Ultra-high dose rate dosimetry: Challenges and opportunities for FLASH radiation therapy

Abstract

The clinical translation of FLASH radiotherapy (RT) requires challenges related to dosimetry and beam monitoring of ultra-high dose rate (UHDR) beams to be addressed. Detectors currently in use suffer from saturation effects under UHDR regimes, requiring the introduction of correction factors. There is significant interest from the scientific community to identify the most reliable solutions and suitable experimental approaches for UHDR dosimetry. This interest is manifested through the increasing number of national and international projects recently proposed concerning UHDR dosimetry. Attaining the desired solutions and approaches requires further optimization of already established technologies as well as the investigation of novel radiation detection and dosimetry methods. New knowledge will also emerge to fill the gap in terms of validated protocols, assessing new dosimetric procedures and standardized methods. In this paper, we discuss the main challenges coming from the peculiar beam parameters characterizing UHDR beams for FLASH RT. These challenges vary considerably depending on the accelerator type and technique used to produce the relevant UHDR radiation environment. We also introduce some general considerations on how the different time structure in the production of the radiation beams, as well as the dose and dose-rate per pulse, can affect the detector response. Finally, we discuss the requirements that must characterize any proposed dosimeters for use in UDHR radiation environments. A detailed status of the current technology is provided, with the aim of discussing the detector features and their performance characteristics and/or limitations in UHDR regimes. We report on further developments for established detectors and novel approaches currently under investigation with a view to predict future directions in terms of dosimetry approaches, practical procedures, and protocols. Due to several on-going detector and dosimetry developments associated with UHDR radiation environment for FLASH RT it is not possible to provide a simple list of recommendations for the most suitable detectors for FLASH RT dosimetry. However, this article does provide the reader with a detailed description of the most up-to-date dosimetric approaches, and describes the behavior of the detectors operated under UHDR irradiation conditions and offers expert discussion on the current challenges which we believe are important and still need to be addressed in the clinical translation of FLASH RT.

Keywords: FLASH; dosimetry; proton therapy; radiotherapy; ultra-high dose rate.

FIGURE 1

(a–f) Beam time structure and pulse duration (τ) for various accelerators delivering ultra‐high dose rate (UHDR) beams. Adapted with addition from Ref. 24

FIGURE 2

(a–e) Ion recombination correction factors calculated for different chambers for the spread‐out Bragg peak (SOBP) beam. Circle and square symbols were calculated using Equation (4), triangle symbols were calculated using Equation (5), and star symbols were calculated using Equation (6). V _H/V _L = 2 in the legend indicates that Equation (5) was used with (‐400, ‐200) voltage pair for the Advanced Markus chamber. V _H/V _L = 3 in the legend indicates that Equation (5) was used with (‐450, ‐150) voltage pair. (f) Polarity correction factor for four different chambers irradiated by a proton beam, at 2–150 Gy/s dose rate, generated by a synchrocyclotron

FIGURE 3

Dose–response curves obtained from the red channel of the EBT3 films irradiated by 198 MeV proton beams at 40 Gy/s and 5 Gy/s dose rates. Error bars are within the symbol size and the dashed curves represent 1‐sigma confidence level

FIGURE 4

The optically stimulated luminescence dosimeters (OSLDs) dose measurement relative to the nominal dose as a function of the dose rate for the three setups studied by Christensen et al. The number of aggregated data points for each dose rate is given above each marker. The appearance of an under‐response above 1000 Gy/s is due to signal averaging of the narrow pencil beam over the OSLDs and is not manifestation of a dose‐rate dependency