A Review of the Alanine Electron Paramagnetic Resonance Dosimetry Method as a Dose Verification Tool for Low-Dose Electron Beam Applications: Implications on Flash Radiotherapy

Alanine dosimetry based on Electron Paramagnetic Resonance (EPR) spectroscopy has been a reliable reference and transfer dosimetry method in high-dose applications, valued for its high precision, accuracy and long-term stability. Additional characteristics, such as dose-rate independence up to 1010 Gy/s under electron beam (e-beam) irradiation, electron energy independence and tissue equivalence, position alanine EPR as a promising candidate to address dosimetric challenges arising in e-beam Flash Radiotherapy (RT), where radiation energy is delivered at Ultra-High Dose-Rates (UHDR) ≥ 40 Gy/s. At such dose-rates, reliable real-time monitoring dosimeters such as ionization chambers in conventional RT, suffer from ion recombination, compromising accuracy in dose determination. Several studies are currently focused on developing real-time beam monitoring systems dedicated specifically for e-beam Flash RT. This creates a need for standardized reference dosimetry methods to validate beam parameters determined by these systems under investigation. This review provides an overview of the potential and limitations of the alanine EPR dosimetry method for control, validation and verification of e-beam Flash RT beam parameters at doses less than 10 Gy, where the method has shown low sensitivity and increased uncertainty. It further discusses strategies to optimize alanine EPR measurements to enhance sensitivity and accuracy at these dose levels. Improved measurement procedures will ensure reliable and accurate e-beam Flash RT accelerator commissioning, performance checks, patient safety and treatment efficacy across all therapeutic dose ranges.