Artificial intelligence in proton adaptive radiation therapy

Adaptive proton therapy workflows are being investigated by multiple institutions and research groups. While both photon and proton adaptive therapy workflows must overcome numerous challenges, the unique aspects of proton interactions resulting in energy deposition in tissue and the limited availability of image guidance with accurate tissue composition information make adaptive proton therapy workflow development a more challenging translational endeavor. Much work has contributed to the clinical deployment of adaptive proton therapy workflows, mostly using in-room computed tomography imaging which achieves the most accurate tissue decomposition. To address the outstanding challenges of adaptive proton therapy, AI tools are being developed to address most of the components of an adaptive workflow, including image correction, contour propagation, treatment planning, dose calculations, and QA of both imaging and treatment plans.