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Background and Aims After the rediscovery of the normal tissue sparing FLASH effect of high dose rate radiation, research activities on this topic have been revived. But especially for protons, the portfolio of accelerators capable of performing studies at ultra-high dose rates is limited. Laser-plasma accelerators (LPA) can generate extremely intense proton bunches of many 10 MeV kinetic energy. In combination with dedicated dose delivery systems, LPA proton sources facilitate peak dose rates well above 10^8 Gy/s in a pulse structure regime complementary to conventional accelerators. Methods The reliable generation of proton spectra beyond 60 MeV at DRACO-PW [Ziegler et al, SciRep2021], combined with a dedicated energy selective pulsed magnet beam transport system [Brack et al, SciRep2020], allows tailored sample-specific dose distributions. Adapted on-shot dosimetry enables the required spectral monitoring of every proton bunch. Two irradiation series on volumetric biological samples were performed at DRACO-PW, accompanied by reference irradiations at the University Proton Therapy Dresden. Results The first small animal pilot study at a laser-driven proton source was conducted successfully. The mouse-ear tumor model’s requirements [Beyreuther et al, PLoS One2018] were fulfilled and verified at high precision (+/- 5%) concerning predefined dose value and conformity. Complementary, a study investigating dose-rate effects such as FLASH was performed irradiating zebrafish embryos with above 10^9 Gy/s. Conclusions We present a laser-based irradiation platform at the DRACO-PW facility that enables systematic radiobiological studies, laying the foundations for further studies at LPA sources exploring ultra-high dose-rate effects, such as FLASH, over previously unreachable parameter space.

Recent years have shown that particle therapy offers highly conformal brain irradiation and optimized healthy tissue sparing. Nevertheless, elevated dose levels in healthy tissue, particularly in the distal beam region, can lead to undesirable long-term side effects. The biological mechanisms of such effects, however, remain unclear. A major obstacle towards correlating effects on clinical and cellular imaging levels is the mapping of radiation dose to specific brain regions or individual cell populations. We present a publicly available dataset of registered, multimodal imaging data of nine mice that received proton brain irradiation of different doses in a clinically relevant setting. It is available open access (https://rodare.hzdr.de/record/801) and comprises a baseline computed tomography (CT) scan, simulated distributions of dose and linear energy transfer, a co-aligned mouse brain atlas as well as magnetic resonance imaging (MRI) follow-up of up to six months. Additionally, we provide registered histological brain sections with eight histological stainings, reflecting all major cell types in adult mice brains. We used the self-developed tool Slice2Volume together with existing methods (Elastix & Big Warp) to fuse image data. The software is available open source: https://github.com/jo-mueller/Slice2Volume The provided image data spans several orders of magnitude of scale. Images of all modalities can be freely overlaid for every mouse as is demonstrated on Figure 1. This, for instance, allows tracing MRI image changes to specific cell populations. Hence, the dataset enables direct correlations and mechanistic observations regarding effects of proton radiation on the anatomical (atlas), clinical (MRI) and microscopic level (histology).

The recent rediscovery of the “Flash-effect” revived the interest in high dose-rate radiation effects throughout the radiobiology community, promising protection of normal tissue, while simultaneously not altering tumour control. Several preclinical and clinical studies are presently dedicated to electron FLASH with Linacs. However, the mechanisms of Flash is still unresolved albeit its clear impact in tissue sparing to radiation toxicity. For protons, the Flash effect was confirmed in a few animal experiments using the beam parameters available at clinical cyclotrons. Laser-driven proton accelerators offer the possibility to extend the range of proton beam parameters to higher dose rates enabling the investigation in vivo of high dose-rate effects for up to 10^9 Gy/s. The general applicability of these beams for radiobiological studies was proven with simple cellular models and zebrafish embryos. One-step further, systematic in vivo experiments were prepared with a proof-of-principle mouse irradiation campaign at the Draco laser accelerator and, for comparison, at the University Proton Therapy Dresden (UPTD). Moreover, to investigate the interplay of oxygen tension, oxygen consumption and proton dose rate in more detail, an experiment with zebrafish embryos was performed at both proton sources. At the conference, we will give an overview of our radiobiological experiments performed at both DRACO and Oncoray/UPTD, for different dose rates and varying oxygen pressures.

After the rediscovery of the normal tissue sparing effect of high dose rate radiation, i.e. the so-called FLASH effect, by Favaudon et al. in 2014, research activities on this topic have been revived and are flourishing ever since. Yet, the exact biological mechanism as well as the required boundary conditions and radiation qualities to reach said sparing remain mostly unclear. We present a laser-based irradiation platform at the Draco PW facility that enables systematic studies into the FLASH regime using proton peak dose rates of up to 10^9 Gy/s. Besides the PW class laser acceleration source, a key component is a pulsed high-field beamline to transport and shape the laser driven proton bunches spectrally and spatially in order to generate homogeneous dose distributions tailored to match the irradiation sample. Making use of the diverse capabilities of the laser driven irradiation platform a pilot experiment of highest complexity has been conducted – a systematic in-vivo tumor irradiation in a specifically developed mouse model. A plethora of online particle diagnostics, including Time-of-Flight, bulk scintillators and screens as well as ionization chambers, in conjunction with diagnostics for retrospective absolute dosimetry (radiochromic films) allowed for an unprecedented level of precision in mean dose delivery (±10 %) and dose homogeneity (±5 %) for the challenging beam qualities of a laser accelerator. The tailored detector suite is complemented by predictive simulations. The talk addresses how our interdisciplinary team overcame all hurdles from animal model development, over enhancing the laser and laser acceleration stability, to dose delivery and online dose monitoring. Results on radiation induced tumor growth delay by laser driven as well as conventionally accelerated proton beams are critically discussed.

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Background and purpose In consequence of a previous study, where no protecting proton Flash effect was found for zebrafish embryos, potential reasons and requirements for inducing a Flash effect should be investigated with the beam pulse structure and the partial oxygen pressure (pO2) as relevant parameters. Materials and methods The experiments were performed at the research electron accelerator ELBE, whose variable pulse structure enables dose delivery as electron Flash and quasi-continuously (reference). Zebrafish embryos were irradiated with ~26 Gy either continuously with a dose rate of ~6.7 Gy/min or in one 111 µs long pulse with a pulse dose rate of 109 Gy/s and a mean dose rate of 105 Gy/s, respectively. Using the OxyLite system to measure the pO2 a low- (pO2 ≤ 5 mmHg) and a high-pO2 group were defined on basis of the oxygen depletion kinetics in sealed embryo samples. Results A protective Flash effect was seen for most endpoints ranging from 4 % less reduction in embryo length to about 20 – 25 % less embryos with spinal curvature and pericardial edema, relative to reference irradiation. The reduction of pO2 below atmospheric levels (148 mmHg) resulted in higher protection, which was however more pronounced in the low-pO2 group. Conclusion The Flash experiment at ELBE showed that the zebrafish embryo model is appropriate for studying the radiobiological response of high dose rate irradiation. Pulse dose and pulse dose rate as important beam parameters were confirmed as well as the pivotal role of pO2 during irradiation.

Radiation induced late side effects such as cognitive decline and normal tissue complications can severely affect quality of life and outcome in long-term survivors of brain tumors. Proton therapy offers a favorable depth-dose deposition with the potential to spare tumor-surrounding normal tissue, thus potentially reducing such side effects. In this study, we describe a preclinical model to reveal underlying biological mechanisms caused by precise high-dose proton irradiation of a brain subvolume. We studied the dose- and time-dependent radiation response of mouse brain tissue, using a high-precision image-guided proton irradiation setup for small animals established at the University Proton Therapy Dresden. The right hippocampal area of ten C57BL/6 and ten C3H/He mice was irradiated. Both strains consisted of four groups treated with increasing doses (0 – 85 Gy and 0 – 80 Gy, respectively). Follow-ups were performed up to six months, including longitudinal monitoring of general health status and regular contrast-enhanced magnetic resonance imaging (MRI) of mouse brains. These findings were related to comprehensive final histological analysis. In mice of the highest dose group, first symptoms of blood-brain barrier (BBB) damage appeared one week after irradiation, while a dose-dependent delay in onset was observed for lower doses. MRI contrast agent leakage occurred in the irradiated brain areas and was progressive in the higher dose groups. Mouse health status and survival corresponded to the extent of contrast agent leakage. Histological analysis revealed tissue changes such as vessel abnormalities, gliosis, and granule cell dispersion, which also partly affected the non-irradiated contralateral hippocampus. All observed effects depended strongly on the prescribed radiation doses and the outcome, i.e. survival, image changes and tissue alterations, within an experimental dose cohort was very consistent. A derived dose-response model will determine doses in future

Purpose: To investigate experimentally, if FLASH irradiation depletes oxygen within water for different radiation types such as photons, protons and carbon ions. Methods: This study presents measurements of the oxygen consumption in sealed, 3D printed water phantoms during irradiation with X-rays, protons and carbon ions at varying dose rates up to 340Gy/s. The oxygen measurement was performed using an optical sensor allowing for non-invasive measurements. Results: Oxygen consumption in water only depends on dose, dose-rate and linear energy transfer (LET) of the irradiation. The total amount of oxygen depleted per 10Gy was found to be 0.04 - 0.18% atm for 225 kV photons, 0.04 - 0.25% atm for 224 MeV protons and 0.09 - 0.17% atm for carbon ions. Consumption depends on dose-rate by an inverse power law and saturates for higher dose rates because of self-interactions of radicals. Higher dose rates yield lower oxygen consumption. No total depletion of oxygen was found for clinical doses. Conclusions: FLASH irradiation does consume oxygen, but not enough to deplete all the oxygen present. For higher dose rates, less oxygen was consumed than at standard radiotherapy dose rates. No total depletion was found for any of the analyzed radiation types for 10Gy dose delivery using FLASH.

Laser-driven proton pulse provide unique properties in terms of pulse structure (ns) and instantaneous dose rate (10^9 Gy/s) but - inherently broadband and highly divergent - pose a challenge to established beamline concepts on the path to application-adapted irradiation field formation, particularly for three-dimensional cases. We present the successful implementation and characterisation of a highly efficient and tuneable dual pulsed solenoid beamline at the Draco PW facility[1] to generate volumetric dose distribution tailored to specific applications[2]. The vast experimental scope and already successfully performed studies range from systematic volumetric in-vivo tumour irradiations in a dedicated mouse model (with a stable mean dose delivery of ±10 % and a spatial dose homogeneity of ±5 % over a cylindrical volume of 5 mm diameter and height) to high-dose-rate irradiations in the FLASH regime (using proton peak dose rates of up to 10^9 Gy/s with about 20 Gy/shot homogeneously over a cylindrical sample volume of 4.5 mm diameter and 3 mm height) as well as particle diagnostics commissioning (with a multitude of spatial and spectral dose distributions). The beamline setup is complemented by a complex beam monitoring and dosimetry detector suite adapted to the ultra-high dose rate pulses and is in its unique synergy and redundancy capable of %-level precision dose delivery to samples as required for systematic irradiation studies. In addition to established radiochromic film dosimetry, the detector suite includes saturation-corrected (transmission) ionisation chambers [3] as well as screen and bulk scintillator setups, partly with tomographic reconstruction capabilities for 3D dose distribution retrieval. Moreover, non-invasive, single-shot-capable online time-of-flight-based spectral characterisation of filtered proton pulses has proven a powerful tool for beam monitoring as well as dosimetric purposes. In this presentation the complex and versatile dose delivery

Demanding applications like radiation therapy of cancer are pushing the frontier of laser driven proton accelerators with controlled and well-defined proton beam properties. This talk will give an overview of recent achievements at the high-contrast high power laser source DRACO at HZDR providing high contrast pulses of >500 TW on target for the reliable generation of proton beams with energies of around 60 MeV. For efficient capturing and shaping of the divergent TNSA proton pulses, a setup of two pulsed highfield solenoid magnets has been developed and proven to reliably generate homogeneous depth dose distributions precisely adapted to the three-dimensional sample geometry for ultra-high pulse dose rate irradiation scenarios. Using this method, worldwide first dose controlled volumetric irradiation of in vivo samples with laseraccelerated protons were conducted. The performance of laser based ion acceleration and the scaling of the laser energy to achieve increased ion energies strongly depend on the laser temporal contrast and its effect on the target plasma scale length. Plasma mirror setups have proven to be a valuable tool to significantly improve the temporal contrast by reducing pre-pulse intensity and steepening the rising edge of the main laser pulse. With such contrast enhancement techniques including novel diagnostic schemes, laser proton acceleration using ultra-thin foil targets as well as renewable debris-free hydrogen jets were investigated in a series of experiments within the near-critical density regime. An important implication of this is the demonstration of a credible path toward high repetition rate laser-based ion acceleration applications.

Primary data and data description to publication: Electron dose rate and oxygen depletion protect zebrafish embryos from radiation damage Abstract: Background and purpose In consequence of a previous study, where no protecting proton Flash effect was found for zebrafish embryos, potential reasons and requirements for inducing a Flash effect should be investigated with the beam pulse structure and the partial oxygen pressure (pO2) as relevant parameters. Materials and methods The experiments were performed at the research electron accelerator ELBE, whose variable pulse structure enables dose delivery as electron Flash and quasi-continuously (reference). Zebrafish embryos were irradiated with ~26 Gy either continuously with a dose rate of ~6.7 Gy/min or in one 111 µs long pulse with a pulse dose rate of 109 Gy/s and a mean dose rate of 105 Gy/s, respectively. Using the OxyLite system to measure the pO2 a low- (pO2 ≤ 5 mmHg) and a high-pO2 group were defined on basis of the oxygen depletion kinetics in sealed embryo samples. Results A protective Flash effect was seen for most endpoints ranging from 4 % less reduction in embryo length to about 20 – 25 % less embryos with spinal curvature and pericardial edema, relative to reference irradiation. The reduction of pO2 below atmospheric levels (148 mmHg) resulted in higher protection, which was however more pronounced in the low-pO2 group. Conclusion The Flash experiment at ELBE showed that the zebrafish embryo model is appropriate for studying the radiobiological response of high dose rate irradiation. Pulse dose and pulse dose rate as important beam parameters were confirmed as well as the pivotal role of pO2 during irradiation.

All source data and scripts for publication: "Tumor irradiation in mice with a laser-accelerated proton beam"

ntense laser-driven proton pulses, inherently broadband and highly divergent, pose a challenge to established beamline concepts on the path to application-adapted irradiation field formation, particularly for 3D. Here we experimentally show the successful implementation of a highly efficient (50% transmission) and tuneable dual pulsed solenoid setup to generate a homogeneous (laterally and in depth) volumetric dose distribution (cylindrical volume of 5 mm diameter and depth) at a single pulse dose of 0.7 Gy via multi-energy slice selection from the broad input spectrum. The experiments were conducted at the Petawatt beam of the Dresden Laser Acceleration Source Draco and were aided by a predictive simulation model verified by proton transport studies. With the characterised beamline we investigated manipulation and matching of lateral and depth dose profiles to various desired applications and targets. Using an adapted dose profile, we performed a first proof-of-technical-concept laser-driven proton irradiation of volumetric in-vitro tumour tissue (SAS spheroids) to demonstrate concurrent operation of laser accelerator, beam shaping, dosimetry and irradiation procedure of volumetric biological samples.

Magnetic resonance imaging (MRI) and immunohistochemical tissue stainings are pivotal for radiotherapeutic workflows. Yet, recent efforts herald a paradigm shift: Radiomic methods are used to extract a large number of quantitative features from image data to detect high-dimensional patterns, which are correlated with relevant clinical endpoints. Preclinical experiments help to understand underlying mechanisms, yet require the backtranslation of clinically used methods and their application to a heterogeneous patient cohort. In the present preclinical experiment, we determine the tumor phenotype from MRI and tumor microenvironment (TME) features in a patient cohort of xenograft tumor models of the head and neck. An artificial heterogeneous patient population was created by mixing two tumor models of different radiosensitivity (SAS & UT-SCC-14) in pooled cohort (N = 108) and exposure to one week of fractionated irradiation with photons and protons. After irradiation, contrast agent-enhanced T1-weighted 3D gradient-echo MRI scans were acquired, tumors were excised and characterized immunohistochemically regarding vascularity (CD31), hypoxia (Pimonidazole) and morphology (H&E). Approximately 200 quantitative features were extracted from MRI and light-microscopy image data with an automated medical image radiomics processor and trainable image segmentation, respectively. TME parameters were analyzed regarding effects of radiation with two-sided t-tests. A fully automated radiomic framework was used for feature selection, model generation using leave-one-out cross validation with the individual tumor model’s identity (i.e. its phenotype) as endpoint. Model performance was assessed through area under the curve (AUC). The used image quantification methods allowed for robust feature extraction. No effects of radiation on the TME were detected except for changes in vessel-adjacent hypoxia. Radiomic analysis was able to predict the tumor model based on TME features (AUC = 0.86

Background: Due to the beneficial inverse physical depth-dose profile, proton radiotherapy (PT) offers the potential to reduce normal tissue toxicity by depositing the maximum dose within the tumor volume while sparing the surrounding tissue. However, range uncertainties and necessary clinical safety margins in combination with varying relative biological effectiveness may result in a critical dose in the normal tissue. Dedicated preclinical studies are needed to assess and better understand potential adverse effects of PT and to develop potential biomarkers and countermeasures for backtranslation into clinics. For this purpose, a high-precision image-guided proton irradiation setup for small animals was established at the University Proton Therapy Dresden that mimics the clinical workflow, including pre-treatment imaging, treatment planning and image-guided brain irradiation. The right hippocampus of C57BL/6 and C3H/HeN mice was irradiated to study the dose- and time-dependent radiation response of mouse brain tissue after short or long-term follow-up analysis. A Monte Carlo model of the proton beam was designed in the simulation toolkit TOPAS to calculate the dose distributions in vivo and to correlate the outcome with proton dose and LET. The geometric accuracy of proton irradiation, detailed dose simulations on mouse CT and cell-based assessment enable a biologically and spatially resolved analysis of short-term radiation response and RBE. In addition, the long-term follow up over six month provides first insights into the formation of normal tissue damage in mouse brain after PT.

Pancreatic ductal adenocarcinoma (PDAC) is a highly therapy resistant tumor entity of unmet need. Over the last decades, radiotherapy has been considered as additional treatment modality to surgery and chemotherapy. Owing to radiosensitive abdominal organs, high precision proton beam radiotherapy has been regarded superior to photon radiotherapy. To further elucidate the potential of combination therapies, we employed a more physiological 3D, matrix-based cell culture model to assess tumoroid formation capacity after photon and proton irradiation. Additionally, we investigated proton and photon irradiation-induced phosphoproteomic changes for identifying clinically exploitable targets. Here, we show that proton irradiation elicits a higher efficacy to reduce 3D PDAC tumoroid formation and a greater extent of phosphoproteome alterations compared with photon irradiation. Targeting of proteins identified in the phosphoproteome that were uniquely altered by protons or photons failed to cause radiation type-specific radiosensitization. Targeting DNA repair proteins associated with non-homologous endjoing, however, revealed a strong radiosensitizing potential independent from the radiation type. In conclusion, our findings suggest proton irradiation to be potentially more effective in PDAC than photons without additional efficacy when combined with DNA repair inhibitors.

Preclinical imaging and irradiation yields valuable insights into clinically relevant research topics. While complementary imaging methods such as computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) can be combined within single devices, this is technically demanding and cost-intensive. Similarly, bedding and setup solutions are often specific to certain devices and research questions. We present a bedding platform for mice that is compatible with various preclinical imaging modalities (combined PET/MRI, cone beam CT) and irradiation with photons and protons. It consists of a 3D-printed bedding unit (acrylonitrile butadiene styrene, ABS) holding the animal and features an inhalation anesthesia mask, jaw fixation, ear pins, and immobilization for the hind leg. It can be embedded on mounting adaptors for multi-modal imaging and into a transport box (polymethyl methacrylate, PMMA) for experiments outside dedicated animal facilities while maintaining the animal’s hygiene status. A vital support unit provides heating, inhalation anesthesia, and a respiration monitor. We dosimetrically evaluated used materials in order to assess their interaction with incident irradiation. Proof-of-concept multi-modal imaging protocols were used on phantoms and mice. The measured attenuation of the bedding unit for 40/60/80/200 kV x-rays was less than 3 %. The measured stopping-power-ratio of ABS was 0.951, the combined water-equivalent thickness of bedding unit and transport box was 4.2 mm for proton energies of 150 MeV and 200 MeV. Proof-of-concept imaging showed no loss of image quality. Imaging data of individual mice from different imaging modalities could be aligned rigidly. The presented bed aims to provide a platform for experiments related to both multi-modal imaging and irradiation, thus offering the possibility for image-guided irradiation which relies on precise imaging and positioning. The usage as a self-contained, stand-alone u

Purpose/Objective: The laser-driven ionizing (LDI) beams have unique property of ultra-high dose rate, ultra-short pulses and carry the potential toward special clinical application. Our aim was to establish an in vivo zebrafish model for radiobiological research on later LDI radiation. Material/methods: 24 hours post-fertilization (hpf) zebrafish (Danio rerio) embryos were irradiated at the University Proton Therapy Dresden with escalated doses (5, 10, 15, 20 and 30 Gy) at two positions along the proton depth-dose curve, at the plateau and at the middle of Spread Out Bragg Peak, and with reference 6 MV photon beams from a clinical linac (n=96 in each group). The experiment was 3 times repeated under the same conditions. On the 3th (96 hpf) and 4th (120 hpf) days after irradiation morphological malformations were documented (photo) and determined quantitatively. Two independent observers measured the length of the embryos, the degree of the yolk sac edema and the diameter of the eyes. Additionally, we have detected the DNA double-strand breaks immunohistochemically (gamma-H2AX foci) after 30 min of the irradiation at the two positions of the proton (mSOBP and plateau) and photon beams, at 5 Gy dose level. Results: Dose-dependent organ developmental deteriorations could be detected morphologically at >10 Gy dose levels. The length of the embryo and the size of the eyes reduced, while the yolk sac edema increased significantly in dose dependent degree after 10 Gy, 15 Gy, 20 Gy and 30 Gy irradiation, at both developmental stages. At 5 Gy dose irradiation we have found significant elevation in the number of DNA double-strand breaks, as compared to the unirradiated control groups. Furthermore, data showed that after proton irradiation the degree of the DNA damage was higher, as compared to the photon irradiation. Conclusion: We could establish a reliable quantitative morphological analysis of dose-dependent organ malformations using an in vivo vertebrate system. The zebr

The combination of the beneficial effects of high dose-rate Flash-RT and proton depth dose distribution promise the differential sparing of normal tissue under similar tumour treating efficacy. However, of the two published attempts [1,2] made at clinical proton facilities, one in vivo study on zebrafish embryo was not able to measure a Flash effect [2]. In the discussion of this experiment, the zebrafish model, a non-ideal pulse-time-regime and an uncertain oxygen level during irradiation were identified as potential explanations for the missing Flash effect. In order to investigate these parameters in detail an experiment was scheduled at the research electron accelerator ELBE at HZDR, because an electron Flash effect was already demonstrated for zebrafish embryo [3]. The highly variable pulse structure of ELBE enables to deliver the dose either in therapy like quasi-continuous (cw) beams or as electron Flash irradiation. Zebrafish embryo were irradiated with 40 Gy with pulse dose rates of 109 Gy/s and mean dose rates of 106 Gy/s in comparison to 0.1 Gy/s with cw irradiation. In addition to this, the Oxylite system was applied to measure and control oxygen depletion kinetics in sealed embryo samples. A protective Flash effect was seen for most endpoints ranging from 4 % less reduction in embryo length to about 20 – 25 % less embryo with spinal curvature and pericardial oedema, relative to cw-irradiation. The reduction of partial oxygen pressure below atmospheric levels results in higher protection, the more the lower the oxygen level. In conclusion, the Flash experiment at ELBE show that the zebrafish embryo model is appropriate for the study of the radiobiological response of high dose rate irradiation. A sufficiently pulse dose seems to be more important than pulse dose rate and the partial oxygen pressure during irradiation plays a pivotal role. [1] Diffenderfer et al.: https://doi.org/10.1016/j.ijrobp.2019.10.049 [2] Beyreuther et al.: https://doi.org/10.1016