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Related Experiment Video

Updated: Jan 20, 2026

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An ESTRO-EPTN Delphi consensus on robustness evaluation in proton therapy.

Francesco Fracchiolla1, Arturs Meijers2, Ester Orlandi3,4

  • 1UO Fisica Sanitaria, APSS, Trento, Italy.

Physics and Imaging in Radiation Oncology
|January 19, 2026
PubMed
Summary

Robustness evaluation in proton therapy planning lacks consensus. This ESTRO study surveyed experts, reaching agreement on key uncertainties and methods, guiding future treatment planning system development.

Keywords:
ConsensusEuropean particle therapy networkProton therapyRobustness evaluation

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Area of Science:

  • Medical Physics
  • Radiation Oncology
  • Clinical Proton Therapy

Background:

  • Robustness evaluation (RE) is critical for proton therapy planning but lacks standardized international guidelines.
  • Clinics currently employ diverse, self-developed RE methods focusing on specific uncertainties.

Purpose of the Study:

  • To survey expert opinions on clinical RE methods within proton therapy.
  • To inform the development of future treatment planning systems (TPS) by establishing consensus.

Main Methods:

  • A Delphi procedure involving 24 European proton therapy centers (radiation oncologists and medical physicists).
  • Drafting and reviewing 39 statements on transitioning to robustly optimized planning.
  • Achieving consensus based on a 75% agreement threshold over two rounds.

Main Results:

  • Consensus was reached on 26 of 39 statements (66.7%), with 5 identified as high-priority.
  • Strong agreement on uncertainties (range, setup, intra-fraction, anatomy changes) and methodologies for RE.
  • Disagreement noted on using the Planning Target Volume (PTV) for both planning and dose reporting.

Conclusions:

  • The ESTRO Delphi consensus provides practical guidance for areas of agreement in RE.
  • Development of guidelines is recommended for standardization of RE methodologies and reporting.
  • TPS vendors are encouraged to align software development with community requirements for robust planning.