Treatment Planning System for Electron FLASH Radiotherapy: Open-source for Clinical Implementation.

Abstract Purpose: A Monte Carlo (MC) beam model and its implementation in a clinical treatment planning system (TPS, Varian Eclipse) are presented for a modified ultra-high dose-rate electron FLASH radiotherapy LINAC (eFLASH-RT) utilizing clinical accessories and geometry. Methods: The gantry head without scattering foils or targets, representative of the LINAC modifications, was modelled in Geant4-based GAMOS MC toolkit. The energy spectrum (σE) and beam source emittance cone angle (θcone) were varied to match the calculated open field central-axis percent depth dose (PDD) and lateral profiles with Gafchromic film measurements. The beam model and its Eclipse configuration were validated with measured profiles of the open field and nominal fields for clinical applicators. A MC forward dose calculation was conducted for a mouse whole brain treatment and an eFLASH-RT plan was compared to a conventional (Conv-RT) electron plan in Eclipse for a human patient with metastatic renal cell carcinoma. Results: The eFLASH beam model agreed best with measurements at σE=0.5 MeV and θcone=3.9±0.2 degrees. The model and its Eclipse configuration were validated to clinically acceptable accuracy (the absolute average error was within 1.5% for in-water lateral, 3% for in-air lateral, and 2% for PDD's). The forward calculation showed adequate dose delivery to the entire mouse brain, while sparing the organ-at-risk (lung). The human patient case demonstrated the planning capability with routine accessories to achieve an acceptable plan (90% of the tumor volume receiving 95% and 90% of the prescribed dose for eFLASH and conventional, respectively). Conclusion: To the best of our knowledge, this is the first functional beam model commissioned in a clinical TPS for eFLASH-RT, enabling planning and evaluation with minimal deviation from Conv-RT workflow. It facilitates the clinical translation as eFLASH-RT and Conv-RT plan quality were comparable for a human patient involving complex geometries and tissue heterogeneity. The methods can be expanded to model other eFLASH irradiators with different beam characteristics.