Identifying best practices for RTTs and dosimetrists: a Delphi consensus study on standardizing workflows in proton...

A recent scoping review identified gaps in proton therapy (PT) guidelines, especially in fields of expertise of radiation therapists (RTTs) and dosimetrists. This study aimed to reach consensus on best practices within seven workflows performed by RTTs working in European proton therapy centers (PTCs).

Delphi consensus methodology was used and applied to 26 statements based on results of an RTT workshop. The process included three rounds, with responses scored using a 5-point Likert scale. Consensus was defined as >66% agreement or disagreement, strong consensus at ≥80%. Predefined criteria were used to select PTCs, and experts were invited to participate via registration.

Forty experts from 15 European PTCs participated. Consensus highlighted the need for specialized training for RTTs working in PT, covering knowledge of uncertainties, working with children, and artificial intelligence. An active role is needed in monitoring the overall treatment course and in knowledge sharing at institutional and national level. Furthermore, consensus was reached on RTT-only workflows based on protocols. In treatment planning, individual beam setups should be used, and additional plan checks are required for quality assurance compared to photon therapy. It was agreed that not all patients need a dry run before treatment. In image-guided PT, manual adjustment to automatic matches should be performed if needed.

Consensus was reached on 24 statements covering seven workflows. This Delphi study provides a foundation for developing practical guidelines for RTTs working in PTCs across Europe. Although consensus was reached, multidisciplinary collaboration is needed.