Impact of Proton Therapy Implementation on Processes, Patient Satisfaction, and Technology Use in a Radiation Therapy Department

Purpose: Because proton therapy (PT) can be regarded as a major radical innovation, its implementation in a radiation therapy (RT) department may have an adverse impact on processes. The current study aimed to investigate the effect of PT implementation on disruptions of clinical processes, patient satisfaction, and technology use. Materials and methods: The study was performed in an independent Dutch RT institute, where PT was implemented in February 2019. Endpoints were (1) process disruptions, (2) patient satisfaction, and (3) technology use. Causal inference and Wilcoxon rank-sum tests in R and MATLAB were used for the analyses. Results: After the implementation of PT, human-related errors and organizational culture-related errors in the photon therapy (PhT) process increased. Our empirical data showed more process disruptions associated with PT than with PhT. The implementation did not significantly affect patients' satisfaction. Analysis of technology use showed a decrease in PT uptime, including treatment stagnations lasting >= 2 days. The organizational process of the entire clinic was affected in the first 13 months after PT implementation because of significantly more process disruptions in PT compared to PhT and an increase in some distinct PhT process disruptions. The decrease in PT machine uptime below 95% caused treatment stagnation with consequences for patients and staffing. Conclusions: This study provides the first quantitative assessment of introducing PT in an ambidextrous, ambitious center that also runs PhT. Incident profiles shifted toward human-related errors in PhT and organizational issues in PT, with no lasting change in patient satisfaction. In conclusion, successful adoption requires stronger preparation and training, early patient engagement, and proactive planning for quality control, frequent updates, and lower initial uptime in partnership with vendors. (c) 2026 The Authors. Published by Elsevier Inc. on behalf of American Society for Radiation Oncology. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).