This paper analyzes the current state of clinical application of proton radiation therapy (PRT) for the treatment of cancer. In particular, the indications for the use of PRT for the treatment of specific pathologies, the results and condition of randomized clinical studies of PRT compared to photon radiation therapy (PhRT) are considered, the cost of PRT is compared with the cost of PhRT. The focus is on discussing the results of PRT using in advanced countriesand Russia for the treatment of several common tumor sites. In the conclusion of the work, the ways of further improvement of radiobiology, dose delivering technology and dosimetric support of PRT are considered.

Purpose: Due to the necessity of improving the education of medical workers it is vital to conduct a review of the current state of training for work associated with the use of high-tech equipment and the use of radiopharmaceuticals for nuclear medicine. Results: To ensure the availability of modern, high-quality medical care, oriented to world standards, it should be considered that the necessary conditions are based not only on the development of medical science and technology, material and technical equipment, but also on the provision of highly qualified personnel with a certain set of competencies. Currently, the training and professional development of personnel for this area is carried out at all levels of vocational education: secondary and higher in accordance with the Lists of specialties and areas of vocational education. At the same time, the issues of developing and approving relevant professional standards and Federal state educational standards (FSES) for the needs of nuclear medicine remain unsolved, which in turn is one of the factors that reduce the demand for specialists in this field in the labor market. At the same time, the issues of developing and approving relevant professional standards and FSES for the needs of nuclear medicine remain unsolved, which in turn is one of the factors that reduce the demand for specialists in this field on the labor market. The personnel crisis is overcome due to the implementation of additional professional programs and practical training at the bases of leading scientific, clinical and educational institutions that are leaders in the field of nuclear medicine and radiopharmaceuticals. Conclusion: In order to address the shortage of personnel for such a booming industry, a clear coordinated plan is needed, which would include systematic measures to train personnel both at the undergraduate level and to improve already prepared specialists. In addition, it is necessary to prepare a pool of highly qualified faculty for training specialists of a new formation. It is necessary to create federal educational standards taking into account that the current state of medical science and on the basis of professional standards. Work in this direction can be successful only if all stakeholders are actively involved: educational organizations, the professional community and government structures. At the same time, it is an obvious fact that, before the adoption of professional standards and the FSES, the available experience of leading scientific and educational organizations in the training of specialists should be adopted and they should receive support and development.

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The most important stage of radiation therapy of oncological diseases is the planning of radiation treatment. In this work, this complex process in relation to proton therapy is proposed to be divided into medical and physical planning. In conventional therapy with photons and electrons, the latter is usually called dosimetric planning, however, when applied to proton radiation therapy, this stage involves a significantly wider range of tasks related to the modification and scanning of the proton beam, spreading and compensation of ranges, taking into account when planning for uncertainties and finiteness of proton ranges, a decrease in the contribution to the dose of secondary neutrons, the creation of error-tolerant optimization algorithms for dosimetric plans, and, finally, a precision calculation of dose distributions. The paper discusses the main stages and problems of physical planning of proton radiation therapy. Particular attention is paid to the formation of an extended high-dose region (extended Bragg peak) using the beam scattering method and scanning method, and to the algorithms for calculating the dose distributions created by protons in the scattering and beam scanning systems. The most detailed consideration is given to different versions of the proton pencil beam method, which allows to increase the dose calculation accuracy and take into account the transverse scattering and fluctuations in proton energy losses, especially at the end of the path (halo effect), analytical and numerical methods. Scanning are divided into three main technologies: homogeneous scanning, single field uniform dose (SFUD), multi-field uniform dose (MFUD), often called intensity modulated proton therapy (IMPT). Actual accounting problems are considered when planning the irradiation of the movement of organs, and uncertainties in determining path lengths and optimization of irradiation plans. In particular features, problems and modern approaches to the optimization of dosimetry plans of proton radiation therapy are discussed. It is noted that one of the most promising practical solutions for the uncertainty management in determining the path lengths of protons in optimization is to include possible errors in the objective function of the optimization algorithm. This technique ensures that an optimized irradiation plan will more reliably protect normal tissues and critical organs adjacent to the irradiation target from overexposure.