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Purpose: This study explored the feasibility of a streamlined pin-shapedridge filter (pin-RF) design for single-energy proton FLASH planning. Methods:An inverse planning framework integrated within a TPS was established for FLASHplanning. The framework involves generating a IMPT plan based on downstreamenergy modulation strategy (IMPT-DS), followed by a nested spot reductionprocess to iteratively reduce the total number of pencil beam directions (PBDs)and energy layers along each PBD for the IMPT-DS plan. The IMPT-DS plan is thentranslated into the pin-RFs for a single-energy IMPT plan (IMPT-RF). Theframework was validated on three lung cases, quantifying the FLASH dose of theIMPT-RF plan using the FLASH effectiveness model and comparing it with thereference dose of a conventional IMPT plan to assess the clinical benefit ofthe FLASH planning technique. Results: The IMPT-RF plans closely matched thecorresponding IMPT-DS plans in high dose conformity, with minimal changes inV7Gy and V7.4Gy for the lung (< 5%) and small increases in Dmax for other OARs(< 3.2 Gy). Comparing the FLASH doses to the doses of corresponding IMPT-RFplans, drastic reductions of up to ~33% were observed in Dmax for OARs in thehigh-to-moderate-dose regions with negligible changes in Dmax for OARs inlow-dose regions. Positive clinical benefits were observed with notablereductions of 18.4-33.0% in Dmax for OARs in the high-dose regions. However, inthe moderate-to-low-dose regions, only marginal positive or even negativeclinical benefit for OARs were observed, such as increased lung V7Gy and V7.4Gy(16.4-38.9%). Conclusions: A streamlined pin-RF design for single-energy protonFLASH planning was validated, revealing positive clinical benefits for OARs inthe high dose regions. The coarsened design of the pin-RF demonstratespotential cost efficiency and efficient production.

Streamlined Pin-Ridge-Filter Design for Single-energy Proton FLASH Planning