The cost of proton therapy equipment remains much higher than that of comparable conventional photon therapy equipment the long-anticipated economies of scale have not, as yet, materialized. Commercial proton delivery systems had been contemplated for decades before they finally appeared in 2001 after overcoming considerable difficulties. There are several reasons for this slow adoption of proton therapy, including technical difficulty, cost, and lack of evidence of cost-competitiveness. The widespread adoption of proton therapy has been slow in comparison to, for example, intensity-modulated photon therapy. During the same period, physicists elsewhere were developing other key technologies, including accelerators, magnetically scanned beams, treatment planning systems, computed tomographic imaging (CT), and magnetic resonance imaging. Remarkably, the research and development program at Harvard continued for more than 40 years ( Wilson, 2004). Physicists at Harvard, collaborating with clinical colleagues at Massachusetts General Hospital, the Massachusetts Eye and Ear Infirmary, and elsewhere, developed much of the physics and technology needed to treat patients with proton beams safely and effectively. In 1962, specialized radiosurgical proton treatments commenced at the Harvard Cyclotron Laboratory ( Kjellberg et al, 1962a Kjellberg et al, 1962b), followed in the mid 1970s by treatments for ocular cancers ( Gragoudas et al, 1982) and larger tumors ( Koehler et al, 1977). In 1954, the first human was treated with proton beams at the Lawrence Berkeley Laboratory ( Lawrence et al, 1958). In that paper, he explained the biophysical rationale for proton therapy as well as the key engineering techniques of beam delivery. The history of proton therapy began in 1946 when Robert Wilson published a seminar paper in which he proposed to use accelerator-produced beams of protons to treat deep-seated tumors in humans ( Wilson, 1946).
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