Optimizing Transmission FLASH Radiotherapy for Large-Field Post-Mastectomy Breast Treatment

Fuente: arXiv
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Autores principales: Zafar, Ahmal Jawad, Dutta, Sunil William, Case, Matthew Joseph, Diamond, Zachary, Bohannon, Duncan, Jagsi, Reshma, Yang, Xiaofeng, Zhou, Jun
Formato: Preprint
Publicado: 2025
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author Zafar, Ahmal Jawad
Dutta, Sunil William
Case, Matthew Joseph
Diamond, Zachary
Bohannon, Duncan
Jagsi, Reshma
Yang, Xiaofeng
Zhou, Jun
author_facet Zafar, Ahmal Jawad
Dutta, Sunil William
Case, Matthew Joseph
Diamond, Zachary
Bohannon, Duncan
Jagsi, Reshma
Yang, Xiaofeng
Zhou, Jun
contents We investigated the effects of scanning speed, beam configuration, and dose-rate modeling on the FLASH effect in post-mastectomy proton transmission-beam (TB) planning and evaluated whether optimizing the spot-scanning path can enhance FLASH. Five left-sided post-mastectomy patients (32 Gy in 5 fractions) were replanned with single-energy (249 MeV) tangential TBs plus a clinical en face background beam. FLASH was evaluated with two models: Krieger's FLASH effectiveness model (FEM) and Folkerts' average dose-rate (ADR) framework. Plans used conventional pencil-beam scanning, split-field delivery, and GA-optimized spot sequences, with vertical scan speeds varied from 10 to 20 mm/ms. FLASH in normal tissues was defined as the percentage of voxels meeting the threshold (>= 4 Gy at >= 40 Gy/s); once a voxel met the criterion, a dose-adjustment factor of 0.67 was applied. The FLASH effect was highly sensitive to scanning pattern and model choice. Increasing vertical scan speed from 10 to 20 mm/ms increased FLASH in the CTV by 22% (ADR) and 12% (FEM); in skin it rose from 41.4% to 58.8% (ADR) and from 8.4% to 13.1% (FEM). Split-field delivery increased the temporal separation between vertical spot columns and yielded superior FLASH, including up to a 9.2 Gy reduction in CTV Dmean with ADR. GA-based optimization shortened scan time and achieved FLASH comparable to split-field delivery, with a CTV Dmean reduction of 7.87 Gy (ADR-GA) and skin Dmean reductions of 2-3 Gy. These findings indicate that FLASH outcomes depend strongly on scanning trajectory, scan speed, and model selection. In addition, path-minimizing spot-delivery optimization (e.g., GA) can further improve dose-rate distributions in healthy voxels.
format Preprint
id arxiv_https___arxiv_org_abs_2510_17044
institution arXiv
publishDate 2025
record_format arxiv
spellingShingle Optimizing Transmission FLASH Radiotherapy for Large-Field Post-Mastectomy Breast Treatment
Zafar, Ahmal Jawad
Dutta, Sunil William
Case, Matthew Joseph
Diamond, Zachary
Bohannon, Duncan
Jagsi, Reshma
Yang, Xiaofeng
Zhou, Jun
Medical Physics
We investigated the effects of scanning speed, beam configuration, and dose-rate modeling on the FLASH effect in post-mastectomy proton transmission-beam (TB) planning and evaluated whether optimizing the spot-scanning path can enhance FLASH. Five left-sided post-mastectomy patients (32 Gy in 5 fractions) were replanned with single-energy (249 MeV) tangential TBs plus a clinical en face background beam. FLASH was evaluated with two models: Krieger's FLASH effectiveness model (FEM) and Folkerts' average dose-rate (ADR) framework. Plans used conventional pencil-beam scanning, split-field delivery, and GA-optimized spot sequences, with vertical scan speeds varied from 10 to 20 mm/ms. FLASH in normal tissues was defined as the percentage of voxels meeting the threshold (>= 4 Gy at >= 40 Gy/s); once a voxel met the criterion, a dose-adjustment factor of 0.67 was applied. The FLASH effect was highly sensitive to scanning pattern and model choice. Increasing vertical scan speed from 10 to 20 mm/ms increased FLASH in the CTV by 22% (ADR) and 12% (FEM); in skin it rose from 41.4% to 58.8% (ADR) and from 8.4% to 13.1% (FEM). Split-field delivery increased the temporal separation between vertical spot columns and yielded superior FLASH, including up to a 9.2 Gy reduction in CTV Dmean with ADR. GA-based optimization shortened scan time and achieved FLASH comparable to split-field delivery, with a CTV Dmean reduction of 7.87 Gy (ADR-GA) and skin Dmean reductions of 2-3 Gy. These findings indicate that FLASH outcomes depend strongly on scanning trajectory, scan speed, and model selection. In addition, path-minimizing spot-delivery optimization (e.g., GA) can further improve dose-rate distributions in healthy voxels.
title Optimizing Transmission FLASH Radiotherapy for Large-Field Post-Mastectomy Breast Treatment
topic Medical Physics
url https://arxiv.org/abs/2510.17044