Periodic Reporting for period 2 - RAPTOR (Real-time Adaptive Particle Therapy of Cancer)
Reporting period: 2023-06-01 to 2025-08-31
Radiotherapy for cancer is usually planned before treatment starts and assumes the patient’s anatomy does not change. In real life, tumours and healthy organs can move or change shape between and during sessions. These changes may reduce treatment accuracy and increase side effects. RAPTOR set out to make proton therapy “adaptive”: updating the treatment plan using the patient’s daily images so that the right dose reaches the right place, every time.
More precise treatments mean better tumour control with fewer side effects. Making adaptive proton therapy practical can improve outcomes for patients across Europe (and beyond) and help healthcare systems deliver high-quality, personalised cancer care more efficiently.
RAPTOR had two goals: (1) create the scientific and technical building blocks needed for online (daily or real-time) adaptive particle therapy—covering imaging, planning, and verification—and (2) train a new generation of experts who can bring these methods into clinics and industry.
RAPTOR delivered integrated solutions across the full adaptive workflow. The consortium developed novel methods for image segmentation, synthetic CT generation, and dose accumulation; produced optimisation engines and visualisation tools for daily treatment planning and 4D dose reconstruction; and advanced in-vivo verification approaches and phantom-based verification tools to enable safe, adaptive treatment workflows. These components were validated in silico, in phantoms, and—critically—combined into end-to-end tests.
A milestone outcome was the first clinical implementation of online adaptive proton therapy at PSI (Switzerland), demonstrating feasibility without extending treatment times.
In total, 15 early-stage researchers were trained through accredited schools, secondments, and an open e-learning platform; several have already defended PhDs or moved into clinical and industrial roles. RAPTOR’s results were widely disseminated through publications, conferences, and public-facing videos. Its legacy will continue via the follow-up EU-MSCA-RAPTORplus project, focused on broader clinical uptake and biologically informed adaptation.
More precise treatments mean better tumour control with fewer side effects. Making adaptive proton therapy practical can improve outcomes for patients across Europe (and beyond) and help healthcare systems deliver high-quality, personalised cancer care more efficiently.
RAPTOR had two goals: (1) create the scientific and technical building blocks needed for online (daily or real-time) adaptive particle therapy—covering imaging, planning, and verification—and (2) train a new generation of experts who can bring these methods into clinics and industry.
RAPTOR delivered integrated solutions across the full adaptive workflow. The consortium developed novel methods for image segmentation, synthetic CT generation, and dose accumulation; produced optimisation engines and visualisation tools for daily treatment planning and 4D dose reconstruction; and advanced in-vivo verification approaches and phantom-based verification tools to enable safe, adaptive treatment workflows. These components were validated in silico, in phantoms, and—critically—combined into end-to-end tests.
A milestone outcome was the first clinical implementation of online adaptive proton therapy at PSI (Switzerland), demonstrating feasibility without extending treatment times.
In total, 15 early-stage researchers were trained through accredited schools, secondments, and an open e-learning platform; several have already defended PhDs or moved into clinical and industrial roles. RAPTOR’s results were widely disseminated through publications, conferences, and public-facing videos. Its legacy will continue via the follow-up EU-MSCA-RAPTORplus project, focused on broader clinical uptake and biologically informed adaptation.
From project start to the end of the action, RAPTOR delivered an end-to-end toolkit for online (daily/real-time) adaptive proton therapy and trained 15 doctoral researchers to use and advance it. Technically, the consortium built the full adaptive loop—imaging → planning → verification—and validated it in silico and with phantoms, aligning methods with clinical workflows. A key milestone was the first clinical implementation of online adaptive proton therapy at PSI (Switzerland), demonstrating feasibility without prolonging treatments; similar integrations are underway at partner sites.
WP1 – Training. Three accredited RAPTOR Schools (virtual “Loop Basic”, Ljubljana “Loop Requirements”, Ticino “Loop Engagement”) plus secondments and regular Science Check-Ins equipped ESRs with scientific, clinical, industrial and communication skills. By project end, 5 ESRs had already defended their PhDs and 6 transitioned to postdoc or clinical roles. The open e-learning platform preserves lectures, ESR videos and public talks for reuse beyond the project.
WP2 – Imaging. We delivered AI tools for automatic organ contouring, synthetic-CT generation from CBCT/MRI, and dose accumulation—the core enablers for daily planning on daily images.
WP3 – Intervention. We developed ultra-fast plan optimisation (daily plans in under a minute), a visualisation/approval tool for clinicians, and a 4D dose reconstruction engine to account for intra-fraction motion—together streamlining safe same-day plan adaptation.
WP4 – Verification. We advanced prompt-gamma imaging (PGI) and proton radiography/range probing (PR/RP) for near real-time treatment verification. Clinical data show PGI could cut range-uncertainty margins (e.g. from 7 mm to 3 mm) and can also act as a checker for CBCT-based adaptations. Joint PGI–PR tests confirmed complementary strengths. A 3D-printed end-to-end phantom and log-file–based dose reconstruction rounded out system tests.
The full workflow was exercised in structured end-to-end campaigns and translated clinically at PSI, where the first patients completed online-adaptive treatments using some of the RAPTOR-built components. Network-wide, the project produced 40+ peer-reviewed papers, extensive conference presentations (80+), and integrated tools with industrial partners—preparing broader uptake.
Exploitation and uptake. While no patents were filed, multiple software components (segmentation, sCT, optimisation, verification) are under evaluation for clinical integration and potential commercialisation with our industrial partners. RAPTOR outputs already influence practice (e.g. PSI clinical use; OncoRay preparing the DEPICT interventional trial using PGI). Continuation of the project is secured via the EU-MSCA-RAPTORplus project (from January 2026) to broaden clinical adoption and explore biologically triggered adaptation.
WP5- Dissemination. Dissemination combined classical and creative channels: 40+ publications, an open e-learning platform, a professionally produced comic-style explainer video, (30+) ESR video series, newsletters, and an active social-media presence (>150 linkedin post). A patient-engagement session at the Final Conference brought patient voices into scientific dialogue. These activities boosted visibility among clinicians, industry, policymakers and the public.
In sum, RAPTOR turned the vision of online adaptive proton therapy into a piloted clinically reality, created a skilled cohort ready to sustain it, and set up the pathways—technical, clinical and educational—for Europe-wide uptake.
WP1 – Training. Three accredited RAPTOR Schools (virtual “Loop Basic”, Ljubljana “Loop Requirements”, Ticino “Loop Engagement”) plus secondments and regular Science Check-Ins equipped ESRs with scientific, clinical, industrial and communication skills. By project end, 5 ESRs had already defended their PhDs and 6 transitioned to postdoc or clinical roles. The open e-learning platform preserves lectures, ESR videos and public talks for reuse beyond the project.
WP2 – Imaging. We delivered AI tools for automatic organ contouring, synthetic-CT generation from CBCT/MRI, and dose accumulation—the core enablers for daily planning on daily images.
WP3 – Intervention. We developed ultra-fast plan optimisation (daily plans in under a minute), a visualisation/approval tool for clinicians, and a 4D dose reconstruction engine to account for intra-fraction motion—together streamlining safe same-day plan adaptation.
WP4 – Verification. We advanced prompt-gamma imaging (PGI) and proton radiography/range probing (PR/RP) for near real-time treatment verification. Clinical data show PGI could cut range-uncertainty margins (e.g. from 7 mm to 3 mm) and can also act as a checker for CBCT-based adaptations. Joint PGI–PR tests confirmed complementary strengths. A 3D-printed end-to-end phantom and log-file–based dose reconstruction rounded out system tests.
The full workflow was exercised in structured end-to-end campaigns and translated clinically at PSI, where the first patients completed online-adaptive treatments using some of the RAPTOR-built components. Network-wide, the project produced 40+ peer-reviewed papers, extensive conference presentations (80+), and integrated tools with industrial partners—preparing broader uptake.
Exploitation and uptake. While no patents were filed, multiple software components (segmentation, sCT, optimisation, verification) are under evaluation for clinical integration and potential commercialisation with our industrial partners. RAPTOR outputs already influence practice (e.g. PSI clinical use; OncoRay preparing the DEPICT interventional trial using PGI). Continuation of the project is secured via the EU-MSCA-RAPTORplus project (from January 2026) to broaden clinical adoption and explore biologically triggered adaptation.
WP5- Dissemination. Dissemination combined classical and creative channels: 40+ publications, an open e-learning platform, a professionally produced comic-style explainer video, (30+) ESR video series, newsletters, and an active social-media presence (>150 linkedin post). A patient-engagement session at the Final Conference brought patient voices into scientific dialogue. These activities boosted visibility among clinicians, industry, policymakers and the public.
In sum, RAPTOR turned the vision of online adaptive proton therapy into a piloted clinically reality, created a skilled cohort ready to sustain it, and set up the pathways—technical, clinical and educational—for Europe-wide uptake.
RAPTOR moves beyond the state of the art by delivering an end-to-end workflow for online, real-time adaptive proton therapy. It links daily imaging (including synthetic-CT generation and automatic contouring) with ultra-fast plan re-optimisation and near real-time verification using prompt-gamma and range-probing methods, all validated through multi-centre end-to-end tests.
The expected impact is improved tumour control with fewer side effects, shorter and more reliable workflows, and more efficient use of clinical resources. The wider societal implications include advancing medical physics education and training, fostering sustained collaboration between academia and industry, and creating rich interdisciplinary opportunities for researchers. Together, these outcomes accelerate the transition to patient-centred radiotherapy, strengthen Europe’s innovation ecosystem, and lay the groundwork for broader, faster uptake of adaptive proton therapy in routine care.
The expected impact is improved tumour control with fewer side effects, shorter and more reliable workflows, and more efficient use of clinical resources. The wider societal implications include advancing medical physics education and training, fostering sustained collaboration between academia and industry, and creating rich interdisciplinary opportunities for researchers. Together, these outcomes accelerate the transition to patient-centred radiotherapy, strengthen Europe’s innovation ecosystem, and lay the groundwork for broader, faster uptake of adaptive proton therapy in routine care.