Proton beams are widely used worldwide to treat localized tumours, the lower entrance dose and no exit dose, thus sparing surrounding normal tissues, being the main advantage of this treatment modality compared to conventional photon techniques. Clinical proton beam therapy treatment planning is based on the use of a general relative biological effectiveness (RBE) of 1.1 along the whole beam penetration depth, without taking into account the documented increase in RBE at the end of the depth dose profile, in the Bragg peak and beyond. However, an inaccurate estimation of the RBE can cause both underdose or overdose, in particular it can cause the unfavourable situation of underdosing the tumour and overdosing the normal tissue just beyond the tumour, which limits the treatment success and increases the risk of complications. In view of a more precise dose delivery that takes into account the variation of RBE, experimental microdosimetry offers valuable tools for the quality assurance of LET or RBE-based treatment planning systems. The purpose of this work is to compare the response of two different microdosimetry systems: the mini-TEPC and the MicroPlus-Bridge detector. Microdosimetric spectra were measured across the 62 MeV spread out Bragg peak of CATANA with the mini-TEPC and with the Bridge microdosimeter. The frequency and dose distributions of lineal energy were compared and the different contributions to the spectra were analysed, discussing the effects of different site sizes and chord length distributions. The shape of the lineal energy distributions measured with the two detectors are markedly different, due to the different water-equivalent sizes of the sensitive volumes: 0.85 μm for the TEPC and 17.3 μm for the silicon detector. When the Loncol’s biological weighting function is applied to calculate the microdosimetric assessment of the RBE, both detectors lead to results that are consistent with biological survival data for glioma U87 cells. Both the mini-TEPC and the MicroPlus-Bridge detector can be used to assess the RBE variation of a 62 MeV modulated proton beam along its penetration depth. The microdosimetric assessment of the RBE based on the Loncol’s weighting function is in good agreement with radiobiological results when the 10% biological uncertainty is taken into account.

An improved biological weighting function (IBWF) is proposed to phenomenologically relate microdosimetric lineal energy probability density distributions with the relative biological effectiveness (RBE) for the in vitro clonogenic cell survival (surviving fraction = 10%) of the most commonly used mammalian cell line, i.e. the Chinese hamster lung fibroblasts (V79). The IBWF, intended as a simple and robust tool for a fast RBE assessment to compare different exposure conditions in particle therapy beams, was determined through an iterative global-fitting process aimed to minimize the average relative deviation between RBE calculations and literature in vitro data in case of exposure to various types of ions from ¹ H to ²³⁸ U. By using a single particle- and energy- independent function, it was possible to establish an univocal correlation between lineal energy and clonogenic cell survival for particles spanning over an unrestricted linear energy transfer range of almost five orders of magnitude (0.2 keV µ m ⁻¹ to 15 000 keV µ m ⁻¹ in liquid water). The average deviation between IBWF-derived RBE values and the published in vitro data was ∼14%. The IBWF results were also compared with corresponding calculations ( in vitro RBE ₁₀ for the V79 cell line) performed using the modified microdosimetric kinetic model (modified MKM). Furthermore, RBE values computed with the reference biological weighting function (BWF) for the in vivo early intestine tolerance in mice were included for comparison and to further explore potential correlations between the BWF results and the in vitro RBE as reported in previous studies. The results suggest that the modified MKM possess limitations in reproducing the experimental in vitro RBE ₁₀ for the V79 cell line in case of ions heavier than ²⁰ Ne. Furthermore, due to the different modelled endpoint, marked deviations were found between the RBE values assessed using the reference BWF and the IBWF for ions heavier than ² H. Finally, the IBWF was unchangingly applied to calculate RBE values by processing lineal energy density distributions experimentally measured with eight different microdosimeters in 19 ¹ H and ¹² C beams at ten different facilities (eight clinical and two research ones). Despite the differences between the detectors, irradiation facilities, beam profiles (pristine or spread out Bragg peak), maximum beam energy, beam delivery (passive or active scanning), energy degradation system (water, PMMA, polyamide or low-density polyethylene), the obtained IBWF-based RBE trends were found to be in good agreement with the corresponding ones in case of computer-simulated microdosimetric spectra (average relative deviation equal to 0.8% and 5.7% for ¹ H and ¹² C ions respectively).

Experimental microdosimetry measures the energy deposited in a microscopic sensitive volume (SV) by single ionizing particles traversing the SV or passing by. The fundamental advantage of experimental microdosimetry over the computational approach is that the first allows to determine distributions of energy deposition when information on the energy and nature of the charged particles at the point of interest is incomplete or fragmentary. This is almost always the case in radiation protection applications, but discrepancies between the modelled and the actual scenarios should be considered also in radiation therapy. Models for physical reality are always imperfect and rely both on basic input data and on assumptions and simplifications that are necessarily implemented. Furthermore, unintended events due to human errors or machine/system failures can be minimized but cannot be completely avoided.Though in proton radiation therapy (PRT) a constant relative biological effectiveness (RBE) of 1.1 is assumed, there is evidence of an increasing RBE towards the end of the proton penetration depth. Treatment Planning Systems (TPS) that take into account a variable linear energy transfer (LET) or RBE are already available and could be implemented in PRT in the near future. However, while the calculated dose distributions produced by the TPS are routinely verified with ionization chambers as part of the quality assurance program of every radiotherapy center, there is no commercial detector currently available to perform routine verification of the radiation quality, calculated by the TPS through LET or RBE distributions. Verification of calculated LET is required to make sure that a complex robustly optimized plan will be delivered as planned. The scientific community is coming to conclusion that a new domain of Quality Assurance additionally to the physical dose verification is required, and microdosimetry can be the right approach to address that. A first important prerequisite is the repeatability and reproducibility of microdosimetric measurements. This work aims at studying experimentally the repeatability and reproducibility of microdosimetric measurements performed with a miniaturized Tissue Equivalent Proportional Counter (mini-TEPC) in a 62 MeV proton beam. Experiments were carried out within 1 year and without propane gas recharging and by different operators. RBE was also calculated by applying the Loncol’s weighting function r(y) to microdosimetric distributions. Demonstration of reproducibility of measured microdosimetric quantities y¯F, y¯D and RBE₁₀ in 62 MeV proton beam makes this TEPC a possible metrological tool for LET verification in proton therapy. Future characterization will be performed in higher energy proton beams.