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Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies
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An adaptive proton FLASH therapy using modularized pin ridge filter.

Ahmal Jawad Zafar1, Xiaofeng Yang1, Zachary Diamond1

  • 1Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia, USA.

Medical Physics
|September 12, 2025
PubMed
Summary
This summary is machine-generated.

This study introduces adaptive proton FLASH therapy (ADP-FLASH) using modular pin ridge filters (pRFs) to optimize treatment plans. The method recycles components from initial plans, maintaining quality and clinical goals for adaptive proton therapy.

Keywords:
FLASH therapyadaptive proton therapyliver SBRTridge filters

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Area of Science:

  • Medical Physics
  • Radiation Oncology
  • Biomedical Engineering

Background:

  • Developed a modular pin ridge filter (pRF) design framework for rapid manufacturing of custom filters for single-energy proton FLASH (fast, low-dose-rate) planning.
  • Previous work focused on optimizing initial single-energy proton FLASH plans.

Purpose of the Study:

  • Propose and validate a method for optimizing adaptive proton FLASH therapy (ADP-FLASH) using modularized pRFs.
  • Recycle module pins from initial plans to reduce pRF adjustments in adaptive FLASH planning.

Main Methods:

  • Created initial single-energy (250 MeV) FLASH-pRF plans using pencil beam directions (PBDs) from intensity-modulated proton therapy (IMPT) plans.
  • Classified PBDs as new/changed or unchanged by comparing spot maps between planning CT (pCT) and re-imaging CT (re-CT).
  • Employed an iterative least-square regression model to identify recyclable PBDs with minimal spot monitor unit (MU) weighting changes, reoptimizing remaining PBDs for the adaptive plan.

Main Results:

  • Observed a decline in plan quality (V100) when applying initial pRF plans to re-CT scans (e.g., 93.5% to 60.2% in one case).
  • ADP-FLASH-pRF approach restored plan quality comparable to initial pCT plans (e.g., 91.7% on re-CT).
  • Recycled 64.7% to 91.2% of PBDs across three liver SBRT cases, maintaining clinical goals and FLASH effects.

Conclusions:

  • Validated a method for recycling pRFs in single-energy proton FLASH planning for SBRT.
  • The ADP-FLASH framework provides a scalable and practical solution for adaptive proton therapy, balancing effectiveness and efficiency.