reserved.)

Background: In radiotherapy, Monte Carlo (MC) methods are considered a gold standard to calculate accurate dose distributions, particularly in heterogeneous tissues. EURADOS organized an international comparison with six participants applying different MC models to a real medical linear accelerator and to one homogeneous and four heterogeneous dosimetric phantoms., Aims: The aim of this exercise was to identify, by comparison of different MC models with a complete experimental dataset, critical aspects useful for MC users to build and calibrate a simulation and perform a dosimetric analysis., Results: Results show on average a good agreement between simulated and experimental data. However, some significant differences have been observed especially in presence of heterogeneities. Moreover, the results are critically dependent on the different choices of the initial electron source parameters., Conclusions: This intercomparison allowed the participants to identify some critical issues in MC modelling of a medical linear accelerator. Therefore, the complete experimental dataset assembled for this intercomparison will be available to all the MC users, thus providing them an opportunity to build and calibrate a model for a real medical linear accelerator.

Selection of an optimal treatment plan requires the comparison of dose distributions and dose-volume histograms (DVH) of all plan variants calculated for the patient. Each treatment plan consists generally of 30 to 40 CT slices, making the comparison difficult and time consuming. The present study proposes an objective index that takes into account both physical and biological criteria for the evaluation of the dose distribution. The DHV-based evaluation index can be calculated according to the following four criteria: ICRU conformity (review of the differences between the dose in the planning target volume and the ICRU recommendations); mean dose and dose homogeneity of the planning target volume; the product of tumour complication probability (TCP) and normal tissue complication probability (NTCP); and finally a criterion that takes into account the dose load of non-segmented tissue portions within the CT slice. The application of the objective index is demonstrated for two different clinical cases (esophagus and breast carcinoma). During the evaluation period, the objective index showed a good correlation between the doctor's decision and the proposed objective index. Thus, the objective index is suitable for a computer-based evaluation of treatment plans.

Simple Summary: This research aims to improve the precision of particle therapy for lung cancer treatment. The heterogeneous, microscopic structure of lung tissue leads to a broadening of the very sharp dose profiles of protons and other light ions. This can result in higher doses in healthy tissue as well as a reduced dose in the target volume and thereby reducing the potential benefit of particle therapy for lung cancer. This review summarizes existing models that account for these lung tissue effects and explore how they can be better integrated into treatment planning. By taking into account these so called lung modulation effects, it is possible to target tumors more precisely while minimizing harm to surrounding healthy tissues, ultimately benefiting cancer patients. Particle therapy presents a promising alternative to conventional photon therapy for treating non-small cell lung cancer (NSCLC). However, the heterogeneous structure of lung tissue leads to the degradation of the Bragg peak and thereby to the degradation of the dose distribution. This review offers a comprehensive overview of the models developed to account for these modulation effects. It summarizes studies focused on determining modulation power as a predictor of this so-called lung modulation. In addition, the review covers early investigations on dose uncertainties caused by lung modulation in CT-based lung phantoms and patient anatomies and discusses future challenges in integrating these solutions into clinical treatment planning routines. [ABSTRACT FROM AUTHOR]

Simple Summary: Ultra-high dose rate radiotherapy with particle beams such as proton and carbon is a major technical challenge. Fast beam delivery and the concentration of the Bragg peak to the tumor must be achieved in the order of milliseconds and can therefore only be realized with 3D range-modulators (3D RM). This work analyzed the robustness of the dose distribution, resulting from a 3D RM for a cube target volume. Firstly, a high-precision dose measurement was performed, and a very good agreement was found between the measured and Monte Carlo simulated dose distribution. Further simulations were conducted to determine how sensitively the resulting dose distribution responds to misalignments of the 3D RM. The results show that the 3D RM must be aligned with accuracy less than 1° to preserve the planned desired dose distribution. As the research and pre-clinical adoption of 3D RMs in particle therapy has become more widespread recently, these results are of high general utility. A 3D range-modulator (RM), optimized for a single energy and a specific target shape, is a promising and viable solution for the ultra-fast dose delivery in particle therapy. The aim of this work was to investigate the impact of potential beam and modulator misalignments on the dose distribution. Moreover, the FLUKA Monte Carlo model, capable of simulating 3D RMs, was adjusted and validated for the 250 MeV single-energy proton irradiation from a Varian ProBeam system. A 3D RM was designed for a cube target shape rotated 45° around two axes using a Varian-internal research version of the Eclipse treatment planning software, and the resulting dose distribution was simulated in a water phantom. Deviations from the ideal alignment were introduced, and the dose distributions from the modified simulations were compared to the original unmodified one. Finally, the FLUKA model and the workflow were validated with base-line data measurements and dose measurements of the manufactured modulator prototype at the HollandPTC facility in Delft. The adjusted FLUKA model, optimized particularly in the scope of a single-energy FLASH irradiation with a PMMA pre-absorber, demonstrated very good agreement with the measured dose distribution resulting from the 3D RM. Dose deviations resulting from modulator-beam axis misalignments depend on the specific 3D RM and its shape, pin aspect ratio, rotation angle, rotation point, etc. A minor modulator shift was found to be more relevant for the distal dose distribution than for the spread-out Bragg Peak (SOBP) homogeneity. On the other hand, a modulator tilt (rotation away from the beam axis) substantially affected not only the depth dose profile, transforming a flat SOBP into a broad, Gaussian-like distribution with increasing rotation angle, but also shifted the lateral dose distribution considerably. This work strives to increase awareness and highlight potential pitfalls as the 3D RM method progresses from a purely research concept to pre-clinical studies and human trials. Ensuring that gantry rotation and the combined weight of RM, PMMA, and aperture do not introduce alignment issues is critical. Given all the other range and positioning uncertainties, etc., not related to the modulator, the RM must be aligned with an accuracy below 1° in order to preserve a clinically acceptable total uncertainty budget. Careful consideration of critical parameters like the pin aspect ratio and possibly a novel robust modulator geometry optimization are potential additional strategies to mitigate the impact of positioning on the resulting dose. Finally, even the rotated cube 3D modulator with high aspect ratio pin structures (~80 mm height to 3 mm pin base width) was found to be relatively robust against a slight misalignment of 0.5° rotation or a 1.5 mm shift in one dimension perpendicular to the beam axis. Given a reliable positioning and QA concept, the additional uncertainties introduced by the 3D RM can be successfully managed adopting the concept into the clinical routine. [ABSTRACT FROM AUTHOR]

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Purpose: Photon fields with energies above ~7 MeV are contaminated by neutrons due to photonuclear reactions. Their influence on dosimetry--although considered to be very low--is widely unexplored. Methods: In this work, Monte Carlo based investigations into this issue performed with FLUKA and EGSNRC are presented. A typical Linac head in 18 MV-X mode was modeled equivalently within both codes. EGSNRC was used for the photon and FLUKA for the neutron production and transport simulation. Water depth dose profiles and the response of different detectors (Farmer chamber, TLD-100, TLD-600H, and TLD-700H chip) in five representative depths were simulated and the neutrons' impact (neutron absorbed dose relative to photon absorbed dose) was calculated. To take account of the neutrons' influence, a theoretically required correction factor was defined and calculated for five representative water depths. Results: The neutrons' impact on the absorbed dose to water was found to be below 0.1% for all depths and their impact on the response of the Farmer chamber and the TLD-700H chip was found to be even less. For the TLD-100 and the TLD-600H chip it was found to be up to 0.3% and 0.7%, respectively. The theoretical correction factors to be applied to absorbed dose to water values measured with these four detectors in a depth different from the reference/calibration depth were calculated and found to be below 0.05% for the Farmer chamber and the TLD-700H chip, but up to 0.15% and 0.35% for the TLD-100 and TLD-600H chips, respectively. In thermoluminescence dosimetry the neutrons' influence (and therefore the additional inaccuracy in measurement) was found to be higher for TLD materials whose 6Li fraction is high, such as TLD-100 and TLD-600H, resulting from the thermal neutron capture reaction on 6Li. Conclusions: The impact of photoneutrons on the absorbed dose to water and on the response of a typical ionization chamber as well as three different types of TLD chips was quantified and was as expected found to be very low relative to that of the primary photons. For most practical reasons the neutrons' influence on dosimetry might be neglected while for absolute precise thermoluminescence dosimetry in high energy photon fields, the use of TLD-700H (<0.03% 6Li) instead of the commonly used TLD-100 (7.4% 6Li) or even the extra neutron sensitive TLD-600H is recommended (95.6% 6Li) due to the additional inaccuracy in measurement for TLD materials with a high 6Li fraction. [ABSTRACT FROM AUTHOR]

Purpose: Proton radiotherapy is rapidly becoming a standard treatment option for cancer. However, even though experimental data show an increase of the relative biological effectiveness (RBE) with depth, particularly at the distal end of the treatment field, a generic RBE of 1.1 is currently used in proton radiotherapy. This discrepancy might affect the effective penetration depth of the proton beam and thus the dose to the surrounding tissue and organs at risk. The purpose of this study was thus to analyze the impact of a tissue and dose dependent RBE of protons on the effective range of the proton beam in comparison to the range based on a generic RBE of 1.1. Methods: Factors influencing the biologically effective proton range were systematically analyzed by means of treatment planning studies using the Local Effect Model (LEM IV) and the treatment planning software TRiP98. Special emphasis was put on the comparison of passive and active range modulation techniques. Results: Beam energy, tissue type, and dose level significantly affected the biological extension of the treatment field at the distal edge. Up to 4 mm increased penetration depth as compared to the depth based on a constant RBE of 1.1. The extension of the biologically effective range strongly depends on the initial proton energy used for the most distal layer of the field and correlates with the width of the distal penumbra. Thus, the range extension, in general, was more pronounced for passive as compared to active range modulation systems, whereas the maximum RBE was higher for active systems. Conclusions: The analysis showed that the physical characteristics of the proton beam in terms of the width of the distal penumbra have a great impact on the RBE gradient and thus also the biologically effective penetration depth of the beam. [ABSTRACT FROM AUTHOR]

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Copyright of Zeitschrift für Medizinische Physik is the property of Elsevier GmbH, Urban & Fischer Verlag and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Strahlentherapie und Onkologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)