Recent developments in absolute dosimetry for FLASH radiotherapy

Ultra-high dose-rate (UHDR) irradiations, known as FLASH radiotherapy (RT), rely on delivery of therapeutic doses at instantaneous dose-rates several orders of magnitude higher than those currently used in conventional radiotherapy. It has been shown that such an extremely short delivery of radiation leads to remarkable reduction of normal tissue toxicity with respect to conventional dose-rate RT. However, dosimetry at UHDRs is complicated and it is essential to understand the effects that will influence detector response. To date, FLASH RT research has been focused on finding pragmatic solutions that allow the use of UHDR beams in the research setting, but there has been limited focus on absolute dosimetry utilizing primary and secondary standard devices. However, very recently, the data on existing standard dosimeters and novel solutions which could serve as secondary standard devices in UHDR dosimetry started emerging. This review provides an overview of the studies that have been conducted employing calorimeters and innovative solutions utilizing ionization chambers.