Recent advances in applying machine learning to proton radiotherapy.

Background.Objectives: In radiation oncology, precision and timeliness of both planning and treatment are paramount values of patient care. Machine learning has increasingly been applied to various aspects of photon radiotherapy to reduce manual error and improve the efficiency of clinical decision making; however, applications to proton therapy remain an emerging field in comparison. This systematic review aims to comprehensively cover all current and potential applications of machine learning to the proton therapy clinical workflow, an area that has not been extensively explored in literature.Methods: PubMed and Embase were utilized to identify studies pertinent to machine learning in proton therapy between 2019 to 2024. An initial search on PubMed was made with the search strategy ''proton therapy', 'machine learning', 'deep learning''. A subsequent search on Embase was made with '('proton therapy') AND ('machine learning' OR 'deep learning')'. In total, 38 relevant studies have been summarized and incorporated.Results: It is observed that U-Net architectures are prevalent in the patient pre-screening process, while convolutional neural networks play an important role in dose and range prediction. Both image quality improvement and transformation between modalities to decrease extraneous radiation are popular targets of various models. To adaptively improve treatments, advanced architectures such as general deep inception or deep cascaded convolution neural networks improve online dose verification and range monitoring.Conclusions: With the rising clinical usage of proton therapy, machine learning models have been increasingly proposed to facilitate both treatment and discovery. Significantly improving patient screening, planning, image quality, and dose and range calculation, machine learning is advancing the precision and personalization of proton therapy.