Technological developments allowing for the widespread clinical adoption of proton radiotherapy

External beam radiation therapy using accelerated protons has undergone significant development since the first patients were treated with accelerated protons in 1954. Widespread adoption of proton therapy is now taking place and is fully justified based on early clinical and technical research and development. Two of the main advantages of proton radiotherapy are improved healthy tissue sparing and increased dose conformation. The latter has been improved dramatically through the clinical realization of Pencil Beam Scanning (PBS). Other significant advancements in the past 30 years have also helped to establish proton radiotherapy as a major clinical modality in the cancer-fighting arsenal. Proton radiotherapy technologies are constantly evolving, and several major breakthroughs have been accomplished which could allow for a major revolution in proton therapy if clinically implemented. In this thesis, I will present research and innovative developments that I personally initiated or participated in that brought proton radiotherapy to its current state as well as my ongoing involvement in leading research and technological developments which will aid in the mass adoption of proton radiotherapy. These include beam dosimetry, patient positioning technologies, and creative methods that verify the Monte Carlo dose calculations which are now used in proton treatment planning. I will also discuss major technological advances concerning beam delivery that should be implemented clinically and new paradigms towards patient positioning. Many of these developments and technologies can benefit the cancer patient population worldwide and are now ready for mass clinical implementation. These developments will improve proton radiotherapy efficiencies and further reduce the cost of proton therapy facilities. This thesis therefore reflects my historical and ongoing efforts to meet market costs and time demands so that the clinical benefit of proton radiotherapy can be realized by a more significant fraction of cancer patients worldwide