Ridge-filter crosstalk in conformal proton FLASH planning: dependence on beamlet pitch and iterative mitigation

Patient-specific ridge filters (PSRFs) can enable conformal single-energy proton FLASH delivery without energy switching. However, converting optimized spot-based dose distributions into physically adjacent ridge-filter structures may introduce inter-beamlet modulation errors not captured by conventional isolated-spot optimization. This study characterized ridge-filter (RF) crosstalk, evaluated its dependence on the beam-width-to-pitch relationship, and developed an iterative mitigation strategy.

A Monte Carlo dose influence matrix was generated for monoenergetic proton beamlets passing through RFs of varying thickness. A baseline spot-weighted IMPT plan was optimized to meet dose constraints and converted into PSRF geometries. PSRF dose distributions were calculated by explicitly modeling the PSRF in the scanned beam path. RF crosstalk was quantified by comparing PSRF and baseline IMPT plans. Lateral beamlet spacings of 8, 10, 12, and 15 mm were evaluated using gamma analysis, DVH metrics, and mean relative dose difference. An iterative re-optimization method was tested in water-phantom and patient CT geometries.

RF crosstalk produced hot and cold spots, reducing agreement between PSRF and baseline IMPT plans. For the same spot size and target geometry, crosstalk increased as beamlet spacing decreased. Iterative re-optimization substantially reduced dose discrepancies, lowering the mean relative dose difference in the target from 8.9% to 3.4% in water and from 3.7% to 1.8% in CT.

RF crosstalk is an important source of dose inconsistency in ridge-filter-based conformal proton FLASH planning. Its dependence on the beam-width-to-pitch relationship and mitigation through iterative re-optimization provide a practical framework for improving the accuracy and robustness of patient-specific single-energy proton FLASH delivery.