Iort aqure in flash mode: dosimetric control in breast cancer cell in vitro experiments

Authors

  • Aleksandra Lenartowicz-Gasik National Centre for Nuclear Research, ul. Andrzeja Sołtana 7, 05-400 Otwock, Poland
  • Paulina Osuchowska Biomedical Engineering Centre, Institute of Optoelectronics, Military University of Technology, ul. gen. Sylwestra Kaliskiego 2, 00-908 Warsaw, Poland
  • Agnieszka Misiarz National Centre for Nuclear Research, ul. Andrzeja Sołtana 7, 05-400 Otwock, Poland
  • Wojciech Soroka National Centre for Nuclear Research, ul. Andrzeja Sołtana 7, 05-400 Otwock, Poland
  • Elżbieta Anna Trafny Biomedical Engineering Centre, Institute of Optoelectronics, Military University of Technology, ul. gen. Sylwestra Kaliskiego 2, 00-908 Warsaw, Poland
  • Zygmunt Mierczyk Biomedical Engineering Centre, Institute of Optoelectronics, Military University of Technology, ul. gen. Sylwestra Kaliskiego 2, 00-908 Warsaw, Poland https://orcid.org/0000-0002-8453-6894
  • Jacek Rzadkiewicz National Centre for Nuclear Research, ul. Andrzeja Sołtana 7, 05-400 Otwock, Poland

DOI:

https://doi.org/10.24425/mms.2025.155811

Abstract

Ultra-high-dose rate (FLASH) radiotherapy is a promising cancer treatment method in which high doses of radiation are delivered in a very short time, minimising damage to healthy tissue while effectively targeting tumour cells. In this study, the IORT AQURE accelerator was used in FLASH mode to irradiate breast cancer cells. Dosimetric verification was carried out to confirm the quality of the beam used in the study and to control the doses (5, 10, and 15 Gy) administered to the cells. Gamma index analysis confirmed the accuracy of dose distribution, with results exceeding 96% for all cell samples. Radiobiological testing demonstrated a 90% reduction in the viability of HCC38 breast cancer cells at a dose of 15 Gy. These results validate the film dosimetry for controlling the beam and doses and the use of the AQURE accelerator in the FLASH mode for preclinical research and confirm its potential for future preclinical studies and clinical applications.

References

[1] Borghini, A., Labate, L., Piccinini, S., Panaino, C. M. V., Andreassi, M. G., & Gizzi, L. A. (2024). FLASH Radiotherapy: Expectations, challenges, and current knowledge. International Journal of Molecular Sciences, 25(5), 2546. https://doi.org/10.3390/ijms25052546

[2] Wilson, J. D., Hammond, E. M., Higgins, G. S., & Petersson, K. (2020). Ultra-high dose rate (FLASH) radiotherapy: silver bullet or fool’s gold? Frontiers in Oncology, 9. https://doi.org/10.3389/fonc.2019.01563

[3] Berry, R. J., Hall, E. J., Forster, D. W., Storr, T. H., & Goodman, M. J. (1969). Survival of mammalian cells exposed to X rays at ultra-high dose-rates. British Journal of Radiology, 42(494), 102-107. https://doi.org/10.1259/0007-1285-42-494-102

[4] Venkatesulu, B. P., Sharma, A., Pollard-Larkin, J. M., Sadagopan, R., Symons, J., Neri, S., Singh, P. K., Tailor, R., Lin, S. H., & Krishnan, S. (2019). Ultra high dose rate (35 Gy/sec) radiation does not spare the normal tissue in cardiac and splenic models of lymphopenia and gastrointestinal syndrome. Scientific Reports, 9(1). https://doi.org/10.1038/s41598-019-53562-y

[5] Buonanno, M., Grilj, V., & Brenner, D. J. (2019). Biological effects in normal cells exposed to FLASH dose rate protons. Radiotherapy and Oncology, 139, 51-55. https://doi.org/10.1016/j.radonc.2019.02.009

[6] Adrian, G., Konradsson, E., Beyer, S., Wittrup, A., Butterworth, K. T., McMahon, S. J., Ghita, M., Petersson, K., & Ceberg, C. (2021). Cancer cells can exhibit a sparing FLASH effect at low doses under normoxic in vitro-conditions. Frontiers in Oncology, 11. https://doi.org/10.3389/fonc.2021.686142

[7] Field, S., & Bewley, D. (1974). Effects of dose-rate on the radiation response of rat skin. International Journal of Radiation Biology and Related Studies in Physics, Chemistry and Medicine, 26(3), 259-267. https://doi.org/10.1080/09553007414551221

[8] Bourhis, J., Sozzi, W. J., Jorge, P. G., Gaide, O., Bailat, C., Duclos, F., Patin, D., Ozsahin, M., Bochud, F., Germond, J., Moeckli, R., & Vozenin, M. (2019). Treatment of a first patient with FLASH-radiotherapy. Radiotherapy and Oncology, 139, 18-22. https://doi.org/10.1016/j.radonc.2019.06.019

[9] Bley, C. R., Wolf, F., Jorge, P. G., Grilj, V., Petridis, I., Petit, B., Böhlen, T. T., Moeckli, R., Limoli, C., Bourhis, J., Meier, V., & Vozenin, M. (2022). Dose- and Volume-Limiting Late Toxicity of FLASH Radiotherapy in Cats with Squamous Cell Carcinoma of the Nasal Planum and in Mini Pigs. Clinical Cancer Research, 28(17), 3814-3823. https://doi.org/10.1158/1078-0432.ccr-22-0262

[10] Montay-Gruel, P., Bouchet, A., Jaccard, M., Patin, D., Serduc, R., Aim, W., Petersson, K., Petit, B., Bailat, C., Bourhis, J., Bräuer-Krisch, E., & Vozenin, M. (2018). X-rays can trigger the FLASH effect: Ultra-high dose-rate synchrotron light source prevents normal brain injury after whole brain irradiation in mice. Radiotherapy and Oncology, 129(3), 582-588. https://doi.org/10.1016/j.radonc.2018.08.016

[11] Simmons, D. A., Lartey, F. M., Schüler, E., Rafat, M., King, G., Kim, A., Ko, R., Semaan, S., Gonzalez, S., Jenkins, M., Pradhan, P., Shih, Z., Wang, J., Von Eyben, R., Graves, E. E., Maxim, P. G., Longo, F. M., & Loo, B. W. (2019). Reduced cognitive deficits after FLASH irradiation of whole mouse brain are associated with less hippocampal dendritic spine loss and neuroinflammation. Radiotherapy and Oncology, 139, 4-10. https://doi.org/10.1016/j.radonc.2019.06.006

[12] Limoli, C. L., Kramár, E. A., Almeida, A., Petit, B., Grilj, V., Baulch, J. E., Ballesteros-Zebadua, P., Loo, B. W., Wood, M. A., & Vozenin, M. (2023). The sparing effect of FLASH-RT on synaptic plasticity is maintained in mice with standard fractionation. Radiotherapy and Oncology, 186, 109767. https://doi.org/10.1016/j.radonc.2023.109767

[13] Favaudon, V., Caplier, L., Monceau, V., Pouzoulet, F., Sayarath, M., Fouillade, C., Poupon, M., Brito, I., Hupé, P., Bourhis, J., Hall, J., Fontaine, J., & Vozenin, M. (2014). Ultrahigh dose-rate FLASH irradiation increases the differential response between normal and tumor tissue in mice. Science Translational Medicine, 6(245). https://doi.org/10.1126/scitranslmed.3008973

[14] Kinj, R., Gaide, O., Jeanneret-Sozzi, W., Dafni, U., Viguet-Carrin, S., Sagittario, E., Kypriotou, M., Chenal, J., Duclos, F., Hebeisen, M., Falco, T., Geyer, R., Jorge, P. G., Moeckli, R., & Bourhis, J. (2024). Randomized phase II selection trial of FLASH and conventional radiotherapy for patients with localized cutaneous squamous cell carcinoma or basal cell carcinoma: A study protocol. Clinical and Translational Radiation Oncology, 45, 100743. https://doi.org/10.1016/j.ctro.2024.100743

[15] McEwen, M. R., & DuSautoy, A. R. (2009). Primary standards of absorbed dose for electron beams. Metrologia, 46(2), S59-S79. https://doi.org/10.1088/0026-1394/46/2/s05

[16] Ashraf, M. R., Rahman, M., Zhang, R., Williams, B. B., Gladstone, D. J., Pogue, B. W., & Bruza, P. (2020). Dosimetry for FLASH Radiotherapy: A review of tools and the role of radioluminescence and Cherenkov emission. Frontiers in Physics, 8. https://doi.org/10.3389/fphy.2020.00328

[17] Romano, F., Bailat, C., Jorge, P. G., Lerch, M. L. F., & Darafsheh, A. (2022). Ultra-high dose rate dosimetry: Challenges and opportunities for FLASH radiation therapy. Medical Physics, 49(7), 4912-4932. https://doi.org/10.1002/mp.15649

[18] Levy, K., Natarajan, S., Wang, J., Chow, S., Eggold, J. T., Loo, P. E., Manjappa, R., Melemenidis, S., Lartey, F. M., Schüler, E., Skinner, L., Rafat, M., Ko, R., Kim, A., Al-Rawi, D. H., Von Eyben, R., Dorigo, O., Casey, K. M., Graves, E. E., Bush, K., Yu, A. S., Koong, A. C., Maxim, P., Loo, B. W., Rankin, E. B. (2020). Abdominal FLASH irradiation reduces radiation-induced gastrointestinal toxicity for the treatment of ovarian cancer in mice. Scientific Reports, 10(1). https://doi.org/10.1038/s41598-020-78017-7

[19] Karsch, L., Beyreuther, E., Burris-Mog, T., Kraft, S., Richter, C., Zeil, K., & Pawelke, J. (2012). Dose rate dependence for different dosimeters and detectors: TLD, OSL, EBT films, and diamond detectors. Medical Physics, 39(5), 2447-2455. https://doi.org/10.1118/1.3700400

[20] Niroomand-Rad, A., Blackwell, C. R., Coursey, B. M., Gall, K. P., Galvin, J. M., McLaughlin, W. L., Meigooni, A. S., Nath, R., Rodgers, J. E., & Soares, C. G. (1998). Radiochromic film dosimetry: Recommendations of AAPM Radiation Therapy Committee Task Group 55. Medical Physics, 25(11), 2093-2115. https://doi.org/10.1118/1.598407

[21] Levin, D. S., Friedman, P. S., Ferretti, C., Ristow, N., Tecchio, M., Litzenberg, D. W., Bashkirov, V., & Schulte, R. (2024). A prototype scintillator real-time beam monitor for ultra-high dose rate radiotherapy. Medical Physics, 51(4), 2905-2923. https://doi.org/10.1002/mp.17018

[22] Lang, X., Luo, F., Li, M., Zhou, K., Li, J., Hu, Z., Mao, R., Xu, Z., & Xiao, G. (2025). Characterization of real-time dose measurement using monitor ionization chamber in electron beam FLASH radiotherapy. Nuclear Engineering and Technology, 103551. https://doi.org/10.1016/j.net.2025.103551

[23] Liu, K., Palmiero, A., Chopra, N., Velasquez, B., Li, Z., Beddar, S., & Schüler, E. (2023). Dual beam-current transformer design for monitoring and reporting of electron ultra-high dose rate (FLASH) beam parameters. Journal of Applied Clinical Medical Physics, 24(2). https://doi.org/10.1002/acm2.13891

[24] Lenartowicz-Gasik, A., Misiarz, A., Markopolski, V., Walo, M., Gryczka, U., Bułka, S., Pawałowski, B., Kruszyna-Mochalska, M., & Rzadkiewicz, J. (2024). Verification of real-time dosimetry of ultra-high dose rate beams at AQURE FLASH RT on the sample surface. Polish Journal of Medical Physics and Engineering, 30(4). https://doi.org/10.2478/pjmpe-2024-0038

[25] Calvo, F. A., Serrano, J., Cambeiro, M., Aristu, J., Asencio, J. M., Rubio, I., Delgado, J. M., Ferrer, C., Desco, M., & Pascau, J. (2022). Intra-Operative Electron Radiation therapy: An update of the evidence collected in 40 years to search for models for Electron-FLASH studies. Cancers, 14(15), 3693. https://doi.org/10.3390/cancers14153693

[26] Ryczkowski, A., Pawałowski, B., Kruszyna-Mochalska, M., Misiarz, A., Lenartowicz-Gasik, A., Wosicki, M., Jodda, A., Adrich, P., & Piotrowski, T. (2024). Commissioning, dosimetric characterisation and machine performance assessment of the AQURE mobile accelerator for intraoperative radiotherapy. Polish Journal of Medical Physics and Engineering, 30(3), 177-181. https://doi.org/10.2478/pjmpe-2024-0021

[27] Dróżdż, A., Waluś, M., Zieliński, M., Malesa, B., Kruszyna-Mochalska, M., Kulcenty, K., Adamczyk, B., Nowaczyk, P., Malicki, J., & Pracz, J. (2021). Verification of electron beam parameters in an intraoperative linear accelerator using dosimetric and radiobiological response methods. Reports of Practical Oncology & Radiotherapy, 26(6), 1029-1034. https://doi.org/10.5603/rpor.a2021.0128

[28] Lenartowicz-Gasik, A., Misiarz, A., Adrich, P., Wronka, S., Piotrowski, T., Pawałowski, B., Nowaczyk, P., Trzuskowski, J., & Rzadkiewicz, J. (2025). Experimental verification of the applicability of the AQURE IOERT accelerator for FLASH radiotherapy. Polish Journal of Medical Physics and Engineering, 31(1), 62-72. https://doi.org/10.2478/pjmpe-2025-0006

[29] Misiarz, A., Lenartowicz, A., Adrich, P., Rzadkiewicz, J., Wronka, S., Trzuskowski, J., Kruszyna-Mochalska, M., Urbański, B., Adamczyk, B., & Pracz, J. (2024). Design and performance validation ofa novel 3d printed thin-walled and transparent electron beam applicators for intraoperative radiation therapy with beam energy up to 12 MeV. Reports of Practical Oncology & Radiotherapy, 29(3), 329-339. https://doi.org/10.5603/rpor.101092

[30] Low, D. A., Harms, W. B., Mutic, S., & Purdy, J. A. (1998). A technique for the quantitative evaluation of dose distributions. Medical Physics, 25(5), 656-661. https://doi.org/10.1118/1.598248

[31] Das, S., Kharade, V., Pandey, V., Kv, A., Pasricha, R. K., & Gupta, M. (2022). Gamma Index Analysis as a Patient-Specific Quality Assurance Tool for High-Precision Radiotherapy: A Clinical Perspective of Single Institute Experience. Cureus. https://doi.org/10.7759/cureus.30885

[32] Low, D. A., & Dempsey, J. F. (2003). Evaluation of the gamma dose distribution comparison method. Medical Physics, 30(9), 2455-2464. https://doi.org/10.1118/1.1598711

[33] Depuydt, T., Van Esch, A., & Huyskens, D. P. (2002). A quantitative evaluation of IMRT dose distributions: refinement and clinical assessment of the gamma evaluation. Radiotherapy and Oncology, 62(3), 309-319. https://doi.org/10.1016/s0167-8140(01)00497-2

[34] Devic, S., Seuntjens, J., Sham, E., Podgorsak, E. B., Schmidtlein, C. R., Kirov, A. S., & Soares, C. G. (2005). Precise radiochromic film dosimetry using a flat-bed document scanner. Medical Physics, 32(7Part1), 2245-2253. https://doi.org/10.1118/1.1929253

[35] Henríquez, F. C., & Castrillón, S. V. (2011). A probability approach to the study on uncertainty effects on gamma index evaluations in radiation therapy. Computational and Mathematical Methods in Medicine, 2011(1). https://doi.org/10.1155/2011/861869

[36] Boucher, S., Esarey, E., Geddes, C., Johnstone, C., Kutsaev, S., W, L. J. B., Méot, F., Mustapha, B., Nakamura, K., Nanni, E., Obst-Huebl, L., Sampayan, S. E., Schroeder, C., Schulte, R., Sheng, K., Snijders, A., Snively, E., Tantawi, S. G., & Jeroen, V. T. (2022). Transformative Technology for FLASH Radiation Therapy: A Snowmass 2021 White Paper. arXiv (Cornell University). https://doi.org/10.48550/arxiv.2203.11047

[37] International Electrotechnical Commission (2007). IEC 60976: Medical electrical equipment - Medical electron accelerators - Functional performance characteristics (2nd ed.). IEC. https://webstore.iec.ch/en/publication/4088

[38] International Electrotechnical Commission (2008). IEC TR 60977: Medical electrical equipment - Medical electron accelerators - Guidelines for functional performance characteristics (2nd ed.). IEC. https://webstore.iec.ch/en/publication/4089

[39] Prasanna, P. G., Citrin, D. E., Hildesheim, J., Ahmed, M. M., Venkatachalam, S., Riscuta, G., Xi, D., Zheng, G., Van Deursen, J., Goronzy, J., Kron, S. J., Anscher, M. S., Sharpless, N. E., Campisi, J., Brown, S. L., Niedernhofer, L. J., O’Loghlen, A., Georgakilas, A. G., Paris, F., . . . Coleman, C. N. (2021). Therapy-Induced senescence: Opportunities to improve anticancer therapy. JNCI Journal of the National Cancer Institute, 113(10), 1285-1298. https://doi.org/10.1093/jnci/djab064

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Published

2025-12-30

How to Cite

Lenartowicz-Gasik, Aleksandra, et al. “Iort Aqure in Flash Mode: Dosimetric Control in Breast Cancer Cell in Vitro Experiments”. Metrology and Measurement Systems, vol. 32, no. 4, Dec. 2025, pp. art. no. 10, 1-15, doi:10.24425/mms.2025.155811.

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