FLASH radiotherapy (RT) is attracting a significant interest since the first investigations carried out in 2014 [1]. Several preclinical studies worldwide have demonstrated that ultra-high dose rate (UHDR) beams produce an improvement of normal tissue sparing, compared to conventional dose-rate RT, while maintaining same tumor control probability (FLASH effect). However, to fully understand the mechanisms behind the effect and to support the future clinical translation of FLASH radiotherapy, novel beam monitoring and dosimetry technologies must be developed, and new approaches studied. Currently used detectors for conventional radiotherapy reference dosimetry, such as ionization chambers, are affected by large ion recombination effects at these extreme regimes [2]. Therefore, the optimization of already established technologies as well as the investigation of new instrumentation for dosimetry is required. Alternative approaches, such as calorimetry or the use of solid-state detectors are currently being investigated and their usage at UHDRs is under assessment [3]. The challenges characterizing dosimetry for FLASH radiotherapy vary considerably depending on the accelerator type and technique used to produce the relevant UHDR radiation environment. Different beam pulse structures can be used for the acceleration of the radiation beams, depending on the specific accelerator, and the related dose and dose-rate per pulse can affect the detector response. A reliable measurement also of the instantaneous dose rate, beyond an accurate measurement of the dose, is also relevant at these extreme regimes. The main challenges coming from the peculiar beam parameters characterizing UHDR beams for FLASH RT will be reported. A status of the current technologies will be provided, including recent developments for established detectors and novel approaches currently under investigation, such as calorimetry and Silicon Carbide detectors [4]. Future perspectives in terms of dosimetric approaches and on-going initiatives at the national and international level for the clinical translation of FLASH RT will be also discussed.
[1] V. Favaudon et al., Science Translational Medicine, 6(245), 245ra93 (2014).
[2] M. McManus M., SCIENTIFIC REPORTS, vol. 10, ISSN: 2045-2322 (2020).
[3] F. Romano et al., Medical Physics, 49:4912-4932. (2022), doi: https://doi.org/10.1002/mp.15649
[4] F. Romano et al., Appl. Sci. 2023, 13(5), 2986; https://doi.org/10.3390/app13052986