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On the acceptance, commissioning, and quality assurance of electron FLASH units.

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Title: On the acceptance, commissioning, and quality assurance of electron FLASH units.
Authors: Palmiero, Allison1 (AUTHOR), Liu, Kevin2,3 (AUTHOR), Colnot, Julie4 (AUTHOR), Chopra, Nitish2 (AUTHOR), Neill, Denae2 (AUTHOR), Connell, Luke2,3 (AUTHOR), Velasquez, Brett2 (AUTHOR), Koong, Albert C.5 (AUTHOR), Lin, Steven H.5 (AUTHOR), Balter, Peter2 (AUTHOR), Tailor, Ramesh2 (AUTHOR), Robert, Charlotte4 (AUTHOR), Germond, Jean‐François6 (AUTHOR), Gonçalves Jorge, Patrik6 (AUTHOR), Geyer, Reiner6 (AUTHOR), Beddar, Sam2,3 (AUTHOR) abeddar@mdanderson.org, Moeckli, Raphael6 (AUTHOR) raphael.moeckli@chuv.ch, Schüler, Emil2,3 (AUTHOR) eschueler@mdanderson.org
Source: Medical Physics. Feb2025, Vol. 52 Issue 2, p1207-1223. 17p.
Subjects: Electron beams, Quality assurance, Radiotherapy, Linear accelerators, Medical practice
Abstract: Background and purpose: FLASH or ultra‐high dose rate (UHDR) radiation therapy (RT) has gained attention in recent years for its ability to spare normal tissues relative to conventional dose rate (CDR) RT in various preclinical trials. However, clinical implementation of this promising treatment option has been limited because of the lack of availability of accelerators capable of delivering UHDR RT. Commercial options are finally reaching the market that produce electron beams with average dose rates of up to 1000 Gy/s. We established a framework for the acceptance, commissioning, and periodic quality assurance (QA) of electron FLASH units and present an example of commissioning. Methods: A protocol for acceptance, commissioning, and QA of UHDR linear accelerators was established by combining and adapting standards and professional recommendations for standard linear accelerators based on the experience with UHDR at four clinical centers that use different UHDR devices. Non‐standard dosimetric beam parameters considered included pulse width, pulse repetition frequency, dose per pulse, and instantaneous dose rate, together with recommendations on how to acquire these measurements. Results: The 6‐ and 9‐MeV beams of an UHDR electron device were commissioned by using this developed protocol. Measurements were acquired with a combination of ion chambers, beam current transformers (BCTs), and dose‐rate–independent passive dosimeters. The unit was calibrated according to the concept of redundant dosimetry using a reference setup. Conclusion: This study provides detailed recommendations for the acceptance testing, commissioning, and routine QA of low‐energy electron UHDR linear accelerators. The proposed framework is not limited to any specific unit, making it applicable to all existing eFLASH units in the market. Through practical insights and theoretical discourse, this document establishes a benchmark for the commissioning of UHDR devices for clinical use. [ABSTRACT FROM AUTHOR]
Copyright of Medical Physics is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. 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.)
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  Data: On the acceptance, commissioning, and quality assurance of electron FLASH units.
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  Data: <searchLink fieldCode="JN" term="%22Medical+Physics%22">Medical Physics</searchLink>. Feb2025, Vol. 52 Issue 2, p1207-1223. 17p.
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  Data: <searchLink fieldCode="DE" term="%22Electron+beams%22">Electron beams</searchLink><br /><searchLink fieldCode="DE" term="%22Quality+assurance%22">Quality assurance</searchLink><br /><searchLink fieldCode="DE" term="%22Radiotherapy%22">Radiotherapy</searchLink><br /><searchLink fieldCode="DE" term="%22Linear+accelerators%22">Linear accelerators</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+practice%22">Medical practice</searchLink>
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  Data: Background and purpose: FLASH or ultra‐high dose rate (UHDR) radiation therapy (RT) has gained attention in recent years for its ability to spare normal tissues relative to conventional dose rate (CDR) RT in various preclinical trials. However, clinical implementation of this promising treatment option has been limited because of the lack of availability of accelerators capable of delivering UHDR RT. Commercial options are finally reaching the market that produce electron beams with average dose rates of up to 1000 Gy/s. We established a framework for the acceptance, commissioning, and periodic quality assurance (QA) of electron FLASH units and present an example of commissioning. Methods: A protocol for acceptance, commissioning, and QA of UHDR linear accelerators was established by combining and adapting standards and professional recommendations for standard linear accelerators based on the experience with UHDR at four clinical centers that use different UHDR devices. Non‐standard dosimetric beam parameters considered included pulse width, pulse repetition frequency, dose per pulse, and instantaneous dose rate, together with recommendations on how to acquire these measurements. Results: The 6‐ and 9‐MeV beams of an UHDR electron device were commissioned by using this developed protocol. Measurements were acquired with a combination of ion chambers, beam current transformers (BCTs), and dose‐rate–independent passive dosimeters. The unit was calibrated according to the concept of redundant dosimetry using a reference setup. Conclusion: This study provides detailed recommendations for the acceptance testing, commissioning, and routine QA of low‐energy electron UHDR linear accelerators. The proposed framework is not limited to any specific unit, making it applicable to all existing eFLASH units in the market. Through practical insights and theoretical discourse, this document establishes a benchmark for the commissioning of UHDR devices for clinical use. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Medical Physics is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. 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.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1002/mp.17483
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        Text: English
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