Upright Radiotherapy Takes Centre Stage at AAPM 2026

There are moments that quietly signal when an idea is becoming something much bigger.

For those following the progress of upright radiotherapy, the 68th Annual Meeting of the American Association of Physicists in Medicine (AAPM) was one of those moments.

This year’s scientific program featured nine peer-reviewed presentations from Stanford University exploring different aspects of upright proton therapy. Spanning clinical implementation, imaging, treatment planning, patient experience and artificial intelligence, the program reflected not just the breadth of research now underway, but the growing maturity of upright radiotherapy as a clinical field.

It is always exciting to see Upright Radiotherapy take center stage at events such as this and we are especially proud to see our collaborators at Stanford sharing the work they have undertaken following the installation of their upright proton therapy system.

Earlier this year, together with the Stanford team and Mevion Medical Systems, we celebrated an extraordinary milestone when the first patient was treated using the Marie® upright patient positioning system integrated with the MEVION S250-FIT proton therapy platform. That achievement represented years of collaboration between engineers, physicists, clinicians and researchers. Seeing that clinical experience now contributing to the scientific program at AAPM demonstrates how quickly the field is progressing.

Building the Evidence

The Stanford program at AAPM this year is particularly impressive due to its breadth.

Rather than focusing on a single aspect of upright treatment, the presentations, symposiums and posters examined nearly every stage of the clinical pathway.

The invited symposium, “Future of Proton Systems: Upright Proton Therapy,” presented by Dr Serdar Charyyev, explored the commissioning experience of the world’s first ultra-compact upright proton therapy system and discussed the opportunities that upright treatment may offer as the technology continues to evolve.

In one of the oral presentations, Dr Yong Yang presented “Benchmarking a New Paradigm: Commissioning and Validation of the First Ultra-Compact Upright Proton Therapy System.” The work demonstrated mechanical and dosimetric accuracy comparable to conventional gantry-based proton systems while validating the complete upright treatment platform.

Another oral presentation by Dr Vivek Jaysukhlal Maradia explored ultra-fast proton delivery for lung cancer. “High-Speed Proton Therapy in a Short Breath-Hold” demonstrated a clinically feasible framework capable of delivering an entire treatment field in under 10 seconds, opening exciting possibilities for motion management and patient comfort.

Looking Beyond the Treatment Room

Several presentations focused on technologies that support upright treatment.

Research led by Dr Zhuoran Jiang evaluated the performance of an integrated upright CT, demonstrating image quality comparable to that of a state-of-the-art diagnostic CT, and explored data-efficient image registration using large-scale vision models for upright radiotherapy workflows.

Artificial intelligence also featured highly. Lloyd Emmanuel Kamole Ghomsi presented research investigating transformer-based synthetic CT generation from MRI, supporting future MR-only proton therapy planning.

The program also addressed practical questions surrounding implementation. Dr Serdar Charyyev presented work demonstrating that a compact proton therapy system can be safely installed within a standard LINAC footprint without compromising neighboring treatment systems, an important consideration for centers exploring future proton therapy adoption.

Keeping Patients at the Heart of Innovation

While many presentations explored technical advances, patient care remained a consistent theme.

Daniel Pham presented research comparing upright proton therapy with conventional supine photon treatment for prostate cancer, reporting reductions in dose to critical organs in the upright proton plans.

Equally inspiring was the work presented by Megan Clark, who described a comprehensive approach to pediatric upright proton therapy. The presentation combined innovative engineering with thoughtful patient-centered design, introducing a novel tilting chair for anesthesia, immersive audiovisual distraction for awake children and educational tools to help reduce anxiety before treatment. It is a powerful reminder that innovation is not only about technology but also about creating better experiences for patients and families.

A Growing Global Community

An encouraging aspect of this year’s AAPM meeting is what it represents for the wider upright radiotherapy community.

Not long ago, upright radiotherapy was viewed as an emerging concept. Today, it is the focus of invited symposium sessions and a growing body of peer-reviewed scientific research covering physics, engineering, imaging, artificial intelligence and patient-centred care.

For everyone working to advance upright radiotherapy, from researchers and clinicians to engineers and industry partners, this growing evidence base is an important step forward.

Congratulations to everyone at Stanford University who contributed to this outstanding body of work, and thank you for continuing to push the boundaries of what is possible in radiotherapy. We are incredibly proud to be working alongside you as upright radiotherapy continues its journey from innovative concept to clinical reality.