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BACKGROUND: Ultra-high dose per pulse (UHDPP) beams have shown to be promising for clinical applications due to their healthy tissue sparing potential. In this radiotherapy modality, a limited number of pulses (often 2.0 µs) and pulse repetition frequencies ≤ 30 Hz were associated with reduced beam instability, consistent with reduced outlier influence. This study showed that increasing the number of pulses (> 25) mitigated the relative contribution of outliers, which is particularly relevant in experimental designs using UHDPP beams. CONCLUSIONS: A framework for analyzing UHDPP beam stability was outlined. Normality tests were a useful tool to identify delivery limitations and quantify the influence of outliers. These outliers can significantly affect the prescribed dose in UHDPP conditions, and they should be considered when designing and interpreting future experiments. Several mechanisms that may underlie observed instabilities were also hypothesized.
Flores-Mancera et al. (Fri,) studied this question.