Treatment Planning System for Electron FLASH Radiotherapy: Open-source for Clinical Implementation

TL;DR

This paper presents the development and validation of an open-source Monte Carlo beam model integrated into a clinical treatment planning system for ultra-high dose-rate electron FLASH radiotherapy, demonstrating its potential for clinical use.

Contribution

The first functional beam model for eFLASH-RT integrated into a clinical TPS, enabling accurate planning and evaluation with minimal workflow changes.

Findings

Beam model matches measurements within 3% accuracy.

Dose delivery to mouse brain was successfully simulated.

Human treatment plan achieved acceptable tumor coverage.

Abstract

Purpose: A Monte Carlo (MC) beam model and its implementation in a clinical treatment planning system (TPS, Varian Eclipse) are presented for a modified ultra-high dose-rate electron FLASH radiotherapy (eFLASH-RT) LINAC. Methods: The gantry head without scattering foils or targets, representative of the LINAC modifications, was modelled in Geant4. The energy spectrum ({\sigma}E) and beam source emittance cone angle ({\theta}cone) were varied to match the calculated and Gafchromic film measured central-axis percent depth dose (PDD) and lateral profiles. Its Eclipse configuration was validated with measured profiles of the open field and nominal fields for clinical applicators. eFLASH-RT plans were MC forward calculated in Geant4 for a mouse brain treatment and compared to a conventional (Conv-RT) plan in Eclipse for a human patient with metastatic renal cell carcinoma. Results: The beam model and its Eclipse configuration agreed best with measurements at {\sigma}E=0.5 MeV and {\theta}cone=3.9+/-0.2 degrees to clinically acceptable accuracy (the absolute average error was within 1.5% for in-water lateral, 3% for in-air lateral, and 2% for PDD). The forward dose calculation showed dose was delivered to the entire mouse brain with adequate conformality. The human patient case demonstrated the planning capability with routine accessories in relatively complex geometry to achieve an acceptable plan (90% of the tumor volume receiving 95% and 90% of the prescribed dose for eFLASH and Conv-RT, respectively). Conclusion: To the best of our knowledge, this is the first functional beam model commissioned in a clinical TPS for eFLASH-RT, enabling planning and evaluation with minimal deviation from Conv-RT workflow. It facilitates the clinical translation as eFLASH-RT and Conv-RT plan quality were comparable for a human patient. The methods can be expanded to model other eFLASH irradiators.