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Compact FLASH and proton systems at the price of a conventional linac

Ultra-fast FLASH radiotherapy and proton beams may spare healthy tissue dramatically, but the machines cost tens of millions. Engineer versions that any hospital can afford.

FLASH radiotherapy (dose delivered in under a second) reduces normal tissue toxicity in animal models with preserved tumour control and has entered early human trials; proton therapy spares normal tissue by physics but costs an order of magnitude more than photon systems. Compact accelerator concepts (very-high-energy electrons, laser-driven and superconducting compact proton sources) could lower cost. The proposal is a focused engineering programme, with milestone funding, to deliver a compact system capable of FLASH-rate delivery at a capital cost comparable to a conventional linac, paired with the clinical trials needed to establish the FLASH effect in humans.

Hypothesis
A compact system delivers FLASH-rate treatment at conventional linac cost within eight years, and randomised trials confirm reduced late toxicity at equal tumour control in at least one indication.
Rationale
Toxicity from radiotherapy limits dose and quality of life; if the FLASH effect holds in humans, cost is the only barrier to universal benefit, and accelerator physics is advancing quickly.
What would test it
Prototype within four years with dosimetric validation; first randomised FLASH versus conventional trial in a toxicity-limited indication such as head and neck or paediatric tumours.
Maturity
preclinical evidence
Who has to act
industry
Cost to try
Large (over $50M)
Years to first evidence
8
Bottlenecks it attacks

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