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Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies
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Clinical implementation considerations for proton dose-driven continuous scanning: comparative analysis of breakpoint

Chunbo Liu1,2, Chris Beltran1, Jiajian Shen3

  • 1Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, United States of America.

Physics in Medicine and Biology
|December 16, 2025
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Summary

Proton therapy

Keywords:
breakpoint strategiesdose-driven continuous scanningproton PBSscan path optimization

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Area of Science:

  • Medical Physics
  • Radiation Oncology

Background:

  • Proton dose-driven continuous scanning (DDCS) offers potential for improved treatment efficiency.
  • Optimizing breakpoint (BP) strategies and scan path is crucial for effective DDCS implementation.

Purpose of the Study:

  • To evaluate different breakpoint strategies and scan path optimization impacts on dose accuracy, beam interruptions, and delivery efficiency in DDCS.
  • To provide insights for clinical implementation of DDCS, balancing key treatment parameters.

Main Methods:

  • Retrospective simulation of proton pencil beam scanning plans for DDCS.
  • Evaluation of five BP strategies (three spot distance-based, two scan ratio-based) with beam current optimized for shortest beam delivery time (BDT).
  • Analysis of three scan paths (default, length-optimized, time-optimized) assessing BP fraction, dose accuracy (Gamma, DVH RMSE), and BDT.

Main Results:

  • Spot distance-based strategies (especially SD2 with length-optimized path) achieved excellent dose accuracy (>98% Gamma, <1% DVH RMSE) and minimized beam interruptions (median 1.1%).
  • Scan ratio-based approaches (especially SR0 with time-optimized path) achieved shorter BDTs while maintaining acceptable dose accuracy (>95% Gamma, <2% DVH RMSE).
  • Scan path optimization reduced beam interruptions for SD-based methods and improved dose accuracy for SR-based methods.

Conclusions:

  • Dose accuracy in DDCS is achievable without compromising beam current optimized for BDT.
  • SD2 with length-optimized path is preferred for minimizing dose deviations and beam interruptions.
  • SR0 with time-optimized path is suitable when shorter BDT is critical, offering complementary strengths for DDCS implementation.