What will the medical physics of proton therapy look like 10 yr from now? A personal view

Abstract

Despite growing rapidly, proton therapy is still a relatively immature treatment modality, at least in comparison to conventional radiotherapy using photons. As such, in this article, the author gives a very personal view of some of the potential areas for development in medical physics for proton therapy in the next 10 yr by identifying six topics for detailed discussion. The first of these are all related to reducing various “parameters” of proton therapy treatments (size and cost, treatment times, penumbras, and margins), while the second group are related to providing more quantitative “knowledge” about the quality of the treatments we are delivering. In conclusion, there is much interesting and important work still to be done in many areas of medical physics related to proton therapy, of which, the topics selected here are just the tip of the iceberg.

Model based patient pre-selection for intensity-modulated proton therapy (IMPT) using automated treatment planning and machine learning

“…Proton therapy has the potential to reduce organ at risk (OAR) dose by taking advantage of the Bragg peak and the finite range of protons in matter, albeit at a higher cost compared to conventional photon radiotherapy [1]. Patient selection for IMPT can, amongst others, be based on treatment site, physician's judgement, healthcare insurance, and dosimetric comparisons with photon therapy.…”

Adapting training for medical physicists to match future trends in radiation oncology

“…The possibilities given by proton and particle therapy are multiple, summarized by the energy deposition characteristics of protons, which can provide clinically favourable dose distributions in comparison with photons, including considerable reduction of integral dose [60]. The field is complex and still in need of further development not least in imaging, treatment planning, treatment delivery and delivery technology, in all of which technological and physical components are essential [61,62].…”

In the future, disruptive innovation in radiation oncology technology will be initiated mostly by entrepreneurs

“…Exactly where this is going to make a substantial difference is hard to tell, because of the extreme hype around machine learning . To give a final example, I hope that a future disruptor will make proton therapy accessible to many patients by making it much cheaper and more compact — otherwise it will remain a relative “niche” treatment option serving very few patients …”

“…8 To give a final example, I hope that a future disruptor will make proton therapy accessible to many patients by making it much cheaper and more compact 9otherwise it will remain a relative "niche" treatment option serving very few patients. 10 The second part of our proposition is about entrepreneurs initiating the innovative technology. Entrepreneurs have played an important role in radiation oncology for many years.…”