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Updated: Jul 16, 2025

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Initial experience with an electron FLASH research extension (FLEX) for the Clinac system.

Kyuhak Oh1, Kyle J Gallagher1, Megan Hyun1

  • 1University of Nebraska Medical Center, Omaha, Nebraska, USA.

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|September 22, 2023
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Summary

Researchers commissioned a new electron FLASH radiotherapy system for preclinical studies. This system enables ultra-high-dose-rate research, showing reduced impact on normal cells compared to conventional rates.

Keywords:
FLASH Research Extension (FLEX)cell viabilityconventional dose rate (CONV)dosimetryelectron Ultra-high dose rate (eFLASH)linear acceleratorstress-activated senescence

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Area of Science:

  • Medical Physics
  • Radiation Oncology
  • Preclinical Research

Background:

  • Ultra-high-dose-rate radiotherapy, known as FLASH, offers potential to improve cancer treatment by widening the therapeutic window.
  • The mechanisms of the FLASH effect are not fully understood, and access to specialized equipment is limited.

Purpose of the Study:

  • To conduct acceptance and commissioning tests for a novel electron FLASH research system designed for preclinical applications.
  • To characterize the dosimetric properties and performance of the new system.

Main Methods:

  • A modified linear accelerator (Clinac 23EX) with a FLASH extension (Clinac-FLEX) was used to deliver a 16 MeV electron beam.
  • Radiochromic film, optically stimulated luminescent dosimeters, and ionization chambers were employed for characterization.
  • Radiation shielding of the existing vault was assessed.

Main Results:

  • The Clinac-FLEX system achieved FLASH dose rates exceeding 3.8 Gy/pulse.
  • Depth dose curves and beam profiles were analyzed, showing good agreement with conventional modes for smaller field sizes.
  • Preliminary studies indicated significantly less impact on normal cell morphology at FLASH dose rates (180 Gy/s) versus conventional rates (18 Gy/s).

Conclusions:

  • The Clinac-FLEX system is a viable platform for preclinical FLASH radiotherapy research.
  • This system can increase accessibility to ultra-high-dose-rate research capabilities for the scientific community.