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Joint range-modulator and spot optimization for Bragg-peak proton FLASH radiotherapy.

Jiayue Han1, Aoxiang Wang2, Ya-Nan Zhu3

  • 1Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, Kansas, USA.

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|November 29, 2025
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Summary

A new Joint Range-Modulator and Spot Optimization (JRSO) method improves proton FLASH (pFLASH) radiotherapy planning by simultaneously optimizing beam parameters. This novel approach enhances plan quality and expands the clinical applicability of pFLASH therapy.

Keywords:
FLASHFLASH proton therapyrange modulator

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Area of Science:

  • Medical Physics
  • Radiation Oncology
  • Computational Biology

Background:

  • Ultra-high-dose-rate (UHDR) radiation therapy, particularly proton FLASH (pFLASH), shows potential for reduced organ-at-risk (OAR) toxicity.
  • Current pFLASH treatment planning involves a two-step process: intensity-modulated proton therapy (IMPT) plan generation followed by patient-specific range modulator (PSRM) optimization.
  • The interplay between spot weights and PSRM design in pFLASH therapy is not fully understood, potentially limiting dosimetric and radiobiological benefits.

Purpose of the Study:

  • To introduce a novel alternating optimization framework, Joint Range-Modulator and Spot Optimization (JRSO), for simultaneous optimization of PSRM and spot weights.
  • To enhance the plan quality of conformal pFLASH radiotherapy through integrated optimization.

Main Methods:

  • JRSO framework developed for simultaneous optimization, removing the need for a one-to-one correspondence between beam spots and PSRM pins.
  • Proton beam diffusion modeled using a Gaussian function.
  • Iterative alternating updates of PSRM design and spot weights, starting from an IMPT-derived solution, while adhering to constraints like minimum monitor units (MMU).

Main Results:

  • JRSO demonstrated superior plan quality compared to conventional methods.
  • In a head-and-neck (HN) case, JRSO reduced the objective function value (0.46 to 0.26), lowered maximum target dose (117.6% to 107.1%), improved conformity index (0.74 to 0.87), and decreased ROI effective dose (6.50 Gy to 6.10 Gy).

Conclusions:

  • The proposed JRSO method offers an advancement for conformal pFLASH radiotherapy planning.
  • JRSO outperforms the conventional approach and may broaden PSRM applicability in complex clinical scenarios, including spot-pin misalignments.
  • Numerical results confirm the robustness and efficiency of the JRSO method.