Patent Publication Number: US-10307617-B2

Title: Charged particle ? patient motion control system apparatus and method of use there

Description:
CROSS-REFERENCES TO RELATED APPLICATIONS 
     This application is a continuation of U.S. patent application Ser. No. 15/176,025 filed Jun. 7, 2016, which is a continuation-in-part of U.S. patent application Ser. No. 15/167,617 filed May 27, 2016, which is:
         a continuation-in-part of U.S. patent application Ser. No. 15/152,479 filed May 11, 2016, which:
           is a continuation-in-part of U.S. patent application Ser. No. 14/216,788 filed Mar. 17, 2014,
               which is a continuation-in-part of U.S. patent application Ser. No. 13/087,096 filed Apr. 14, 2011, which claims benefit of U.S. provisional patent application No. 61/324,776 filed Apr. 16, 2010; and   is a continuation-in-part of U.S. patent application Ser. No. 13/788,890 filed Mar. 7, 2013;   
               is a continuation-in-part of U.S. patent application Ser. No. 14/952,817 filed Nov. 25, 2015, which is a continuation-in-part of U.S. patent application Ser. No. 14/293,861 filed Jun. 2, 2014, which is a continuation-in-part of U.S. patent application Ser. No. 12/985,039 filed Jan. 5, 2011, which claims the benefit of U.S. provisional patent application No. 61/324,776, filed Apr. 16, 2010;   is a continuation-in-part of U.S. patent application Ser. No. 14/860,577 filed Sep. 21, 2015, which is a continuation of U.S. patent application Ser. No. 14/223,289 filed Mar. 24, 2014, which is a continuation-in-part of U.S. patent application Ser. No. 14/216,788 filed Mar. 17, 2014, which is a continuation-in-part of U.S. patent application Ser. No. 12/985,039 filed Jan. 5, 2011, which claims the benefit of U.S. provisional patent application No. 61/324,776, filed Apr. 16, 2010; and   is a continuation-in-part U.S. patent application Ser. No. 15/073,471 filed Mar. 17, 2016, which claims benefit of U.S. provisional patent application No. 62/304,839 filed Mar. 7, 2016,   
           is a continuation-in-part of U.S. patent application Ser. No. 14/860,577 filed Sep. 21, 2015, which is a continuation of U.S. patent application Ser. No. 14/223,289 filed Mar. 24, 2014, which is a continuation-in-part of U.S. patent application Ser. No. 14/216,788 filed Mar. 17, 2014, which is a continuation-in-part of U.S. patent application Ser. No. 13/572,542 filed Aug. 10, 2012, which is a continuation-in-part of U.S. patent application Ser. No. 12/425,683 filed Apr. 17, 2009, which claims the benefit of U.S. provisional patent application No. 61/055,395 filed May 22, 2008, now U.S. Pat. No. 7,939,809 B2;   all of which are incorporated herein in their entirety by this reference thereto.       

    
    
     BACKGROUND OF THE INVENTION 
     Field of the Invention 
     This invention relates generally to imaging and/or treatment of solid cancers. More particularly, the invention relates to control of a charged particle beam state, such as charged particle position, direction, intensity, density, energy, and/or distribution and/or positioning control of a patient. 
     Discussion of the Prior Art 
     Cancer Treatment 
     Proton therapy works by aiming energetic ionizing particles, such as protons accelerated with a particle accelerator, onto a target tumor. These particles damage the DNA of cells, ultimately causing their death. Cancerous cells, because of their high rate of division and their reduced ability to repair damaged DNA, are particularly vulnerable to attack on their DNA. 
     Patents related to the current invention are summarized here. 
     Proton Beam Therapy System 
     F. Cole, et. al. of Loma Linda University Medical Center “Multi-Station Proton Beam Therapy System”, U.S. Pat. No. 4,870,287 (Sep. 26, 1989) describe a proton beam therapy system for selectively generating and transporting proton beams from a single proton source and accelerator to a selected treatment room of a plurality of patient treatment rooms. 
     Imaging 
     P. Adamee, et. al. “Charged Particle Beam Apparatus and Method for Operating the Same”, U.S. Pat. No. 7,274,018 (Sep. 25, 2007) and P. Adamee, et. al. “Charged Particle Beam Apparatus and Method for Operating the Same”, U.S. Pat. No. 7,045,781 (May 16, 2006) describe a charged particle beam apparatus configured for serial and/or parallel imaging of an object. 
     K. Hiramoto, et. al. “Ion Beam Therapy System and its Couch Positioning System”, U.S. Pat. No. 7,193,227 (Mar. 20, 2007) describe an ion beam therapy system having an X-ray imaging system moving in conjunction with a rotating gantry. 
     C. Maurer, et. al. “Apparatus and Method for Registration of Images to Physical Space Using a Weighted Combination of Points and Surfaces”, U.S. Pat. No. 6,560,354 (May 6, 2003) described a process of X-ray computed tomography registered to physical measurements taken on the patient&#39;s body, where different body parts are given different weights. Weights are used in an iterative registration process to determine a rigid body transformation process, where the transformation function is used to assist surgical or stereotactic procedures. 
     M. Blair, et. al. “Proton Beam Digital Imaging System”, U.S. Pat. No. 5,825,845 (Oct. 20, 1998) describe a proton beam digital imaging system having an X-ray source that is movable into a treatment beam line that can produce an X-ray beam through a region of the body. By comparison of the relative positions of the center of the beam in the patient orientation image and the isocentre in the master prescription image with respect to selected monuments, the amount and direction of movement of the patient to make the best beam center correspond to the target isocentre is determined. 
     S. Nishihara, et. al. “Therapeutic Apparatus”, U.S. Pat. No. 5,039,867 (Aug. 13, 1991) describe a method and apparatus for positioning a therapeutic beam in which a first distance is determined on the basis of a first image, a second distance is determined on the basis of a second image, and the patient is moved to a therapy beam irradiation position on the basis of the first and second distances. 
     Problem 
     There exists in the art of charged particle irradiation therapy a need to know and/or control position, direction, energy, intensity, and/or cross-sectional area or shape of the charged particle beam relative to a patient position, where the controls are individualized to individual patients and/or individual tumor shapes. 
     SUMMARY OF THE INVENTION 
     The invention comprises a motion control system used to control a charged particle beam shape and direction relative to a patient and/or imaging system. 
    
    
     
       DESCRIPTION OF THE FIGURES 
       A more complete understanding of the present invention is derived by referring to the detailed description and claims when considered in connection with the Figures, wherein like reference numbers refer to similar items throughout the Figures. 
         FIG. 1A  and  FIG. 1B  illustrate component connections of a charged particle beam therapy system; 
         FIG. 2  illustrates a charged particle therapy system; 
         FIG. 3  illustrates a method of multi-axis charged particle beam irradiation control; 
         FIG. 4A  and  FIG. 4B  illustrate a top view of a beam control tray and a side view of the beam control tray, respectively. 
         FIG. 5  illustrates patient specific tray inserts for insertion into the beam control tray; 
         FIG. 6A  illustrates insertion of the individualized tray assembly into the beam path and  FIG. 6B  illustrates retraction of the tray assembly into a nozzle of the charged particle cancer therapy system; 
         FIG. 7  illustrates a tomography system; 
         FIG. 8  illustrates a beam path identification system; 
         FIG. 9A  illustrates a beam path identification system coupled to a beam transport system and a tomography scintillation detector and  FIG. 9B  illustrates the scintillation detector rotating with the patient and gantry nozzle; 
         FIG. 10  illustrates a treatment delivery control system; 
         FIG. 11  illustrates beam state determination systems; and 
         FIG. 12A  and  FIG. 12B  illustrate control of a patient interface system with a pendant and work-flow control system, respectively. 
     
    
    
     Elements and steps in the figures are illustrated for simplicity and clarity and have not necessarily been rendered according to any particular sequence. For example, steps that are performed concurrently or in different order are illustrated in the figures to help improve understanding of embodiments of the present invention. 
     DETAILED DESCRIPTION OF THE INVENTION 
     The invention relates generally to control of a charged particle beam shape and direction relative to a patient position and/or an imaging surface, such as a scintillation plate of a tomography system. 
     In one embodiment, multiple linked control stations are used to control position of elements of a beam transport system, nozzle, and/or patient specific beam shaping element relative to a dynamically controlled patient position and/or an imaging surface, element, or system. 
     In another embodiment, a tomography system is optionally used in combination with a charged particle cancer therapy system. Optionally and preferably, a common injector, accelerator, and beam transport system is used for both charged particle based tomographic imaging and charged particle cancer therapy. In one case, an output nozzle of the beam transport system is positioned with a gantry system while the gantry system and/or a patient support maintains a scintillation plate of the tomography system on the opposite side of the patient from the output nozzle. 
     In another example, a charged particle state determination system, of a cancer therapy system or tomographic imaging system, uses one or more coated layers in conjunction with a scintillation detector or a tomographic imaging system at time of tumor and surrounding tissue sample mapping and/or at time of tumor treatment, such as to determine an input vector of the charged particle beam into a patient and/or an output vector of the charged particle beam from the patient. 
     In another example, the charged particle tomography apparatus is used in combination with a charged particle cancer therapy system. For example, tomographic imaging of a cancerous tumor is performed using charged particles generated with an injector, accelerator, and guided with a delivery system. The cancer therapy system uses the same injector, accelerator, and guided delivery system in delivering charged particles to the cancerous tumor. For example, the tomography apparatus and cancer therapy system use a common raster beam method and apparatus for treatment of solid cancers. More particularly, the invention comprises a multi-axis and/or multi-field raster beam charged particle accelerator used in: (1) tomography and (2) cancer therapy. Optionally, the system independently controls patient translation position, patient rotation position, two-dimensional beam trajectory, delivered radiation beam energy, delivered radiation beam intensity, beam velocity, timing of charged particle delivery, and/or distribution of radiation striking healthy tissue. The system operates in conjunction with a negative ion beam source, synchrotron, patient positioning, imaging, and/or targeting method and apparatus to deliver an effective and uniform dose of radiation to a tumor while distributing radiation striking healthy tissue. 
     In another embodiment, a treatment delivery control system (TDCS) or main controller is used to control multiple aspects of the cancer therapy system, including one or more of: an imaging system, such as a CT or PET; a positioner, such as a couch or patient interface module; an injector or injection system; a radio-frequency quadrupole system; a ring accelerator or synchrotron; an extraction system; an irradiation plan; and a display system. The TDCS is preferably a control system for automated cancer therapy once the patient is positioned. The TDCS integrates output of one or more of the below described cancer therapy system elements with inputs of one or more of the below described cancer therapy system elements. More generally, the TDCS controls or manages input and/or output of imaging, an irradiation plan, and charged particle delivery. 
     In yet another embodiment, one or more trays are inserted into the positively charged particle beam path, such as at or near the exit port of a gantry nozzle in close proximity to the patient. Each tray holds an insert, such as a patient specific insert for controlling the energy, focus depth, and/or shape of the charged particle beam. Examples of inserts include a range shifter, a compensator, an aperture, a ridge filter, and a blank. Optionally and preferably, each tray communicates a held and positioned insert to a main controller of the charged particle cancer therapy system. The trays optionally hold one or more of the imaging sheets configured to emit light upon transmission of the charged particle beam through a corresponding localized position of the one or more imaging sheets. 
     Charged Particle Beam Therapy 
     Throughout this document, a charged particle beam therapy system, such as a proton beam, hydrogen ion beam, or carbon ion beam, is described. Herein, the charged particle beam therapy system is described using a proton beam. However, the aspects taught and described in terms of a proton beam are not intended to be limiting to that of a proton beam and are illustrative of a charged particle beam system, a positively charged beam system, and/or a multiply charged particle beam system, such as C 4+  or C 6+ . Any of the techniques described herein are equally applicable to any charged particle beam system. 
     Referring now to  FIG. 1A , a charged particle beam system  100  is illustrated. The charged particle beam preferably comprises a number of subsystems including any of: a main controller  110 ; an injection system  120 ; a synchrotron  130  that typically includes: (1) an accelerator system  132  and (2) an internal or connected extraction system  134 ; a beam transport system  135 ; a scanning/targeting/delivery system  140 ; a patient interface module  150 ; a display system  160 ; and/or an imaging system  170 . 
     An exemplary method of use of the charged particle beam system  100  is provided. The main controller  110  controls one or more of the subsystems to accurately and precisely deliver protons to a tumor of a patient. For example, the main controller  110  obtains an image, such as a portion of a body and/or of a tumor, from the imaging system  170 . The main controller  110  also obtains position and/or timing information from the patient interface module  150 . The main controller  110  optionally controls the injection system  120  to inject a proton into a synchrotron  130 . The synchrotron typically contains at least an accelerator system  132  and an extraction system  134 . The main controller  110  preferably controls the proton beam within the accelerator system, such as by controlling speed, trajectory, and timing of the proton beam. The main controller then controls extraction of a proton beam from the accelerator through the extraction system  134 . For example, the controller controls timing, energy, and/or intensity of the extracted beam. The controller  110  also preferably controls targeting of the proton beam through the scanning/targeting/delivery system  140  to the patient interface module  150 . One or more components of the patient interface module  150 , such as translational and rotational position of the patient, are preferably controlled by the main controller  110 . Further, display elements of the display system  160  are preferably controlled via the main controller  110 . Displays, such as display screens, are typically provided to one or more operators and/or to one or more patients. In one embodiment, the main controller  110  times the delivery of the proton beam from all systems, such that protons are delivered in an optimal therapeutic manner to the tumor of the patient. 
     Herein, the main controller  110  refers to a single system controlling the charged particle beam system  100 , to a single controller controlling a plurality of subsystems controlling the charged particle beam system  100 , or to a plurality of individual controllers controlling one or more sub-systems of the charged particle beam system  100 . 
     Example I 
     Charged Particle Cancer Therapy System Control 
     Referring now to  FIG. 1B , an example of a charged particle cancer therapy system  100  is provided. A main controller receives input from one, two, three, or four of a respiration monitoring and/or controlling controller  180 , a beam controller  185 , a rotation controller  147 , and/or a timing to a time period in a respiration cycle controller  148 . The beam controller  185  preferably includes one or more or a beam energy controller  182 , the beam intensity controller  340 , a beam velocity controller  186 , and/or a horizontal/vertical beam positioning controller  188 . The main controller  110  controls any element of the injection system  120 ; the synchrotron  130 ; the scanning/targeting/delivery system  140 ; the patient interface module  150 ; the display system  160 ; and/or the imaging system  170 . For example, the respiration monitoring/controlling controller  180  controls any element or method associated with the respiration of the patient; the beam controller  185  controls any of the elements controlling acceleration and/or extraction of the charged particle beam; the rotation controller  147  controls any element associated with rotation of the patient  830  or gantry; and the timing to a period in respiration cycle controller  148  controls any aspects affecting delivery time of the charged particle beam to the patient. As a further example, the beam controller  185  optionally controls any magnetic and/or electric field about any magnet in the charged particle cancer therapy system  100 . One or more beam state sensors  190  sense position, direction, intensity, and/or energy of the charged particles at one or more positions in the charged particle beam path. A tomography system  700 , described infra, is optionally used to monitor intensity and/or position of the charged particle beam. 
     Referring now to  FIG. 2 , an illustrative exemplary embodiment of one version of the charged particle beam system  100  is provided. The number, position, and described type of components is illustrative and non-limiting in nature. In the illustrated embodiment, the injection system  120  or ion source or charged particle beam source generates protons. The injection system  120  optionally includes one or more of: a negative ion beam source, an ion beam focusing lens, and a tandem accelerator. The protons are delivered into a vacuum tube that runs into, through, and out of the synchrotron. The generated protons are delivered along an initial path  262 . Focusing magnets  230 , such as quadrupole magnets or injection quadrupole magnets, are used to focus the proton beam path. A quadrupole magnet is a focusing magnet. An injector bending magnet  232  bends the proton beam toward a plane of the synchrotron  130 . The focused protons having an initial energy are introduced into an injector magnet  240 , which is preferably an injection Lamberson magnet. Typically, the initial beam path  262  is along an axis off of, such as above, a circulating plane of the synchrotron  130 . The injector bending magnet  232  and injector magnet  240  combine to move the protons into the synchrotron  130 . Main bending magnets, dipole magnets, turning magnets, or circulating magnets  250  are used to turn the protons along a circulating beam path  264 . A dipole magnet is a bending magnet. The main bending magnets  250  bend the initial beam path  262  into a circulating beam path  264 . In this example, the main bending magnets  250  or circulating magnets are represented as four sets of four magnets to maintain the circulating beam path  264  into a stable circulating beam path. However, any number of magnets or sets of magnets are optionally used to move the protons around a single orbit in the circulation process. The protons pass through an accelerator  270 . The accelerator accelerates the protons in the circulating beam path  264 . As the protons are accelerated, the fields applied by the magnets are increased. Particularly, the speed of the protons achieved by the accelerator  270  are synchronized with magnetic fields of the main bending magnets  250  or circulating magnets to maintain stable circulation of the protons about a central point or region  280  of the synchrotron. At separate points in time the accelerator  270 /main bending magnet  250  combination is used to accelerate and/or decelerate the circulating protons while maintaining the protons in the circulating path or orbit. An extraction element of an inflector/deflector system is used in combination with a Lamberson extraction magnet  292  to remove protons from their circulating beam path  264  within the synchrotron  130 . One example of a deflector component is a Lamberson magnet. Typically the deflector moves the protons from the circulating plane to an axis off of the circulating plane, such as above the circulating plane. Extracted protons are preferably directed and/or focused using an extraction bending magnet  237  and extraction focusing magnets  235 , such as quadrupole magnets along a positively charged particle beam transport path  268  in a beam transport system  135 , such as a beam path or proton beam path, into the scanning/targeting/delivery system  140 . Two components of a scanning system  140  or targeting system typically include a first axis control  142 , such as a vertical control, and a second axis control  144 , such as a horizontal control. In one embodiment, the first axis control  142  allows for about 100 mm of vertical or y-axis scanning of the proton beam  268  and the second axis control  144  allows for about 700 mm of horizontal or x-axis scanning of the proton beam  268 . A nozzle system  146  is used for imaging the proton beam, for defining shape of the proton beam, and/or as a vacuum barrier between the low pressure beam path of the synchrotron and the atmosphere. Protons are delivered with control to the patient interface module  150  and to a tumor of a patient. All of the above listed elements are optional and may be used in various permutations and combinations. 
     Proton Beam Extraction 
     Referring now to  FIG. 3 , both: (1) an exemplary proton beam extraction system  300  from the synchrotron  130  and (2) a charged particle beam intensity control system  305  are illustrated. For clarity,  FIG. 3  removes elements represented in  FIG. 2 , such as the turning magnets, which allows for greater clarity of presentation of the proton beam path as a function of time. Generally, protons are extracted from the synchrotron  130  by slowing the protons. As described, supra, the protons were initially accelerated in a circulating path, which is maintained with a plurality of main bending magnets  250 . The circulating path is referred to herein as an original central beamline  264 . The protons repeatedly cycle around a central point in the synchrotron  280 . The proton path traverses through a radio frequency (RF) cavity system  310 . To initiate extraction, an RF field is applied across a first blade  312  and a second blade  314 , in the RF cavity system  310 . The first blade  312  and second blade  314  are referred to herein as a first pair of blades. 
     In the proton extraction process, an RF voltage is applied across the first pair of blades, where the first blade  312  of the first pair of blades is on one side of the circulating proton beam path  264  and the second blade  314  of the first pair of blades is on an opposite side of the circulating proton beam path  264 . The applied RF field applies energy to the circulating charged-particle beam. The applied RF field alters the orbiting or circulating beam path slightly of the protons from the original central beamline  264  to an altered circulating beam path  265 . Upon a second pass of the protons through the RF cavity system, the RF field further moves the protons off of the original proton beamline  264 . For example, if the original beamline is considered as a circular path, then the altered beamline is slightly elliptical. The frequency of the applied RF field is timed to apply outward or inward movement to a given band of protons circulating in the synchrotron accelerator. Orbits of the protons are slightly more off axis compared to the original circulating beam path  264 . Successive passes of the protons through the RF cavity system are forced further and further from the original central beamline  264  by altering the direction and/or intensity of the RF field with each successive pass of the proton beam through the RF field. Timing of application of the RF field and/or frequency of the RF field is related to the circulating charged particles circulation pathlength in the synchrotron  130  and the velocity of the charged particles so that the applied RF field has a period, with a peak-to-peak time period, equal to a period of time of beam circulation in the synchrotron  130  about the center  280  or an integer multiple of the time period of beam circulation about the center  280  of the synchrotron  130 . Alternatively, the time period of beam circulation about the center  280  of the synchrotron  130  is an integer multiple of the RF period time. The RF period is optionally used to calculated the velocity of the charged particles, which relates directly to the energy of the circulating charged particles. 
     The RF voltage is frequency modulated at a frequency about equal to the period of one proton cycling around the synchrotron for one revolution or at a frequency than is an integral multiplier of the period of one proton cycling about the synchrotron. The applied RF frequency modulated voltage excites a betatron oscillation. For example, the oscillation is a sine wave motion of the protons. The process of timing the RF field to a given proton beam within the RF cavity system is repeated thousands of times with each successive pass of the protons being moved approximately one micrometer further off of the original central beamline  264 . For clarity, the approximately 1000 changing beam paths with each successive path of a given band of protons through the RF field are illustrated as the altered beam path  265 . The RF time period is process is known, thus energy of the charged particles at time of hitting the extraction material or material  330 , described infra, is known. 
     With a sufficient sine wave betatron amplitude, the altered circulating beam path  265  touches and/or traverses a material  330 , such as a foil or a sheet of foil. The foil is preferably a lightweight material, such as beryllium, a lithium hydride, a carbon sheet, or a material having low nuclear charge components. Herein, a material of low nuclear charge is a material composed of atoms consisting essentially of atoms having six or fewer protons. The foil is preferably about 10 to 150 microns thick, is more preferably about 30 to 100 microns thick, and is still more preferably about 40 to 60 microns thick. In one example, the foil is beryllium with a thickness of about 50 microns. When the protons traverse through the foil, energy of the protons is lost and the speed of the protons is reduced. Typically, a current is also generated, described infra. Protons moving at the slower speed travel in the synchrotron with a reduced radius of curvature  266  compared to either the original central beamline  264  or the altered circulating path  265 . The reduced radius of curvature  266  path is also referred to herein as a path having a smaller diameter of trajectory or a path having protons with reduced energy. The reduced radius of curvature  266  is typically about two millimeters less than a radius of curvature of the last pass of the protons along the altered proton beam path  265 . 
     The thickness of the material  330  is optionally adjusted to create a change in the radius of curvature, such as about ½, 1, 2, 3, or 4 mm less than the last pass of the protons  265  or original radius of curvature  264 . The reduction in velocity of the charged particles transmitting through the material  330  is calculable, such as by using the pathlength of the betatron oscillating charged particle beam through the material  330  and/or using the density of the material  330 . Protons moving with the smaller radius of curvature travel between a second pair of blades. In one case, the second pair of blades is physically distinct and/or is separated from the first pair of blades. In a second case, one of the first pair of blades is also a member of the second pair of blades. For example, the second pair of blades is the second blade  314  and a third blade  316  in the RF cavity system  310 . A high voltage DC signal, such as about 1 to 5 kV, is then applied across the second pair of blades, which directs the protons out of the synchrotron through an extraction magnet  292 , such as a Lamberson extraction magnet, into a transport path  268 . 
     Control of acceleration of the charged particle beam path in the synchrotron with the accelerator and/or applied fields of the turning magnets in combination with the above described extraction system allows for control of the intensity of the extracted proton beam, where intensity is a proton flux per unit time or the number of protons extracted as a function of time. For example, when a current is measured beyond a threshold, the RF field modulation in the RF cavity system is terminated or reinitiated to establish a subsequent cycle of proton beam extraction. This process is repeated to yield many cycles of proton beam extraction from the synchrotron accelerator. 
     In another embodiment, instead of moving the charged particles to the material  330 , the material  330  is mechanically moved to the circulating charged particles. Particularly, the material  330  is mechanically or electromechanically translated into the path of the circulating charged particles to induce the extraction process, described supra. In this case, the velocity or energy of the circulating charged particle beam is calculable using the pathlength of the beam path about the center  280  of the synchrotron  130  and from the force applied by the bending magnets  250 . 
     In either case, because the extraction system does not depend on any change in magnetic field properties, it allows the synchrotron to continue to operate in acceleration or deceleration mode during the extraction process. Stated differently, the extraction process does not interfere with synchrotron acceleration. In stark contrast, traditional extraction systems introduce a new magnetic field, such as via a hexapole, during the extraction process. More particularly, traditional synchrotrons have a magnet, such as a hexapole magnet, that is off during an acceleration stage. During the extraction phase, the hexapole magnetic field is introduced to the circulating path of the synchrotron. The introduction of the magnetic field necessitates two distinct modes, an acceleration mode and an extraction mode, which are mutually exclusive in time. The herein described system allows for acceleration and/or deceleration of the proton during the extraction step and tumor treatment without the use of a newly introduced magnetic field, such as by a hexapole magnet. 
     Charged Particle Beam Intensity Control 
     Control of applied field, such as a radio-frequency (RF) field, frequency and magnitude in the RF cavity system  310  allows for intensity control of the extracted proton beam, where intensity is extracted proton flux per unit time or the number of protons extracted as a function of time. 
     Still referring  FIG. 3 , the intensity control system  305  is further described. In this example, an intensity control feedback loop is added to the extraction system, described supra. When protons in the proton beam hit the material  330  electrons are given off from the material  330  resulting in a current. The resulting current is converted to a voltage and is used as part of an ion beam intensity monitoring system or as part of an ion beam feedback loop for controlling beam intensity. The voltage is optionally measured and sent to the main controller  110  or to an intensity controller subsystem  340 , which is preferably in communication or under the direction of the main controller  110 . More particularly, when protons in the charged particle beam path pass through the material  330 , some of the protons lose a small fraction of their energy, such as about one-tenth of a percent, which results in a secondary electron. That is, protons in the charged particle beam push some electrons when passing through material  330  giving the electrons enough energy to cause secondary emission. The resulting electron flow results in a current or signal that is proportional to the number of protons going through the target or extraction material  330 . The resulting current is preferably converted to voltage and amplified. The resulting signal is referred to as a measured intensity signal. 
     The amplified signal or measured intensity signal resulting from the protons passing through the material  330  is optionally used in monitoring the intensity of the extracted protons and is preferably used in controlling the intensity of the extracted protons. For example, the measured intensity signal is compared to a goal signal, which is predetermined in an irradiation of the tumor plan. The difference between the measured intensity signal and the planned for goal signal is calculated. The difference is used as a control to the RF generator. Hence, the measured flow of current resulting from the protons passing through the material  330  is used as a control in the RF generator to increase or decrease the number of protons undergoing betatron oscillation and striking the material  330 . 
     Hence, the voltage determined off of the material  330  is used as a measure of the orbital path and is used as a feedback control to control the RF cavity system. 
     In one example, the intensity controller subsystem  340  preferably additionally receives input from: (1) a detector  350 , which provides a reading of the actual intensity of the proton beam and/or (2) an irradiation plan  360 . The irradiation plan provides the desired intensity of the proton beam for each x, y, energy, and/or rotational position of the patient/tumor as a function of time. Thus, the intensity controller  340  receives the desired intensity from the irradiation plan  350 , the actual intensity from the detector  350  and/or a measure of intensity from the material  330 , and adjusts the amplitude and/or the duration of application of the applied radio-frequency field in the RF cavity system  310  to yield an intensity of the proton beam that matches the desired intensity from the irradiation plan  360 . 
     As described, supra, the protons striking the material  330  is a step in the extraction of the protons from the synchrotron  130 . Hence, the measured intensity signal is used to change the number of protons per unit time being extracted, which is referred to as intensity of the proton beam. The intensity of the proton beam is thus under algorithm control. Further, the intensity of the proton beam is controlled separately from the velocity of the protons in the synchrotron  130 . Hence, intensity of the protons extracted and the energy of the protons extracted are independently variable. Still further, the intensity of the extracted protons is controllably variable while scanning the charged particles beam in the tumor from one voxel to an adjacent voxel as a separate hexapole and separated time period from acceleration and/or treatment is not required, as described supra. 
     For example, protons initially move at an equilibrium trajectory in the synchrotron  130 . An RF field is used to excite or move the protons into a betatron oscillation. In one case, the frequency of the protons orbit is about 10 MHz. In one example, in about one millisecond or after about 10,000 orbits, the first protons hit an outer edge of the target material  130 . The specific frequency is dependent upon the period of the orbit. Upon hitting the material  130 , the protons push electrons through the foil to produce a current. The current is converted to voltage and amplified to yield a measured intensity signal. The measured intensity signal is used as a feedback input to control the applied RF magnitude or RF field. An energy beam sensor, described infra, is optionally used as a feedback control to the RF field frequency or RF field of the RF field extraction system  310  to dynamically control, modify, and/or alter the delivered charge particle beam energy, such as in a continuous pencil beam scanning system operating to treat tumor voxels without alternating between an extraction phase and a treatment phase. Preferably, the measured intensity signal is compared to a target signal and a measure of the difference between the measured intensity signal and target signal is used to adjust the applied RF field in the RF cavity system  310  in the extraction system to control the intensity of the protons in the extraction step. Stated again, the signal resulting from the protons striking and/or passing through the material  130  is used as an input in RF field modulation. An increase in the magnitude of the RF modulation results in protons hitting the foil or material  130  sooner. By increasing the RF, more protons are pushed into the foil, which results in an increased intensity, or more protons per unit time, of protons extracted from the synchrotron  130 . 
     In another example, a detector  350  external to the synchrotron  130  is used to determine the flux of protons extracted from the synchrotron and a signal from the external detector is used to alter the RF field, RF intensity, RF amplitude, and/or RF modulation in the RF cavity system  310 . Here the external detector generates an external signal, which is used in a manner similar to the measured intensity signal, described in the preceding paragraphs. Preferably, an algorithm or irradiation plan  360  is used as an input to the intensity controller  340 , which controls the RF field modulation by directing the RF signal in the betatron oscillation generation in the RF cavity system  310 . The irradiation plan  360  preferably includes the desired intensity of the charged particle beam as a function of time and/or energy of the charged particle beam as a function of time, for each patient rotation position, and/or for each x-, y-position of the charged particle beam. 
     In yet another example, when a current from material  330  resulting from protons passing through or hitting material is measured beyond a threshold, the RF field modulation in the RF cavity system is terminated or reinitiated to establish a subsequent cycle of proton beam extraction. This process is repeated to yield many cycles of proton beam extraction from the synchrotron accelerator. 
     In still yet another embodiment, intensity modulation of the extracted proton beam is controlled by the main controller  110 . The main controller  110  optionally and/or additionally controls timing of extraction of the charged particle beam and energy of the extracted proton beam. 
     The benefits of the system include a multi-dimensional scanning system. Particularly, the system allows independence in: (1) energy of the protons extracted and (2) intensity of the protons extracted. That is, energy of the protons extracted is controlled by an energy control system and an intensity control system controls the intensity of the extracted protons. The energy control system and intensity control system are optionally independently controlled. Preferably, the main controller  110  controls the energy control system and the main controller  110  simultaneously controls the intensity control system to yield an extracted proton beam with controlled energy and controlled intensity where the controlled energy and controlled intensity are independently variable and/or continually available as a separate extraction phase and acceleration phase are not required, as described supra. Thus the irradiation spot hitting the tumor is under independent control of:
         time;   energy;   intensity;   x-axis position, where the x-axis represents horizontal movement of the proton beam relative to the patient, and   y-axis position, where the y-axis represents vertical movement of the proton beam relative to the patient.       

     In addition, the patient is optionally independently translated and/or rotated relative to a translational axis of the proton beam at the same time. 
     Beam Transport 
     The beam transport system  135  is used to move the charged particles from the accelerator to the patient, such as via a nozzle in a gantry, described infra. 
     Charged Particle Energy 
     The beam transport system  135  optionally includes means for determining an energy of the charged particles in the charged particle beam. For example, an energy of the charged particle beam is determined via calculation, such as via equation 1, using knowledge of a magnet geometry and applied magnetic field to determine mass and/or energy. Referring now to equation 1, for a known magnet geometry, charge, q, and magnetic field, B, the Larmor radius, ρ L , or magnet bend radius is defined as: 
                     ρ   L     =         v   ⊥       Ω   c       =         2   ⁢   Em       qB               (     eq   .           ⁢   1     )               
where: v ⊥  is the ion velocity perpendicular to the magnetic field, Ω c  is the cyclotron frequency, q is the charge of the ion, B is the magnetic field, m is the mass of the charge particle, and E is the charged particle energy. Solving for the charged particle energy yields equation 2.
 
     
       
         
           
             
               
                 
                   E 
                   = 
                   
                     
                       
                         ( 
                         
                           
                             ρ 
                             L 
                           
                           ⁢ 
                           qB 
                         
                         ) 
                       
                       2 
                     
                     
                       2 
                       ⁢ 
                       m 
                     
                   
                 
               
               
                 
                   ( 
                   
                     eq 
                     . 
                     
                         
                     
                     ⁢ 
                     2 
                   
                   ) 
                 
               
             
           
         
       
     
     Thus, an energy of the charged particle in the charged particle beam in the beam transport system  135  is calculable from the know magnet geometry, known or measured magnetic field, charged particle mass, charged particle charge, and the known magnet bend radius, which is proportional to and/or equivalent to the Larmor radius. 
     Nozzle 
     After extraction from the synchrotron  130  and transport of the charged particle beam along the proton beam path  268  in the beam transport system  135 , the charged particle beam exits through the nozzle system  146 . In one example, the nozzle system includes a nozzle foil covering an end of the nozzle system  146  or a cross-sectional area within the nozzle system forming a vacuum seal. The nozzle system includes a nozzle that expands in x/y-cross-sectional area along the z-axis of the proton beam path  268  to allow the proton beam  268  to be scanned along the x-axis and y-axis by the vertical control element and horizontal control element, respectively. The nozzle foil is preferably mechanically supported by the outer edges of an exit port of the nozzle  146 . An example of a nozzle foil is a sheet of about 0.1 inch thick aluminum foil. 
     Generally, the nozzle foil separates atmosphere pressures on the patient side of the nozzle foil from the low pressure region, such as about 10 −5  to 10 −7  torr region, on the synchrotron  130  side of the nozzle foil. The low pressure region is maintained to reduce scattering of the circulating charged particle beam in the synchrotron. Herein, the exit foil of the nozzle is optionally the first sheet  760  of the charged particle beam state determination system  750 , described infra. 
     Charged Particle Control 
     Referring now to  FIG. 4A ,  FIG. 4B ,  FIG. 5 ,  FIG. 6A , and  FIG. 6B , a charged particle beam control system is described where one or more patient specific beam control assemblies are removably inserted into the charged particle beam path proximate the nozzle of the charged particle cancer therapy system  100 , where the patient specific beam control assemblies adjust the beam energy, diameter, cross-sectional shape, focal point, and/or beam state of the charged particle beam to properly couple energy of the charged particle beam to the individual&#39;s specific tumor. 
     Beam Control Tray 
     Referring now to  FIG. 4A  and  FIG. 4B , a beam control tray assembly  400  is illustrated in a top view and side view, respectively. The beam control tray assembly  400  optionally comprises any of a tray frame  410 , a tray aperture  412 , a tray handle  420 , a tray connector/communicator  430 , and means for holding a patient specific tray insert  510 , described infra. Generally, the beam control tray assembly  400  is used to: (1) hold the patient specific tray insert  510  in a rigid location relative to the beam control tray  400 , (2) electronically identify the held patient specific tray insert  510  to the main controller  110 , and (3) removably insert the patient specific tray insert  510  into an accurate and precise fixed location relative to the charged particle beam, such as the proton beam path  268  at the nozzle of the charged particle cancer therapy system  100 . 
     For clarity of presentation and without loss of generality, the means for holding the patient specific tray insert  510  in the tray frame  410  of the beam control tray assembly  400  is illustrated as a set of recessed set screws  415 . However, the means for holding the patient specific tray insert  510  relative to the rest of the beam control tray assembly  400  is optionally any mechanical and/or electromechanical positioning element, such as a latch, clamp, fastener, clip, slide, strap, or the like. Generally, the means for holding the patient specific tray insert  510  in the beam control tray  400  fixes the tray insert and tray frame relative to one another even when rotated along and/or around multiple axes, such as when attached to a charged particle cancer therapy system  100  dynamic gantry nozzle  610  or gantry nozzle, which is an optional element of the nozzle system  146 , that moves in three-dimensional space relative to a fixed point in the beamline, proton beam path  268 , and/or a given patient position. As illustrated in  FIG. 4A  and  FIG. 4B , the recessed set screws  415  fix the patient specific tray insert  510  into the aperture  412  of the tray frame  410 . The tray frame  410  is illustrated as circumferentially surrounding the patient specific tray insert  510 , which aids in structural stability of the beam control tray assembly  400 . However, generally the tray frame  410  is of any geometry that forms a stable beam control tray assembly  400 . 
     Still referring to  FIG. 4A  and now referring to  FIG. 5  and  FIG. 6A , the optional tray handle  420  is used to manually insert/retract the beam control tray assembly  400  into a receiving element of the gantry nozzle or dynamic gantry nozzle  610 . While the beam control tray assembly  400  is optionally inserted into the charged particle beam path  268  at any point after extraction from the synchrotron  130 , the beam control tray assembly  400  is preferably inserted into the positively charged particle beam proximate the dynamic gantry nozzle  610  as control of the beam shape is preferably done with little space for the beam shape to defocus before striking the tumor. Optionally, insertion and/or retraction of the beam control tray assembly  400  is semi-automated, such as in a manner of a digital-video disk player receiving a digital-video disk, with a selected auto load and/or a selected auto unload feature. 
     Patient Specific Tray Insert 
     Referring again to  FIG. 5 , a system of assembling trays  500  is described. The beam control tray assembly  400  optionally and preferably has interchangeable patient specific tray inserts  510 , such as a range shifter insert  511 , a patient specific ridge filter insert  512 , an aperture insert  513 , a compensator insert  514 , or a blank insert  515 . As described, supra, any of the range shifter insert  511 , the patient specific ridge filter insert  512 , the aperture insert  513 , the compensator insert  514 , or the blank insert  515  after insertion into the tray frame  410  are inserted as the beam control tray assembly  400  into the positively charged particle beam path  268 , such as proximate the dynamic gantry nozzle  610 . 
     Still referring to  FIG. 5 , the patient specific tray inserts  510  are further described. The patient specific tray inserts comprise a combination of any of: (1) a standardized beam control insert and (2) a patient specific beam control insert. For example, the range shifter insert or  511  or compensator insert  514  used to control the depth of penetration of the charged particle beam into the patient is optionally: (a) a standard thickness of a beam slowing material, such as a first thickness of Lucite, (b) one member of a set of members of varying thicknesses and/or densities where each member of the set of members slows the charged particles in the beam path by a known amount, or (c) is a material with a density and thickness designed to slow the charged particles by a customized amount for the individual patient being treated, based on the depth of the individual&#39;s tumor in the tissue, the thickness of intervening tissue, and/or the density of intervening bone/tissue. Similarly, the ridge filter insert  512  used to change the focal point or shape of the beam as a function of depth is optionally: (1) selected from a set of ridge filters where different members of the set of ridge filters yield different focal depths or (2) customized for treatment of the individual&#39;s tumor based on position of the tumor in the tissue of the individual. Similarly, the aperture insert is: (1) optionally selected from a set of aperture shapes or (2) is a customized individual aperture insert  513  designed for the specific shape of the individual&#39;s tumor. The blank insert  515  is an open slot, but serves the purpose of identifying slot occupancy, as described infra. 
     Slot Occupancy/Identification 
     Referring again to  FIG. 4A ,  FIG. 4B , and  FIG. 5 , occupancy and identification of the particular patient specific tray insert  510  into the beam control tray assembly  400  is described. Generally, the beam control tray assembly  400  optionally contains means for identifying, to the main controller  110  and/or a treatment delivery control system described infra, the specific patient tray insert  510  and its location in the charged particle beam path  268 . First, the particular tray insert is optionally labeled and/or communicated to the beam control tray assembly  400  or directly to the main controller  110 . Second, the beam control tray assembly  400  optionally communicates the tray type and/or tray insert to the main controller  110 . In various embodiments, communication of the particular tray insert to the main controller  110  is performed: (1) directly from the tray insert, (2) from the tray insert  510  to the tray assembly  400  and subsequently to the main controller  110 , and/or (3) directly from the tray assembly  400 . Generally, communication is performed wirelessly and/or via an established electromechanical link. Identification is optionally performed using a radio-frequency identification label, use of a barcode, or the like, and/or via operator input. Examples are provided to further clarify identification of the patient specific tray insert  510  in a given beam control tray assembly  400  to the main controller. 
     In a first example, one or more of the patient specific tray inserts  510 , such as the range shifter insert  511 , the patient specific ridge filter insert  512 , the aperture insert  513 , the compensator insert  514 , or the blank insert  515  include an identifier  520  and/or and a first electromechanical identifier plug  530 . The identifier  520  is optionally a label, a radio-frequency identification tag, a barcode, a 2-dimensional bar-code, a matrix-code, or the like. The first electromechanical identifier plug  530  optionally includes memory programmed with the particular patient specific tray insert information and a connector used to communicate the information to the beam control tray assembly  400  and/or to the main controller  110 . As illustrated in  FIG. 5 , the first electromechanical identifier plug  530  affixed to the patient specific tray insert  510  plugs into a second electromechanical identifier plug, such as the tray connector/communicator  430 , of the beam control tray assembly  400 , which is described infra. 
     In a second example, the beam control tray assembly  400  uses the second electromechanical identifier plug to send occupancy, position, and/or identification information related to the type of tray insert or the patient specific tray insert  510  associated with the beam control tray assembly to the main controller  110 . For example, a first tray assembly is configured with a first tray insert and a second tray assembly is configured with a second tray insert. The first tray assembly sends information to the main controller  110  that the first tray assembly holds the first tray insert, such as a range shifter, and the second tray assembly sends information to the main controller  110  that the second tray assembly holds the second tray insert, such as an aperture. The second electromechanical identifier plug optionally contains programmable memory for the operator to input the specific tray insert type, a selection switch for the operator to select the tray insert type, and/or an electromechanical connection to the main controller. The second electromechanical identifier plug associated with the beam control tray assembly  400  is optionally used without use of the first electromechanical identifier plug  530  associated with the tray insert  510 . 
     In a third example, one type of tray connector/communicator  430  is used for each type of patient specific tray insert  510 . For example, a first connector/communicator type is used for holding a range shifter insert  511 , while a second, third, fourth, and fifth connector/communicator type is used for trays respectively holding a patient specific ridge filter insert  512 , an aperture insert  513 , a compensator insert  514 , or a blank insert  515 . In one case, the tray communicates tray type with the main controller. In a second case, the tray communicates patient specific tray insert information with the main controller, such as an aperture identifier custom built for the individual patient being treated. 
     Tray Insertion/Coupling 
     Referring now to  FIG. 6A  and  FIG. 6B  a beam control insertion process  600  is described. The beam control insertion process  600  comprises: (1) insertion of the beam control tray assembly  400  and the associated patient specific tray insert  510  into the charged particle beam path  268  and/or dynamic gantry nozzle  610 , such as into a tray assembly receiver  620  and (2) an optional partial or total retraction of beam of the tray assembly receiver  620  into the dynamic gantry nozzle  610 . 
     Referring now to  FIG. 6A , insertion of one or more of the beam control tray assemblies  400  and the associated patient specific tray inserts  510  into the dynamic gantry nozzle  610  is further described. In  FIG. 6A , three beam control tray assemblies, of a possible n tray assemblies, are illustrated, a first tray assembly  402 , a second tray assembly  404 , and a third tray assembly  406 , where n is a positive integer of 1, 2, 3, 4, 5 or more. As illustrated, the first tray assembly  402  slides into a first receiving slot  403 , the second tray assembly  404  slides into a second receiving slot  405 , and the third tray assembly  406  slides into a third receiving slot  407 . Generally, any tray optionally inserts into any slot or tray types are limited to particular slots through use of a mechanical, physical, positional, and/or steric constraints, such as a first tray type configured for a first insert type having a first size and a second tray type configured for a second insert type having a second distinct size at least ten percent different from the first size. 
     Still referring to  FIG. 6A , identification of individual tray inserts inserted into individual receiving slots is further described. As illustrated, sliding the first tray assembly  402  into the first receiving slot  403  connects the associated electromechanical connector/communicator  430  of the first tray assembly  402  to a first receptor  626 . The electromechanical connector/communicator  430  of the first tray assembly communicates tray insert information of the first beam control tray assembly to the main controller  110  via the first receptor  626 . Similarly, sliding the second tray assembly  404  into the second receiving slot  405  connects the associated electromechanical connector/communicator  430  of the second tray assembly  404  into a second receptor  627 , which links communication of the associated electromechanical connector/communicator  430  with the main controller  110  via the second receptor  627 , while a third receptor  628  connects to the electromechanical connected placed into the third slot  407 . The non-wireless/direct connection is preferred due to the high radiation levels within the treatment room and the high shielding of the treatment room, which both hinder wireless communication. The connection of the communicator and the receptor is optionally of any configuration and/or orientation. 
     Tray Receiver Assembly Retraction 
     Referring again to  FIG. 6A  and  FIG. 6B , retraction of the tray receiver assembly  620  relative to a nozzle end  612  of the dynamic gantry nozzle  610  is described. The tray receiver assembly  620  comprises a framework to hold one or more of the beam control tray assemblies  400  in one or more slots, such as through use of a first tray receiver assembly side  622  through which the beam control tray assemblies  400  are inserted and/or through use of a second tray receiver assembly side  624  used as a backstop, as illustrated holding the plugin receptors configured to receive associated tray connector/communicators  430 , such as the first, second, and third receptors  626 ,  627 ,  628 . Optionally, the tray receiver assembly  620  retracts partially or completely into the dynamic gantry nozzle  610  using a retraction mechanism  660  configured to alternatingly retract and extend the tray receiver assembly  620  relative to a nozzle end  612  of the gantry nozzle  610 , such as along a first retraction track  662  and a second retraction track  664  using one or more motors and computer control. Optionally the tray receiver assembly  620  is partially or fully retracted when moving the gantry, nozzle, and/or gantry nozzle  610  to avoid physical constraints of movement, such as potential collision with another object in the patient treatment room. 
     For clarity of presentation and without loss of generality, several examples of loading patient specific tray inserts into tray assemblies with subsequent insertion into an positively charged particle beam path proximate a gantry nozzle  610  are provided. 
     In a first example, a single beam control tray assembly  400  is used to control the charged particle beam  268  in the charged particle cancer therapy system  100 . In this example, a patient specific range shifter insert  511 , which is custom fabricated for a patient, is loaded into a patient specific tray insert  510  to form a first tray assembly  402 , where the first tray assembly  402  is loaded into the third receptor  628 , which is fully retracted into the gantry nozzle  610 . 
     In a second example, two beam control assemblies  400  are used to control the charged particle beam  268  in the charged particle cancer therapy system  100 . In this example, a patient specific ridge filter  512  is loaded into a first tray assembly  402 , which is loaded into the second receptor  627  and a patient specific aperture  513  is loaded into a second tray assembly  404 , which is loaded into the first receptor  626  and the two associated tray connector/communicators  430  using the first receptor  626  and second receptor  627  communicate to the main controller  110  the patient specific tray inserts  510 . The tray receiver assembly  620  is subsequently retracted one slot so that the patient specific ridge filter  512  and the patient specific aperture reside outside of and at the nozzle end  612  of the gantry nozzle  610 . 
     In a third example, three beam control tray assemblies  400  are used, such as a range shifter  511  in a first tray inserted into the first receiving slot  403 , a compensator in a second tray inserted into the second receiving slot  405 , and an aperture in a third tray inserted into the third receiving slot  407 . 
     Generally, any patient specific tray insert  510  is inserted into a tray frame  410  to form a beam control tray assembly  400  inserted into any slot of the tray receiver assembly  620  and the tray assembly is not retracted or retracted any distance into the gantry nozzle  610 . 
     Tomography/Beam State 
     In one embodiment, the charged particle tomography apparatus is used to image a tumor in a patient. As current beam position determination/verification is used in both tomography and cancer therapy treatment, for clarity of presentation and without limitation beam state determination is also addressed in this section. However, beam state determination is optionally used separately and without tomography. 
     In another example, the charged particle tomography apparatus is used in combination with a charged particle cancer therapy system using common elements. For example, tomographic imaging of a cancerous tumor is performed using charged particles generated with an injector, accelerator, and guided with a delivery system that are part of the cancer therapy system, described supra. 
     In various examples, the tomography imaging system is optionally simultaneously operational with a charged particle cancer therapy system using common elements, allows tomographic imaging with rotation of the patient, is operational on a patient in an upright, semi-upright, and/or horizontal position, is simultaneously operational with X-ray imaging, and/or allows use of adaptive charged particle cancer therapy. Further, the common tomography and cancer therapy apparatus elements are optionally operational in a multi-axis and/or multi-field raster beam mode. 
     In conventional medical X-ray tomography, a sectional image through a body is made by moving one or both of an X-ray source and the X-ray film in opposite directions during the exposure. By modifying the direction and extent of the movement, operators can select different focal planes, which contain the structures of interest. More modern variations of tomography involve gathering projection data from multiple directions by moving the X-ray source and feeding the data into a tomographic reconstruction software algorithm processed by a computer. Herein, in stark contrast to known methods, the radiation source is a charged particle, such as a proton ion beam or a carbon ion beam. A proton beam is used herein to describe the tomography system, but the description applies to a heavier ion beam, such as a carbon ion beam. Further, in stark contrast to known techniques, herein the radiation source is preferably stationary while the patient is rotated. 
     Referring now to  FIG. 7 , an example of a tomography apparatus is described and an example of a beam state determination is described. In this example, the tomography system  700  uses elements in common with the charged particle beam system  100 , including elements of one or more of the injection system  120 , accelerator  130 , targeting/delivery system  140 , patient interface module  150 , display system  160 , and/or imaging system  170 , such as the X-ray imaging system. One or more scintillation plates, such as a scintillating plastic, are used to measure energy, intensity, and/or position of the charged particle beam. For instance, a scintillation plate  710  is positioned behind the patient  730  relative to the targeting/delivery system  140  elements, which is optionally used to measure intensity and/or position of the charged particle beam after transmitting through the patient. Optionally, a second scintillation plate or a charged particle induced photon emitting sheet, described infra, is positioned prior to the patient  730  relative to the targeting/delivery system  140  elements, which is optionally used to measure incident intensity and/or position of the charged particle beam prior to transmitting through the patient. The charged particle beam system  100  as described has proven operation at up to and including 330 MeV, which is sufficient to send protons through the body and into contact with the scintillation material. Particularly, 250 MeV to 330 MeV are used to pass the beam through a standard sized patient with a standard sized pathlength, such as through the chest. The intensity or count of protons hitting the plate as a function of position is used to create an image. The velocity or energy of the proton hitting the scintillation plate is also used in creation of an image of the tumor  720  and/or an image of the patient  730 . The patient  730  is rotated about the y-axis and a new image is collected. Preferably, a new image is collected with about every one degree of rotation of the patient resulting in about 360 images that are combined into a tomogram using tomographic reconstruction software. The tomographic reconstruction software uses overlapping rotationally varied images in the reconstruction. Optionally, a new image is collected at about every 2, 3, 4, 5, 10, 15, 30, or 45 degrees of rotation of the patient. 
     In one embodiment, a tomogram or an individual tomogram section image is collected at about the same time as cancer therapy occurs using the charged particle beam system  100 . For example, a tomogram is collected and cancer therapy is subsequently performed: without the patient moving from the positioning systems, such as in a semi-vertical partial immobilization system, a sitting partial immobilization system, or the a laying position. In a second example, an individual tomogram slice is collected using a first cycle of the accelerator  130  and using a following cycle of the accelerator  130 , the tumor  720  is irradiated, such as within about 1, 2, 5, 10, 15 or 30 seconds. In a third case, about 2, 3, 4, or 5 tomogram slices are collected using 1, 2, 3, 4, or more rotation positions of the patient  730  within about 5, 10, 15, 30, or 60 seconds of subsequent tumor irradiation therapy. 
     In another embodiment, the independent control of the tomographic imaging process and X-ray collection process allows simultaneous single and/or multi-field collection of X-ray images and tomographic images easing interpretation of multiple images. Indeed, the X-ray and tomographic images are optionally overlaid to from a hybrid X-ray/proton beam tomographic image as the patient  730  is optionally in the same position for each image. 
     In still another embodiment, the tomogram is collected with the patient  730  in the about the same position as when the patient&#39;s tumor is treated using subsequent irradiation therapy. For some tumors, the patient being positioned in the same upright or semi-upright position allows the tumor  720  to be separated from surrounding organs or tissue of the patient  730  better than in a laying position. Positioning of the scintillation plate  710  behind the patient  730  allows the tomographic imaging to occur while the patient is in the same upright or semi-upright position. 
     The use of common elements in the tomographic imaging and in the charged particle cancer therapy allows benefits of the cancer therapy, described supra, to optionally be used with the tomographic imaging, such as proton beam x-axis control, proton beam y-axis control, control of proton beam energy, control of proton beam intensity, timing control of beam delivery to the patient, rotation control of the patient, and control of patient translation all in a raster beam mode of proton energy delivery. The use of a single proton or cation beamline for both imaging and treatment facilitates eases patient setup, reduces alignment uncertainties, reduces beam state uncertainties, and eases quality assurance. 
     In yet still another embodiment, initially a three-dimensional tomographic proton based reference image is collected, such as with hundreds of individual rotation images of the tumor  720  and patient  730 . Subsequently, just prior to proton treatment of the cancer, just a few 2-dimensional control tomographic images of the patient are collected, such as with a stationary patient or at just a few rotation positions, such as an image straight on to the patient, with the patient rotated about 45 degrees each way, and/or the patient rotated about 90 degrees each way about the y-axis. The individual control images are compared with the 3-dimensional reference image. An adaptive proton therapy is subsequently performed where: (1) the proton cancer therapy is not used for a given position based on the differences between the 3-dimensional reference image and one or more of the 2-dimensional control images and/or (2) the proton cancer therapy is modified in real time based on the differences between the 3-dimensional reference image and one or more of the 2-dimensional control images. 
     Charged Particle State Determination/Verification/Photonic Monitoring 
     Still referring to  FIG. 7 , the tomography system  700  is optionally used with a charged particle beam state determination system  750 , optionally used as a charged particle verification system. The charged particle state determination system  750  optionally measures, determines, and/or verifies one of more of: (1) position of the charged particle beam, (2) direction of the charged particle beam, (3) intensity of the charged particle beam, (4) energy of the charged particle beam, and (5) a history of the charged particle beam. 
     For clarity of presentation and without loss of generality, a description of the charged particle beam state determination system  750  is described and illustrated separately in  FIG. 8  and  FIG. 9A ; however, as described herein elements of the charged particle beam state determination system  750  are optionally and preferably integrated into the nozzle system  146  and/or the tomography system  700  of the charged particle treatment system  100 . More particularly, any element of the charged particle beam state determination system  750  is integrated into the nozzle system  146 , the dynamic gantry nozzle  610 , and/or tomography system  700 , such as a surface of the scintillation plate  710  or a surface of a scintillation detector, plate, or system. The nozzle system  146  or the dynamic gantry nozzle  610  provides an outlet of the charged particle beam from the vacuum tube initiating at the injection system  120  and passing through the synchrotron  130  and beam transport system  135 . Any plate, sheet, fluorophore, or detector of the charged particle beam state determination system is optionally integrated into the nozzle system  146 . For example, an exit foil of the nozzle  610  is optionally a first sheet  760  of the charged particle beam state determination system  750  and a first coating  762  is optionally coated onto the exit foil, as illustrated in  FIG. 7 . Similarly, optionally a surface of the scintillation plate  710  is a support surface for a fourth coating  792 , as illustrated in  FIG. 7 . The charged particle beam state determination system  750  is further described, infra. 
     Referring now to  FIG. 7 ,  FIG. 8 , and  FIG. 9A , four sheets, a first sheet  760 , a second sheet  770 , a third sheet  780 , and a fourth sheet  790  are used to illustrated detection sheets and/or photon emitting sheets upon transmittance of a charged particle beam. Each sheet is optionally coated with a photon emitter, such as a fluorophore, such as the first sheet  760  is optionally coated with a first coating  762 . Without loss of generality and for clarity of presentation, the four sheets are each illustrated as units, where the light emitting layer is not illustrated. Thus, for example, the second sheet  770  optionally refers to a support sheet, a light emitting sheet, and/or a support sheet coated by a light emitting element. The four sheets are representative of n sheets, where n is a positive integer. 
     Referring now to  FIG. 7  and  FIG. 8 , the charged particle beam state verification system  750  is a system that allows for monitoring of the actual charged particle beam position in real-time without destruction of the charged particle beam. The charged particle beam state verification system  750  preferably includes a first position element or first beam verification layer, which is also referred to herein as a coating, luminescent, fluorescent, phosphorescent, radiance, or viewing layer. The first position element optionally and preferably includes a coating or thin layer substantially in contact with a sheet, such as an inside surface of the nozzle foil, where the inside surface is on the synchrotron side of the nozzle foil. Less preferably, the verification layer or coating layer is substantially in contact with an outer surface of the nozzle foil, where the outer surface is on the patient treatment side of the nozzle foil. Preferably, the nozzle foil provides a substrate surface for coating by the coating layer. Optionally, a binding layer is located between the coating layer and the nozzle foil, substrate, or support sheet. Optionally, the position element is placed anywhere in the charged particle beam path. Optionally, more than one position element on more than one sheet, respectively, is used in the charged particle beam path and is used to determine a state property of the charged particle beam, as described infra. 
     Still referring to  FIG. 7  and  FIG. 8 , the coating, referred to as a fluorophore, yields a measurable spectroscopic response, spatially viewable by a detector or camera, as a result of transmission by the proton beam. The coating is preferably a phosphor, but is optionally any material that is viewable or imaged by a detector where the material changes spectroscopically as a result of the charged particle beam hitting or transmitting through the coating or coating layer. A detector or camera views secondary photons emitted from the coating layer and determines a current position of the charged particle beam  269  or final treatment vector of the charged particle beam by the spectroscopic differences resulting from protons and/or charged particle beam passing through the coating layer. For example, the camera views a surface of the coating surface as the proton beam or positively charged cation beam is being scanned by the first axis control  142 , vertical control, and the second axis control  144 , horizontal control, beam position control elements during treatment of the tumor  720 . The camera views the current position of the charged particle beam  269  as measured by spectroscopic response. The coating layer is preferably a phosphor or luminescent material that glows and/or emits photons for a short period of time, such as less than 5 seconds for a 50% intensity, as a result of excitation by the charged particle beam. The detector observes the temperature change and/or observe photons emitted from the charged particle beam traversed spot. Optionally, a plurality of cameras or detectors are used, where each detector views all or a portion of the coating layer. For example, two detectors are used where a first detector views a first half of the coating layer and the second detector views a second half of the coating layer. Preferably, at least a portion of the detector is mounted into the nozzle system to view the proton beam position after passing through the first axis and second axis controllers  142 ,  144 . Preferably, the coating layer is positioned in the proton beam path  268  in a position prior to the protons striking the patient  730 . 
     Referring now to  FIG. 1  and  FIG. 7 , the main controller  110 , connected to the camera or detector output, optionally and preferably compares the final proton beam position  269  with the planned proton beam position and/or a calibration reference to determine if the actual proton beam position  269  is within tolerance. The charged particle beam state determination system  750  preferably is used in one or more phases, such as a calibration phase, a mapping phase, a beam position verification phase, a treatment phase, and a treatment plan modification phase. The calibration phase is used to correlate, as a function of x-, y-position of the glowing response the actual x-, y-position of the proton beam at the patient interface. During the treatment phase, the charged particle beam position is monitored and compared to the calibration and/or treatment plan to verify accurate proton delivery to the tumor  720  and/or as a charged particle beam shutoff safety indicator. Referring now to  FIG. 10 , the position verification system  172  and/or the treatment delivery control system  112 , upon determination of a tumor shift, an unpredicted tumor distortion upon treatment, and/or a treatment anomaly optionally generates and or provides a recommended treatment change  1070 . The treatment change  1070  is optionally sent out while the patient  730  is still in the treatment position, such as to a proximate physician or over the internet to a remote physician, for physician approval  1072 , receipt of which allows continuation of the now modified and approved treatment plan. 
     Example I 
     Referring now to  FIG. 7 , a first example of the charged particle beam state determination system  750  is illustrated using two cation induced signal generation surfaces, referred to herein as the first sheet  760  and a third sheet  780 . Each sheet is described below. 
     Still referring to  FIG. 7 , in the first example, the optional first sheet  760 , located in the charged particle beam path prior to the patient  730 , is coated with a first fluorophore coating  762 , wherein a cation, such as in the charged particle beam, transmitting through the first sheet  760  excites localized fluorophores of the first fluorophore coating  762  with resultant emission of one or more photons. In this example, a first detector  812  images the first fluorophore coating  762  and the main controller  110  determines a current position of the charged particle beam using the image of the fluorophore coating  762  and the detected photon(s). The intensity of the detected photons emitted from the first fluorophore coating  762  is optionally used to determine the intensity of the charged particle beam used in treatment of the tumor  720  or detected by the tomography system  700  in generation of a tomogram and/or tomographic image of the tumor  720  of the patient  730 . Thus, a first position and/or a first intensity of the charged particle beam is determined using the position and/or intensity of the emitted photons, respectively. 
     Still referring to  FIG. 7 , in the first example, the optional third sheet  780 , positioned posterior to the patient  730 , is optionally a cation induced photon emitting sheet as described in the previous paragraph. However, as illustrated, the third sheet  780  is a solid state beam detection surface, such as a detector array. For instance, the detector array is optionally a charge coupled device, a charge induced device, CMOS, or camera detector where elements of the detector array are read directly, as does a commercial camera, without the secondary emission of photons. Similar to the detection described for the first sheet, the third sheet  780  is used to determine a position of the charged particle beam and/or an intensity of the charged particle beam using signal position and/or signal intensity from the detector array, respectively. 
     Still referring to  FIG. 7 , in the first example, signals from the first sheet  760  and third sheet  780  yield a position before and after the patient  730  allowing a more accurate determination of the charged particle beam through the patient  730  therebetween. Optionally, knowledge of the charged particle beam path in the targeting/delivery system  740 , such as determined via a first magnetic field strength across the first axis control  142  or a second magnetic field strength across the second axis control  144  is combined with signal derived from the first sheet  760  to yield a first vector of the charged particles prior to entering the patient  730  and/or an input point of the charged particle beam into the patient  730 , which also aids in: (1) controlling, monitoring, and/or recording tumor treatment and/or (2) tomography development/interpretation. Optionally, signal derived from use of the third sheet  780 , posterior to the patient  730 , is combined with signal derived from tomography system  700 , such as the scintillation plate  710 , to yield a second vector of the charged particles posterior to the patient  730  and/or an output point of the charged particle beam from the patient  730 , which also aids in: (1) controlling, monitoring, deciphering, and/or (2) interpreting a tomogram or a tomographic image. 
     For clarity of presentation and without loss of generality, detection of photons emitted from sheets is used to further describe the charged particle beam state determination system  750 . However, any of the cation induced photon emission sheets described herein are alternatively detector arrays. Further, any number of cation induced photon emission sheets are used prior to the patient  730  and/or posterior to the patient  730 , such a 1, 2, 3, 4, 6, 8, 10, or more. Still further, any of the cation induced photon emission sheets are place anywhere in the charged particle beam, such as in the synchrotron  130 , in the beam transport system  135 , in the targeting/delivery system  140 , the nozzle  146 , in the gantry room, and/or in the tomography system  700 . Any of the cation induced photon emission sheets are used in generation of a beam state signal as a function of time, which is optionally recorded, such as for an accurate history of treatment of the tumor  720  of the patient  730  and/or for aiding generation of a tomographic image. 
     Example II 
     Referring now to  FIG. 8 , a second example of the charged particle beam state determination system  750  is illustrated using three cation induced signal generation surfaces, referred to herein as the second sheet  770 , the third sheet  780 , and the fourth sheet  790 . Any of the second sheet  770 , the third sheet  780 , and the fourth sheet  790  contain any of the features of the sheets described supra. 
     Still referring to  FIG. 8 , in the second example, the second sheet  770 , positioned prior to the patient  730 , is optionally integrated into the nozzle  146 , but is illustrated as a separate sheet. Signal derived from the second sheet  770 , such as at point A, is optionally combined with signal from the first sheet  760  and/or state of the targeting/delivery system  140  to yield a first vector, v 1a , from point A to point B of the charged particle beam prior to the sample or patient  730  at a first time, t 1 , and a second vector, v 2a , from point F to point G of the charged particle beam prior to the sample at a second time, t 2 . 
     Still referring to  FIG. 8 , in the second example, the third sheet  780  and the fourth sheet  790 , positioned posterior to the patient  730 , are optionally integrated into the tomography system  700 , but are illustrated as a separate sheets. Signal derived from the third sheet  780 , such as at point D, is optionally combined with signal from the fourth sheet  790  and/or signal from the tomography system  700  to yield a first vector, v 1b , from point C 2  to point D and/or from point D to point E of the charged particle beam posterior to the patient  730  at the first time, t 1 , and a second vector, v 2a , such as from point H to point I of the charged particle beam posterior to the sample at a second time, t 2 . Signal derived from the third sheet  780  and/or from the fourth sheet  790  and the corresponding first vector at the second time, t 2 , is used to determine an output point, C 2 , which may and often does differ from an extension of the first vector, v 1a , from point A to point B through the patient to a non-scattered beam path of point C 1 . The difference between point C 1  and point C 2  and/or an angle, α, between the first vector at the first time, v 1a , and the first vector at the second time, v 1b , is used to determine/map/identify, such as via tomographic analysis, internal structure of the patient  730 , sample, and/or the tumor  720 , especially when combined with scanning the charged particle beam in the x/y-plane as a function of time, such as illustrated by the second vector at the first time, v 2a , and the second vector at the second time, v 2b , forming angle β and/or with rotation of the patient  730 , such as about the y-axis, as a function of time. 
     Still referring to  FIG. 8 , multiple detectors/detector arrays are illustrated for detection of signals from multiple sheets, respectively. However, a single detector/detector array is optionally used to detect signals from multiple sheets, as further described infra. As illustrated, a set of detectors  810  is illustrated, including a second detector  814  imaging the second sheet  770 , a third detector  816  imaging the third sheet  780 , and a fourth detector  818  imaging the fourth sheet  790 . Any of the detectors described herein are optionally detector arrays, are optionally coupled with any optical filter, and/or optionally use one or more intervening optics to image any of the four sheets  760 ,  770 ,  780 ,  790 . Further, two or more detectors optionally image a single sheet, such as a region of the sheet, to aid optical coupling, such as F-number optical coupling. 
     Still referring to  FIG. 8 , a vector of the charged particle beam is determined. Particularly, in the illustrated example, the third detector  816 , determines, via detection of secondary emitted photons, that the charged particle beam transmitted through point D and the fourth detector  818  determines that the charged particle beam transmitted through point E, where points D and E are used to determine the first vector at the second time, v 1b , as described supra. To increase accuracy and precision of a determined vector of the charged particle beam, a first determined beam position and a second determined beam position are optionally and preferably separated by a distance, d 1 , such as greater than 0.1, 0.5, 1, 2, 3, 5, 10, or more centimeters. A support element  752  is illustrated that optionally connects any two or more elements of the charged particle beam state determination system  750  to each other and/or to any element of the charged particle beam system  100 , such as a rotating platform  756  used to co-rotate the patient  730  and any element of the tomography system  700 . 
     Example III 
     Still referring to  FIG. 9A , a third example of the charged particle beam state determination system  750  is illustrated in an integrated tomography-cancer therapy system  900 . 
     Referring to  FIG. 9A , multiple sheets and multiple detectors are illustrated determining a charged particle beam state prior to the patient  730 . As illustrated, a first camera  812  spatially images photons emitted from the first sheet  760  at point A, resultant from energy transfer from the passing charged particle beam, to yield a first signal and a second camera  814  spatially images photons emitted from the second sheet  770  at point B, resultant from energy transfer from the passing charged particle beam, to yield a second signal. The first and second signals allow calculation of the first vector, v 1a , with a subsequent determination of an entry point  732  of the charged particle beam into the patient  730 . Determination of the first vector, v 1a , is optionally supplemented with information derived from states of the magnetic fields about the first axis control  142 , the vertical control, and the second axis control  144 , the horizontal axis control, as described supra. 
     Still referring to  FIG. 9A , the charged particle beam state determination system is illustrated with multiple resolvable wavelengths of light emitted as a result of the charged particle beam transmitting through more than one molecule type, light emission center, and/or fluorophore type. For clarity of presentation and without loss of generality a first fluorophore in the third sheet  780  is illustrated as emitting blue light, b, and a second fluorophore in the fourth sheet  790  is illustrated as emitting red light, r, that are both detected by the third detector  816 . The third detector is optionally coupled with any wavelength separation device, such as an optical filter, grating, or Fourier transform device. For clarity of presentation, the system is described with the red light passing through a red transmission filter blocking blue light and the blue light passing through a blue transmission filter blocking red light. Wavelength separation, using any means, allows one detector to detect a position of the charged particle beam resultant in a first secondary emission at a first wavelength, such as at point C, and a second secondary emission at a second wavelength, such as at point D. By extension, with appropriate optics, one camera is optionally used to image multiple sheets and/or sheets both prior to and posterior to the sample. Spatial determination of origin of the red light and the blue light allow calculation of the first vector at the second time, v 1b , and an actual exit point  736  from the patient  730  as compared to a non-scattered exit point  734  from the patient  730  as determined from the first vector at the first time, v 1a . 
     Still referring to  FIG. 9A  and referring now to  FIG. 9B , the integrated tomography-cancer therapy system  900  is illustrated with an optional configuration of elements of the charged particle beam state determination system  750  being co-rotatable with the nozzle  146  of the cancer therapy system  100 . More particularly, in one case sheets of the charged particle beam state determination system  750  positioned prior to, posterior to, or on both sides of the patient  730  co-rotate with the scintillation plate  710  about any axis, such as illustrated with rotation about the y-axis. In various cases, co-rotation is achieved by co-rotation of the gantry of the charged particle beam system and a support of the patient, such as the rotatable platform  756 , which is also referred to herein as a movable or dynamically positionable patient platform, patient chair, or patient couch. Mechanical elements, such as the support element  752  affix the various elements of the charged particle beam state determination system  750  relative to each other, relative to the nozzle  146 , and/or relative to the patient  730 . For example, the support elements  752  maintain a second distance, d 2 , between a position of the tumor  720  and the third sheet  780  and/or maintain a third distance, d 3 , between a position of the third sheet  780  and the scintillation plate  710 . More generally, support elements  752  optionally dynamically position any element about the patient  730  relative to one another or in x,y,z-space in a patient diagnostic/treatment room, such as via computer control. 
     Referring now to  FIG. 9B , positioning the nozzle  146  of a gantry  960  on an opposite side of the patient  730  from a detection surface, such as the scintillation plate  710 , in a gantry movement system  950  is described. Generally, in the gantry movement system  950 , as the gantry  960  rotates about an axis the nozzle  146  and/or one or more magnets of the beam transport system  135  are repositioned. As illustrated, the nozzle  146  is positioned by the gantry  960  in a first position at a first time, t 1 , and in a second position at a second time, t 2 , where n positions are optionally possible. An electromechanical system  712 , such as a patient table, patient couch, patient couch, and/or a scintillation plate holder maintains the patient  730  between the nozzle  146  and the scintillation plate  710  of the tomography system  700 . Similarly, not illustrated for clarity of presentation, the electromechanical system  712  maintains a position of the third sheet  780  and/or a position of the fourth sheet  790  on a posterior or opposite side of the patient  730  from the nozzle  146  as the gantry  960  rotates or moves the nozzle  146 . Similarly, the electromechanical system  712  maintains a position of the first sheet  760  or first screen and/or a position of the second sheet  770  or second screen on a same or prior side of the patient  730  from the nozzle  146  as the gantry  960  rotates or moves the nozzle  146 . As illustrated, the electromechanical system  712  optionally positions the first sheet  760  in the positively charged particle path at the first time, t 1 , and rotates, pivots, and/or slides the first sheet  760  out of the positively charged particle path at the second time, t 2 . The electromechanical system  712  is optionally and preferably connected to the main controller  110  and/or the treatment delivery control system  112 . The electromechanical system  712  optionally maintains a fixed distance between: (1) the patient and the nozzle  146  or the nozzle end  612 , (2) the patient  730  or tumor  720  and the scintillation plate  710 , and/or (3) the nozzle  146  and the scintillation plate  710  at a first treatment time with the gantry  960  in a first position and at a second treatment time with the gantry  960  in a second position. Use of a common charged particle beam path for both imaging and cancer treatment and/or maintaining known or fixed distances between beam transport/guide elements and treatment and/or detection surface enhances precision and/or accuracy of a resultant image and/or tumor treatment, such as described supra. 
     System Integration 
     Any of the systems and/or elements described herein are optionally integrated together and/or are optionally integrated with known systems. 
     Treatment Delivery Control System 
     Referring now to  FIG. 10 , a centralized charged particle treatment system  1000  is illustrated. Generally, once a charged particle therapy plan is devised, a central control system or treatment delivery control system  112  is used to control sub-systems while reducing and/or eliminating direct communication between major subsystems. Generally, the treatment delivery control system  112  is used to directly control multiple subsystems of the cancer therapy system without direct communication between selected subsystems, which enhances safety, simplifies quality assurance and quality control, and facilitates programming. For example, the treatment delivery control system  112  directly controls one or more of: an imaging system, a positioning system, an injection system, a radio-frequency quadrupole system, a linear accelerator, a ring accelerator or synchrotron, an extraction system, a beam line, an irradiation nozzle, a gantry, a display system, a targeting system, and a verification system. Generally, the control system integrates subsystems and/or integrates output of one or more of the above described cancer therapy system elements with inputs of one or more of the above described cancer therapy system elements. 
     Still referring to  FIG. 10 , an example of the centralized charged particle treatment system  1000  is provided. Initially, a doctor, such as an oncologist, prescribes  1010  or recommends tumor therapy using charged particles. 
     Subsequently, treatment planning  1020  is initiated and output of the treatment planning step  1020  is sent to an oncology information system  1030  and/or is directly sent to the treatment delivery system  112 , which is an example of the main controller  110 . 
     Still referring to  FIG. 10 , the treatment planning step  1020  is further described. Generally, radiation treatment planning is a process where a team of oncologist, radiation therapists, medical physicists, and/or medical dosimetrists plan appropriate charged particle treatment of a cancer in a patient. Typically, one or more imaging systems  170  are used to image the tumor and/or the patient, described infra. Planning is optionally: (1) forward planning and/or (2) inverse planning. Cancer therapy plans are optionally assessed with the aid of a dose-volume histogram, which allows the clinician to evaluate the uniformity of the dose to the tumor and surrounding healthy structures. Typically, treatment planning is almost entirely computer based using patient computed tomography data sets using multimodality image matching, image coregistration, or fusion. 
     Forward Planning 
     In forward planning, a treatment oncologist places beams into a radiotherapy treatment planning system including: how many radiation beams to use and which angles to deliver each of the beams from. This type of planning is used for relatively simple cases where the tumor has a simple shape and is not near any critical organs. 
     Inverse Planning 
     In inverse planning, a radiation oncologist defines a patient&#39;s critical organs and tumor and gives target doses and importance factors for each. Subsequently, an optimization program is run to find the treatment plan which best matches all of the input criteria. 
     Oncology Information System 
     Still referring to  FIG. 10 , the oncology information system  1030  is further described. Generally, the oncology information system  1030  is one or more of: (1) an oncology-specific electronic medical record, which manages clinical, financial, and administrative processes in medical, radiation, and surgical oncology departments; (2) a comprehensive information and image management system; and (3) a complete patient information management system that centralizes patient data; and (4) a treatment plan provided to the charged particle beam system  100 , main controller  110 , and/or the treatment delivery control system  112 . Generally, the oncology information system  1030  interfaces with commercial charged particle treatment systems. 
     Safety System/Treatment Delivery Control System 
     Still referring to  FIG. 10 , the treatment delivery control system  112  is further described. Generally, the treatment delivery control system  112  receives treatment input, such as a charged particle cancer treatment plan from the treatment planning step  1020  and/or from the oncology information system  1030  and uses the treatment input and/or treatment plan to control one or more subsystems of the charged particle beam system  100 . The treatment delivery control system  112  is an example of the main controller  110 , where the treatment delivery control system receives subsystem input from a first subsystem of the charged particle beam system  100  and provides to a second subsystem of the charged particle beam system  100 : (1) the received subsystem input directly, (2) a processed version of the received subsystem input, and/or (3) a command, such as used to fulfill requisites of the treatment planning step  1020  or direction of the oncology information system  1030 . Generally, most or all of the communication between subsystems of the charged particle beam system  100  go to and from the treatment delivery control system  112  and not directly to another subsystem of the charged particle beam system  100 . Use of a logically centralized treatment delivery control system has many benefits, including: (1) a single centralized code to maintain, debug, secure, update, and to perform checks on, such as quality assurance and quality control checks; (2) a controlled logical flow of information between subsystems; (3) an ability to replace a subsystem with only one interfacing code revision; (4) room security; (5) software access control; (6) a single centralized control for safety monitoring; and (7) that the centralized code results in an integrated safety system  1040  encompassing a majority or all of the subsystems of the charged particle beam system  100 . Examples of subsystems of the charged particle cancer therapy system  100  include: a radio frequency quadrupole  1050 , a radio frequency quadrupole linear accelerator, the injection system  120 , the synchrotron  130 , the accelerator system  132 , the extraction system  134 , any controllable or monitorable element of the beam line  268 , the targeting/delivery system  140 , the nozzle  146 , a gantry  1060  or an element of the gantry  1060 , the patient interface module  150 , a patient positioner  152 , the display system  160 , the imaging system  170 , a patient position verification system  172 , any element described supra, and/or any subsystem element. A treatment change  1070  at time of treatment is optionally computer generated with or without the aid of a technician or physician and approved while the patient is still in the treatment room, in the treatment chair, and/or in a treatment position. 
     Safety 
     Referring now to  FIG. 11 , a redundant safety system  1100  is described. In one optional and preferred embodiment, the charged particle beam system  100  includes redundant systems for determination of one or more of: (1) beam position, (2) beam direction, (3) beam intensity, (4) beam energy, and (5) beam shape. The redundant safety system  1000  is further described herein. 
     Beam Position 
     A beam positioning system  1110  or beam position determination/verification system is linked to the main controller  100  or treatment delivery control system  112 . The beam positioning system  1110  includes any electromechanical system, optical system, and/or calculation for determining a current position of the charged particle beam. In a first case, after calibration, the scanning/targeting/delivery system  140  uses x/y-positioning magnets, such as in the first axis control  142  and the second axis control  144 , to position the charged particle beam. In a second case, a photonic emission position system  1114  is used to measure a position of the charged particle beam, where the photonic emission system  1114  uses a secondary emission of a photon upon passage of the charged particle beam, such as described supra for the first sheet  760 , the second sheet  770 , the third sheet  780 , and the fourth sheet  790 . In a third a case, a scintillation positioning system  1116 , such as via use of a detector element in the tomography system  700 , is used to measure a position of the charged particle beam. Any permutation or combination of the three cases described herein yield multiple or redundant measures of the charged particle beam position and therefrom one or more measures of a charged particle beam vector during a period of time. 
     Beam Intensity 
     A beam intensity system  1120  or beam intensity determination/verification system is linked to the main controller  100  or treatment delivery control system  112 . Herein, intensity is a number of positively charged particles passing a point or plane as a function of time. The beam intensity system  1110  includes any electromechanical system, optical system, and/or calculation for determining a current intensity of the charged particle beam. In a first case, the extraction system  134  uses an electron emission system  1122 , such as a secondary emission of electrons upon passage of the charged particle beam through the extraction material  330 , to determine an intensity of the charged particle beam. In a second case, the duration of the applied RF-field and/or a magnitude of the RF-field applied in the RF-cavity system  310  is used to calculate the intensity of the charged particle beam, as described supra. In a third case, a photon emission system  1124 , such as a magnitude of a signal representing the emitted photons from the photonic emission system  1114 , is used to measure the intensity of the charged particle beam. In a fourth case, a scintillation intensity determination system  1126  measures the intensity of the charged particle beam, such as with a detector of the tomography system  700 . 
     Beam Energy 
     A beam energy system  1130  or beam energy determination/verification system is linked to the main controller  100  or treatment delivery control system  112 . Herein, energy is optionally referred to as a velocity of the positively charged particles passing a point, where energy is dependent upon mass of the charged particles. The beam energy system  1110  includes any electromechanical system, optical system, and/or calculation for determining a current energy of the charged particle beam. In a first case, an RF-cavity energy system  1132  calculates an energy of the charged particles in the charged particle beam, such as via relating a period of an applied RF-field in the RF-cavity system  310  to energy, such as described supra. In a second case, an in-line energy system  1134  is used to measure a value related to beam energy, such as described above in equations 1 and 2. In a third case, a scintillation energy system  1136  is used to measure an energy of the charged particle beam, such as via use of a detector in the tomography system  700 . 
     Optionally and preferably, two or more measures/determination/calculations of a beam state property, such as position, direction, shape, intensity, and/or energy yield a redundant measure of the measured state for use in a beam safety system and/or an emergency beam shut-off system. Optionally and preferably, the two or more measures of a beam state property are used to enhance precision and/or accuracy of determination of the beam state property through statistical means. Optionally and preferably, any of the beam state properties are recorded and/or used to predict a future state, such as position, intensity, and/or energy of the charged particle beam, such as in a neighboring voxel in the tumor  720  adjacent to a currently treated voxel in the tumor  720  of the patient  730 . 
     Motion Control System 
     Referring now to  FIG. 12A , a motion control system  1200  is illustrated. Generally, the motion control system controls, as a function of time: (1) the charged particle beam state, such as direction, shape, intensity, and/or energy; (2) a patient position; and/or (3) an imaging system. The motion control system  1200  is further described herein. 
     The motion control system  1200  optionally uses one or more patient interface controllers  1210 , such as an external motion control system  1212 , an internal motion control system  1214 , an external pendant  1216 , and an internal pendant  1218 . As illustrated, the patient  730  is in a treatment room  1222  separated from a control room  1224  by a radiation shielded wall  1226  and a window  1228  or view port. The external motion control system  1212 , internal motion control system  1214 , external pendant  1216 , and the internal pendant  1218  optionally and preferably control the same elements, allowing one or more operators control of the motion control system. Any of the patient interface controllers  1210  are optionally linked to each other or to the main controller  110  via wireless means; however, interconnections of the patient interface controllers  1210  to each other and/or to the main controller  110  are preferably hard-wired due to high radiation levels in the treatment room  1222 . For example, the external pendant  1216  is linked via a first communication bundle  1217  to the external motion control system  1212 , the internal pendant  1218  is linked via a second communication bundle  1219  to the internal motion system controller  1214 , and/or the internal and external motion control system  1212 ,  1214  are hardwired to each other and/or to the main controller  110 . The first communication bundle  1217  and the second communication bundle  1219  optionally provide power to the external pendant  1216  and the internal pendant  1218 , respectively. The second communication bundle  1219  is optionally attached and/or linked to the nozzle system  146  and/or an element of the beam transport system  135  to keep the second communication bundle: (1) accessible to the operator, (2) out of the way of the charged particle beam, and/or (3) out of the way of motion of the patient  730 /patient interface module  150 . Optionally, a patient specific treatment module  1290  is replaceably plugged into and/or attached to the one or more patient interface controllers  1210 , such as the internal pendant  1218 . The patient treatment module  1290  optionally contains one or more of: image information about the individual being treated and/or preprogrammed treatment steps for the individual being treated, where some controls of the charged particle beam system  100 , such as related to charged particle beam aiming and/or patient positioning are optionally limited by the preprogrammed treatment steps of any information/hardware of the patient treatment module. Optionally, the internal pendant  1218  replaceably mounts to a bracket, hook, slot, or the like mounted on the nozzle system  146  or the beam transport system  135  to maintain close access for the operator when not in use. The operator optionally and preferably uses, at times, a mobile control pendant, such as the external pendant  1216  or the internal pendant  1218 . The operator optionally has access via a direct doorway  1229  between treatment room  1222  and the control room  1224 . Use of multiple patient interface controllers  1210  gives flexibility to an operator of the motion control system  1200 , as further described infra. 
     Example I 
     In a first example, the operator of the motion control system  1200  is optionally seated or standing by a fixed position controller, such as by a desktop or wall mounted version of the external motion control system  1212 . Similarly, the internal motion control system  1214  is optionally and preferably in a fixed position, such as at a desktop system or wall mounted system. 
     Example II 
     In a second example, the operator optionally and preferably uses, at times, the external pendant  1216 , which allows the operator to view the patient  730 , the beam transport system  135 , the patient interface module  150 , and/or the imaging system  170  through the safety of the window  1228 . Optionally and preferably, the beam transport system  135  is configured with one or more mechanical stops to not allow the charged particle beam to aim at the window  1228 , thereby providing a continuously safe zone for the operator. Direct viewing and control of the charged particle beam system  100 , imaging system  170 , and/or tomography system  700  relative to the current position of the patient  730  allows backup security in terms of unexpected aim of a treatment beam and/or movement of the patient  730 . Controlled elements and/or processes of the charged particle beam system  100  via the pendants is further described, infra. 
     Example III 
     In a third example, the operator optionally and preferably uses, at times, the internal pendant  1218 , which allows the operator both direct access and view of: (1) the patient  730 , (2) the beam transport system  135 , (3) the patient interface module  150 , and/or (4) the imaging system  170 , which has multiple benefits. In a first case, the operator can adjust any element of the patient interface module  150 , such as a patient positioning device and/or patient motion constraint device. In a second case, the operator has access to load/unload: (1) the patient specific tray insert  510  into the beam control tray assembly  400 ; (2) the beam control tray assembly  400  into the nozzle system  146 , as described supra; and/or (3) any imaging material, such as an X-ray film. 
     Example IV 
     In a fourth example, the gantry comprises at least two imaging devices, where each imaging device moves with rotation of the gantry and where the two imaging devices view the patient  730  along two axes forming an angle of ninety degrees, in the range of eighty-five to ninety-five degrees, and/or in the range of seventy-five to one hundred five degrees. 
     Pendant 
     Referring still to  FIG. 12A  and referring now to  FIG. 12B , a pendant system  1250 , such as a system using the external pendant  1216  and/or internal pendent  1218  is described. In a first case, the external pendant  1216  and internal pendant  1218  have identical controls. In a second case, controls and/or functions of the external pendant  1216  intersect with controls and/or function of the internal pendant  1218 . Particular processes and functions of the internal pendant  1218  are provided below, without loss of generality, to facilitate description of the external and internal pendants  1216 ,  1218 . The internal pendant  1218  optionally comprises any number of input buttons, screens, tabs, switches, or the like. The pendant system  1250  is further described, infra. 
     Example I 
     Referring now to  FIG. 12B , a first example of the internal pendant  1218  is provided. In this example, in place of and/or in conjunction with a particular button, such as a first button  1270  and/or a second button  1280 , moving or selecting a particular element, processes are optionally described, displayed, and/or selected within a flow process control unit  1260  of the internal pendant  1218 . For example, one or more display screens and/or printed elements describe a set of processes, such as a first process  1261 , a second process  1263 , a third process  1265 , and a fourth process  1267  and are selected through a touch screen selection process or via a selection button, such as a corresponding first selector  1262 , second selector  1264 , third selector  1266 , and fourth selector  1268 . 
     Example II 
     Referring still to  FIG. 12B , a second example of the internal pendant  1218  is provided. In this example, one or more buttons or the like, such as the first button  1270 , and/or one or more of the processes, such as the first process  1261 , are customizable, such as to an often repeated set of steps and/or to steps particular to treatment of a given patient  730 . The customizable element, such as the first button  1270 , is optionally further setup, programmed, controlled, and/or limited via information received from the patient treatment module  1290 . In this example, a button, or the like, operates as an emergency all stop button, which at the minimum shuts down the accelerator, redirects the charged particle beam to a beam stop separate from a path through the patient, or stops moving the patient  730 . 
     Example III 
     In place of and/or in conjunction with a particular button, such as the first button  1270  and/or the second button  1280 , moving or selecting a particular element, processes are optionally described, displayed, and/or selected within a flow process control unit  1260  of the internal pendant  1218 . For example, one or more display screens and/or printed elements describe a set of processes, such as a first process  1261 , a second process  1263 , a third process  1265 , and a fourth process  1267  and are selected through a touch screen selection process or via a selection button, such as a corresponding first selector  1262 , second selector  1264 , third selector  1266 , and fourth selector  1268 . 
     Referring still to  FIG. 12B , as illustrated for clarity and without loss or generalization, the first process  1261  and/or a display screen thereof operable by the first selector  1262  selects, initiates, and/or processes a set of steps related to the beam control tray assembly  400 . For instance, the first selector  1262 , functioning as a tray button: (1) confirms presence a requested patient specific tray insert  510  in a requested tray assembly; (2) confirms presence of a request patient specific tray insert in a receiving slot of the control tray assembly; (3) retracts the beam control tray assembly  400  into the nozzle system  146 ; (4) confirms information using the electromechanical identifier plug, such as the first electromechanical identifier plug  530 ; (5) confirms information using the patient treatment module  1290 ; and/or (6) performs a set of commands and/or movements identified with the first selector  1262  and/or identified with the first process  1261 . Similarly, the second process  1263 , corresponding to a second process display screen and/or the second selector  1264 ; the third process  1265 , corresponding to a third process display screen and/or the third selector  1266 ; and the fourth process  1267 , corresponding to a fourth process display screen and/or the fourth selector  1268  control and/or activate a set of actions, movements, and/or commands related to positioning the patient  730 , imaging the patient  730 , and treating the patient  730 , respectively. 
     Still yet another embodiment includes any combination and/or permutation of any of the elements described herein. 
     Herein, any number, such as 1, 2, 3, 4, 5, is optionally more than the number, less than the number, or within 1, 2, 5, 10, 20, or 50 percent of the number. 
     The particular implementations shown and described are illustrative of the invention and its best mode and are not intended to otherwise limit the scope of the present invention in any way. Indeed, for the sake of brevity, conventional manufacturing, connection, preparation, and other functional aspects of the system may not be described in detail. Furthermore, the connecting lines shown in the various figures are intended to represent exemplary functional relationships and/or physical couplings between the various elements. Many alternative or additional functional relationships or physical connections may be present in a practical system. 
     In the foregoing description, the invention has been described with reference to specific exemplary embodiments; however, it will be appreciated that various modifications and changes may be made without departing from the scope of the present invention as set forth herein. The description and figures are to be regarded in an illustrative manner, rather than a restrictive one and all such modifications are intended to be included within the scope of the present invention. Accordingly, the scope of the invention should be determined by the generic embodiments described herein and their legal equivalents rather than by merely the specific examples described above. For example, the steps recited in any method or process embodiment may be executed in any order and are not limited to the explicit order presented in the specific examples. Additionally, the components and/or elements recited in any apparatus embodiment may be assembled or otherwise operationally configured in a variety of permutations to produce substantially the same result as the present invention and are accordingly not limited to the specific configuration recited in the specific examples. 
     Benefits, other advantages and solutions to problems have been described above with regard to particular embodiments; however, any benefit, advantage, solution to problems or any element that may cause any particular benefit, advantage or solution to occur or to become more pronounced are not to be construed as critical, required or essential features or components. 
     As used herein, the terms “comprises”, “comprising”, or any variation thereof, are intended to reference a non-exclusive inclusion, such that a process, method, article, composition or apparatus that comprises a list of elements does not include only those elements recited, but may also include other elements not expressly listed or inherent to such process, method, article, composition or apparatus. Other combinations and/or modifications of the above-described structures, arrangements, applications, proportions, elements, materials or components used in the practice of the present invention, in addition to those not specifically recited, may be varied or otherwise particularly adapted to specific environments, manufacturing specifications, design parameters or other operating requirements without departing from the general principles of the same. 
     Although the invention has been described herein with reference to certain preferred embodiments, one skilled in the art will readily appreciate that other applications may be substituted for those set forth herein without departing from the spirit and scope of the present invention. Accordingly, the invention should only be limited by the Claims included below.