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Purpose/Objective In a previous experiment at the HZDR research electron accelerator ELBE high mean dose rates of 105 Gy/s in combination with partial oxygen pressure below 5 mmHg protect zebrafish embryo from radiation damage compared to continuous reference irradiation (mean dose rate of 0.11 Gy/s) and higher oxygen pressure (Pawelke et al. Radiother Oncol 2021). However, the influence of beam pulse structure on the radiation response remains unanswered and should be resolved in an upcoming experiment. Material/Methods In addition to the Flash and the reference regime, the ELBE accelerator was used to mimic the pulse structure of a clinical electron linac delivering a dose of 28 Gy by 5 pulses at a frequency of 250 Hz. For comparison, a fourth regime of similar mean dose rate, but continuous beam (280 Gy/s) mimicking FLASH irradiation at a isochronous proton cyclotron (Beyreuther et al. Radiother Oncol 2019) was applied. Wild type zebrafish embryo (24 hpf) were irradiated and the radiation induced malformation were studied during the four day follow up for all four regimes. Zebrafish embryo irradiation was performed under low oxygen pressure and the depletion of depletion during irradiation was measured online. Results Compared to the reference regime a protecting Flash effect was found the three other pulse regimes for endpoints, except embryo survival. Analysing the radiation induced malformation more detailed significant correlations to mean and pulse dose rate are revealed. Surprisingly, the beam delivery in macro pulses (Linac regime) reduces the Flash effect relative to delivery at the same pulse dose rate but in a single pulse. Conclusion. The ELBE electron accelerator can be applied to study the influence of beam dose rate and pulse structure on the Flash effect by varying both parameters over several orders of magnitude. Hence, ELBE is an ideal tool for systematic studies on optimal electron beam parameters for Flash, including pulse structures that are r

Background and purpose Continuing recent experiments at the research electron accelerator ELBE at the Helmholtz-Zentrum Dresden-Rossendorf the influence of beam pulse time structure on the Flash effect should be investigated in a zebrafish embryo model. Materials and methods The pulse structures of an isochronous and a synchrocyclotron were mimicked at ELBE with mean dose rates of 287 Gy/s and 177 Gy/s and pulse dose rates of 106 Gy/s and 109 Gy/s, respectively; and a macro pulsing for the latter. For comparison, a maximum (mean dose rate 2.5 x 105 Gy/s, pulse dose rate ~109 Gy/s) and a reference (mean dose rate of ~8 Gy/min) regime were applied. Radiation induced changes were assessed in zebrafish embryos over four days post irradiation. Results A significant protecting Flash effect with a clear dependence on mean dose rate was revealed for almost all endpoints and all electron pulse regimes relative to the reference. The macro pulse dependent prolongation of treatment time of the synchrotron-like regime reduce the protecting effect compared to the maximum regime delivered at same pulse but higher mean dose rate. The protecting Flash effect of the cyclotron-like regime was confirmed at a clinical isochronous proton cyclotron comparing the effects induced by 300 Gy/s relative to conventional proton beam delivery. Conclusion The mean dose rate or treatment time are more important than pulse dose rate for the extent of the normal tissue protecting Flash effect.

Background and purpose In consequence of a previous study, where no protecting proton Flash effect was found for zebrafish embryos, potential reasons and requirements for inducing a Flash effect should be investigated with the beam pulse structure and the partial oxygen pressure (pO2) as relevant parameters. Materials and methods The experiments were performed at the research electron accelerator ELBE, whose variable pulse structure enables dose delivery as electron Flash and quasi-continuously (reference). Zebrafish embryos were irradiated with ~26 Gy either continuously with a dose rate of ~6.7 Gy/min or in one 111 µs long pulse with a pulse dose rate of 109 Gy/s and a mean dose rate of 105 Gy/s, respectively. Using the OxyLite system to measure the pO2 a low- (pO2 ≤ 5 mmHg) and a high-pO2 group were defined on basis of the oxygen depletion kinetics in sealed embryo samples. Results A protective Flash effect was seen for most endpoints ranging from 4 % less reduction in embryo length to about 20 – 25 % less embryos with spinal curvature and pericardial edema, relative to reference irradiation. The reduction of pO2 below atmospheric levels (148 mmHg) resulted in higher protection, which was however more pronounced in the low-pO2 group. Conclusion The Flash experiment at ELBE showed that the zebrafish embryo model is appropriate for studying the radiobiological response of high dose rate irradiation. Pulse dose and pulse dose rate as important beam parameters were confirmed as well as the pivotal role of pO2 during irradiation.

Primary data and data description to publication: Electron dose rate and oxygen depletion protect zebrafish embryos from radiation damage Abstract: Background and purpose In consequence of a previous study, where no protecting proton Flash effect was found for zebrafish embryos, potential reasons and requirements for inducing a Flash effect should be investigated with the beam pulse structure and the partial oxygen pressure (pO2) as relevant parameters. Materials and methods The experiments were performed at the research electron accelerator ELBE, whose variable pulse structure enables dose delivery as electron Flash and quasi-continuously (reference). Zebrafish embryos were irradiated with ~26 Gy either continuously with a dose rate of ~6.7 Gy/min or in one 111 µs long pulse with a pulse dose rate of 109 Gy/s and a mean dose rate of 105 Gy/s, respectively. Using the OxyLite system to measure the pO2 a low- (pO2 ≤ 5 mmHg) and a high-pO2 group were defined on basis of the oxygen depletion kinetics in sealed embryo samples. Results A protective Flash effect was seen for most endpoints ranging from 4 % less reduction in embryo length to about 20 – 25 % less embryos with spinal curvature and pericardial edema, relative to reference irradiation. The reduction of pO2 below atmospheric levels (148 mmHg) resulted in higher protection, which was however more pronounced in the low-pO2 group. Conclusion The Flash experiment at ELBE showed that the zebrafish embryo model is appropriate for studying the radiobiological response of high dose rate irradiation. Pulse dose and pulse dose rate as important beam parameters were confirmed as well as the pivotal role of pO2 during irradiation.

Background and purpose Motivated by first animal trials showing the normal tissue protecting effect of electron and photon Flash irradiation relative to conventional continuous beam delivery, the feasibility of proton Flash should be assessed. Materials and methods A setup and beam parameter settings for the treatment of zebrafish embryo with proton Flash and proton beam of conventional dose rate were established at the University Proton Therapy Dresden. Zebrafish embryos were treated with graded doses and the differential effect on embryonic survival and the induction of morphological malformations was followed for up to four days after irradiation. Results Beam parameters for the realization of proton Flash were set and tested with respect to controlled dose delivery to biological samples. The dose dependent embryonic survival data obtained for protons delivered as Flash and with a beam of conventional dose rate of 5 Gy/min show not significant influence of proton dose rate. Similarly, just a trend towards a protective effect of proton Flash was revealed for the induction of pericardial oedema as one type of acute radiation effect and spinal curvature as a developmental abnormality. Conclusion The feasibility of Flash proton irradiation was successfully shown, whereas more experiments are required to understand the absence of a clear protecting effect and therefore to figure out the limits and requirements for the Flash effect.

During the last decade, the increasing application of proton radiotherapy and the rising number of long-term survivors gave rise to a vital discussion on potential effects on normal tissue. So far, deviations from clinically applied generic RBE (relative biological effectiveness) of 1.1 were just obtained by in vitro studies, whereas indications from in vivo trials and clinical studies are rare. In the present work, wildtype zebrafish embryos (Danio rerio) were applied to characterize effects of plateau and mid-SOBP proton radiation relative to that induced by clinical MV photon beam reference. Based on embryonic survival data, RBE values of 1.13 ± 0.08 and of 1.20 ± 0.04 were determined four days after irradiations with 20 Gy plateau and SOBP protons relative to 6 MV photon beams. These RBE values were confirmed by relating the rates of embryos with morphological abnormalities for the respective radiation qualities and doses. Besides survival, the rate of spine bending, as one type of developmental abnormality, and of pericardial edema, as an example for acute radiation effects, were assessed. The results revealed that independent on radiation quality both rates increased with time approaching almost 100 % at the 4th day post irradiation with doses higher than 15 Gy. To sum up, the applicability of the zebrafish embryo as a robust and simple alternative model for in vivo characterization of radiobiological effects in normal tissue was validated and the obtained RBE values are comparable to previous finding in animal trials.