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Related Experiment Video

Updated: May 6, 2026

Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies

Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies

Published on: February 6, 2019

Treatment parameters consideration for universal range shifter-based multi-energy proton FLASH-RT.

Yiling Zeng^1,2,3, Hong Quan², Qi Zhang^1,2

¹Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Medical Physics

|October 1, 2025

Summary

Ultra-high dose rate irradiation offers better normal tissue sparing. Optimizing planning parameters for multi-energy Bragg peak proton FLASH radiotherapy is crucial for balancing tumor control and normal tissue protection, especially when using a universal range shifter.

Keywords:

Bragg peak beam FLASH effect proton therapy universal range shifter

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Area of Science:

Medical Physics
Radiation Oncology
Radiotherapy Technology

Background:

Ultra-high dose rate (UHDR) irradiation, or FLASH radiotherapy (FLASH-RT), demonstrates superior normal tissue sparing compared to conventional dose rates.
Multi-energy proton beams (MEBP) combined with a universal range shifter (URS) and fast energy-switching gantry are key technologies for achieving UHDR delivery.

Purpose of the Study:

Investigate the impact of the URS on MEBP FLASH-RT plans.
Evaluate the influence of planning parameters (spot spacing, layer spacing, beam orientation) and patient selection factors (fractional dose, target size) on FLASH-RT plan quality.

Main Methods:

Generated single-field MEBP plans for water phantoms and a brain case, with and without the URS.
Systematically varied planning parameters including spot spacing, layer spacing, and beam orientation.
Assessed the effects of fractional dose and target size on dose and FLASH-related metrics (e.g., V40Gy/s).

Main Results:

The URS increased spot size, reducing required spots/energy layers but broadening the penumbra and distal falloff, increasing normal tissue Dmean.
Optimized spot spacing (1.5σ) and layer spacing (1.0 R80) improved V40Gy/s while maintaining plan quality.
Smaller field sizes, higher fractional doses (up to 25 GyRBE), and smaller target volumes enhanced V40Gy/s.

Conclusions:

The URS significantly affects MEBP plan quality, necessitating a balance between normal tissue sparing and the FLASH effect.
Careful selection of planning parameters is critical for effective FLASH-RT, particularly for treating complex-shaped tumors.