{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T17:57:26Z","timestamp":1792000646535,"version":"4.4.0"},"reference-count":21,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Multi-room proton therapy centers face unique operational challenges related to shared beam delivery systems, extended treatment hours, and high clinical complexity. This study presents a structured framework of key performance indicators (KPIs) and reports longitudinal single-institution operational reference data from a multi-room proton therapy center to support operational assessment and continuous quality improvement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods and materials<\/jats:title>\n                    <jats:p>Operational KPIs were retrospectively evaluated for calendar year 2024 at a three-room proton therapy center utilizing pencil beam scanning. KPIs were categorized into three areas: beam performance, treatment planning and pre-treatment workflow, and treatment room operations. Beam performance metrics included site- and room-specific uptime and beam pauses. Treatment planning metrics quantified CT simulation\u2013to\u2013patient scheduling timelines with attribution to physician, dosimetry, and physics components. Treatment room operations metrics included appointment variance, slot utilization, and waiting-for-beam (WFB) time. Data were collected automatically using a commercial analytics platform integrating radio-frequency identification tracking and oncology information system. Metrics were analyzed longitudinally and stratified by treatment room, disease site, and workflow component.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>For calendar year 2024, aggregate site uptime was 95.3%, weighted according to clinical operating time across the three treatment rooms; individual room uptimes ranged from 91.8% to 97.2%. Beam pauses were frequent but brief, resulting in 2,238 minutes of cumulative lost treatment time across 2024, equivalent to approximately 0.5% of total clinical operating time. Annual mean treatment planning time was 8.5 business days, with physician-related activities contributing the greatest variability across disease sites. Monthly average appointment variance ranged from 5 to 11 minutes, with most treatments initiated within 10 minutes of scheduled time. Across 2024, slot utilization was stable, with 73% of fractions completed within scheduled slots. Mean overrun and underrun durations were modest, although P90 overrun durations exceeded 10 minutes throughout the year. Mean WFB times were low and consistent, ranging from 1.5 to 2.3 minutes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study presents a practical KPI framework and a single-institution operational reference data for multi-room proton therapy center. These metrics may support longitudinal monitoring, identification of workflow inefficiencies, data-driven decision-making, and future multi-institutional benchmarking efforts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0360926","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T17:37:04Z","timestamp":1791999424000},"page":"e0360926","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["An operational key performance indicator framework and reference data from a multi-room pencil beam scanning proton therapy center"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-6280-7179","authenticated-orcid":true,"given":"Jatinder","family":"Saini","sequence":"first","affiliation":[{"name":"University of Washington School of Medicine","place":["Seattle, Washington, United States of America"],"department":["Department of Radiation Oncology"]},{"name":"Fred Hutchinson Cancer Center-Proton Therapy","place":["Seattle, Washington, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tony","family":"Wong","sequence":"additional","affiliation":[{"name":"University of Washington School of Medicine","place":["Seattle, Washington, United States of America"],"department":["Department of Radiation Oncology"]},{"name":"Fred Hutchinson Cancer Center-Proton Therapy","place":["Seattle, Washington, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Schwarz","sequence":"additional","affiliation":[{"name":"University of Washington School of Medicine","place":["Seattle, Washington, United States of America"],"department":["Department of Radiation Oncology"]},{"name":"Fred Hutchinson Cancer Center-Proton Therapy","place":["Seattle, Washington, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Randall","family":"McClure","sequence":"additional","affiliation":[{"name":"Fred Hutchinson Cancer Center-Proton Therapy","place":["Seattle, Washington, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4469-0889","authenticated-orcid":true,"given":"Annemarie","family":"Shepherd","sequence":"additional","affiliation":[{"name":"University of Washington School of Medicine","place":["Seattle, Washington, United States of America"],"department":["Department of Radiation Oncology"]},{"name":"Fred Hutchinson Cancer Center-Proton Therapy","place":["Seattle, Washington, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Zeng","sequence":"additional","affiliation":[{"name":"University of Washington School of Medicine","place":["Seattle, Washington, United States of America"],"department":["Department of Radiation Oncology"]},{"name":"Fred Hutchinson Cancer Center-Proton Therapy","place":["Seattle, Washington, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramesh","family":"Rengan","sequence":"additional","affiliation":[{"name":"University of Washington School of Medicine","place":["Seattle, Washington, United States of America"],"department":["Department of Radiation Oncology"]},{"name":"Fred Hutchinson Cancer Center-Proton Therapy","place":["Seattle, Washington, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,14]]},"reference":[{"key":"pone.0360926.ref001","author":"National Association for Proton Therapy"},{"issue":"7","key":"pone.0360926.ref002","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1038\/nrclinonc.2013.79","article-title":"Charged particle therapy--optimization, challenges and future directions","volume":"10","author":"JS Loeffler","year":"2013","journal-title":"Nat Rev Clin Oncol"},{"issue":"1","key":"pone.0360926.ref003","article-title":"Clinical commissioning of intensity-modulated proton therapy systems: Report of AAPM Task Group 185","volume":"48","author":"JB Farr","year":"2021","journal-title":"Med Phys"},{"issue":"8","key":"pone.0360926.ref004","doi-asserted-by":"crossref","DOI":"10.1002\/mp.13622","article-title":"AAPM task group 224: Comprehensive proton therapy machine quality assurance","volume":"46","author":"B Arjomandy","year":"2019","journal-title":"Medical Physics"},{"key":"pone.0360926.ref005","volume-title":"PTCOG Report #2: PTCOG Safety Group Report on Aspects of Safety in Particle Therapy","author":"J Flanz","year":"2016"},{"key":"pone.0360926.ref006","volume-title":"White paper on particle therapy efficiency: aspects of quality assurance","author":"J Flanz","year":"2016"},{"issue":"6","key":"pone.0360926.ref007","doi-asserted-by":"crossref","first-page":"3968","DOI":"10.1120\/jacmp.v13i6.3968","article-title":"Impact of proton beam availability on patient treatment schedule in radiation oncology","volume":"13","author":"ED Miller","year":"2012","journal-title":"J Appl Clin Med Phys"},{"issue":"7","key":"pone.0360926.ref008","doi-asserted-by":"crossref","first-page":"3975","DOI":"10.1118\/1.4952731","article-title":"Quantitative analysis of treatment process time and throughput capacity for spot scanning proton therapy","volume":"43","author":"K Suzuki","year":"2016","journal-title":"Med Phys"},{"issue":"7","key":"pone.0360926.ref009","doi-asserted-by":"crossref","first-page":"4329","DOI":"10.1118\/1.3604153","article-title":"Quantitative analysis of beam delivery parameters and treatment process time for proton beam therapy","volume":"38","author":"K Suzuki","year":"2011","journal-title":"Med Phys"},{"issue":"8","key":"pone.0360926.ref010","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1007\/s10916-021-01756-1","article-title":"Reduce patient treatment wait time in a proton beam facility - a gatekeeper approach","volume":"45","author":"YL Huang","year":"2021","journal-title":"J Med Syst"},{"issue":"1020","key":"pone.0360926.ref011","doi-asserted-by":"crossref","DOI":"10.1259\/bjr\/27428078","article-title":"Modelling the throughput capacity of a single-accelerator multitreatment room proton therapy centre","volume":"85","author":"AH Aitkenhead","year":"2012","journal-title":"Br J Radiol"},{"key":"pone.0360926.ref012","doi-asserted-by":"crossref","first-page":"101208","DOI":"10.1016\/j.ijpt.2025.101208","article-title":"Benchmarking modern day pencil beam scanning proton therapy treatment times: Insights from real time location service treatment time data","volume":"18","author":"K McConnell","year":"2025","journal-title":"Int J Part Ther"},{"issue":"1107","key":"pone.0360926.ref013","doi-asserted-by":"crossref","first-page":"20190820","DOI":"10.1259\/bjr.20190820","article-title":"Retrospective analysis of reduced energy switching and room switching times on throughput efficiency of a multi-room proton therapy center","volume":"93","author":"D Mah","year":"2020","journal-title":"Br J Radiol"},{"issue":"6","key":"pone.0360926.ref014","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1016\/j.clon.2017.01.039","article-title":"Reducing patient waiting times for radiation therapy and improving the treatment planning process: A discrete-event simulation model (radiation treatment planning)","volume":"29","author":"V Babashov","year":"2017","journal-title":"Clin Oncol (R Coll Radiol)"},{"issue":"6","key":"pone.0360926.ref015","doi-asserted-by":"crossref","first-page":"101261","DOI":"10.1016\/j.adro.2023.101261","article-title":"Process modeling a radiation oncology clinic workflow from therapeutic simulation to treatment: Identifying impending strain and possible treatment delays","volume":"8","author":"VK Chowdhry","year":"2023","journal-title":"Adv Radiat Oncol"},{"key":"pone.0360926.ref016","unstructured":"Hutchinson F. Equipment, treatment rooms & software \u2014 Proton therapy. Fred Hutch. https:\/\/www.fredhutch.org\/en\/patient-care\/treatments\/proton-therapy\/getting-treatment\/equipment-treatment-rooms-software.html#:~:text=The%20delivery%20system%20doesn\u2019t,used%20to%20require%20a%20gantry Accessed 2025 December 31."},{"key":"pone.0360926.ref017","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.ejmp.2020.10.027","article-title":"Validation and practical implementation of seated position radiotherapy in a commercial TPS for proton therapy","volume":"80","author":"D Maes","year":"2020","journal-title":"Phys Med"},{"issue":"1","key":"pone.0360926.ref018","doi-asserted-by":"crossref","first-page":"51","DOI":"10.14338\/IJPT-16-0000.1","article-title":"Clinical commissioning of a pencil beam scanning treatment planning system for proton therapy","volume":"3","author":"J Saini","year":"2016","journal-title":"Int J Part Ther"},{"issue":"19","key":"pone.0360926.ref019","doi-asserted-by":"crossref","first-page":"7659","DOI":"10.1088\/1361-6560\/aa82a5","article-title":"Dosimetric evaluation of a commercial proton spot scanning Monte-Carlo dose algorithm: Comparisons against measurements and simulations","volume":"62","author":"J Saini","year":"2017","journal-title":"Phys Med Biol"},{"issue":"1","key":"pone.0360926.ref020","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1186\/s13014-025-02756-y","article-title":"Implementing ocular treatment with pencil beam scanning: The FHCC experience","volume":"20","author":"J Saini","year":"2025","journal-title":"Radiat Oncol"},{"issue":"1","key":"pone.0360926.ref021","doi-asserted-by":"crossref","first-page":"4648","DOI":"10.1038\/s41598-022-08440-5","article-title":"Treatment of ocular tumors through a novel applicator on a conventional proton pencil beam scanning beamline","volume":"12","author":"R Regmi","year":"2022","journal-title":"Sci Rep"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0360926","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T17:37:08Z","timestamp":1791999428000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0360926"}},"subtitle":[],"editor":[{"given":"Suhairul","family":"Hashim","sequence":"first","affiliation":[{"name":"Universiti Teknologi Malaysia - Main Campus Skudai: Universiti Teknologi Malaysia","place":["MALAYSIA"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,10,14]]},"references-count":21,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,10,14]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0360926","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,14]]}}}