Validation of a Novel Cone-Less Set-up for Electron FLASH Radiation Delivery on a Clinical-Use Linear Accelerator.

PURPOSE/OBJECTIVE(S) Ultra-high dose rate (FLASH) radiotherapy (RT) at ≥40 Gray per second has been shown preclinically to achieve improved normal tissue sparing while maintaining tumor control similar to that of conventional dose-rate RT. Many published FLASH-RT delivery models are inaccessible for widespread use and/or not applicable for clinical translation. We previously described a model for reversible configuration of a clinical linear accelerator (LINAC) that can deliver ∼16-18 MeV electron FLASH-RT at source-to-surface distances (SSDs) 80% of the central axis was 10.6 cm and 9.6 cm, and symmetry (defined as the maximum dose difference between any two symmetric points about the central axis in the flat portion of the beam, as a percentage of central dose) was 2.24% and 2.20%. PDD values for the cone-less set-up at Dmax, R95, R85, and R50 were, respectively, 3.1, 4.1, 5.3, and 6.8 cm. CONCLUSION We have developed a novel cone-less set-up that allows for the delivery of electron FLASH-RT utilizing a clinical LINAC at practical SSDs and verified that its beam profiles are clinically feasible. Further work will be done to characterize additional SSDs and field sizes, along with the addition of a custom skin collimator to further shape the beam. This will pave the way for practical treatment using electron FLASH-RT to a host of oncologic indications, including cutaneous malignancies and partial breast irradiation in the future.