ArticleJournal of applied clinical medical physics2015
Flattening filter-free accelerators: a report from the AAPM Therapy Emerging Technology Assessment Work Group.
Article in Journal of applied clinical medical physics, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 84 papers.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
84 citing papers in PubMed, 185 citations in OpenAlex.
- Assessment of 6MV flattening filter free (FFF) beam commissioning parameters for Versa HD and TrueBeam: A comparison study.Journal of applied clinical medical physics · 2026Article
- Radiobiological effects of flattening filter and flattening filter free radiotherapy x-ray on inflammatory and apoptotic pathways in cardiac and pulmonary tissues in an MCF-7 xenograft breast cancer model.Journal of radiation research · 2026Article
- Pulse‑level characterization of low monitor unit deliveries on a modern linear accelerator using a plastic scintillation detector.Journal of applied clinical medical physics · 2026Article
- Dosimetric comparison of FF and FFF modes under non-ideal bolus-fitting conditions for post-mastectomy chest wall irradiations.Journal of applied clinical medical physics · 2026Article
- Review
- Measurement of Percentage Depth-Dose Distributions in Clinical Dosimetry: Conventional Techniques and Emerging Sensor Technologies.Sensors (Basel, Switzerland) · 2026Review
- Dosimetric effects of internal margin, auto flash, and virtual bolus in VMAT-based whole-breast radiotherapy under motion variations.Journal of applied clinical medical physics · 2026Article
- Comparative dosimetric analysis of flattening-filter and flattening-filter-free photon beams in radiotherapy based on TRS-398 calibration protocol.Reports of practical oncology and radiotherapy : journal of Greatpoland Cancer Center in Poznan and Polish Society of Radiation Oncology · 2026Article
- Small-volume plan optimization of inoperable early-stage centrally-located non-small-cell lung cancer using VMAT-based SBRT under the DIBH scenario: a single-arc model or a dual-arc plan?Frontiers in oncology · 2026Article
- Dosimetric and treatment efficiency comparison of lung SBRT using three different motion management strategies.Clinical and translational radiation oncology · 2026Article
- Understanding cardiac toxicity and immune responses to thoracic radiation therapy in non-small cell lung cancer - implications for future research.Frontiers in oncology · 2026Review
- Assessment of the backscattered skin dose from the beam stopper on Halcyon and Ethos radiotherapy systems.Journal of applied clinical medical physics · 2025Article
- Surface dose analysis and dosimetric comparison of Halcyon versus Truebeam in breast cancer radiotherapy: An OSL dosimetry study.Journal of applied clinical medical physics · 2025Article
- Evaluation of radiation treatment plan quality in head and neck cancer: a comparative analysis of RapidArc technique with flattening filter and flattening filter-free photon beams.Ecancermedicalscience · 2025Article
- Intensity Modulated Therapy for Patients With Breast Cancer. Practical Guidelines and Tips for an Effective Treatment Planning Strategy.Advances in radiation oncology · 2024Article
- MR-linac MLC positioning QA by digitally stitching dual double-exposed films.Journal of applied clinical medical physics · 2024Article
- Comparison Flattening Filter and Flattening Filter-Free Techniques in Small-Fields Dosimetry with Various Types of Detectors.Asian Pacific journal of cancer prevention : APJCP · 2024Article
- Accuracy of Beamscan Software in Determining the Inflection Point from the FFF Beam Profile Using Several Array Detectors.Asian Pacific journal of cancer prevention : APJCP · 2024Article
- A comprehensive Study of the Out of Field Non Target Dose Associated with 6 and 10 MV Flattened and Flattening Filter Free X Ray Beam in a True Beam Linear Accelerator.Asian Pacific journal of cancer prevention : APJCP · 2024Article
- Commissioning and clinical evaluation of a novel high-resolution quality assurance digital detector array for SRS and SBRT.Journal of applied clinical medical physics · 2024Article
24 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
11 authors at 9 institutions in 1 country.
Funding
Abstract
This report describes the current state of flattening filter-free (FFF) radiotherapy beams implemented on conventional linear accelerators, and is aimed primarily at practicing medical physicists. The Therapy Emerging Technology Assessment Work Group of the American Association of Physicists in Medicine (AAPM) formed a writing group to assess FFF technology. The published literature on FFF technology was reviewed, along with technical specifications provided by vendors. Based on this information, supplemented by the clinical experience of the group members, consensus guidelines and recommendations for implementation of FFF technology were developed. Areas in need of further investigation were identified. Removing the flattening filter increases beam intensity, especially near the central axis. Increased intensity reduces treatment time, especially for high-dose stereotactic radiotherapy/radiosurgery (SRT/SRS). Furthermore, removing the flattening filter reduces out-of-field dose and improves beam modeling accuracy. FFF beams are advantageous for small field (e.g., SRS) treatments and are appropriate for intensity-modulated radiotherapy (IMRT). For conventional 3D radiotherapy of large targets, FFF beams may be disadvantageous compared to flattened beams because of the heterogeneity of FFF beam across the target (unless modulation is employed). For any application, the nonflat beam characteristics and substantially higher dose rates require consideration during the commissioning and quality assurance processes relative to flattened beams, and the appropriate clinical use of the technology needs to be identified. Consideration also needs to be given to these unique characteristics when undertaking facility planning. Several areas still warrant further research and development. Recommendations pertinent to FFF technology, including acceptance testing, commissioning, quality assurance, radiation safety, and facility planning, are presented. Examples of clinical applications are provided. Several of the areas in which future research and development are needed are also indicated.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.