Purpose To collect national data from medical physicists on work effort, challenges, and job satisfaction in high-dose rate (HDR) brachytherapy (BT) as a function of procedure complexity. Methods and Materials A survey was administered in cooperation with IROC-Houston. Question topics included demographics, practice patterns, caseload, procedure complexity, relative time and effort required for simple and complex cases, and challenges/satisfaction associated with HDR BT. Results Of 429 completed responses, 365 performed HDR BT. The most commonly treated anatomic sites were gynecologic, prostate, and skin, with 56% of respondents’ clinics performing interstitial procedures. Respondents indicated that the median time and intensity ratios of a single-channel HDR BT, relative to a weekly chart check (CPT77336), were 5 and 3, respectively, implying a work ratio of 15. When comparing the most complex procedure with a single-channel treatment, the median time and intensity ratios reported were both 5, implying a work ratio of 25. The time and intensity ratios scaled with increasing complexity for gyne procedures (ie, 1, 2-3, and ≥4 channels). Most respondents reported that it was more stressful to cover HDR BT versus external beam radiation therapy (EBRT) (82%) and to switch between services (73%). Job satisfaction was impacted most positively by direct patient contact and the experience level of authorized users, but most negatively by increased stress compared with other services and maintaining skill levels due to infrequent cases. Only the subset of respondents at clinics treating complex gyne with a high caseload (≥25 patients/y) indicated that staff allocation was inadequate or that a colleague had left their position due to HDR BT. Conclusions The results show a relationship between work effort and procedure complexity, which is currently not addressed in national staffing recommendations. To sustain a workforce capable of supporting HDR brachytherapy into the future, professional societies/leaders must recognize the stress and intensity of complex cases and adjust staffing recommendations accordingly.

PURPOSE:High-dose-rate (HDR) brachytherapy (BT) is an effective but resource-intensive treatment modality, demanding a highly skilled workforce, team coordination, and logistics. This study presents findings from a comprehensive national survey conducted in 2023, targeting all registered IROC-Houston (Imaging and Radiation Oncology Core) sites in the United States. METHODS AND MATERIALS:The primary objective was to analyze national BT practice patterns and workload dynamics among medical physicists involved in HDR BT treatments. A secondary aim, explored in a companion publication (part 2), examines work effort, job satisfaction, and challenges faced by medical physicists in this field. RESULTS:The survey received 365 complete responses, revealing an experienced workforce, with 71% reporting over 10 years of BT service and 75% performing complex gynecologic treatments involving more than 3 channels. Two-thirds of respondents were employed at nonacademic institutions, and 53% indicated that the medical physics full-time equivalent was <1 at their clinic. The most frequently performed procedure was gynecologic BT (96%), followed by skin (34%), prostate (33%), and breast (23%). Adoption of advanced planning tools was variable, with 66% using inverse planning and 34% employing automatic catheter reconstruction. Additionally, 32% of all respondents performed magnetic resonance imaging (MRI) based planning, with 14% reporting frequent use. Of the subgroup performing complex gynecologic treatments, 38% reported the utilization of MRIs. Uptake of MRI-based planning appears to have increased only slightly over the past decade. CONCLUSIONS:The survey demonstrated that medical physicists are involved in and responsible for nearly every technical aspect of the HDR BT process. This study presents one of the largest national surveys on medical physics practice patterns to date. The findings highlight ongoing challenges in allocating resources, varying procedure complexity, and logistical demands. Future initiatives should focus on developing improved resource allocation metrics to optimize staffing based on procedure complexity and caseload.

Phase unwrapping is a critical step in interferometric imaging modalities such as holography and synthetic aperture radar, yet conventional analytical algorithms struggle in low signal-to-noise and high-speckle environments. This study presents an artificial intelligence (AI)-based phase-unwrapping framework using a Pix2Pix conditional generative adversarial network (cGAN). A model was designed for robustness under Rayleigh-distributed speckle noise and phase decorrelation, conditions representative of realistic interferometric measurements. Trained on synthetically generated wrapped–unwrapped phase pairs, the AI approach was compared against established analytical phase-unwrapping methods, a quality-guided unwrapping algorithm (Herraez)and a minimum-norm network-flow optimization method (Costantini). Quantitative evaluation using the root mean square error (RMSE), structural similarity index measure (SSIM), and a composite performance index demonstrated that the cGAN was superior under noisy conditions, successfully recovering phase information beyond its training noise range at σ=10, and accurately unwrapping phases up to σ=20. This was under a pure unwrapping performance analysis, utility performance was also tested comparing all images to clean noiseless phase. The Pix2Pix model also proved resilient to detector artifacts, despite not being explicitly trained on them, and its worst performance yielded RMSE and SSIM values of 0.089 and 0.927, respectively, with perfect values being 0 and 1. The proposed framework simultaneously unwraps and denoises the phase, offering a simple, open-source, and highly adaptable alternative for phase unwrapping in noisy interferometric systems. Future work will focus on extending the framework to experimental datasets.

BACKGROUND AND PURPOSE:Safe delivery of prostate stereotactic body radiotherapy (SBRT) relies on precise target localization. Without access to real-time intrafraction motion management, careful optimization of IGRT protocols is necessary to safeguard treatment accuracy and patient outcomes. METHODS:An IGRT workflow is proposed that incorporates surface-monitoring (SGRT) to complement cone-beam CT (CBCT) imaging. The study evaluates 23 consecutive SBRT prostate patients who were treated on a prospective registry study. Each patient received pre- and mid-treatment and a subset received post-treatment CBCTs. The frequency and magnitude of SGRT triggered beam interruptions as well as treatment times were recorded. RESULTS:The median number of CBCTs acquired per fraction was four and the median treatment time was 23 min (IQR 19-27). SGRT detected intra-fraction surface-based motion beyond a combined 4 mm vector isocenter tolerance in 62% of all fractions treated, with a maximum motion of 15 mm. On average < 2 beam interruptions were triggered by SGRT per treatment fraction. There was no statistically significant correlation between overall treatment time and SGRT-triggered beam interruptions (r = 0.048, p = 0.645). There was a weak but statistically relevant correlation of overall treatment time with the maximum detected motion (r = 0.23, p = 0.026). SGRT detected five fractions where the patients had persistently moved outside the SGRT tolerance, and for three of these (60%), a CBCT verified that the target was out of tolerance. CONCLUSION:SGRT is a valuable tool that complements CBCT-based IGRT. An SGRT motion vector tolerance of 4 mm provides a pragmatic compromise between detecting patient motion and treatment efficiency. Overall, persistent patient motion during treatment was infrequent in this cohort, however, SGRT was able to detect several cases where the internal target was outside of the tolerance highlighting that patient monitoring with SGRT can contribute to improved quality and safety for prostate SBRT.

Objective: In this study, we describe and critically review our experience in the commissioning of the surface-guided radiation therapy (SGRT) system from C-RAD (Uppsala, Sweden), integrated with a Varian TrueBeam HyperArc linear accelerator (LINAC). Materials and Methods: The C-RAD SGRT system was commissioned according to the guidelines of the American Association of Physicists in Medicine Task Group 147 and the European Society for Radiotherapy and Oncology–Advisory Committee for Radiation Oncology Practice report. The commissioning tests included the isocenter, camera thermal drift, reproducibility, static localization accuracy with a 6-degree-of-freedom (DOF) couch, dynamic gating delivery, and an end-to-end test. The tools and phantoms employed for this verification included: (a) Sentinel 4DCT daily check device, (b) Catalyst⁺ HD daily check device, (c) Penta-guide, (d) gating phantom, (e) calibration board, (f) Winston-Lutz phantom, and (g) the Little John anthropomorphic phantom. Results/Discussion: The reproducibility of both the Sentinel 4DCT and Catalyst⁺ HD cameras demonstrated accuracy within ± 1 mm. The radiation isocenter measurements for both the Sentinel 4DCT and Catalyst⁺ HD cameras were found to be <1 mm, well within the recommended reports of the relevant international guidelines. The static localization accuracy of the Catalyst⁺ HD camera with a 6DOF couch was determined to be 0.15 ± 0.13 mm, 0.42 ± 0.23 mm, and 0.20 ± 0.15 mm for the vertical, longitudinal, and lateral directions, respectively. The rotational accuracy for roll, pitch, and yaw was found to be 0.05°±0.05°, 0.12°±0.18°, and 0.13°±0.10°, respectively. All results were within the tolerances recommended by the international recommendations and highlight the accuracy and precision of the C-RAD SGRT system in conjunction with the TrueBeam HyperArc LINAC. Conclusion: The newly installed advanced C-RAD SGRT systems have been successfully integrated with the Varian TrueBeam LINAC for clinical use, marking a significant milestone as the first deployment of SGRT technology of its kind in India.

Background and Purpose: The safe delivery of prostate stereotactic radiation therapy (SBRT) requires robust imaging and target position verification. When intrafraction internal real-time motion management capabilities are not available, there is a need to optimize image guidance (IGRT) protocols to maximize patient safety.Materials and Methods: An IGRT workflow is proposed that incorporates surface-guidance (SGRT) to complement cone-beam CT (CBCT) imaging. This study, which combined SGRT throughout each fraction and a CBCT pre, mid, and post each fraction, evaluates 23 prostate patients who were treated on a prospective registry study.Results: The median number of CBCTs acquired per fraction was four and the median treatment time was 23 minutes (IQR 19-27). SGRT detected intra-fraction surface-based motion beyond a 4 mm tolerance in 62% of all fractions treated, with a maximum motion of 15 mm. SGRT detected five fractions where the patient had persistently moved outside the SGRT tolerance, and for three of these (60%), a CBCT verified target motion up to 9 mm.Conclusion: SGRT is a valuable tool that complements CBCT-based IGRT and may contribute to improved quality and safety for prostate SBRT.

Abstract Introduction: Cancer survival has increased in part due to treatment advances. However, anthracycline chemotherapy increases cardiovascular (CV) morbidity risk, including atherosclerotic CV disease (ASCVD). Among those receiving anthracyclines, it is yet unclear who is at greatest risk of ASCVD, a major cause of CV mortality. Elucidating pathophysiologic processes involved in the development ASCVD could shed light on strategies to identify those at risk. Methods: Analyses were performed on 279 lymphoma and breast cancer survivors enrolled in the PREVENT study [clinical trial WF-98213) through Wake Forest NCI Community Oncology Research Base (NCORP) and Alliance (A221501)]. CV dysfunction was measured via cardiac MRI (cMRI) at baseline (pre-treatment) and 6-months post-diagnosis to ascertain aortic distensibility and wall thickness in the descending aorta. Biomarkers were measured at baseline and 6-months and were log-transformed to base 2. Multiple linear regression was used to determine associations between biomarker and outcome at 6 months, adjusted for baseline biomarker and cMRI outcome, age, race, sex, body mass index, and smoking history. Results: The mean age (SD) of cancer survivors 49 (12) years; 92% were women. The mean aortic distensibility and mean wall thickness at baseline was 0.002 (0.0014) and 2.99 (0.41), respectively. Table 1 shows the associations between biomarkers and aortic distensibility and wall thickness of the descending aorta. After adjustment for confounders, Arginine, CRP, MPO, and ornithine were associated with 6-month aortic distensibility, and the HDL and SDMA were associated with aortic wall thickness. Conclusions: The findings of this study suggest that biomarkers in oxidative stress and inflammatory pathways may be involved in pathophysiology of ASCVD among cancer survivors receiving anthracyclines. These results require further study in larger cohorts to better define mechanistic pathways involved. Association of Biomarkers with Atherosclerosis-Related Cardiovascular Dysfunction Citation Format: Kerryn W. Reding, Alexi Vasbinder, Nathaniel O'Connell, Biniyam Demissei, Warren Szewczyk, Richard Cheng, Amy Ladd, Alexander Lucas, Juergen Meyer, Stephen Bowen, Fadi Salloum, Ralph D'Agostino, Glenn Lesser, Kathryn Weaver, Bonnie Ky, W. H. Wilson Tang, W. Gregory Hundley. Biomarkers associated with atherosclerosis-related cardiovascular dysfunction in cancer survivors treated with anthracyclines [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6296.

BackgroundProton Minibeam Radiation Therapy has shown to widen the therapeutic window compared to conventional radiation treatment in pre-clinical studies. The underlying biological mechanisms, however, require more research.PurposeThe purpose of this study was to develop and characterize a mechanical collimation setup capable of producing 250µm wide proton minibeams with a center-to-center distance of 1000µm.MethodsTo find the optimal arrangement Monte Carlo simulations were employed using the Geant4 toolkit TOPAS to maximize key parameters such as the peak-to-valley dose ratio (PVDR) and the valley dose rate. The experimental characterization of the optimized setup was carried out with film dosimetry at the University Proton Therapy beamline in Dresden and the proton beamline of the University of Washington Medical Center in Seattle with 150MeV and 50.5MeV, respectively. A microDiamond detector (PTW, Freiburg, Germany) was utilized at both beamlines for online proton minibeam dosimetry.ResultsA PVDR of 10 was achieved in Dresden and a PVDR of 14 in Seattle. Dosimetry measurements were carried out with EBT3 films at a depth of 5mm in a polymethylmethacrylate (PMMA) phantom. When comparing film dosimetry with the microDiamond, excellent agreement was observed in the valleys. However, the peak dose showed a discrepancy of approximately 10% in the 150MeV beam and 20% in the 50.5MeV beam between film and microDiamond.DiscussionThe characteristics of the minibeams generated with our system compares well with those of other collimated minibeams despite being smaller. The deviations of microDiamond measurements from film readings might be subject to the diamond detector responding differently in the peak and valley regions. Applying previously reported correction factors aligns the dose profile measured by the microDiamond with the profile acquired with EBT3 films in Dresden.ConclusionThe novel proton minibeam system can be operated independently of specific beamlines. It can be transported easily and hence used for inter-institutional comparative studies. The quality of the minibeams allows us to perform in vitro and in vivo experiments in the future. The microDiamond was demonstrated to have great potential for online dosimetry for proton minibeams, yet requires more research to explain the observed discrepancies.

Purpose To assess practice patterns and physics staffing levels for a range of HDR brachytherapy (BT) procedures across different clinical settings within the US. Materials and Methods A survey was designed to assess practice patterns of the US physics brachytherapy workforce. The survey was distributed in October 2023 by IROC-Houston (U24CA180803) using RedCap in the form of an email with background, instructions, and a non-personalized link to the survey. The survey covered: i) demographics, employment, experience level, and equipment, ii) practice patterns, and case load, iii) time and intensity as a function of procedure complexity and challenges/satisfaction associated with HDR BT. We present survey responses from section (ii) and results from a sub-analysis performed to assess physics FTE allocation. Chi-squared tests were used for group comparisons with significance assessed at the p<0.05 level. Results Of 429 respondents, 365 respondents performed HDR BT and were included for analysis. The percentage of respondents reporting particular HDR BT practice patterns is noted in () below in 1)- 4) and a sub-analysis for assessing physics full time equivalent (FTE) allocation is in 5). 1) Gynecologic (GYN) treatments using single channel (96%), 2-3 channels (78%), 4-12 channels (44%), and GYN ≥13 channels (33%), in addition to skin (33%), prostate (32%), breast (22%), and sarcoma (10%). 2) MRI-based treatment planning performed frequently (14%), sometimes (19%), or never (67%). 3) Interstitial BT performed frequently (33%), sometimes (23%), or never (44%). 4) The average number of physicist FTE allocated to HDR BT <1.0 (53%), 1.0-1.9 (23%), ≥ 2.0 (10%). 5) The percentage of FTE ≥1.0 assigned to different practice settings is shown below in a)-d) and compared, indicating statistically significant differences (p<0.05) for: a) Planning with MRI vs. without MRI: 52% vs. 32%. b) Interstitial vs. no interstitial: 50% vs. 26%. c) Annual volume grouped by applicator type (<25 patients vs. ≥25 patients): GYN single; 27% vs. 52%. GYN 2-3 channels; 34% vs. 64%. GYN 4-12 channels; 48% vs. 74%. GYN 13+ channels; 55% vs. 88%. Prostate interstitial; 44% vs. 69%. d) Hospital setting (non-academic vs. academic); 31.2% vs. 56%. If MRI based planning or interstitial BT is performed, the likelihood of physics FTE ≥1.0 was higher than their counterpart groups. Regardless of complexity, respondents reported a higher physics FTE when treating a higher volume of patients per year (≥ 25 patients). Also, academic hospitals were associated with ≥1.0 physics FTE. Of note, the current overall MRI utilization rate for HDR BT (33%) did not change compared to the ABS practice patterns survey for MRI- based HDR BT for GYN cancer in 2014. Conclusion To our knowledge, this is the first survey of US medical physicists for HDR BT practice patterns and physics staffing. Our survey reflects that patient volume and HDR BT procedure complexity are influential factors for increased physics FTE. Proper physics staffing estimation and recommendations accounting for complexity and patient volume need further assessment by professional societies and leaders.

BackgroundThis manuscript describes modifications to a pencil beam scanning (PBS) proton gantry that enables ultra-high dose rates (UHDR) irradiation, including treatment planning and validation.MethodsBeamline modifications consisted of opening the energy slits and setting the degrader to pass-through mode to maximize the dose rate. A range shifter was inserted upstream from the isocenter to enlarge the spot size and make it rotationally symmetric. We measured the beamline transport efficiency and investigated the variation in output due to the recombination of charge in the dose monitoring chamber. The output calibration was performed through a parallel plate chamber (PPC05), and an intercomparison was performed for various detectors. The pre-clinical field for mice irradiation consisted of different dose levels to deliver uniform doses in transmission mode. The field dose rates were determined through log files while scripting in TPS was used to estimate PBS dose rates. The survival experiments consisted of irradiating the full pelvis of the mice at UHDR and conventional dose rates.ResultsThe spot size was constant with beam current and had a sigma of 8.5 mm at the isocenter. The beam output increased by 35% at 720 nA compared to 5.6 nA, primarily due to recombination in the dose-monitoring ion chambers. The Faraday Cup and PPC05 agreed within 2%, while other detectors were within 3% of FC for dose rates <60 Gy/s. The pre-clinical fields’ PBS dose rate is above 45 Gy/sec for all voxels within the target volume. The average and PBS dose rates decrease as field size increases and approaches 40 Gy/s for a field size of 7x7 cm2. All UHDR arms showed better survival than the corresponding conventional dose rate arms.ConclusionsWe successfully modified a clinical system to perform UHDR pre-clinical experiments. As part of our pre-clinical experiments, we observed the FLASH effect concerning mice survival.

Purpose: Animal studies with ultrahigh dose-rate radiation therapy (FLASH, >40 Gy/s) preferentially spare normal tissues without sacrificing antitumor efficacy compared with conventional dose-rate radiation therapy (CONV). At the University of Washington, we developed a cyclotron-generated preclinical scattered proton beam with FLASH dose rates. We present the technical details of our FLASH radiation system and preliminary biologic results from whole pelvis radiation. Methods and Materials: A Scanditronix MC50 compact cyclotron beamline has been modified to produce a 48.7 MeV proton beam at dose rates between 0.1 and 150 Gy/s. The system produces a 6 cm diameter scattered proton beam (flat to ± 3%) at the target location. Female C57BL/6 mice 5 to 6 weeks old were used for all experiments. To study normal tissue effects in the distal colon, mice were irradiated using the entrance region of the proton beam to the whole pelvis, 18.5 Gy at different dose rates: control, CONV (0.6-1 Gy/s) and FLASH (50-80 Gy/s). Survival was monitored daily and EdU (5-ethynyl-2´-deoxyuridine) staining was performed at 24- and 96-hours postradiation. Cleaved caspase-3 staining was performed 24-hours postradiation. To study tumor control, allograft B16F10 tumors were implanted in the right flank and received 18 Gy CONV or FLASH proton radiation. Tumor growth and survival were monitored. Results: After 18.5 Gy whole pelvis radiation, survival was 100% in the control group, 0% in the CONV group, and 44% in the FLASH group (P < .01). EdU staining showed cell proliferation was significantly higher in the FLASH versus CONV group at both 24-hours and 96-hours postradiation in the distal colon, although both radiation groups showed decreased proliferation compared with controls (P < .05). Lower cleaved caspase-3 staining was seen in the FLASH versus conventional group postradiation (P < .05). Comparable flank tumor control was observed in the CONV and FLASH groups. Conclusions: We present our preclinical FLASH proton radiation system and biologic results showing improved survival after whole pelvis radiation, with equivalent tumor control.

Clinically negligible mean discrepancies were observed for both robustness tests showing that neither the reference surface size nor the algorithms investigated caused systematic variations in the shifts for this group of patients. Maximum discrepancies of up to 3 mm and 3° were found between the algorithms, which indicate some variation, but within clinical tolerance. Overall, different selection of reference surfaces and algorithms had a minor effect on clinical shifts for SGRT of the breast.

We adapted a clinical proton system for preclinical irradiations at UHDR. Our results confirm the presence of the FLASH effect.

Optical Calorimetry (OC) is based on interferometry and provides a direct measurement of spatially resolved absorbed dose to water by measuring refractive index changes induced by radiation. The purpose of this work was to optimize and characterize in software an OC system tailored for ultra-high dose rate applications and to build and test a prototype in a clinical environment. A radiation dosimeter using the principles of OC was designed in optical modelling software. Traditional image quality instruments, fencepost and contrast phantoms, were utilized both in software and experimentally in a lab environment to investigate noise reduction techniques and to test the spatial and dose resolution of the system. Absolute dose uncertainty was assessed by measurements in a clinical 6 MV Flattening Filter Free (FFF) photon beam with dose rates in the range 0.2–6 Gy/s achieved via changing the distance from the source. Design improvements included: equalizing the pathlengths of the interferometer, isolating the system from external vibrations and controlling the system’s internal temperature as well as application of mathematical noise reduction techniques. Simulations showed that these improvements should increase the spatial resolution from 22 to 35 lp/mm and achieve a minimum detectable dose of 0.2 Gy, which was confirmed experimentally. In the FFF beam, the absolute dose uncertainty was dose rate dependent and decreased from 2.5 ± 0.8 to 2.5 ± 0.2 Gy for dose rates of 0.2 and 6 Gy/s, respectively. A radiation dosimeter utilizing the principles of OC was developed and constructed. Optical modelling software and image quality phantoms allowed for iterative testing and refinement. The refined OC system proved capable of measuring absorbed dose to water in a linac generated photon beam. Reduced uncertainty at higher dose rates indicates the potential for OC as a dosimetry system for high dose rate techniques such as microbeam and ultra-high dose-rate radiotherapy.

Purpose: Spatially Fractionated Radiation Therapy (SFRT) is characterized by large differences in peak and valley doses. Preclinical and clinical studies suggest that differences in biological mechanisms lead to differential normal tissue and tumor response compared to uniform irradiation. We hypothesize that to evaluate clinical effectiveness and understand fundamental biological mechanisms, radiobiological rather than physical dose quantities should be utilized for comparisons. The aim of this work is to determine whether Equivalent Uniform Dose (EUD) is a superior predictor of cell survival than absorbed dose. Methods: Absorbed dose parameters were compared to the Equivalent Uniform Dose to assess their predictive value for the relative effectiveness of uniform and SFRT with X-rays. A Bayesian bootstrap technique was utilized to model uncertainties in the biological fit parameters for a human fibroblast (MRC5) and two human tumor cell lines (LN18 and A549). Dose uncertainties were evaluated through measurements and error modeling of SFRT profiles. A dimensionless Relative Effectiveness Factor (REF) is proposed to quantify differences between uniform and SFRT irradiation. Results: For all cell lines, cell survival after SFRT matched uniform irradiation within the estimated uncertainties at equal values of the EUD. Average and peak dose showed poor correlation with in vitro cell survival. The proposed REF factor is dose dependent and suggests enhanced cell killing for both tumor cell lines (1.14 ± .08 for LN18, 1.32 ± .13 for A549 at 8 Gy EUD) for SFRT. Normal human fibroblasts showed reduced cell killing relative to uniform irradiation (.58 ± .06 for MRC5). Synthetically generated SFRT dose profiles revealed that EUD uncertainties are dominated by valley dose uncertainties, especially at high doses. Discussion : EUD is more predictive of cell survival than average or valley dose. Valley dose is close to equal to the EUD for values > 10 Gy and has the advantage of being independent of uncertainties in biological parameters. The REF is a novel and useful metric to compare quantitative differences in SFRT and uniform irradiation. Conclusion : EUD is recommended for comparisons of SFRT and uniform irradiation. The results suggest an increase in survival of normal-human fibroblast cells and reduced survival for both tumor cell lines after SFRT relative to uniform irradiation.

Optical Calorimetry (OC) is a 2D Digital Holographic Interferometry (DHI)-based measurement technique with potential applications for the 3D dosimetry of ultra-high dose rate (FLASH) radiation therapy beams through tomographic reconstruction. This application requires accurate measurements of DHI signals in environments with low signal-to-noise ratios (SNRs) in order to accurately measure absorbed energy to a medium per unit mass (Dose). However, tomographic reconstruction accuracy is sensitive to noise in the measurements. In this study, a virtual model of an OC dosimeter was used to characterize and model major sources of noise within a DHI setup, allowing for the modelled noise sources to be selectively reduced. The tomographic reconstruction of the 3D dose distribution was achieved using the inverse Abel transform. Reducing the noise contribution from atmospheric turbulence and mechanical vibration by one half improved the central axis reconstruction error from 6.5% to 1.3% and 1.1%, respectively, and the mean dose difference from 2.9% to 0.4% and 0.3%, respectively. This indicates the potential of the tomographic DHI-based 3D OC dosimeter to reconstruct accurate 3D dose distributions from a single projection if the specified sources of noise can be reduced to acceptable levels. The used methodology is applicable to any application of tomographic DHI where reconstruction quality is highly sensitive to noise.