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We present MONAS (MicrOdosimetry-based modelliNg for relative biologicaleffectiveness (RBE) ASsessment) toolkit. MONAS is a TOPAS Monte Carloextension, that combines simulations of microdosimetric distributions withradiobiological microdosimetry-based models for predicting cell survival curvesand dose-dependent RBE. MONAS expands TOPAS microdosimetric extension, byincluding novel specific energy scorers. These spectra are used as physicalinput to three different formulations of the Microdosimetric Kinetic Model(MKM), and to the Generalized Stochastic Microdosimetric Model (GSM2), topredict dose-dependent cell survival fraction and RBE. MONAS predictions arethen validated against experimental microdosimetric spectra and in vitrosurvival fraction data. We present two different applications of the code: i)the depth-RBE curve calculation from a passively scattered proton SOBP, and ii)the calculation of the 3D RBE distribution on a real head and neck patientgeometry treated with protons. MONAS can estimate dose dependent RBE and cellsurvival curves from experimentally validated microdosimetric spectra with fourclinically relevant radiobiological models. From the radiobiologicalcharacterization of a proton SOBP field, we observe the well-known trend ofincreasing RBE values at the distal edge of the radiation field. The 3D RBE mapcalculated confirmed the trend observed in the analysis of the SOBP, with thehighest RBE values found in the distal edge of the target. MONAS extensionoffers a comprehensive microdosimetry-based framework for assessing thebiological effects of particle radiation in both research and clinicalenvironments, contributing to bridging the gap between a microdosimetricdescription of the radiation field and its application in proton therapytreatment with variable RBE.

Integrating microdosimetric in vitro RBE models for particle therapy  into TOPAS MC using the MicrOdosimetry-based modeling for RBE Assessment  (MONAS) tool