A feasibility study of ultra-high dose rate mini-GRID therapy using very-high-energy electron beams for a simulated pediatric brain case

Radiation damage and recovery of plastic scintillators under ultra-high dose rate 200 MeV electrons at CERN CLEAR facility

Objective.The FLASH effect holds significant potential in improving radiotherapy treatment outcomes. Very high energy electrons (VHEEs) with energies in the range of 50-250 MeV can effectively target tumors deep in the body and can be accelerated to achieve ultra-high dose rates (UHDR), making them a promising modality for delivering FLASH radiotherapy in the clinic. However, apart from suitable VHEE sources, clinical translation requires accurate dosimetry, which is challenging due to the limitation of standard dosimeters under UHDR conditions. In this study, water-equivalent and real-time plastic scintillation dosimeters (PSDs) are tested to evaluate their viability for FLASH VHEE dosimetry.Approach.A 4-channel PSD, consisting of polystyrene-based BCF12 and Medscint proprietary scintillators, polyvinyltoluene-based EJ-212 and a blank plastic fiber channel for Cherenkov subtraction was exposed to the 200 MeV VHEE UHDR beam at the CLEAR CERN facility. The Hyperscint RP200 platform was used to assess linearity to dose pulses of up to 90 Gy and dose rates up to4.6×109Gy s-1, and to investigate radiation damage and recovery after dose accumulation of 37.2 kGy.Mainresults.While blank fiber response was linear across the entire dose range studied, light output saturated above 45 Gy/pulse for scintillators. Despite radiation damage, linearity was preserved, though it resulted in a decrease of scintillator and blank fiber light output of<1.87%/kGy and a shift in spectra towards longer wavelengths. Short-term recovery (<100 h) of these changes was observed and depended on rest duration and accumulated dose. After long-term rest (<172 days), light output recovery was partial, with 6%-22% of residual permanent damage remaining, while spectral recovery was complete.Significance.We showed that PSDs are sensitive to radiation damage, but maintain dose linearity even after a total accumulated dose of 37.2 kGy, and exhibit significant response recovery. This work highlights the potential of PSDs for dosimetry in UHDR conditions.

Very High-Energy Electron Therapy Toward Clinical Implementation

The use of very high energy electron (VHEE) beams, with energies between 50 and 400 MeV, has drawn considerable interest in radiotherapy due to their deep tissue penetration, sharp beam edges, and low sensitivity to tissue density. VHEE beams can be precisely steered with magnetic components, positioning VHEE therapy as a cost-effective option between photon and proton therapies. However, the clinical implementation of VHEE therapy (VHEET) requires advances in several areas: developing compact, stable, and efficient accelerators; creating sophisticated treatment planning software; and establishing clinically validated protocols. In addition, the perspective of VHEE to access ultra-high dose-rate regime presents a promising avenue for the practical integration of FLASH radiotherapy of deep tumors and metastases with VHEET (FLASH-VHEET), enhancing normal tissue sparing while maintaining the inherent dosimetric advantages of VHEET. However, FLASH-VHEET systems require validation of time-dependent dose parameters, thus introducing additional technological challenges. Here, we discuss recent progress in VHEET research, focusing on both conventional and FLASH modalities, and covering key aspects including dosimetric properties, radioprotection, accelerator technology, beam focusing, radiobiological effects, and clinical outcomes. Furthermore, we comprehensively analyze initial VHEET in silico studies on coverage across various tumor sites.

Mini-GRID radiotherapy on the CLEAR very-high-energy electron beamline: collimator optimization, film dosimetry, and Monte Carlo simulations

Objective.Spatially-fractionated radiotherapy (SFRT) delivered with a very-high-energy electron (VHEE) beam and a mini-GRID collimator was investigated to achieve synergistic normal tissue-sparing through spatial fractionation and the FLASH effect.Approach.A tungsten mini-GRID collimator for delivering VHEE SFRT was optimized using Monte Carlo (MC) simulations. Peak-to-valley dose ratios (PVDRs), depths of convergence (DoCs, PVDR ≤ 1.1), and peak and valley doses in a water phantom from a simulated 150 MeV VHEE source were evaluated. Collimator thickness, hole width, and septal width were varied to determine an optimal value for each parameter that maximized PVDR and DoC. The optimized collimator (20 mm thick rectangular prism with a 15 mm × 15 mm face with a 7 × 7 array of 0.5 mm holes separated by 1.1 mm septa) was 3D-printed and used for VHEE irradiations with the CERN linear electron accelerator for research beam. Open beam and mini-GRID irradiations were performed at 140, 175, and 200 MeV and dose was recorded with radiochromic films in a water tank. PVDR, central-axis (CAX) and valley dose rates and DoCs were evaluated.Main results.Films demonstrated peak and valley dose rates on the order of 100 s of MGy/s, which could promote FLASH-sparing effects. Across the three energies, PVDRs of 2-4 at 13 mm depth and DoCs between 39 and 47 mm were achieved. Open beam and mini-GRID MC simulations were run to replicate the film results at 200 MeV. For the mini-GRID irradiations, the film CAX dose was on average 15% higher, the film valley dose was 28% higher, and the film PVDR was 15% lower than calculated by MC.Significance.Ultimately, the PVDRs and DoCs were determined to be too low for a significant potential for SFRT tissue-sparing effects to be present, particularly at depth. Further beam delivery optimization and investigations of new means of spatial fractionation are warranted.

Development and optimisation of grid inserts for a preclinical radiotherapy system and corresponding Monte Carlo beam simulations

Objective. To develop a physical grid collimator compatible with the X-RAD preclinical radiotherapy system and create a corresponding Monte Carlo (MC) model.Approach. This work presents a methodology for the fabrication of a grid collimator designed for utilisation on the X-RAD preclinical radiotherapy system. Additionally, a MC simulation of the grid is developed, which is compatible with the X-RAD treatment planning system. The grid was manufactured by casting a low melting point alloy, cerrobend, into a silicone mould. The silicone was moulded around a 3D-printed replica of the grid, enabling the production of diverging holes with precise radii and spacing. A MC simulation was conducted on an equivalent 3D grid model and validated using 11 layers of GAFChromic EBT-3 film interspersed in a 3D-printed water-equivalent phantom. A 3D dose distribution was constructed from the film layers, enabling a direct comparison with the MC Simulation.Main results. The film and the MC dose distribution demonstrated a gamma passing rate of 99% for a 1%, 0.5 mm criteria with a 10% threshold applied. The peak-to-valley dose ratio and output factor at the surface were determined to be 20.4 and 0.79, respectively.Significance. The pairing of the grid collimator with a MC simulation can significantly enhance the practicality of grid therapy on the X-RAD. This combination enables further exploration of the biological implications of grid therapy, supported by a knowledge of the complex dose distributions. Moreover, this methodology can be adapted for use in other systems and scenarios.