A comprehensive pre‐clinical treatment quality assurance program using unique spot patterns for proton pencil beam scanning FLASH radiotherapy

Abstract

BackgroundQuality assurance (QA) for ultra‐high dose rate (UHDR) irradiation is a crucial aspect in the emerging field of FLASH radiotherapy (FLASH‐RT). This innovative treatment approach delivers radiation at UHDR, demanding careful adoption of QA protocols and procedures. A comprehensive understanding of beam properties and dosimetry consistency is vital to ensure the safe and effective delivery of FLASH‐RT.PurposeTo develop a comprehensive pre‐treatment QA program for cyclotron‐based proton pencil beam scanning (PBS) FLASH‐RT. Establish appropriate tolerances for QA items based on this study's outcomes and TG‐224 recommendations.MethodsA 250 MeV proton spot pattern was designed and implemented using UHDR with a 215nA nozzle beam current. The QA pattern that covers a central uniform field area, various spot spacings, spot delivery modes and scanning directions, and enabling the assessment of absolute, relative and temporal dosimetry QA parameters. A strip ionization chamber array (SICA) and an Advanced Markus chamber were utilized in conjunction with a 2 cm polyethylene slab and a range (R80) verification wedge. The data have been monitored for over 3 months.ResultsThe relative dosimetries were compliant with TG‐224. The variations of temporal dosimetry for scanning speed, spot dwell time, and spot transition time were within ± 1 mm/ms, ± 0.2 ms, and ± 0.2 ms, respectively. While the beam‐to‐beam absolute output on the same day reached up to 2.14%, the day‐to‐day variation was as high as 9.69%. High correlation between the absolute dose and dose rate fluctuations were identified. The dose rate of the central 5 × 5 cm2 field exhibited variations within 5% of the baseline value (155 Gy/s) during an experimental session.ConclusionsA comprehensive QA program for FLASH‐RT was developed and effectively assesses the performance of a UHDR delivery system. Establishing tolerances to unify standards and offering direction for future advancements in the evolving FLASH‐RT field.