First clinical implementation of a highly efficient daily online adapted proton therapy (DAPT) workflow

Area of Science:

• Medical Physics
• Radiation Oncology
• Radiotherapy Technology

Background:

• Daily adaptive proton therapy (DAPT) offers potential for improved treatment precision.
• Implementing an efficient online DAPT workflow in a clinical setting is a significant technological advancement.

Purpose of the Study:

• To present the first clinical implementation of an efficient online daily adaptive proton therapy (DAPT) workflow.
• To evaluate the efficiency, safety, and clinical benefits of the DAPT workflow in a real-world setting.

Main Methods:

• A DAPT workflow involving pre-treatment planning (template and fallback) and online re-optimization using daily CT images.
• Automated Quality Assurance (QA) including geometric checks, sanity checks, and independent dose calculation.
• Offline dose recalculation and gamma analysis (3%/3 mm) using machine log-files.

Main Results:

• DAPT treatment sessions averaged 23 minutes, within the standard 30-minute slot.
• Online adaptation and QA averaged under 7 minutes per fraction.
• Over 85% of fractions used the online adapted plan, with 92% showing improved dose metrics.

Conclusions:

• The DAPT workflow was successfully implemented clinically, demonstrating efficiency and time adherence.
• Daily online adaptive proton therapy is feasible and offers improved dose metrics for patients.
• This represents the first clinical application of daily online adaptive proton therapy.