Patent Publication Number: US-2018028835-A1

Title: Counter balanced /  cantilevered charged particle cancer therapy gantry system and method of use thereof

Description:
CROSS-REFERENCES TO RELATED APPLICATIONS 
     This application:
         is a continuation-in-part of U.S. patent application Ser. No. 15/467,840 filed Mar. 23, 2017, which is a continuation-in-part of U.S. patent application Ser. No. 15/402,739 filed Jan. 10, 2017, which is a continuation-in-part of U.S. patent application Ser. No. 15/348,625 filed Nov. 10, 2016, which is a continuation-in-part of U.S. patent application Ser. No. 15/167,617 filed May 27, 2016; and   claims benefit of U.S. provisional patent application No. 62/561,148 filed Sep. 20, 2017.       

    
    
     BACKGROUND OF THE INVENTION 
     Field of the Invention 
     The invention relates generally to a cancer therapy treatment apparatus and method of use thereof, such as for imaging and/or treating a tumor. 
     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. 
     Problem 
     There exists in the art of charged particle cancer therapy a need for safe, accurate, precise, and rapid imaging of a patient and/or treatment of a tumor using charged particles. 
     SUMMARY OF THE INVENTION 
     The invention relates generally to a cantilevered gantry of a charged particle cancer therapy system, such as for imaging and treating a tumor. 
    
    
     
       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  illustrate component connections of a charged particle beam therapy system,  FIG. 1B  illustrates a charged particle therapy system; 
         FIG. 2  illustrates a tomography system; 
         FIG. 3  illustrates a beam path identification system; 
         FIG. 4A  illustrates a beam path identification system coupled to a beam transport system and a tomography scintillation detector;  FIG. 4B  illustrates an x-axis ionization strip detector;  FIG. 4C  illustrates a y-axis ionization strip detector;  FIG. 4D  illustrates a kinetic energy dissipation chamber;  FIG. 4E  illustrates ionization strips integrated with the kinetic energy dissipation chamber;  FIG. 4F  illustrates an alternating kinetic energy dissipation chamber-targeting chamber;  FIG. 4G  illustrates a beam mapping chamber;  FIG. 4H  illustrates beam direction compensating chambers; and  FIG. 4I  illustrates the scintillation detector rotating with the patient and gantry nozzle; 
         FIG. 5  illustrates a treatment delivery control system; 
         FIG. 6A  illustrates a two-dimensional-two-dimensional imaging system relative to a cancer treatment beam,  FIG. 6B  illustrates multiple gantry supported imaging systems, and  FIG. 6C  illustrates a rotatable cone beam; 
         FIG. 7A  illustrates a process of determining position of treatment room objects and  FIG. 7B  illustrates an iterative position tracking, imaging, and treatment system; 
         FIG. 8  illustrates a fiducial marker enhanced tomography imaging system; 
         FIG. 9  illustrates a fiducial marker enhanced treatment system; 
         FIGS. 10 (A-C) illustrate isocenterless cancer treatment systems; 
         FIG. 11  illustrates a gantry counterweight system; 
         FIG. 12  illustrates a counterweighted gantry system; 
         FIG. 13A  illustrates a rolling floor system with a movable nozzle,  FIG. 13B , a patient positioning system,  FIG. 13C , and a nozzle extension track guidance system,  FIG. 13D ; 
         FIG. 14  illustrates a hybrid cancer-treatment imaging system; 
         FIG. 15  illustrates a combined patient positioning system-imaging system; 
         FIG. 16A  illustrates a combined gantry-rolling floor system and  FIG. 16B  illustrates a segmented bearing; 
         FIG. 17  illustrates a wall mounted gantry system; 
         FIG. 18  illustrates a floor mounted gantry system; 
         FIG. 19  illustrates a gantry superstructure system; 
         FIG. 20  illustrates a transformable axis system for tumor treatment; 
         FIG. 21  illustrates a semi-automated cancer therapy imaging/treatment system; 
         FIG. 22  illustrates a system of automated generation of a radiation treatment plan; 
         FIG. 23  illustrates a system of automatically updating a cancer radiation treatment plan during treatment; and 
         FIG. 24  illustrates an automated radiation treatment plan development and implementation system. 
     
    
    
     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 comprises a method and apparatus for directing positively charged particles, comprising the steps of: (1) directing the positively charged particles along a beamline; (2) rotating a cantilevered rotatable gantry arm, both connected to a rotatable gantry support and supporting the beamline, about a horizontal rotation axis of the rotatable gantry support; and (3) countering torque, of at least the cantilevered rotatable gantry arm, about the rotation axis using a counterweight connected to the rotatable gantry support. Optionally, the gantry movement is used as part of rotating the rotatable gantry arm three hundred sixty degrees around an inner gantry arm side motion defined volume, which allows access to one side of a treatment room and the gantry arc swept volume, such as for entrance, mounting a patient positioning system, and/or for a ground based support structure. 
     The above described embodiment is optionally used in combination with a proton therapy cancer treatment system and/or a proton tomography imaging system. Generally, one or more detectors imaging photons emitted from the coated layers, also referred to as imaging sheets or layers, are used to determine one or more point positions of the charged particle beam at a given time. Combining the point positions yields localized vectors pinpointing the charged particle beam position, such as entering a patient. The resulting charged particle state determination system using one or more coated layers is used 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 where common synchrotron, beam transport, and/or nozzle elements are used for both proton imaging and cancer treatment. 
     The above described embodiment is optionally used in combination with a set of fiducial marker detectors configured to detect photons emitted from and/or reflected off of a set of fiducial markers positioned on one or more objects in a treatment room and resultant determined distances and/or calculated angles are used to determine relative positions of multiple objects or elements in the treatment room. Generally, in an iterative process, at a first time objects, such as a treatment beamline output nozzle, a specific portion of a patient relative to a tumor, a scintillation detection material, an X-ray system element, and/or a detection element, are mapped and relative positions and/or angles therebetween are determined. At a second time, the position of the mapped objects is used in: (1) imaging, such as X-ray, positron emission tomography, and/or proton beam imaging and/or (2) beam targeting and treatment, such as positively charged particle based cancer treatment. As relative positions of objects in the treatment room are dynamically determined using the fiducial marking system, engineering and/or mathematical constraints of a treatment beamline isocenter is removed. 
     In combination, a method and apparatus is described for determining a position of a tumor in a patient for treatment of the tumor using positively charged particles in a treatment room. More particularly, the method and apparatus use a set of fiducial markers and fiducial detectors to mark/determine relative position of static and/or moveable objects in a treatment room using photons passing from the markers to the detectors. Further, position and orientation of at least one of the objects is calibrated to a reference line, such as a zero-offset beam treatment line passing through an exit nozzle, which yields a relative position of each fiducially marked object in the treatment room. Treatment calculations are subsequently determined using the reference line and/or points thereon. The inventor notes that the treatment calculations are optionally and preferably performed without use of an isocenter point, such as a central point about which a treatment room gantry rotates, which eliminates mechanical errors associated with the isocenter point being an isocenter volume in practice. 
     In combination, a method and apparatus for imaging a tumor of a patient using positively charged particles and X-rays, comprises the steps of: (1) transporting the positively charged particles from an accelerator to a patient position using a beam transport line, where the beam transport line comprises a positively charged particle beam path and an X-ray beam path; (2) detecting scintillation induced by the positively charged particles using a scintillation detector system; (3) detecting X-rays using an X-ray detector system; (4) positioning a mounting rail through linear extension/retraction to: at a first time and at a first extension position of the mounting rail, position the scintillation detector system opposite the patient position from the exit nozzle and at a second time and at a second extension position of the mounting rail, position the X-ray detector system opposite the patient position from the exit nozzle; (5) generating an image of the tumor using output of the scintillation detector system and the X-ray detector system; and (6) alternating between the step of detecting scintillation and treating the tumor via irradiation of the tumor using the positively charged particles. 
     In combination, a tomography system is optionally used in combination with a charged particle cancer therapy system. The tomography system uses tomography or tomographic imaging, which refers to imaging by sections or sectioning through the use of a penetrating wave, such as a positively charge particle from an injector and/or accelerator. 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 material, scintillation detector and/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, accelerated with an 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. 
     For clarity of presentation and without loss of generality, throughout this document, treatment systems and imaging systems are described relative to a tumor of a patient. However, more generally any sample is imaged with any of the imaging systems described herein and/or any element of the sample is treated with the positively charged particle beam(s) described herein. 
     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  131  and (2) an internal or connected extraction system  134 ; a radio-frequency cavity system  180 ; a beam transport system  135 ; a scanning/targeting/delivery system  140 ; a nozzle system  146 ; 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  131  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  or a patient with a patient positioning system. 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 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, a positive 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 . Optionally, focusing magnets  127 , 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  128  bends the proton beam toward a plane of the synchrotron  130 . The focused protons having an initial energy are introduced into an injector magnet  129 , which is preferably an injection Lambertson 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  128  and injector magnet  129  combine to move the protons into the synchrotron  130 . Main bending magnets, dipole magnets, turning magnets, or circulating magnets  132  are used to turn the protons along a circulating beam path  164 . A dipole magnet is a bending magnet. The main bending magnets  132  bend the initial beam path  262  into a circulating beam path  164 . In this example, the main bending magnets  132  or circulating magnets are represented as four sets of four magnets to maintain the circulating beam path  164  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  133 . The accelerator accelerates the protons in the circulating beam path  164 . As the protons are accelerated, the fields applied by the magnets are increased. Particularly, the speed of the protons achieved by the accelerator  133  are synchronized with magnetic fields of the main bending magnets  132  or circulating magnets to maintain stable circulation of the protons about a central point or region  136  of the synchrotron. At separate points in time the accelerator  133 /main bending magnet  132  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 Lambertson extraction magnet  137  to remove protons from their circulating beam path  164  within the synchrotron  130 . One example of a deflector component is a Lambertson 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  142  and optional extraction focusing magnets  141 , such as quadrupole magnets, and optional bending 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  143 , such as a vertical control, and a second axis control  144 , such as a horizontal control. In one embodiment, the first axis control  143  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 directing the proton beam, 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. 
     Ion Extraction from Ion Source 
     For clarity of presentation and without loss of generality, examples focus on protons from the ion source. However, more generally cations of any charge are optionally extracted from a corresponding ion source with the techniques described herein. For instance, C 4+  or C 6+  are optionally extracted using the ion extraction methods and apparatus described herein. Further, by reversing polarity of the system, anions are optionally extracted from an anion source, where the anion is of any charge. 
     Herein, for clarity of presentation and without loss of generality, ion extraction is coupled with tumor treatment and/or tumor imaging. However, the ion extraction is optional used in any method or apparatus using a stream or time discrete bunches of ions. 
     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. 
     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 or nozzle system  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. 
     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 relative to the patient 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 optionally stationary while the patient is rotated. 
     Referring now to  FIG. 2 , an example of a tomography apparatus is described and an example of a beam state determination is described. In this example, the tomography system  200  uses elements in common with the charged particle beam system  100 , including elements of one or more of the injection system  120 , the accelerator  130 , a positively charged particle beam transport path  268  within a beam transport housing  261  in the beam transport system  135 , the targeting/delivery system  140 , the patient interface module  150 , the display system  160 , and/or the imaging system  170 , such as the X-ray imaging system. 
     The scintillation material is optionally one or more scintillation plates, such as a scintillating plastic, used to measure energy, intensity, and/or position of the charged particle beam. For instance, a scintillation material  210  or scintillation plate is positioned behind the patient  230  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  230  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  220  and/or an image of the patient  230 . The patient  230  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. 
     Herein, the scintillation material  210  or scintillator is any material that emits a photon when struck by a positively charged particle or when a positively charged particle transfers energy to the scintillation material sufficient to cause emission of light. Optionally, the scintillation material  210  emits the photon after a delay, such as in fluorescence or phosphorescence. However, preferably, the scintillator has a fast fifty percent quench time, such as less than 0.0001, 0.001, 0.01, 0.1, 1, 10, 100, or 1,000 milliseconds, so that the light emission goes dark, falls off, or terminates quickly. Preferred scintillation materials include sodium iodide, potassium iodide, cesium iodide, an iodide salt, and/or a doped iodide salt. Additional examples of the scintillation materials include, but are not limited to: an organic crystal, a plastic, a glass, an organic liquid, a luminophor, and/or an inorganic material or inorganic crystal, such as barium fluoride, BaF 2 ; calcium fluoride, CaF 2 , doped calcium fluoride, sodium iodide, NaI; doped sodium iodide, sodium iodide doped with thallium, NaI(TI); cadmium tungstate, CdWO 4 ; bismuth germanate; cadmium tungstate, CdWO 4 ; calcium tungstate, CaWO 4 ; cesium iodide, CsI; doped cesium iodide; cesium iodide doped with thallium, CsI(Tl); cesium iodide doped with sodium CsI(Na); potassium iodide, KI; doped potassium iodide, gadolinium oxysulfide, Gd 2 O 2 S; lanthanum bromide doped with cerium, LaBr 3 (Ce); lanthanum chloride, LaCl 3 ; cesium doped lanthanum chloride, LaCl 3 (Ce); lead tungstate, PbWO 4 ; LSO or lutetium oxyorthosilicate (Lu 2 SiO 5 ); LYSO, Lu 1.8 Y 0.2 SiO 5 (Ce); yttrium aluminum garnet, YAG(Ce); zinc sulfide, ZnS(Ag); and zinc tungstate, ZnWO 4 . 
     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  220  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  230  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 and/or integrated to from a hybrid X-ray/proton beam tomographic image as the patient  230  is optionally in the same position for each image. 
     In still another embodiment, the tomogram is collected with the patient  230  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  220  to be separated from surrounding organs or tissue of the patient  230  better than in a laying position. Positioning of the scintillation material  210  behind the patient  230  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 eases patient setup, reduces alignment uncertainties, reduces beam state uncertainties, and eases quality assurance. 
     In yet still another embodiment, initially a three-dimensional tomographic X-ray and/or proton based reference image is collected, such as with hundreds of individual rotation images of the tumor  220  and patient  230 . 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 X-ray source and/or 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 optionally 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. 2 , the tomography system  200  is optionally used with a charged particle beam state determination system  250 , optionally used as a charged particle verification system. The charged particle state determination system  250  optionally measures, determines, and/or verifies one of more of: (1) position of the charged particle beam, such as a treatment beam  269 , (2) direction of the treatment beam  269 , (3) intensity of the treatment beam  269 , (4) energy of the treatment beam  269 , (5) position, direction, intensity, and/or energy of the charged particle beam, such as a residual charged particle beam  267  after passing through a sample or the patient  230 , and/or (6) 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  250  is described and illustrated separately in  FIG. 3  and  FIG. 4A ; however, as described herein elements of the charged particle beam state determination system  250  are optionally and preferably integrated into the nozzle system  146  and/or the tomography system  200  of the charged particle treatment system  100 . More particularly, any element of the charged particle beam state determination system  250  is integrated into the nozzle system  146 , a dynamic gantry nozzle, and/or tomography system  200 , such as a surface of the scintillation material  210  or a surface of a scintillation detector, plate, or system. The nozzle system  146  or the dynamic gantry nozzle 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 is optionally a first sheet  252  of the charged particle beam state determination system  250  and a first coating  254  is optionally coated onto the exit foil, as illustrated in  FIG. 2 . Similarly, optionally a surface of the scintillation material  210  is a support surface for a fourth coating  292 , as illustrated in  FIG. 2 . The charged particle beam state determination system  250  is further described, infra. 
     Referring now to  FIG. 2 ,  FIG. 3 , and  FIG. 4A , four sheets, a first sheet  252 , a second sheet  270 , a third sheet  280 , and a fourth sheet  290  are used to illustrate 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  252  is optionally coated with a first coating  254 . 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  270  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. 2  and  FIG. 3 , the charged particle beam state verification system  250  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  250  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. 2  and  FIG. 3 , 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, as viewed 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 position of a treatment beam  269 , which is also referred to as a current position of the charged particle beam 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  143 , vertical control, and the second axis control  144 , horizontal control, beam position control elements during treatment of the tumor  220 . The camera views the current position of the charged particle beam or treatment 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  143 ,  144 . Preferably, the coating layer is positioned in the proton beam path  268  in a position prior to the protons striking the patient  230 . 
     Referring now to  FIG. 1  and  FIG. 2 , the main controller  110 , connected to the camera or detector output, optionally and preferably compares the final proton beam position or position of the treatment beam  269  with the planned proton beam position and/or a calibration reference, such as a calibrated beamline, to determine if the actual proton beam position or position of the treatment beam  269  is within tolerance. The charged particle beam state determination system  250  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 first axis control  143  and the second axis control  144  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  220  and/or as a charged particle beam shutoff safety indicator. Referring now to  FIG. 5 , the position verification system  179  and/or a 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  230  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. 2 , a first example of the charged particle beam state determination system  250  is illustrated using two cation induced signal generation surfaces, referred to herein as the first sheet  252  and a third sheet  780 . Each sheet is described below. 
     Still referring to  FIG. 2 , in the first example, the optional first sheet  252 , located in the charged particle beam path prior to the patient  230 , is coated with a first fluorophore coating  254 , wherein a cation, such as in the charged particle beam, transmitting through the first sheet  252  excites localized fluorophores of the first fluorophore coating  254  with resultant emission of one or more photons. In this example, a first detector  212  images the first fluorophore coating  254  and the main controller  110  determines a current position of the charged particle beam using the image of the fluorophore coating  254  and the detected photon(s). The intensity of the detected photons emitted from the first fluorophore coating  254  is optionally used to determine the intensity of the charged particle beam used in treatment of the tumor  220  or detected by the tomography system  200  in generation of a tomogram and/or tomographic image of the tumor  220  of the patient  230 . 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. 2 , in the first example, the optional third sheet  280 , positioned posterior to the patient  230 , is optionally a cation induced photon emitting sheet as described in the previous paragraph. However, as illustrated, the third sheet  280  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  280  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. 2 , in the first example, signals from the first sheet  252  and third sheet  280  yield a position before and after the patient  230  allowing a more accurate determination of the charged particle beam through the patient  230  therebetween. Optionally, knowledge of the charged particle beam path in the targeting/delivery system  140 , such as determined via a first magnetic field strength across the first axis control  143  or a second magnetic field strength across the second axis control  144  is combined with signal derived from the first sheet  252  to yield a first vector of the charged particles prior to entering the patient  230  and/or an input point of the charged particle beam into the patient  230 , 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  280 , posterior to the patient  230 , is combined with signal derived from tomography system  200 , such as the scintillation material  210 , to yield a second vector of the charged particles posterior to the patient  230  and/or an output point of the charged particle beam from the patient  230 , 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  250 . 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  230  and/or posterior to the patient  230 , 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 system  146 , in the treatment room, and/or in the tomography system  200 . 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  220  of the patient  230  and/or for aiding generation of a tomographic image. 
     Example II 
     Referring now to  FIG. 3 , a second example of the charged particle beam state determination system  250  is illustrated using three cation induced signal generation surfaces, referred to herein as the second sheet  270 , the third sheet  280 , and the fourth sheet  290 . Any of the second sheet  270 , the third sheet  280 , and the fourth sheet  290  contain any of the features of the sheets described supra. 
     Still referring to  FIG. 3 , in the second example, the second sheet  270 , positioned prior to the patient  230 , is optionally integrated into the nozzle and/or the nozzle system  146 , but is illustrated as a separate sheet. Signal derived from the second sheet  270 , such as at point A, is optionally combined with signal from the first sheet  252  and/or state of the targeting/delivery system  140  to yield a first line or vector, v 1a , from point A to point B of the charged particle beam prior to the sample or patient  230  at a first time, t 1 , and a second line or 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. 3 , in the second example, the third sheet  280  and the fourth sheet  290 , positioned posterior to the patient  230 , are optionally integrated into the tomography system  200 , but are illustrated as a separate sheets. Signal derived from the third sheet  280 , such as at point D, is optionally combined with signal from the fourth sheet  290  and/or signal from the tomography system  200  to yield a first line segment or 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  230  at the first time, t 1 , and a second line segment or vector, v 2b , 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  280  and/or from the fourth sheet  290  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 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  230 , sample, and/or the tumor  220 , 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  230 , such as about the y-axis, as a function of time. 
     Still referring to  FIG. 3 , 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  211  is illustrated, including a second detector  214  imaging the second sheet  270 , a third detector  216  imaging the third sheet  280 , and a fourth detector  218  imaging the fourth sheet  290 . 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  252 ,  270 ,  280 ,  290 . 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. 3 , a vector or line segment of the charged particle beam is determined. Particularly, in the illustrated example, the third detector  216 , determines, via detection of secondary emitted photons, that the charged particle beam transmitted through point D and the fourth detector  218  determines that the charged particle beam transmitted through point E, where points D and E are used to determine the first vector or line segment 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  252  is illustrated that optionally connects any two or more elements of the charged particle beam state determination system  250  to each other and/or to any element of the charged particle beam system  100 , such as a rotating platform  256  used to position and/or co-rotate the patient  230  and any element of the tomography system  200 . 
     Example III 
     Still referring to  FIG. 4A , a third example of the charged particle beam state determination system  250  is illustrated in an integrated tomography-cancer therapy system  400 . 
     Referring to  FIG. 4A , multiple sheets and multiple detectors are illustrated determining a charged particle beam state prior to the patient  230 . As illustrated, a first camera  212  spatially images photons emitted from the first sheet  260  at point A, resultant from energy transfer from the passing charged particle beam, to yield a first signal and a second camera  214  spatially images photons emitted from the second sheet  270  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 or line segment, v 1a , with a subsequent determination of an entry point  232  of the charged particle beam into the patient  230 . Determination of the first vector, v 1a , is optionally supplemented with information derived from states of the magnetic fields about the first axis control  143 , the vertical control, and the second axis control  144 , the horizontal axis control, as described supra. 
     Still referring to  FIG. 4A , 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  280  is illustrated as emitting blue light, b, and a second fluorophore in the fourth sheet  290  is illustrated as emitting red light, r, that are both detected by the third detector  216 . 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  236  from the patient  230  as compared to a non-scattered exit point  234  from the patient  230  as determined from the first vector at the first time, v 1a . 
     Ion Beam State Determination/Energy Dissipation System 
     Referring now to  FIG. 4B-4H  an ion beam state determination/kinetic energy dissipation system is described. Generally, a dual use chamber is described functioning at a first time, when filled with gas, as an element in an ion beam state determination system and functioning at a second time, when filled with liquid, as an element of a kinetic energy dissipation system. The dual purpose/use chamber is further described herein. 
     Ionization Strip Detector 
     Referring now to  FIGS. 4 (A-C), an ion beam location determination system is described. In  FIG. 4A , x/y-beam positions are determined using a first sheet  260  and a second sheet  270 , such as where the sheets emit photons. In  FIG. 4B , the first sheet  260  comprises a first axis, or x-axis, ionization strip detector  410 . In the first ionization strip detector  410 , an x-axis position of the positive ion beam is determined using vertical strips, where interaction of the positive ion with one or more vertical strips of the x-axis interacting strips  411  results in electron emission, the current carried by the interacting strip and converted to an x-axis position signal, such as with an x-axis register  412 , detector, integrator, and/or amplifier. Similarly, in the second ionization strip detector  415 , a y-axis position of the positive ion beam is determined using horizontal strips, where interaction of the positive ion results with one or more horizontal strips of the y-axis ionization strips  416  results in another electron emission, the resulting current carried by the y-axis interacting strip and converted to a y-axis position signal, such as with a y-axis register  417 , detector, integrator, and/or amplifier. 
     Dual Use Ion Chamber 
     Referring now to  FIG. 4D  a dual use ionization chamber  420  is illustrated. The dual use ionization chamber  420  is optionally positioned anywhere in an ion beam path, in a negatively charged particle beam path, and/or in a positively charged particle beam path, where the positively charged particle beam path is used herein for clarity of presentation. Herein, for clarity of presentation and without loss of generality, the dual use ionization chamber  420  is integrated into and/or is adjacent the nozzle system  146 . The dual use ionization chamber  420  comprises any material, but is optionally and preferably a plastic, polymer, polycarbonate, and/or an acrylic. The dual use ionization chamber  420  comprises: a charged particle beam entrance side  423  and a charged particle beam exit side  425 . The positively charged particle beam path optionally and preferably passes through an entrance aperture  424  in the beam entrance side of the dual use ionization chamber  420  and exits the dual use ionization chamber  420  through an exit aperture  426  in the charged particle beam exit side  425 . The entrance aperture  424  and/or the exit aperture  426  are optionally covered with a liquid tight and/or gas tight optic or film, such as a window, glass, optical cell surface, film, membrane, a polyimide film, an aluminum coated film, and/or an aluminum coated polyimide film. 
     Example I 
     In a first example, referring now to  FIG. 4D  and  FIG. 4E , the entrance aperture  424  and exit aperture  426  of the charged particle beam entrance side  423  and the charged particle beam exit side  425 , respectively, of the dual use ionization chamber  420  are further described. More particularly, the first ionization strip detector  410  and the second ionization strip detector  415  are coupled with the dual use ionization chamber  420 . As illustrated, the first ionization strip detector  410  and the second ionization strip detector  415  cover the entrance aperture  424  and optionally and preferably form a liquid and/or gas tight seal to the entrance side  423  of the dual use ionization chamber  420 . 
     Example II 
     In a second example, referring still to  FIG. 4D  and  FIG. 4E , the entrance aperture  424  and exit aperture  426  of the charged particle beam entrance side  423  and the charged particle beam exit side  425 , respectively, of the dual use ionization chamber  420  are further described. More particularly, in this example, the first ionization strip detector  410  and the second ionization strip detector  415  are integrated into the exit aperture  426  of the use ionization chamber  420 . As illustrated, an aluminum coated film  421  is also integrated into the exit aperture  426 . 
     Example III 
     In a third example, referring still to  FIG. 4D  and  FIG. 4E , the first ionization detector  410  and the second ionization detector  415  are optionally used to: (1) cover and/or function as an element of a seal of the entrance aperture  424  and/or the exit aperture  426  and/or (2) function to determine a position and/or state of the positively charged ion beam at and/or near one or both of the entrance aperture  424  and the exit aperture  426  of the dual use ionization chamber  420 . 
     Referring now to  FIG. 4F , two uses of the dual use ionization chamber  420  are described. At a first time, the dual use ionization chamber  420  is filled, at least to above a path of the charged particle beam, with a liquid. The liquid is used to reduce and/or dissipate the kinetic energy of the positively charged particle beam. At a second time, the dual use ionization chamber  420  is filled, at least in a volume of the charged particle beam, with a gas. The gas, such as helium, functions to maintain the charged particle beam integrity, focus, state, and/or dimensions as the helium scatters the positively charged particle beam less than air, where the pathlength of the dual use ionization chamber  420  is necessary to separate elements of the nozzle system, such as the first axis control  143 , the second axis control  144 , the first sheet  260 , the second sheet  270 , the third sheet  280 , the fourth sheet  290 , and/or one or more instances of the first ionization detector  410  and the second ionization detector  415 . 
     Kinetic Energy Dissipater 
     Referring still to  FIG. 4F , the kinetic energy dissipation aspect of the dual use ionization chamber  420  is further described. At a first time, a liquid, such as water is moved, such as with a pump, into the dual use ionization chamber  420 . The water interacts with the proton beam to slow and/or stop the proton beam. At a second time, the liquid is removed, such as with a pump and/or drain, from the dual use ionization chamber  420 . Through use of more water than will fit into the dual use ionization chamber  420 , the radiation level of the irradiated water per unit volume is decreased. The decreased radiation level allows more rapid access to the ionization chamber, which is very useful for maintenance and even routine use of a high power proton beam cancer therapy system. The inventor notes that immediate access to the chamber is allowed versus a standard and mandatory five hour delay to allow radiation dissipation using a traditional solid phase proton beam energy reducer. 
     Example I 
     Still referring to  FIG. 4F , an example of use of a liquid movement/exchange system  430  is provided, where the liquid exchange system  430  is used to dissipate kinetic energy and/or to disperse radiation. Generally, the liquid exchange system moves water from the use purpose ionization chamber  420 , having a first volume  427 , using one or more water lines  436 , to a liquid reservoir tank  432  having a second volume  434 . Generally, any radiation build-up in the first volume  427  is diluted by circulating water through the water lines  436  to the second volume  434 , where the second volume is at least 0.25, 0.5, 1, 2, 3, 5, or 10 times the size of the first volume. As illustrated, more than one drain line is attached to the dual use ionization chamber  420 , which allows the dual use ionization chamber  420  to drain regardless of orientation of the nozzle system  146  as the dual use ionization chamber  420  optionally and preferably co-moves with the nozzle system  146  and/or is integrated into the nozzle system  146 . Optionally, the liquid movement/exchange system  430  is used to remove radiation from the treatment room  922 , to reduce radiation levels of discharged fluids to acceptable levels via dilution, and/or to move the temporarily radioactive fluid to another area or room for later reuse in the liquid movement/exchange system  430 . 
     Example II 
     Still referring to  FIG. 4F , an example of a gas movement/exchange system  440  is provided, where the gas exchange system  440  is used to fill/empty gas, such as helium, from the dual use ionization chamber  420 . As illustrated, helium, from a pressurized helium tank  442  and/or a helium displacement chamber  444 , is moved, such as via a regulator  446  or pump and/or via displacement by water, to/from the dual use ionization chamber  420  using one or more gas lines. For instance, as water is pumped into the dual use ionization chamber  420  from the liquid reservoir tank  432 , the water displaces the helium forcing the helium back into the helium displacement chamber  444 . Alternatingly, the helium is moved back into the dual use ionization chamber  420  by draining the water, as described supra, and/or by increasing the helium pressure, such as through use of the pressurized helium tank  442 . A desiccator is optionally used in the system. 
     It should be appreciated that the gas/liquid reservoirs, movement lines, connections, and pumps are illustrative in nature of any liquid movement system and/or any gas movement system. Further, the water, used in the examples for clarity of presentation, is more generally any liquid, combination of liquids, hydrocarbon, mercury, and/or liquid bromide. Similarly, the helium, used in the examples for clarity of presentation, is more generally any gas, mixture of gases, neon, and/or nitrogen. 
     Generally, the liquid in the liquid exchange system  430 , replaces graphite, copper, or metal used as a kinetic energy reducer in the cancer therapy system  100 . Still more generally, the liquid exchange system  420  is optionally used with any positive particle beam type, any negative particle beam type, and/or with any accelerator type, such as a cyclotron or a synchrotron, to reduce kinetic energy of the ion beam while diluting and/or removing radiation from the system. 
     Beam Energy Reduction 
     Still referring to  FIG. 4F  and referring now to  FIG. 4H , the kinetic energy dissipation aspect of the dual use ionization chamber  420  is further described. A pathlength, b, between the entrance aperture  424  and exit aperture  426 , of 55 cm through water is sufficient to block a 330 MeV proton beam, where a 330 MeV proton beam is sufficient for proton transmission tomography through a patient. Thus, smaller pathlengths are optionally used to reduce the energy of the proton beam. 
     Still referring to  FIG. 4F , in a first optional embodiment, a series of liquid cells of differing pathlengths are optionally moved into and out of the proton beam to reduce energy of the proton beam and thus control a depth of penetration into the patient  230 . For example, any combination of liquid cells, such as the dual use ionization chamber  420 , having pathlengths of 1, 2, 4, 8, 16, or 32 cm or any pathlength from 0.1 to 100 cm are optionally used. Once an energy degradation pathlength is set to establish a main distance into the patient  230 , energy controllers of the proton beam are optionally used to scan varying depths into the tumor. 
     Still referring to  FIG. 4F  and referring again to  FIG. 4H , in a second, preferred, optional embodiment, one or more pathlength adjustable liquid cells, such as the dual use ionization chamber  420 , are positioned in the proton beam path to use the proton beam energy to a preferred energy to target a depth of penetration into the patient  230 . Two examples are used to further describe the pathlength adjustable liquid cells yielding a continuous variation of proton beam energy. 
     Example I 
     A first example of a continuously variable proton beam energy controller  470  is illustrated in  FIG. 4H . It should be appreciated that a first triangular cross-section is used to represent the dual use ionization chamber  420  for clarity of presentation and without loss of generality. More generally, any cross-section, continuous and/or discontinuous as a function of x/y-axis position, is optionally used. Here, a continuous function, pathlength variable with x- and/or y-axis movement first liquid cell  428  comprises a triangular cross-section. As illustrated, at a first time, t 1 , the proton beam path  268  has a first pathlength, b 1 , through the first liquid cell  428 . At a second time, after translation of the first liquid cell  428  upward along the y-axis, the proton beam path has a second pathlength, b 2 , through the first liquid cell  428 . Thus, by moving the first liquid cell  428 , having a non-uniform thickness, the proton beam path  268  passes through differing amounts of liquid, yielding a range of kinetic energy dissipation. Simply, a longer pathlength, such as the second pathlength, b 2 , being longer than the first pathlength, b 1 , results in a greater slowing of the charged particles in the proton beam path. Herein, an initial pathlength of unit length one is replaced with the second pathlength that is plus-or-minus at least 1, 2, 3, 4, 5, 10, 20, 30, 50, 100, or 200 percent of the first pathlength. 
     Example II 
     A second example of a continuously variable proton beam energy controller  470  is illustrated in  FIG. 4H . As illustrated, by increasing or decreasing the first pathlength, b 1 , the resultant proton beam path  268  is possibly offset downward or upward respectively. To correct the proton beam path  268  back to an original vector, such as the treatment beam path  269 , a second liquid cell  429  is used. As illustrated: (1) a third pathlength, b 3 , through the second liquid cell  429  is equal to the first pathlength, b 1 , at the first time, t 1 ; (2) the sign of the entrance angle of the proton beam path  268  is reversed when entering the second liquid cell  429  compared to entering the first liquid cell  428 ; and (3) the sign of the exit angle of the proton beam  268  exiting the second liquid cell  429  is opposite the first liquid cell  428 . Further, as the first liquid cell  428  is moved in a first direction, such as upward along the y-axis as illustrated, to maintain a fourth pathlength, b 4 , in the second liquid cell  429  matching the second pathlength, b 2 , through the first liquid cell  428  at a second time, t 2 , the second liquid cell  429  is moved in an opposite direction, such as downward along the y-axis. More generally, the second liquid cell  429  optionally: (1) comprises a shape of the first liquid cell  428 ; (2) is rotated one-hundred eighty degrees relative to the first liquid cell  428 ; and (3) is translated in an opposite direction of translation of the first liquid cell  428  through the proton beam path  268  as a function of time. Generally, 1, 2, 3, 4, 5, or more liquid cells of any combination of shapes are used to slow the proton beam to a desired energy and direct the resultant proton beam, such as the treatment beam  269  along a chosen vector as a function of time. 
     Example III 
     Still referring to  FIG. 4F  and  FIG. 4H , the proton beam, is optionally accelerated to an energy level/speed and, using the variable pathlength dual use ionization chamber  420 , the first liquid cell  428 , and/or the second liquid cell  429 , the energy of the extracted beam is reduced to varying magnitudes, which is a form of scanning the tumor  220 , as a function of time. This allows the synchrotron  130  to accelerate the protons to one energy and after extraction control the energy of the proton beam, which allows a more efficient use of the synchrotron  130  as increasing or decreasing the energy with the synchrotron  130  typically results in a beam dump and recharge and/or requires significant time and/or energy, which slows treatment of the cancer while increasing cost of the cancer. 
     Beam State Determination 
     Referring now to  FIG. 4G , a beam state determination system  460  is described that uses one or more of the first liquid cell  428 , the second liquid cell  429 , and/or the dual use ionization chamber  420 . For clarity of presentation and without loss of generality, as illustrated, the first liquid cell  428  comprises an orthotope shape. The beam state determination system  460  comprises at least a beam sensing element  461  responsive to the proton beam connected to the main controller  110 . Optionally and preferably, the beam sensing element  461  is positioned into various x,y,z-positions inside the liquid containing orthotope as a function of time, which allows a mapping of properties of the proton beam, such as: intensity, depth of penetration, energy, radial distribution about an incident vector of the proton beam, and/or a resultant mean angle. As illustrated, the beam sensing element  461  is positioned in the proton beam path at a first time, t 1 , using a three-dimensional probe positioner, comprising: a telescoping z-axis sensor positioner  462 , a y-axis positioning rail  464 , and an x-axis positioning rail and is positioned out of the proton beam path at a second time, t 2  using the three-dimensional probe positioner. Generally, the probe positioner is any system capable of positioning the beam sensing element  461  as a function of time. 
     Still again to  FIG. 4A  and referring now to  FIG. 4I , the integrated tomography-cancer therapy system  400  is illustrated with an optional configuration of elements of the charged particle beam state determination system  250  being co-rotatable with the nozzle system  146  of the cancer therapy system  100 . More particularly, in one case sheets of the charged particle beam state determination system  250  positioned prior to, posterior to, or on both sides of the patient  230  co-rotate with the scintillation material  210  about any axis, such as illustrated with rotation about the y-axis. Further, any element of the charged particle beam state determination system  250 , such as a detector, two-dimensional detector, multiple two-dimensional detectors, and/or light coupling optic move as the gantry moves, such as along a common arc of movement of the nozzle system  146  and/or at a fixed distance to the common arc. For instance, as the gantry moves, a monitoring camera positioned on the opposite side of the tumor  220  or patient  230  from the nozzle system  146  maintains a position on the opposite side of the tumor  220  or patient  230 . 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  253 , 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  251  affix the various elements of the charged particle beam state determination system  250  relative to each other, relative to the nozzle system  146 , and/or relative to the patient  230 . For example, the support elements  251  maintain a second distance, d 2 , between a position of the tumor  220  and the third sheet  280  and/or maintain a third distance, d 3 , between a position of the third sheet  280  and the scintillation material  210 . More generally, support elements  251  optionally dynamically position any element about the patient  230  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. 4I , positioning the nozzle system  146  of a gantry  490  or gantry system on an opposite side of the patient  230  from a detection surface, such as the scintillation material  210 , in a gantry movement system  450  is described. Generally, in the gantry movement system  450 , as the gantry  490  rotates about an axis the nozzle/nozzle system  146  and/or one or more magnets of the beam transport system  135  are repositioned. As illustrated, the nozzle system  146  is positioned by the gantry  490  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, such as a patient table, patient couch, patient couch, patient rotation device, and/or a scintillation plate holder maintains the patient  230  between the nozzle system  146  and the scintillation material  210  of the tomography system  200 . Similarly, not illustrated for clarity of presentation, the electromechanical system maintains a position of the third sheet  280  and/or a position of the fourth sheet  290  on a posterior or opposite side of the patient  230  from the nozzle system  146  as the gantry  490  rotates or moves the nozzle system  146 . Similarly, the electromechanical system maintains a position of the first sheet  260  or first screen and/or a position of the second sheet  270  or second screen on a same or prior side of the patient  230  from the nozzle system  146  as the gantry  490  rotates or moves the nozzle system  146 . As illustrated, the electromechanical system optionally positions the first sheet  260  in the positively charged particle path at the first time, t 1 , and rotates, pivots, and/or slides the first sheet  260  out of the positively charged particle path at the second time, t 2 . The electromechanical system is optionally and preferably connected to the main controller  110  and/or the treatment delivery control system  112 . The electromechanical system optionally maintains a fixed distance between: (1) the patient and the nozzle system  146  or the nozzle end, (2) the patient  230  or tumor  220  and the scintillation material  210 , and/or (3) the nozzle system  146  and the scintillation material  210  at a first treatment time with the gantry  490  in a first position and at a second treatment time with the gantry  490  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. 5 , a centralized charged particle treatment system  500  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. 5 , an example of the centralized charged particle treatment system  1000  is provided. Initially, a doctor, such as an oncologist, prescribes  510  or recommends tumor therapy using charged particles. Subsequently, treatment planning  520  is initiated and output of the treatment planning step  520  is sent to an oncology information system  530  and/or is directly sent to the treatment delivery system  112 , which is an example of the main controller  110 . 
     Still referring to  FIG. 5 , the treatment planning step  520  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 co-registration, 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. 5 , the oncology information system  530  is further described. Generally, the oncology information system  530  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  530  interfaces with commercial charged particle treatment systems. 
     Safety System/Treatment Delivery Control System 
     Still referring to  FIG. 5 , 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  520  and/or from the oncology information system  530  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  520  or direction of the oncology information system  530 . 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  540  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  550 , a radio frequency quadrupole linear accelerator, the injection system  120 , the synchrotron  130 , the accelerator system  131 , the extraction system  134 , any controllable or monitorable element of the beam line  268 , the targeting/delivery system  140 , the nozzle system  146 , a gantry  560  or an element of the gantry  560 , the patient interface module  150 , a patient positioner  152 , the display system  160 , the imaging system  170 , a patient position verification system  179 , any element described supra, and/or any subsystem element. A treatment change  570  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. 
     Integrated Cancer Treatment-Imaging System 
     One or more imaging systems  170  are optionally used in a fixed position in a cancer treatment room and/or are moved with a gantry system, such as a gantry system supporting: a portion of the beam transport system  135 , the targeting/delivery control system  140 , and/or moving or rotating around a patient positioning system, such as in the patient interface module. Without loss of generality and to facilitate description of the invention, examples follow of an integrated cancer treatment-imaging system. In each system, the beam transport system  135  and/or the nozzle system  146  indicates a positively charged beam path, such as from the synchrotron, for tumor treatment and/or for tomography, as described supra. 
     Example I 
     Referring now to  FIG. 6A , a first example of an integrated cancer treatment-imaging system  600  is illustrated. In this example, the charged particle beam system  100  is illustrated with a treatment beam  269  directed to the tumor  220  of the patient  230  along the z-axis. Also illustrated is a set of imaging sources  610 , imaging system elements, and/or paths therefrom and a set of detectors  620  corresponding to a respective element of the set of imaging sources  610 . Herein, the set of imaging sources  610  are referred to as sources, but are optionally any point or element of the beam train prior to the tumor or a center point about which the gantry rotates. Hence, a given imaging source is optionally a dispersion element used to form cone beam. As illustrated, a first imaging source  612  yields a first beam path  632  and a second imaging source  614  yields a second beam path  634 , where each path passes at least into the tumor  220  and optionally and preferably to a first detector array  622  and a second detector array  624 , respectively, of the set of detectors  620 . Herein, the first beam path  632  and the second beam path  634  are illustrated as forming a ninety degree angle, which yields complementary images of the tumor  220  and/or the patient  230 . However, the formed angle is optionally any angle from ten to three hundred fifty degrees. Herein, for clarity of presentation, the first beam path  632  and the second beam path  634  are illustrated as single lines, which optionally is an expanding, uniform diameter, or focusing beam. Herein, the first beam path  632  and the second beam path  634  are illustrated in transmission mode with their respective sources and detectors on opposite sides of the patient  230 . However, a beam path from a source to a detector is optionally a scattered path and/or a diffuse reflectance path. Optionally, one or more detectors of the set of detectors  620  are a single detector element, a line of detector elements, or preferably a two-dimensional detector array. Use of two two-dimensional detector arrays is referred to herein as a two-dimensional-two-dimensional imaging system or a 2D-2D imaging system. 
     Still referring to  FIG. 6A , the first imaging source  612  and the second imaging source  614  are illustrated at a first position and a second position, respectively. Each of the first imaging source  612  and the second imaging source  614  optionally: (1) maintain a fixed position; (2) provide the first beam path(s)  632  and the second beam path(s)  634 , respectively, such as to an imaging system detector  620  or through the gantry  490 , such as through a set of one or more holes or slits; (3) provide the first beam path  632  and the second beam path  634 , respectively, off axis to a plane of movement of the nozzle system  146 ; (4) move with the gantry  490  as the gantry  490  rotates about at least a first axis; (5) move with a secondary imaging system independent of movement of the gantry, as described supra; and/or (6) represent a narrow cross-diameter section of an expanding cone beam path. 
     Still referring to  FIG. 6A , the set of detectors  620  are illustrated as coupling with respective elements of the set of sources  610 . Each member of the set of detectors  620  optionally and preferably co-moves/and/or co-rotates with a respective member of the set of sources  610 . Thus, if the first imaging source  612  is statically positioned, then the first detector  622  is optionally and preferably statically positioned. Similarly, to facilitate imaging, if the first imaging source  612  moves along a first arc as the gantry  490  moves, then the first detector  622  optionally and preferably moves along the first arc or a second arc as the gantry  490  moves, where relative positions of the first imaging source  612  on the first arc, a point that the gantry  490  moves about, and relative positions of the first detector  622  along the second arc are constant. To facilitate the process, the detectors are optionally mechanically linked, such as with a mechanical support to the gantry  469  in a manner that when the gantry  490  moves, the gantry moves both the source and the corresponding detector. Optionally, the source moves and a series of detectors, such as along the second arc, capture a set of images. As illustrated in  FIG. 6A , the first imaging source  612 , the first detector array  622 , the second imaging source  614 , and the second detector array  624  are coupled to a rotatable imaging system support  462 , which optionally rotates independently of the gantry  490  as further described infra. As illustrated in  FIG. 6B , the first imaging source  612 , the first detector array  622 , the second imaging source  614 , and the second detector array  624  are coupled to the gantry  490 , which in this case is a rotatable gantry. 
     Still referring to  FIG. 6A , optionally and preferably, elements of the set of sources  610  combined with elements of the set of detectors  620  are used to collect a series of responses, such as one source and one detector yielding a detected intensity and rotatable imaging system support  462  preferably a set of detected intensities to form an image. For instance, the first imaging source  612 , such as a first X-ray source or first cone beam X-ray source, and the first detector  622 , such as an X-ray film, digital X-ray detector, or two-dimensional detector, yield a first X-ray image of the patient at a first time and a second X-ray image of the patient at a second time, such as to confirm a maintained location of a tumor or after movement of the gantry and/or nozzle system  146  or rotation of the patient  230 . A set of n images using the first imaging source  612  and the first detector  622  collected as a function of movement of the gantry and/or the nozzle system  146  supported by the gantry and/or as a function of movement and/or rotation of the patient  230  are optionally and preferably combined to yield a three-dimensional image of the patient  230 , such as a three-dimensional X-ray image of the patient  230 , where n is a positive integer, such as greater than 1, 2, 3, 4, 5, 10, 15, 25, 50, or 100. The set of n images is optionally gathered as described in combination with images gathered using the second imaging source  614 , such as a second X-ray source or second cone beam X-ray source, and the second detector  624 , such as a second X-ray detector, where the use of two, or multiple, source/detector combinations are combined to yield images where the patient  230  has not moved between images as the two, or the multiple, images are optionally and preferably collected at the same time, such as with a difference in time of less than 0.01, 0.1, 1, or 5 seconds. Longer time differences are optionally used. Preferably the n two-dimensional images are collected as a function of rotation of the gantry  490  about the tumor and/or the patient and/or as a function of rotation of the patient  230  and the two-dimensional images of the X-ray cone beam are mathematically combined to form a three-dimensional image of the tumor  220  and/or the patient  230 . Optionally, the first X-ray source and/or the second X-ray source is the source of X-rays that are divergent forming a cone through the tumor. A set of images collected as a function of rotation of the divergent X-ray cone around the tumor with a two-dimensional detector that detects the divergent X-rays transmitted through the tumor is used to form a three-dimensional X-ray of the tumor and of a portion of the patient, such as in X-ray computed tomography. 
     Still referring to  FIG. 6A , use of two imaging sources and two detectors set at ninety degrees to one another allows the gantry  490  or the patient  230  to rotate through half an angle required using only one imaging source and detector combination. A third imaging source/detector combination allows the three imaging source/detector combination to be set at sixty degree intervals allowing the imaging time to be cut to that of one-third that gantry  490  or patient  230  rotation required using a single imaging source-detector combination. Generally, n source-detector combinations reduces the time and/or the rotation requirements to 1/n. Further reduction is possible if the patient  230  and the gantry  490  rotate in opposite directions. Generally, the used of multiple source-detector combination of a given technology allow for a gantry that need not rotate through as large of an angle, with dramatic engineering benefits. 
     Still referring to  FIG. 6A , the set of sources  610  and set of detectors  620  optionally use more than one imaging technology. For example, a first imaging technology uses X-rays, a second used fluoroscopy, a third detects fluorescence, a fourth uses cone beam computed tomography or cone beam CT, and a fifth uses other electromagnetic waves. Optionally, the set of sources  610  and the set of detectors  620  use two or more sources and/or two or more detectors of a given imaging technology, such as described supra with two X-ray sources to n X-ray sources. 
     Still referring to  FIG. 6A , use of one or more of the set of sources  610  and use of one or more of the set of detectors  620  is optionally coupled with use of the positively charged particle tomography system described supra. As illustrated in  FIG. 6A , the positively charged particle tomography system uses a second mechanical support  643  to co-rotate the scintillation material  210  with the gantry  490 , as well as to co-rotate an optional sheet, such as the first sheet  260  and/or the fourth sheet  290 . 
     Example II 
     Referring now to  FIG. 6B , a second example of the integrated cancer treatment-imaging system  600  is illustrated using greater than three imagers. 
     Still referring to  FIG. 6B , two pairs of imaging systems are illustrated. Particularly, the first and second imaging source  612 ,  614  coupled to the first and second detectors  622 ,  624  are as described supra. For clarity of presentation and without loss of generality, the first and second imaging systems are referred to as a first X-ray imaging system and a second X-ray imaging system. The second pair of imaging systems uses a third imaging source  616  coupled to a third detector  626  and a fourth imaging source  618  coupled to a fourth detector  628  in a manner similar to the first and second imaging systems described in the previous example. Here, the second pair of imaging systems optionally and preferably uses a second imaging technology, such as fluoroscopy. Optionally, the second pair of imaging systems is a single unit, such as the third imaging source  616  coupled to the third detector  626 , and not a pair of units. Optionally, one or more of the set of imaging sources  610  are statically positioned while one of more of the set of imaging sources  610  co-rotate with the gantry  490 . Pairs of imaging sources/detector optionally have common and distinct distances, such as a first distance, d 1 , such as for a first source-detector pair and a second distance, d 2 , such as for a second source-detector or second source-detector pair. As illustrated, the tomography detector or the scintillation material  210  is at a third distance, d 3 . The distinct differences allow the source-detector elements to rotate on a separate rotation system at a rate different from rotation of the gantry  490 , which allows collection of a full three-dimensional image while tumor treatment is proceeding with the positively charged particles. 
     Example III 
     For clarity of presentation, referring now to  FIG. 6C , any of the beams or beam paths described herein is optionally a cone beam  690  as illustrated. The patient support  152  is an mechanical and/or electromechanical device used to position, rotate, and/or constrain any portion of the tumor  220  and/or the patient  230  relative to any axis. 
     Tomography Detector System 
     A tomography system optically couples the scintillation material to a detector. As described, supra, the tomography system optionally and preferably uses one or more detection sheets, beam tracking elements, and/or tracking detectors to determine/monitor the charged particle beam position, shape, and/or direction in the beam path prior to and/or posterior to the sample, imaged element, patient, or tumor. Herein, without loss of generality, the detector is described as a detector array or two-dimensional detector array positioned next to the scintillation material; however, the detector array is optionally optically coupled to the scintillation material using one or more optics. Optionally and preferably, the detector array is a component of an imaging system that images the scintillation material  210 , where the imaging system resolves an origin volume or origin position on a viewing plane of the secondary photon emitted resultant from passage of the residual charged particle beam  267 . As described, infra, more than one detector array is optionally used to image the scintillation material  210  from more than one direction, which aids in a three-dimensional reconstruction of the photonic point(s) of origin, positively charged particle beam path, and/or tomographic image. 
     Imaging 
     Generally, medical imaging is performed using an imaging apparatus to generate a visual and/or a symbolic representation of an interior constituent of the body for diagnosis, treatment, and/or as a record of state of the body. Typically, one or more imaging systems are used to image the tumor and/or the patient. For example, the X-ray imaging system and/or the positively charged particle imaging system, described supra, are optionally used individually, together, and/or with any additional imaging system, such as use of X-ray radiography, magnetic resonance imaging, medical ultrasonography, thermography, medical photography, positron emission tomography (PET) system, single-photon emission computed tomography (SPECT), and/or another nuclear/charged particle imaging technique. 
     As part of an imaging system, time-of-flight of the residual charged particle beam is optionally used to determine the residual energy/velocity of the charged particle beam after passing through the patient along with knowledge of the charged particle beam energy entering the patient to map/image internal constituents/components of the patient. For example, a first time-of-flight detection panel is used to determine when a charged particle reaches the first detection panel and a second time-of-flight detection panel is used to determine when the charged particle reaches the second detection panel, where the two detection panels are positioned on an opposite side of a patient position relative to the exit nozzle  146 . The distance between detection panel elements detecting the charged particle and the elapsed time is used to determine velocity/energy of the charged particle. Optionally, a particle decelerator, such as a metal film, an electron emitting film, and/or a beryllium sheet is used to slow the charged particle between the first and second time-of-flight detection panels and/or as a current emitting element of the second time-of-flight detection panel to bring elapsed times down from the picosecond and/or nanosecond time period to a more readily measured time interval of millisecond or microseconds. 
     Fiducial Marker 
     Fiducial markers and fiducial detectors are optionally used to locate, target, track, avoid, and/or adjust for objects in a treatment room that move relative to the nozzle or nozzle system  146  of the charged particle beam system  100  and/or relative to each other. Herein, for clarity of presentation and without loss of generality, fiducial markers and fiducial detectors are illustrated in terms of a movable or statically positioned treatment nozzle and a movable or static patient position. However, generally, the fiducial markers and fiducial detectors are used to mark and identify position, or relative position, of any object in a treatment room, such as a cancer therapy treatment room  922 . Herein, a fiducial indicator refers to either a fiducial marker or a fiducial detector. Herein, photons travel from a fiducial marker to a fiducial detector. 
     Herein, fiducial refers to a fixed basis of comparison, such as a point or a line. A fiducial marker or fiducial is an object placed in the field of view of an imaging system, which optionally appears in a generated image or digital representation of a scene, area, or volume produced for use as a point of reference or as a measure. Herein, a fiducial marker is an object placed on, but not into, a treatment room object or patient. Particularly, herein, a fiducial marker is not an implanted device in a patient. In physics, fiducials are reference points: fixed points or lines within a scene to which other objects can be related or against which objects can be measured. Fiducial markers are observed using a sighting device for determining directions or measuring angles, such as an alidade or in the modern era a digital detection system. Two examples of modern position determination systems are the Passive Polaris Spectra System and the Polaris Vicra System (NDI, Ontario, Canada). 
     Referring now to  FIG. 7A , use of a fiducial marker system  700  is described. Generally, a fiducial marker is placed  710  on an object, light from the fiducial marker is detected  730 , relative object positions are determined  740 , and a subsequent task is performed, such as treating a tumor  770 . For clarity of presentation and without loss of generality, non-limiting examples of uses of fiducial markers in combination with X-ray and/or positively charged particle tomographic imaging and/or treatment using positively charged particles are provided, infra. 
     Example I 
     Referring now to  FIG. 8 , a fiducial marker aided tomography system  800  is illustrated and described. Generally, a set of fiducial marker detectors  820  detects photons emitted from and/or reflected off of a set of fiducial markers  810  and resultant determined distances and calculated angles are used to determine relative positions of multiple objects or elements, such as in the treatment room  922 . 
     Still referring to  FIG. 8 , initially, a set of fiducial markers  810  are placed on one or more elements. As illustrated, a first fiducial marker  811 , a second fiducial marker  812 , and a third fiducial marker  813  are positioned on a first, preferably rigid, support element  852 . As illustrated, the first support element  852  supports a scintillation material  210 . As each of the first, second, and third fiducial markers  811 ,  812 ,  813  and the scintillation material  210  are affixed or statically positioned onto the first support element  852 , the relative position of the scintillation material  210  is known, based on degrees of freedom of movement of the first support element, if the positions of the first fiducial marker  811 , the second fiducial marker  812 , and/or the third fiducial marker  813  is known. In this case, one or more distances between the first support element  852  and a third support element  856  are determined, as further described infra. 
     Still referring to  FIG. 8 , a set of fiducial detectors  820  are used to detect light emitted from and/or reflected off one or more fiducial markers of the set of fiducial markers  810 . As illustrated, ambient photons  821  and/or photons from an illumination source reflect off of the first fiducial marker  811 , travel along a first fiducial path  831 , and are detected by a first fiducial detector  821  of the set of fiducial detectors  820 . In this case, a first signal from the first fiducial detector  821  is used to determine a first distance to the first fiducial marker  811 . If the first support element  852  supporting the scintillation material  210  only translates, relative to the nozzle system  146 , along the z-axis, the first distance is sufficient information to determine a location of the scintillation material  210 , relative to the nozzle system  146 . Similarly, photons emitted, such as from a light emitting diode embedded into the second fiducial marker  812  travel along a second fiducial path  832  and generate a second signal when detected by a second fiducial detector  822 , of the set of fiducial detectors  820 . The second signal is optionally used to confirm position of the first support element  852 , reduce error of a determined position of the first support element  852 , and/or is used to determine extent of a second axis movement of the first support element  852 , such as tilt of the first support element  852 . Similarly, photons passing from the third fiducial marker  813  travel along a third fiducial path  833  and generate a third signal when detected by a third fiducial detector  823 , of the set of fiducial detectors  820 . The third signal is optionally used to confirm position of the first support element  852 , reduce error of a determined position of the first support element  852 , and/or is used to determine extent of a second or third axis movement of the first support element  852 , such as rotation of the first support element  852 . 
     If all of the movable elements within the treatment room  922  move together, then determination of a position of one, two, or three fiducial markers, dependent on degrees of freedom of the movable elements, is sufficient to determine a position of all of the co-movable movable elements. However, optionally two or more objects in the treatment room  922  move independently or semi-independently from one another. For instance, a first movable object optionally translates, tilts, and/or rotates relative to a second movable object. One or more additional fiducial markers of the set of fiducial markers  810  placed on each movable object allows relative positions of each of the movable objects to be determined. 
     Still referring to  FIG. 8 , a position of the patient  230  is determined relative to a position of the scintillation material  210 . As illustrated, a second support element  854  positioning the patient  230  optionally translates, tilts, and/or rotates relative to the first support element  852  positioning the scintillation material  210 . In this case, a fourth fiducial marker  814 , attached to the second support element  854  allows determination of a current position of the patient  230 . As illustrated, a position of a single fiducial element, the fourth fiducial marker  814 , is determined by the first fiducial detector  821  determining a first distance to the fourth fiducial marker  814  and the second fiducial detector  822  determining a second distance to the fourth fiducial marker  814 , where a first arc of the first distance from the first fiducial detector  821  and a second arc of the second distance from the second fiducial detector  822  overlap at a point of the fourth fiducial marker  834  marking the position of the second support element  852  and the supported position of the patient  230 . Combined with the above described system of determining location of the scintillation material  210 , the relative position of the scintillation material  210  to the patient  230 , and thus the tumor  220 , is determined. 
     Still referring to  FIG. 8 , one fiducial marker and/or one fiducial detector is optionally and preferably used to determine more than one distance or angle to one or more objects. In a first case, as illustrated, light from the fourth fiducial marker  814  is detected by both the first fiducial detector  821  and the second fiducial detector  822 . In a second case, as illustrated, light detected by the first fiducial detector  821 , passes from the first fiducial marker  811  and the fourth fiducial marker  814 . Thus, (1) one fiducial marker and two fiducial detectors are used to determine a position of an object, (2) two fiducial markers on two elements and one fiducial detector is used to determine relative distances of the two elements to the single detector, and/or as illustrated and described below in relation to  FIG. 10A , and/or (3) positions of two or more fiducial markers on a single object are detected using a single fiducial detector, where the distance and orientation of the single object is determined from the resultant signals. Generally, use of multiple fiducial markers and multiple fiducial detectors are used to determine or overdetermine positions of multiple objects, especially when the objects are rigid, such as a support element, or semi-rigid, such as a person, head, torso, or limb. 
     Still referring to  FIG. 8 , the fiducial marker aided tomography system  800  is further described. As illustrated, the set of fiducial detectors  820  are mounted onto the third support element  856 , which has a known position and orientation relative to the nozzle system  146 . Thus, position and orientation of the nozzle system  146  is known relative to the tumor  220 , the patient  230 , and the scintillation material  210  through use of the set of fiducial markers  810 , as described supra. Optionally, the main controller  110  uses inputs from the set of fiducial detectors  820  to: (1) dictate movement of the patient  230  or operator; (2) control, adjust, and/or dynamically adjust position of any element with a mounted fiducial marker and/or fiducial detector, and/or (3) control operation of the charged particle beam, such as for imaging and/or treating or performing a safety stop of the positively charged particle beam. Further, based on past movements, such as the operator moving across the treatment room  922  or relative movement of two objects, the main controller is optionally and preferably used to prognosticate or predict a future conflict between the treatment beam  269  and the moving object, in this case the operator, and take appropriate action or to prevent collision of the two objects. 
     Example II 
     Referring now to  FIG. 9 , a fiducial marker aided treatment system  3400  is described. To clarify the invention and without loss of generality, this example uses positively charged particles to treat a tumor. However, the methods and apparatus described herein apply to imaging a sample, such as described supra. 
     Still referring to  FIG. 9 , four additional cases of fiducial marker-fiducial detector combinations are illustrated. In a first case, photons from the first fiducial marker  811  are detected using the first fiducial detector  821 , as described in the previous example. However, photons from a fifth fiducial marker  815  are blocked and prevented from reaching the first fiducial detector  821  as a sixth fiducial path  836  is blocked, in this case by the patient  230 . The inventor notes that the absence of an expected signal, disappearance of a previously observed signal with the passage of time, and/or the emergence of a new signal each add information on existence and/or movement of an object. In a second case, photons from the fifth fiducial marker  815  passing along a seventh fiducial path  837  are detected by the second fiducial detector  822 , which illustrates one fiducial marker yielding a blocked and unblocked signal usable for finding an edge of a flexible element or an element with many degrees of freedom, such as a patient&#39;s hand, arm, or leg. In a third case, photons from the fifth fiducial marker  815  and a sixth fiducial marker  816 , along the seventh fiducial path  837  and an eighth fiducial path  838  respectively, are detected by the second fiducial detector  822 , which illustrates that one fiducial detector optionally detects signals from multiple fiducial markers. In this case, photons from the multiple fiducial sources are optionally of different wavelengths, occur at separate times, occur for different overlapping periods of time, and/or are phase modulated. In a fourth case, a seventh fiducial marker  817  is affixed to the same element as a fiducial detector, in this case the front surface plane of the third support element  856 . Also, in the fourth case, a fourth fiducial detector  824 , observing photons along a ninth fiducial path  839 , is mounted to a fourth support element  858 , where the fourth support element  858  positions the patient  230  and tumor  220  thereof and/or is attached to one or more fiducial source elements. 
     Still referring to  FIG. 9  the fiducial marker aided treatment system  900  is further described. As described, supra, the set of fiducial markers  810  and the set of fiducial detectors  820  are used to determine relative locations of objects in the treatment room  922 , which are the third support element  856 , the fourth support element  858 , the patient  230 , and the tumor  220  as illustrated. Further, as illustrated, the third support element  856  comprises a known physical position and orientation relative to the nozzle system  146 . Hence, using signals from the set of fiducial detectors  820 , representative of positions of the fiducial markers  810  and room elements, the main controller  110  controls the treatment beam  269  to target the tumor  220  as a function of time, movement of the nozzle system  146 , and/or movement of the patient  230 . 
     Example III 
     Referring now to  FIG. 10A , a fiducial marker aided treatment room system  1000  is described. Without loss of generality and for clarity of presentation, a zero vector  1001  is a vector or line emerging from the nozzle system  146  when the first axis control  143 , such as a vertical control, and the second axis control  144 , such as a horizontal control, of the scanning system  140  is turned off. Without loss of generality and for clarity of presentation, a zero point  1002  is a point on the zero vector  1001  at a plane of an exit face the nozzle system  146 . Generally, a defined point and/or a defined line are used as a reference position and/or a reference direction and fiducial markers are defined in space relative to the point and/or line. 
     Six additional cases of fiducial marker-fiducial detector combinations are illustrated to further describe the fiducial marker aided treatment room system  1000 . In a first case, the patient  230  position is determined. Herein, a first fiducial marker  811  marks a position of a patient positioning system  1350  and a second fiducial marker  812  marks a position of a portion of skin of the patient  230 , such as a limb, joint, and/or a specific position relative to the tumor  220 . In a second case, multiple fiducial markers of the set of fiducial markers  810  and multiple fiducial detectors of said set of fiducial detectors  820  are used to determine a position/relative position of a single object, where the process is optionally and preferably repeated for each object in the treatment room  922 . As illustrated, the patient  230  is marked with the second fiducial marker  812  and a third fiducial marker  813 , which are monitored using a first fiducial detector  821  and a second fiducial detector  822 . In a third case, a fourth fiducial marker  814  marks the scintillation material  210  and a sixth fiducial path  836  illustrates another example of a blocked fiducial path. In a fourth case, a fifth fiducial marker  815  marks an object not always present in the treatment room, such as a wheelchair  1040 , walker, or cart. In a sixth case, a sixth fiducial marker  816  is used to mark an operator  1050 , who is mobile and must be protected from an unwanted irradiation from the nozzle system  146 . 
     Still referring to  FIG. 10A , clear field treatment vectors and obstructed field treatment vectors are described. A clear field treatment vector comprises a path of the treatment beam  269  that does not intersect a non-standard object, where a standard object includes all elements in a path of the treatment beam  269  used to measure a property of the treatment beam  269 , such as the first sheet  260 , the second sheet  270 , the third sheet  280 , and the fourth sheet  290 . Examples of non-standard objects or interfering objects include an arm of the patient couch, a back of the patient couch, and/or a supporting bar, such a robot arm. Use of fiducial indicators, such as a fiducial marker, on any potential interfering object allows the main controller  110  to only treat the tumor  220  of the patient  230  in the case of a clear field treatment vector. For example, fiducial markers are optionally placed along the edges or corners of the patient couch or patient positioning system or indeed anywhere on the patient couch. Combined with a-priori knowledge of geometry of the non-standard object, the main controller can deduce/calculate presence of the non-standard object in a current or future clear field treatment vector, forming a obstructed field treatment vector, and perform any of: increasing energy of the treatment beam  269  to compensate, moving the interfering non-standard object, and/or moving the patient  230  and/or the nozzle system  146  to a new position to yield a clear field treatment vector. Similarly, for a given determined clear filed treatment vector, a total treatable area, using scanning of the proton beam, for a given nozzle-patient couch position is optionally and preferably determined. Further, the clear field vectors are optionally and preferably predetermined and used in development of a radiation treatment plan. 
     Referring again to  FIG. 7A ,  FIG. 8 ,  FIG. 9 , and  FIG. 10A , generally, one or more fiducial markers and/or one or more fiducial detectors are attached to any movable and/or statically positioned object/element in the treatment room  922 , which allows determination of relative positions and orientation between any set of objects in the treatment room  922 . 
     Sound emitters and detectors, radar systems, and/or any range and/or directional finding system is optionally used in place of the source-photon-detector systems described herein. 
     2D-2D X-Ray Imaging 
     Still referring to  FIG. 10A , for clarity of presentation and without loss of generality, a two-dimensional-two-dimensional (2D-2D) X-ray imaging system  1060  is illustrated, which is representative of any source-sample-detector transmission based imaging system. As illustrated, the 2D-2D imaging system  1060  includes a 2D-2D source end  1062  on a first side of the patient  230  and a 2D-2D detector end  1064  on a second side, an opposite side, of the patient  230 . The 2D-2D source end  1062  holds, positions, and/or aligns source imaging elements, such as: (1) one or more imaging sources; (2) the first imaging source  612  and the second imaging source  622 ; and/or (3) a first cone beam X-ray source and a second cone beam X-ray source; while, the 2D-2D detector end  1064 , respectively, holds, positions, and/or aligns: (1) one or more imaging detectors  1066 ; (2) a first imaging detector and a second imaging detector; and/or (3) a first cone beam X-ray detector and a second cone beam X-ray detector. 
     In practice, optionally and preferably, the 2D-2D imaging system  1060  as a unit rotates about a first axis around the patient, such as an axis of the treatment beam  269 , as illustrated at the second time, t 2 . For instance, at the second time, t 2 , the 2D-2D source end  1062  moves up and out of the illustrated plane while the 2D-2D detector end  1064  moves down and out of the illustrated plane. Thus, the 2D-2D imaging system may operate at one or more positions through rotation about the first axis while the treatment beam  269  is in operation without interfering with a path of the treatment beam  269 . 
     Optionally and preferably, the 2D-2D imaging system  1060  does not physically obstruct the treatment beam  269  or associated residual energy imaging beam from the nozzle system  146 . Through relative movement of the nozzle system  146  and the 2D-2D imaging system  1060 , a mean path of the treatment beam  269  and a mean path of X-rays from an X-ray source of the 2D-2D imaging system  1060  form an angle from 0 to 90 degrees and more preferably an angle of greater than 10, 20, 30, or 40 degrees and less than 80, 70, or 60 degrees. Still referring to  FIG. 10A , as illustrated at the second time, t 2 , the angle between the mean treatment beam and the mean X-ray beam is 45 degrees. 
     The 2D-2D imaging system  1060  optionally rotates about a second axis, such as an axis perpendicular to  FIG. 10A  and passing through the patient and/or passing through the first axis. Thus, as illustrated, as the exit port of the output nozzle system  146  moves along an arc and the treatment beam  269  enters the patient  230  from another angle, rotation of the 2D-2D imaging system  1060  about the second axis perpendicular to  FIG. 10A , the first axis of the 2D-2D imaging system  1060  continues to rotate about the first axis, where the first axis is the axis of the treatment beam  269  or the residual charged particle beam  267  in the case of imaging with protons. 
     Optionally and preferably, one or more elements of the 2D-2D X-ray imaging system  1060  are marked with one or more fiducial elements, as described supra. As illustrated, the 2D-2D detector end  1064  is configured with a seventh fiducial marker  817  and an eighth fiducial marker  818  while the 2D-2D source end  1062  is configured with a ninth fiducial marker  819 , where any number of fiducial markers are used. 
     In many cases, movement of one fiducial indicator necessitates movement of a second fiducial indicator as the two fiducial indicators are physically linked. Thus, the second fiducial indicator is not strictly needed, given complex code that computes the relative positions of fiducial markers that are often being rotated around the patient  230 , translated past the patient  230 , and/or moved relative to one or more additional fiducial markers. The code is further complicated by movement of non-mechanically linked and/or independently moveable obstructions, such as a first obstruction object moving along a first concentric path and a second obstruction object moving along a second concentric path. The inventor notes that the complex position determination code is greatly simplified if the treatment beam path  269  to the patient  230  is determined to be clear of obstructions, through use of the fiducial indicators, prior to treatment of at least one of and preferably every voxel of the tumor  220 . Thus, multiple fiducial markers placed on potentially obstructing objects simplifies the code and reduces treatment related errors. Typically, treatment zones or treatment cones are determined where a treatment cone from the output nozzle system  146  to the patient  230  does not pass through any obstructions based on the current position of all potentially obstructing objects, such as a support element of the patient couch. As treatment cones overlap, the path of the treatment beam  269  and/or a path of the residual charged particle beam  267  is optionally moved from treatment cone to treatment cone without use of the imaging/treatment beam continuously as moved along an arc about the patient  230 . A transform of the standard tomography algorithm thus allows physical obstructions to the imaging/treatment beam to be avoided. 
     Isocenterless System 
     The inventor notes that a fiducial marker aided imaging system, the fiducial marker aided tomography system  800 , and/or the fiducial marker aided treatment system  900  are applicable in a treatment room  922  not having a treatment beam isocenter, not having a tumor isocenter, and/or is not reliant upon calculations using and/or reliant upon an isocenter. Further, the inventor notes that all positively charged particle beam treatment centers in the public view are based upon mathematical systems using an isocenter for calculations of beam position and/or treatment position and that the fiducial marker aided imaging and treatment systems described herein do not need an isocenter and are not necessarily based upon mathematics using an isocenter, as is further described infra. In stark contrast, a defined point and/or a defined line are used as a reference position and/or a reference direction and fiducial markers are defined in space relative to the point and/or line. 
     Traditionally, the isocenter  263  of a gantry based charged particle cancer therapy system is a point in space about which an output nozzle rotates. In theory, the isocenter  263  is an infinitely small point in space. However, traditional gantry and nozzle systems are large and extremely heavy devices with mechanical errors associated with each element. In real life, the gantry and nozzle rotate around a central volume, not a point, and at any given position of the gantry-nozzle system, a mean or unaltered path of the treatment beam  269  passes through a portion of the central volume, but not necessarily the single point of the isocenter  263 . Thus, to distinguish theory and real-life, the central volume is referred to herein as a mechanically defined isocenter volume, where under best engineering practice the isocenter has a geometric center, the isocenter  263 . Further, in theory, as the gantry-nozzle system rotates around the patient, the mean or unaltered lines of the treatment beam  269  at a first and second time, preferably all times, intersect at a point, the point being the isocenter  263 , which is an unknown position. However, in practice the lines pass through the mechanically identified isocenter volume  1012 . The inventor notes that in all gantry supported movable nozzle systems, calculations of applied beam state, such as energy, intensity, and direction of the charged particle beam, are calculated using a mathematical assumption of the point of the isocenter  263 . The inventor further notes, that as in practice the treatment beam  269  passes through the mechanically defined isocenter volume but misses the isocenter  263 , an error exists between the actual treatment volume and the calculated treatment volume of the tumor  220  of the patient  230  at each point in time. The inventor still further notes that the error results in the treatment beam  269 : (1) not striking a given volume of the tumor  220  with the prescribed energy and/or (2) striking tissue outside of the tumor. Mechanically, this error cannot be eliminated, only reduced. However, use of the fiducial markers and fiducial detectors, as described supra, removes the constraint of using an unknown position of the isocenter  263  to determine where the treatment beam  269  is striking to fulfill a doctor provided treatment prescription as the actual position of the patient positioning system, tumor  220 , and/or patient  230  is determined using the fiducial markers and output of the fiducial detectors with no use of the isocenter  263 , no assumption of an isocenter  263 , and/or no spatial treatment calculation based on the isocenter  263 . Rather, a physically defined point and/or line, such as the zero point  1002  and/or the zero vector  1001 , in conjunction with the fiducials are used to: (1) determine position and/or orientation of objects relative to the point and/or line and/or (2) perform calculations, such as a radiation treatment plan. 
     Referring again to  FIG. 7A  and referring again to  FIG. 10A , optionally and preferably, the task of determining the relative object positions  740  uses a fiducial element, such as an optical tracker, mounted in the treatment room  922 , such as on the gantry or nozzle system, and calibrated to a “zero” vector  1001  of the treatment beam  269 , which is defined as the path of the treatment beam when electromagnetic and/or electrostatic steering of one or more final magnets in the beam transport system  135  and/or an output nozzle system  146  attached to a terminus thereof is/are turned off. The zero vector  1001  is a path of the treatment beam  269  when the first axis control  143 , such as a vertical control, and the second axis control  144 , such as a horizontal control, of the scanning system  140  is turned off. A zero point  1002  is any point, such as a point on the zero vector  1001 . Herein, without loss of generality and for clarity of presentation, the zero point  1002  is a point on the zero vector  1001  crossing a plane defined by a terminus of the nozzle of the nozzle system  146 . Ultimately, the use of a zero vector  1001  and/or the zero point  1002  is a method of directly and optionally actively relating the coordinates of objects, such as moving objects and/or the patient  230  and tumor  220  thereof, in the treatment room  922  to one another; not passively relating them to an imaginary point in space such as a theoretical isocenter than cannot mechanically be implemented in practice as a point in space, but rather always as an a isocenter volume, such as an isocenter volume including the isocenter point in a well-engineered system. Examples further distinguish the isocenter based and fiducial marker based targeting system. 
     Example I 
     Referring now to  FIG. 10B , an isocenterless system  1005  of the fiducial marker aided treatment room system  1000  of  FIG. 10A  is described. As illustrated, the nozzle/nozzle system  146  is positioned relative to a reference element, such as the third support element  856 . The reference element is optionally a reference fiducial marker and/or a reference fiducial detector affixed to any portion of the nozzle system  146  and/or a rigid, positionally known mechanical element affixed thereto. A position of the tumor  220  of the patient  230  is also determined using fiducial markers and fiducial detectors, as described supra. As illustrated, at a first time, t 1 , a first mean path of the treatment beam  269  passes through the isocenter  263 . At a second time, t 2 , resultant from inherent mechanical errors associated with moving the nozzle system  146 , a second mean path of the treatment beam  269  does not pass through the isocenter  263 . In a traditional system, this would result in a treatment volume error. However, using the fiducial marker based system, the actual position of the nozzle system  146  and the patient  230  is known at the second time, t 2 , which allows the main controller to direct the treatment beam  269  to the targeted and prescription dictated tumor volume using the first axis control  143 , such as a vertical control, and the second axis control  144 , such as a horizontal control, of the scanning system  140 . Again, since the actual position at the time of treatment is known using the fiducial marker system, mechanical errors of moving the nozzle system  146  are removed and the x/y-axes adjustments of the treatment beam  269  are made using the actual and known position of the nozzle system  146  and the tumor  220 , in direct contrast to the x/y-axes adjustments made in traditional systems, which assume that the treatment beam  269  passes through the isocenter  263 . In essence: (1) the x/y-axes adjustments of the traditional targeting systems are in error as the unmodified treatment beam  269  is not passing through the assumed isocenter and (2) the x/y-axes adjustments of the fiducial marker based system know the actual position of the treatment beam  269  relative to the patient  230  and the tumor  220  thereof, which allows different x/y-axes adjustments that adjust the treatment beam  269  to treat the prescribed tumor volume with the prescribed dosage. 
     Example II 
     Referring now to  FIG. 10C  an example is provided that illustrates errors in an isocenter  263  with a fixed beamline position and a moving patient positioning system. As illustrated, at a first time, t 1 , the mean/unaltered treatment beam path  269  passes through the tumor  220 , but misses the isocenter  263 . As described, supra, traditional treatment systems assume that the mean/unaltered treatment beam path  269  passes through the isocenter  263  and adjust the treatment beam to a prescribed volume of the tumor  220  for treatment, where both the assumed path through the isocenter and the adjusted path based on the isocenter are in error. In stark contrast, the fiducial marker system: (1) determines that the actual mean/unaltered treatment beam path  269  does not pass through the isocenter  263 , (2) determines the actual path of the mean/unaltered treatment beam  269  relative to the tumor  220 , and (3) adjusts, using a reference system such as the zero line  1001  and/or the zero point  1002 , the actual mean/unaltered treatment beam  269  to strike the prescribed tissue volume using the first axis control  143 , such as a vertical control, and the second axis control  144 , such as a horizontal control, of the scanning system  140 . As illustrated, at a second time, t 2 , the mean/unaltered treatment beam path  269  again misses the isocenter  263  resulting in treatment errors in the traditional isocenter based targeting systems, but as described, the steps of: (1) determining the relative position of: (a) the mean/unaltered treatment beam  269  and (b) the patient  230  and tumor  220  thereof and (2) adjusting the determined and actual mean/unaltered treatment beam  269 , relative to the tumor  220 , to strike the prescribed tissue volume using the first axis control  143 , the second axis control  144 , and energy of the treatment beam  269  are repeated for the second time, t 2 , and again through the n th  treatment time, where n is a positive integer of at least 5, 10, 50, 100, or 500. 
     Referring again to  FIG. 8  and  FIG. 9 , generally at a first time, objects, such as the patient  230 , the scintillation material  210 , an X-ray system, and the nozzle system  146  are mapped and relative positions are determined. At a second time, the position of the mapped objects is used in imaging, such as X-ray and/or proton beam imaging, and/or treatment, such as cancer treatment. Further, an isocenter is optionally used or is not used. Still further, the treatment room  922  is, due to removal of the beam isocenter knowledge constraint, optionally designed with a static or movable nozzle system  146  in conjunction with any patient positioning system along any set of axes as long as the fiducial marking system is utilized. 
     Referring now to  FIG. 7B , optional uses of the fiducial marker system  700  are described. After the initial step of placing the fiducial markers  710 , the fiducial markers are optionally illuminated  720 , such as with the ambient light or external light as described above. Light from the fiducial markers is detected  730  and used to determine relative positions of objects  740 , as described above. Thereafter, the object positions are optionally adjusted  750 , such as under control of the main controller  110  and the step of illuminating the fiducial markers  720  and/or the step of detecting light from the fiducial markers  730  along with the step of determining relative object positions  740  is iteratively repeated until the objects are correctly positioned. Simultaneously or independently, fiducial detectors positions are adjusted  780  until the objects are correctly placed, such as for treatment of a particular tumor voxel. Using any of the above steps: (1) one or more images are optionally aligned  760 , such as a collected X-ray image and a collected proton tomography image using the determined positions; (2) the tumor  220  is treated  770 ; and/or (3) changes of the tumor  220  are tracked  790  for dynamic treatment changes and/or the treatment session is recorded for subsequent analysis. 
     Gantry 
     Referring now to  FIGS. 11-19 , a gantry system is described. 
     Counterweighted Gantry System 
     Referring now to  FIG. 11 , a counterweighted gantry system  1100  is described. In the counterweighted gantry system  1100 , the gantry  490  comprises a counterweight  1120  positioned opposite a gantry rotation axis  1411  from the nozzle system  146 , such as connected by an intervening rotatable gantry support  1210 . Ideally, the counterweight results in no net moment of the gantry-counterweight system about the axis of rotation of the gantry. In practice, the counterweight mass and distance forces, herein all elements on one side of the axis or rotation of the gantry, is within 10, 5, 2, 1, 0.1, or 0.01 percent of the mass and distance forces of the section of the gantry on the opposite side of the axis of rotation of the gantry. Hence, as illustrated at a first time, t 1 , a first downward force, F 1 , resultant from all elements of the gantry  490  on a first side of the gantry rotation axis  1411  and/or isocenter  263  balances, counters, and/or equals a second downward force, F 2 , on a second, opposite, side of the gantry rotation axis  1411  and/or isocenter  263 . Stated another way, the moment of inertia, a quantity expressing a body&#39;s tendency to resist angular acceleration, of a product of masses and the square of distances of objects on a first side of the gantry rotation axis  1411  resists acceleration of a product of masses and the square of distances of objects on a second, opposite, side of the gantry rotation axis  1411 . As illustrated at a second time, t 2 , despite rotation of the gantry to a second position, a third downward force, F 3 , and a fourth downward force, F 4 , on opposite sides of the gantry rotation axis  1411  are still balanced. Thus, the system has no net moment of inertia. The inventor notes that the balanced system greatly reduces drive motor requirements and/or greatly enhances movement precision resultant from the smaller net forces and/or applied forces for movement of the gantry  490 . Optionally, gear backlash is compensated for separately on opposite sides of a meridian position, such as where the beam path through the nozzle system  146  is aligned with gravity and/or a last movement of the rotatable beamline section  138  is against gravity, which results in a reproducible gantry position in the presence of gear slop/backlash versus gravity. 
     Example I 
     Referring now to  FIG. 12 , for clarity of presentation and without loss of generality, an example of the counterweighted gantry system  1100  is illustrated. As illustrated, first downward, inertial, rotational, and/or gravitational forces on a first side, top side as illustrated, of the gantry rotational axis  1411  counters second downward, inertial, rotational, and/or gravitational forces on a second side, bottom side as illustrated, of the gantry rotational axis  1411 . To achieve the balanced forces, counterweights  1120  are added to the gantry  490 , such as a first counterweight  1122 , a second counterweight  1124 , and/or a counterweight connector  1126  attached to a rotatable gantry support  1210 . The counterweights are optionally and preferably elements of a modular installation, as further described infra. 
     Rotation 
     Still referring to  FIG. 12 , rotation of the gantry  490  is described. Generally, the rotatable gantry support  1210  is mounted to a support structure, not illustrated for clarity of presentation, such as with a set of bearings and/or radial ball bearings. As illustrated, a first bearing  1211 , a second bearing  1212 , and a third bearing  1213 , guide and support movement of the gantry  490 . Optionally and preferably, the set of bearings include multiple bearing elements about the rotatable gantry support  1210  on a first end of a rotatable beamline section  138  of a rotatable beamline support arm  498  of the gantry  490  and a bearing on a second end of the gantry support arm  498 . 
     Installation 
     The charged particle beam system  100  is optionally built in: (1) a greenfield, which is an undeveloped or agricultural tract of land that is a potential site for industrial or urban development or (2) a brownfield, which is an urban area that has previously been built upon. Herein, a built-up brownfield refers to an existing hospital related structure comprising 2, 3, 4, 5 or more stories and a lowest level, such as a basement. 
     The class of particle accelerator systems for cancer therapy using protons include massive structural elements that are readily installed in a greenfield. However, installation in an existing structure, such as a basement of a building is complicated by the size of individual elements of the charged particle beam system and mass of individual elements of the charged particle beam system. For example, installation of a 300 MeV cyclotron in a four story building requires installation by crane, removal of the roof, breaking through each floor, setting by crane the 20+ ton object on the ground floor/basement and then repairing the floors and roof of the building, which is extremely disruptive, especially in a functioning hospital and/or in the presence of immune system compromised patients. 
     Herein, a system of installation is described, via example, where elements of the charged particle beam system  100  are installed into a built-up brownfield hospital related structure. 
     Example I 
     In the installation system, all elements of the charged particle beam system  100  are optionally and preferably:
         less than 5,000, 10,000, 15,000, 25,000, or 35,000 pounds;   transportable on a standard eighteen wheel semi-truck or smaller truck;   moved through the built-up brownfield hospital related structure using equipment passable through standard hallways and/or elevators; and/or   assembled in a basement and/or ground level of the built-up brownfield hospital related structure.       

     For clarity of presentation and without loss of generality, transport of several subsystems of the charged particle beam system  100  are further described. A first subsystem, the accelerator and/or beam transport line, is moved as individual magnet assemblies, such as the main bending magnets  132 . A second subsystem, the gantry  490 , is divided for movement into a first gantry support section  491 , a second gantry support section  492 , a third gantry support section  493 , a fourth gantry support section  494 , and a fifth gantry support section  495 , as further described infra. A third subsystem, the rotatable gantry support  1210 , is optionally and preferably assembled from multiple sub-units, such as a first rotatable gantry support element  1215 , a second rotatable gantry support element  1216 , and a third rotatable gantry support element  1217 . A fourth subsystem, the gantry support, is optionally and preferably a free-standing system, which, without a requirement of wall mounting, further described infra, is optionally and preferably assembled in sections, such as modular sections. Stated again, an existing brownfield wall is not a mechanical element required to resist gravitational forces related to the gantry, as further described infra, so the gantry support structures are transportable stands. Generally, movement of sub-systems as sub-assembly components reduces the mass of individual elements to a weight and mass movable through the hallways and/or elevators. 
     Example II 
     In a second example, one or more the top five largest components of the charged particle beam system  100  are transported through an elevator shaft and/or an elevator car of an elevator. Herein, an elevator comprises: (1) a standard existing brownfield passenger in the hospital related facility, such as a standard passenger elevator with capacities ranging from 1,000 to 6,000 pounds in 500 pound increments or (2) a standard freight elevator, such as a Class A general freight loading elevator designed to carry goods and not passengers, though passenger transport is not illegal. In each case, the elevators&#39; capacity is related to the available floor space and associated elevator shaft horizontal cross-section dimension. In both cases, the load is handled on and off the car platform manually or by means of hand trucks. 
     Example III 
     In some designs of the charged particle beam system  100 , a bearing is used to guide and support movement of the gantry  490 . One or more bearings, such as the third bearing  1213 , are quite large to allow walking access to the treatment room through the bearing, such as for use with a gantry rotatable 360 degrees about the gantry axis of rotation, and have a diameter exceeding a horizontal cross-section dimension of an elevator shaft. Referring now to  FIG. 16B , an optional configuration of the third bearing  1213  is illustrated, where the third bearing is assembled from two or more components. As illustrated, the third bearing  1213  comprises a first bearing section  1610 , a second bearing section  1620 , and a third bearing section  1630 , where splitting the bearing into sections allows transport of a large bearing, such as greater than 8, 9, 10, 11, or 12 foot in diameter, through a standard hospital hallway and/or standard passenger elevator shaft, such as via the elevator car or a crane transport operating the in the elevator shaft. As illustrated, the third bearing  1213  comprises a first circular segment or a first arc-to-chord section, a second circular segment or a second arc-to chord section, and a middle section connecting, such as via welding and/or bolting, the first circular segment and the second circular segment. 
     Optionally and preferably, one or more cranes and/or overhead transport systems are permanently installed in and/or about the charged particle beam system  100 , such as in and/or about the treatment room, gantry, and/or accelerator. 
     Example I 
     In a first example, as illustrated, a section of the gantry  490  supporting the rotational beamline section  138  and the nozzle system  146  is optionally and preferably assembled from multiple sub-units, such as a first gantry support section  491 , a second gantry support section  492 , a third gantry support section  493 , a fourth gantry support section  494 , and a fifth gantry support section  495 . Several of the sections are further described. The first gantry section  491  couples to the rotatable gantry support  1210  using a gantry connector section  1130 . The third gantry section  493 , combined with the fourth gantry section  494  and the fifth gantry section  495 , provides an aperture through which the rotational beamline section  138  passes and/or contains the nozzle system  146 . 
     Example II 
     In a second example, the rotatable gantry support  1210  is optionally and preferably assembled from multiple sub-units, such as a first rotatable gantry support element  1215 , a second rotatable gantry support element  1216 , and a third rotatable gantry support element  1217 . 
     Example III 
     In a third example, the counterweighted gantry system  1100  is readily installed into an existing facility. As further described using  FIGS. 17-19  below, the counterweighted gantry system  1100  is free standing, so the structure is optionally and preferably a bolt together assembly  1250 , which allows installation of the unit into an existing structure. 
     Gantry Rotation 
     Referring still to  FIG. 12  and referring now to  FIGS. 13 (A-D), rotation of the gantry  490  relative to a rolling floor system  1300 , also referred to as a segmented floor, is described, where the segmented sections allow for the floor system to contour to a curved surface, change direction around a roller, and/or spool as further described infra. 
     Referring still to  FIG. 12 , as the rotatable beamline support arm  498  of the gantry  490  rotates around the gantry rotation axis  1411 , the rotatable beamline section  138  of the beam transport system  135  is moved around the gantry rotation axis  1411  and the nozzle system  146 , illustrated in  FIG. 13  for clarity of presentation, extending from the aperture through the third gantry section  493  rotates around the tumor  220 , the patient  230 , the gantry rotation axis  1411 , and/or the isocenter  263 . Referring now to  FIG. 13A , the nozzle system  146 , extending from the aperture through the third gantry section  493 , illustrated in  FIG. 12 , is illustrated in a first position, a horizontal position, through a movable floor, described infra. Referring now to  FIG. 13B , for clarity of presentation, the nozzle system  146  is rotated from the first position illustrated in  FIG. 13A  at a first time, t 1 , to a second position illustrated in  FIG. 12  at a second time, t 2 , using the gantry  490  Referring still to  FIG. 13A  and  FIG. 13B , the gantry  490 , optionally and preferably, rotates the nozzle system  146  from a position under the patient  230  through a floor  1310 , as described infra, along a curved wall, as described infra, and through a ceiling area, as described infra. 
     Rolling Floor 
     Referring still to  FIG. 13A , the rolling floor system  1300 , also referred to as a rolling wall-floor system, is further described. The rolling floor system  1300  comprises a rolling floor  1320 , such as a segmented floor. As illustrated, the rolling floor  1320  comprises sections moving along/past a flat floor section  1322 , such as inset into the floor  1310 ; a wall section  1324 , such as along/inset into a curved wall section  1340  of a wall; an upper spooler section  1326 , such as into/around/wound around an upper spooler  1332  or upper spool; and a lower spooling section  1328 , such as into/around a lower spooler  1334  or lower spool. Herein, a spooler is a device, such as a cylinder, on which an object, such as the segmented floor is wound. A floor movement system  1330  optionally includes one or more spoolers, such as the upper spooler  1332 , the lower spooler  1334 , one or more rollers  1336 , and/or one or more spools  1338 . 
     Referring still to  FIG. 13A  and now to  FIG. 13C , the rolling floor system  1300  is described relative to a patient positioning system  1350 . Generally, the patient positioning system  1350  comprises multiple degrees of freedom for positioning the patient  230  in an x, y, z position with yaw, tilt, and/or roll, and/or as a function of patient rotation and time. The floor section  1322  of the rolling floor system  1300 , through which the nozzle system  146  penetrates, passes underneath the tumor  220  of the patient  230  when the patient  230 , positioned by the patient positioning system  1350 , is in a treatment position, such as in the treatment beam path  269 . Similarly, the gantry  490  rotates the nozzle system  146  around the patient  230 , such as along a concave or curved wall section  1340  of the wall and rotates the nozzle system  146  in an arc above the patient  230  with continued rotation of the gantry  490  and spooling of the linked/physically clocked rolling floor system  1300 . 
     The inventor notes that existing gantries, to allow movement of the gantry under the patient, position the patient in space, such as along a plank into a middle of an open chamber ten feet or more off of the floor, which is distressful to the patient and prevents an operator from approaching the patient during treatment. In stark contrast, referring now to  FIG. 13A  and  FIG. 13D , the rolling floor system  1300  allows presence of the floor  1310  without a gap and/or hole in the floor through which a person could fall and still allows the gantry  490  to rotate under the patient  230 . More particularly, a nozzle extension  1380  integrated into the nozzle system  146  comprises a set of guides  1382  and a set of rollers  1384 , where the rollers are in a track  1372  that transitions from a curved section corresponding to the curved wall to a flat section corresponding to the flat floor  1310 . When the gantry  490  positions the nozzle system  146  and the corresponding co-rotating/clocked floor system  1300  along the curved wall  1340 , the rollers  1384  are at a first track position and a first guide position, such as illustrated at a first time, t 1 . As the gantry  490  rotates past a plane of the floor  1310  toward a bottom position at a third time, t 3 , the rollers remain in the track, but slide up the guides  1382  to a floor position  1386 . Thus, the patient  230  and/or the operator have a continuous floor  1310  when the nozzle system  146  penetrates through the floor with rotation of the gantry  490  under a plane of the floor as the flat section  1322  of the rolling floor continuously fills floor space vacated by the moving nozzle system  146  and opens up floor space for the rotating nozzle system  146  moving with the rotatable beamline support arm  498  of the gantry  490 . Optionally, the nozzle system  146  continues rotation around the patient  220 , such as back up through the floor  1310  along an upward curved path  497  with a corresponding upward curved track section  1376 . Similarly, optionally the nozzle system  146  rotates 360 degrees around the patient  230  during use. 
     Patient Positioning/Imaging 
     Referring now to  FIG. 13A ,  FIG. 14 , and  FIG. 15 , patient imaging is further described. 
     Referring now to  FIG. 13A , a hybrid cancer treatment-imaging system  1400  is illustrated, where the imaging system rotates on an optionally and preferably independently rotatable mount from the second bearing  1212  and/or the rotatable gantry support  1210 . Referring now to  FIG. 14 , an example of the hybrid cancer treatment-imaging system  1400  is illustrated. Generally, the gantry  490 , which optionally and preferably supports the nozzle system  146 , rotates around the tumor  220  and/or an isocenter  263 . As illustrated, the gantry  490  rotates about a gantry rotation axis  1411 , such as using the rotatable gantry support  1210 . In one case, the gantry  490  is supported on a first end by a first buttress, wall, or support and on a second end by a second buttress, wall, or support. However, as further described, infra, preferably the gantry  490  is supported using floor based mounts. A fourth optional rotation track  1214  or bearing and a fifth optional rotation track  1218  or bearing coupling the rotatable gantry support and the gantry  490  are illustrated, where the rotation tracks are any mechanical connection. Referring again to  FIG. 12 , for clarity of presentation, only a portion of the gantry  490  is illustrated to provide visualization of a supported rotational beamline section  138  of the beam transport system  135  or a section of the beamline between the synchrotron  130  and the patient  230 . To further clarify, the gantry  490  is illustrated, at one moment in time, supporting the nozzle system  146  of the beam transport system  135  in an orientation resulting in a vertical and downward vector of the treatment beam  269 . As the rotatable gantry support  1210  rotates, the gantry  490 , the rotational beamline section  138  of the beam transport line  135 , the nozzle system  146  and the treatment beam  269  rotate about the gantry rotation axis  1411 , forming a set of treatment beam vectors originating at circumferential positions about tumor  220  or isocentre  263  and passing through the tumor  220 . Optionally, an X-ray beam path, from an X-ray source, runs through and moves with the nozzle system  146  parallel to the treatment beam  269 . Prior to, concurrently with, intermittently with, and/or after the tumor  220  is treated with the set of treatment beam vectors, one or more elements of the imaging system  170  image the tumor  220  of the patient  230 . 
     Referring again to  FIG. 14 , the hybrid cancer treatment-imaging system  1400  is illustrated with an optional set of rails  1420  and an optional rotatable imaging system support  1412  that rotates the set of rails  1420 , where the set of rails  1420  optionally includes n rails where n is a positive integer. Elements of the set of rails  1420  support elements of the imaging system  170 , the patient  230 , and/or a patient positioning system. The rotatable imaging system support  1412  is optionally concentric with the rotatable gantry support  1210 . The rotatable gantry support  1210  and the rotatable imaging system support  1412  optionally: co-rotate, rotate at the same rotation rate, rotate at different rates, or rotate independently. A reference point  1415  is used to illustrate the case of the rotatable gantry support  1210  remaining in a fixed position, such as a treatment position at a third time, t 3 , and a fourth time, t 4 , while the rotatable imaging system support  1412  rotates the set of rails  1420 . 
     Still referring to  FIG. 14 , any rail of the set of rails optionally rotates circumferentially around the x-axis, as further described infra. For instance, the first rail  1422  is optionally rotated as a function of time with the gantry  490 , such as on an opposite side of the nozzle system  146  relative to the tumor  220  of the patient  230 . 
     Still referring to  FIG. 14 , a first rail of the set of rails  1420  is optionally retracted at a first time, t 1 , and extended at a second time, t 2 , as is any of the set of rails. Further, any of the set of rails  1420  is optionally used to position a source or a detector at any given extension/retraction point. A second rail  1424  and a third rail  1426  of the set of rails  1420  are illustrated. Generally, the second rail  1424  and the third rail  1426  are positioned on opposite sides of the patient  230 , such as a sinister side and a dexter side of the patient  230 . Generally, the second rail  1424 , also referred to as a source side rail, positions an imaging source system element and the third rail  1426 , also referred to as a detector side rail, positions an imaging detector system element on opposite sides of the patient  230 . Optionally and preferably, the second rail  1424  and the third rail  1426  extend and retract together, which keeps a source element mounted, directly or indirectly, on the second rail  1424  opposite the patient  230  from a detector element mounted, directly or indirectly, on the third rail  1426 . Optionally, the second rail  1424  and the third rail  1426  position positron emission detectors for monitoring emissions from the tumor  220  and/or the patient  230 , as further described infra. 
     Still referring to  FIG. 14 , a rotational imaging system  1440  is described. For example, the second rail  1424  is illustrated with: (1) a first source system element  1441  of a first imaging system, or first imaging system type, at a first extension position of the second rail  1424 , which is optically coupled with a first detector system element  1451  of the first imaging system on the third rail  1426  and (2) a second source system element  1443  of a second imaging system, or second imaging system type, at a second extension position of the second rail  1424 , which is optically coupled with a second detector system element  1453  of the second imaging system on the third rail  1426 , which allows the first imaging system to image the patient  230  in a treatment position and, after translation of the first rail  1424  and the second rail  1426 , the second imaging system to image the patient  230  in the patient&#39;s treatment position. Optionally the first imaging system or primary imaging system and the second imaging system or secondary imaging system are supplemented with a tertiary imaging system, which uses any imaging technology. Optionally, first signals from the first imaging system are fused with second signals from the second imaging system to: (1) form a hybrid image; (2) correct an image; and/or (3) form a first image using the first signals and modified using the second signals or vise-versa. 
     Still referring to  FIG. 14 , the second rail  1424  and third rail  1426  are optionally alternately translated inward and outward relative to the patient, such as away from the first buttress and toward the first buttress, as described infra. In a first case, the second rail  1424  and the third rail  1426  extend outward on either side of the patient, as illustrated in  FIG. 14 . Further, in the first case the patient  230  is optionally maintained in a treatment position, such as in a constrained laying position that is not changed between imaging and treatment with the treatment beam  269 . In a second case, the patient  230  is relatively translated between the second rail  1424  and the third rail  1426 . In the second case, the patient is optionally imaged out of the treatment beam path  269 . Further, in the second case the patient  230  is optionally maintained in a treatment orientation, such as in a constrained laying position that is not changed until after the patient is translated back into a treatment position and treated. In a third case, the second rail  1424  and the third rail  1426  are translated away from the rotatable gantry support  1210  and/or the patient  230  is translated toward the rotatable gantry support  1210  to yield movement of the patient  230  relative to one or more elements of the first imaging system type or second imaging system type. Optionally, images using at least one imaging system type, such as the first imaging system type, are collected as a function of the described relative movement of the patient  230 , such as along the x-axis and/or as a function of rotation of the first imaging system type and the second imaging system type around the x-axis, where the first imaging type and second imaging system type use differing types of sources, use differing types of detectors, are generally thought of as distinct by those skilled in the art, and/or have differing units of measure. Optionally, the source is emissions from the body, such as a radioactive emission, decay, and/or gamma ray emission, and the second rail  1424  and the third rail  1426  position and/or translate one or more emission detectors, such as a first positron emission detector on a first side of the tumor  220  and a second positron emission detector on an opposite side of the tumor  220 . 
     Example I 
     Still referring to  FIG. 14 , an example of the hybrid cancer treatment-rotational imaging system is illustrated. In one example of the hybrid cancer treatment-rotational imaging system, the second rail  1424  and third rail  1426  are optionally circumferentially rotated around the patient  230 , such as after relative translation of the second rail  1424  and third rail  1426  to opposite sides of the patient  230 . As illustrated, the second rail  1424  and third rail  1426  are affixed to the rotatable imaging system support  1412 , which optionally rotates independently of the rotatable gantry support  1210 . As illustrated, the first source system element  1441  of the first imaging system, such as a two-dimensional X-ray imaging system, affixed to the second rail  1424  and the first detector system element  1451  collect a series of preferably digital images, preferably two-dimensional images, as a function of co-rotation of the second rail  1424  and the third rail  1426  around the tumor  220  of the patient  230 , which is positioned along the gantry rotation axis  1411  and/or about the isocenter  263  of the charged particle beam line in a treatment room. As a function of rotation of the rotatable imaging system support  1412  about the gantry rotation axis  1411 , two-dimensional images are generated, which are combined to form a three-dimensional image, such as in tomographic imaging. Optionally, collection of the two-dimensional images for subsequent tomographic reconstruction are collected: (1) with the patient in a constrained treatment position, (2) while the charged particle beam system  100  is treating the tumor  220  of the patient  230  with the treatment beam  269 , (3) during positive charged particle beam tomographic imaging, and/or (4) along an imaging set of angles rotationally offset from a set of treatment angles during rotation of the gantry  490  and/or rotation of the patient  230 , such as on a patient positioning element of a patient positioning system. 
     Optionally, one or more of the imaging systems described herein monitor treatment of the tumor  220  and/or are used as feedback to control the treatment of the tumor  220  by the treatment beam  269 . 
     Referring to  FIG. 15 , a combined patient positioning system-imaging system  1500  is described. Generally, the combined patient positioning system-imaging system  1500  comprises a joint imaging/patient positioning system  1510  and a translation/rotation imaging system  1520 . The joint imaging/patient positioning system  1510  co-moves or jointly moves the translation/rotation imaging system  1520  and the patient  230  as both a patient support  1514  and the translation/rotation imaging system  1520  are attached to an end of a robotic arm used to position the patient relative to a proton treatment beam, as further described infra. 
     Still referring to  FIG. 15 , the joint imaging/patient positioning system  1500  is further described. The joint imaging/patient positioning system  1510  allows movement of the patient  230  along one or more of: an x-axis, a y-axis, and a z-axis. Further, the patient positioning system  1510  allows yaw, tilt, and roll of the patient as well as rotation of the patient  230  relative to a point in space, such as one or more rotation axes passing through the joint imaging/patient positioning system  1510  and/or an isocenter point  263  of a treatment room. For clarity of presentation and without loss of generality, all permutations and combinations of patient movement relative to a treatment proton beam line are illustrated with a base unit  1512 , such as affixed to a floor or wall of the treatment room; an attachment unit  1516 , of the translation/rotation imaging system  1520 ; and a multi-element robotic arm section  1518  connecting the base unit  1512  and the attachment unit  1516 . 
     Still referring to  FIG. 15 , the translation aspect of the translation/rotation imaging system  1520  is further described. The translation/rotation imaging system  1520  comprises a ring or a source-detector rotational positioning unit  1522 , an imaging system source support  1524 , a first imaging source  612 , an imaging system detector support  1526 , and a first detector array  622 . The imaging system source support  1524  is used to move a source, such as the first imaging source  612 , of the translation/rotation imaging system  1520  and the detector support  1526  is used to move a detector, such as the first detector array  622 , of the translation/rotation imaging system  1520 . For clarity of presentation and without loss of generality, the first imaging source  612  is used to represent any one or more of the imaging sources described herein and the first detector array  622  is used to represent one or more of the imaging detectors described herein. As illustrated, in a first case, the imaging source  612 , such as an X-ray source, moves past the patient  230  on the imaging system source support  1524 , such as under control of the main controller  110  directing a motor or drive to move the imaging source  612  along a guide, drive system, or rail. In the illustrated case, the source-detector rotational positioning unit  1522  is connected to an element, such as the patient support  1514 , that is positioned relative to the nozzle system  146  and/or treatment beam path  269 . However, the source-detector rotational positioning unit  1522  is optionally connected to the attachment element  1516  or the rotatable imaging system support  1412 . Optionally, the patient support  1514  uses a first electromechanical interface  1532  that moves the translation/rotation imaging system  1520  relative to the patient support  1514  and hence the patient  230 . Optionally, the first electromechanical interface  1532  is a solid/connected element and a second electromechanical interface  1534  and a third electromechanical interface  1536  are used to move the imaging system source support  1524  and the imaging system detector support  1526 , respectively, relative to the patient support  1514  and hence the patient  230 . 
     Referring again to  FIG. 14  and still referring to  FIG. 15 , generally, any mechanical/electromechanical system is used to connect the source-detector rotational positioning unit  1522  to the attachment unit  1516  and/or an intervening connector, such as the patient support  1514  or a secondary attachment unit  1540 , as further described infra. Notably, the patient support  1514  and/or patient  230  optionally pass into and/or through an aperture through the source-detector rotational positioning unit  1522 . In practice, any of the first through third electromechanical connectors  1532 ,  1534 ,  1536  function to move a first element relative to a second element, such as along a track/rail and/or any mechanically guiding system, such as driven by a belt, gear, motor, and/or any motion driving source/system. 
     Still referring to  FIG. 15 , optionally, the imaging system source support  1524  extends/retracts away/toward the attachment unit, which results in translation of the X-ray source past the patient  230 . Similarly, as illustrated, the first detector array  622 , such as an two-dimensional X-ray detector panel, moves past the patient on the imaging system detector support  1526 , such as under control of the main controller directing a motor or drive to move the first detector array  622 , such as an X-ray detector panel, along a guide, drive system, or rail. Optionally, the imaging system detector support  1526  extends/retracts away/toward the source-detector rotational positioning unit  1522 , which results in translation of the X-ray detector past the patient  230 . 
     Referring again to  FIG. 15 , the interface of the translation/rotation imaging system  1520  and the patient support  1514  to the joint imaging/patient positioning system  1510  is described. Essentially, as the attachment unit  1516  of the joint imaging/patient positioning system  1510  is directly connected/physically static relative to both the translation/rotation imaging system  1520  and the patient support  1514 , as the imaging/patient positioning system  1510  moves the patient support  1514  the entire translation/rotation imaging system  1520  moves with the patient support. Thus, no net difference in position between the translation/rotation imaging system  1520  and the patient  230  or patient support  1514  results as the joint imaging/patient positioning system  1510  positions the patient  230  relative to the positively charged particle tumor treatment beam  269  and/or nozzle system  146 . However, individual elements of the translation/rotation imaging system  1520  are allowed to move relative to the patient  230 , such as in the translation movements described above and the rotation movements described below. 
     Referring still to  FIG. 15 , the imaging source  612  and the first detector array  622  rotate around the patient in and out of the page. More precisely, both: (1) the first imaging source  612  and the imaging system source support  1524  and (2) the first detector array  622  and the imaging system detector support  1526 , while connected to the source-detector positioning unit, rotate about patient support  1514  and the patient  230 . Just as illustrated in  FIG. 14 , all of: (1) the first imaging source  612 , (2) the imaging system source support  1524 , (3) the first detector array  622 , and (4) the imaging system detector support  1526 , optionally and preferably rotate around the patient  230  independent of movement of the patient, relative to a current position of the positively charged particle treatment beam passing through the nozzle system  146 , using the imaging/patient positioning system  1510 . Generally, the first imaging source  612  and the first detector array  622  are positioned at any position from 0 to 360 degrees around the patient  230  and/or the first imaging source  612  and the first detector array  622  are positioned at any translation position relative to a longitudinal axis of the patient  230 , such as from head to toe. 
     Integrated Gantry, Patient Positioning, Imaging, and Rolling Floor System 
     Referring now to  FIG. 16A , a gantry superstructure  1600  is illustrated. For clarity of presentation and without loss of generality, several examples are used to further described the gantry superstructure  1600 . 
     Example I 
     In a first example, the counterweighted gantry system  1100  and the rolling floor system  1300  are illustrated relative to one another. In this example, the patient positioning system  1350  is illustrated using the hybrid cancer treatment-imaging system  1400  described, supra, where a patient platform/support  1356  is mounted onto/inside the second bearing  1212 , such as on a nonrotating or minimally rotating element of the rotatable imaging system support  1412 , where the patient platform  1356  is extendable over the flat section  1322  of the rolling floor system  1300 . Further, an optional single element counterweight extension  1126  is illustrated, such as optionally affixed to the first counterweight  1122 . 
     Example II 
     In a second example, the gantry superstructure  1600  is configured as a three hundred sixty degree rotatable gantry system. More particularly, in this example the fifth gantry support section  495  is not used or present, which results in a cantilevered gantry arm supported on only a first end, such as the first gantry support section  491  connected to the rotatable gantry support  1210 . In this system, the counterweight system  1120 , connected to a second and preferably opposite side of the rotatable gantry support  1210 , functions as a counterweight to the gantry support arm  498  and elements supported by the gantry support arm  498 , such as the rotatable beamline section  138  and the nozzle system  146 . The cantilevered gantry system is further rotatable about the gantry rotation axis  1411 , which is optionally and preferably horizontal or within 1, 2, 3, 5, 10, or 25 degrees of horizontal. 
     Example III 
     In a third example of the gantry superstructure  1600 , the cantilevered three hundred sixty degree rotatable gantry system is supported on a single side of the patient position, such as via use of the first pier  1810 . The first pier  1810 , further described infra, optionally supports a first floor section  1312 , of the floor  1310 , to the rotatable gantry support side of a beamline path swept by the treatment beam  269  during rotation of the rotatable gantry support arm  498  through an arc of 10 to 360 degrees. The support of the first floor section  1312  passes through at least a portion of the rotatable gantry support  1210  and/or the second bearing  1212  to allow full rotation of the gantry support arm  498 , such as through an arc exceeding 180, 200, 300, or 359 degrees. More particularly, as the first pier  1810  and supports for the first floor section  1312  pass through the rotatable gantry support  1210 , the mechanical supports do not intersect a volume swept by the rotatable gantry support arm  498  or a side of the rotatable gantry support arm  498 , such as the inner side of the rotatable gantry support arm  498  relative to a central point about which the rotatable gantry support arm  498  rotates. The second floor section  1314 , of the floor  1310 , outside of the volume swept by the rotatable gantry support arm  498 , is optionally supported by the second pier  1820 , further described infra. Combined, the first floor section  1312  and the second floor section  1314 , such as on opposite sides of the flat floor section  1322  of the rolling floor  1320 , are supported by support structures, such as the first pier  1810  and the second pier  1820 , that do not intersect the volume defined by the gantry support arm  498  at any position of a 360 degree rotation. 
     Example IV 
     In a fourth example, access to the cantilevered three hundred sixty degree rotatable gantry system with the split floor is described. The inventor notes that if a three hundred sixty degree rotatable gantry is supported on both ends of a gantry arm arc, the arc sweeps out a volume with a hole in the middle, such as sweeping out an egg white volume with an egg yolk as the enclosed, non-gantry arm contacted volume. As a result, any entranceway for an average sized adult into the treatment area, the yolk in the analogy, is either temporarily impeded by the gantry support arm  498  or is through an aperture in a bearing, such as through the second bearing  1212  or third bearing  1213 . Temporary impedance of human exit, such as by a multi-ton gantry support arm  498 , is a fire hazard and/or safety hazard. However, the cantilevered 360 degree rotatable gantry system described herein, without use of a bearing and support on one side/end of the gantry support arm  498 , such as the third bearing  1213  or fifth gantry section  495  as illustrated, allows direct access to the entire floor  1310 , such as via any access point/doorway to the second floor section  1314  with subsequent passage across the rolling floor  1320 , the egg white by analogy, to the first floor section  1312 , the egg yolk by analogy. 
     Example V 
     In a fifth example, the patient positioning system  1350  is mounted to the second floor section  1314  to reduce mass positioned on the first floor section  1312 , supported through the rotatable gantry support  1210 . 
     Example VI 
     In a sixth example, the accelerator is positioned below the gantry  490 , which reduces the footprint of the combined accelerator and gantry. Optionally, the beam transport system  135  from the accelerator, such as the synchrotron  130  positioned below the gantry  490 , transports the positively charged particles upwards and through a section of the rotatable gantry support  1210 . Optionally, the volume swept by the rotatable gantry arm  498  passed within a volume radially circumferentially encircled by the synchrotron  130 , which further reduces space and still give full access to all elements of the synchrotron  130  and the gantry  490 . 
     Example VII 
     In a seventh example, the rolling floor  1320  forms a continuous loop in the cantilevered three hundred sixty degree rotatable gantry system. 
     Example VIII 
     In an eighth example, an actual position of the cantilevered rotatable gantry system is monitored, determined, and/or confirmed using the fiducial indicators  2040 , described, infra, such as a fiducial source and/or a fiducial detector/marker placed on any section of the gantry  490 , patient positioning system  1350 , and/or patient  230 . 
     Floor Force Directed Gantry System 
     Referring now to  FIG. 17 , a wall mounted gantry system  1700  is illustrated, where a wall mounted gantry  499  is bolted to a first wall  1710 , such as a first buttress, with a first set of bolts  1714 , optionally using a first mounting element  1712 , and mounted to a second wall  1720 , such as a second buttress  1720 , such a through a second mounting element  1722 , with a second set of bolts  1714 . The inventor notes that in this design, forces, such as a first force, F 1 , and a second force, F 2 , are directed outward into the first wall  1710  and the second wall  1720 , respectively, where at least twenty percent of resolved force is along the x-axis as illustrated. Thus, the wall mounted gantry system  499  must be designed to overcome tensile stress on the bolts, greatly increasing mounting costs of the wall mounted gantry system  499 . Further, the wall mounted gantry  499  design thus requires that the walls of the building are specially designed to withstand the multi-ton horizontal forces resultant from the wall mounted gantry  499 . Further, as the wall mounted gantry  1700  must rotate about an axis of rotation to function, the wall mounted gantry  1700  cannot be connected to front and back walls, but rather can only be mounted to side walls, such as the first wall  1710  and the second wall  1720  as illustrated. Thus, when the wall mounted gantry  499  rotates, the center of mass of the wall mounted gantry  499  necessarily moves into a position that is not between the end mounting points, such as the first mounting element  1712  and the second mounting element  1722 . With movement of the center of mass of the wall mounted gantry  499  outside of the supports, the gantry must be configured with additional systems to prevent the wall mounted gantry system  499  from tipping over. In stark contrast, referring now to  FIG. 18 , in a floor mounted gantry system  1800  the gantry  490  is optionally and preferably designed to rest directly onto a support, such as the floor  1310 , with no requirement of a wall mounted system. As illustrated, the mass of the gantry  490  results in only downward forces, such as a third force, F 3 , into ground or a first pier  1810  and as a fourth force, F 4 , into ground and/or a second pier  1820 . Generally, in the floor mounted gantry system, the center of mass of the gantry  490  is inside a footprint of the piers, such as the first pier  1810  and the second pier  1820  and maintains a footprint inside the piers even as the gantry rotates due to use of additional piers into or out of  FIG. 18  and/or due to use of the counter mass in the counterweighted gantry system  1100 . 
     Referring now to  FIG. 19 , an example of the gantry superstructure  1600  is illustrated incorporating the gantry  490 , the gantry support arm  498 , the counterweight system  1120 , the rotatable beamline section  138 , and the rolling floor system  1300 . The rotatable gantry support  1210  is illustrated with the optional hybrid cancer treatment-imaging system  1400 . Further, the first pier  1810  and the second pier  1820  of the floor mounted gantry system  1800  are illustrated, which are representative of any number of underfloor gantry support elements designed to support the gantry  490 , where the underfloor gantry support elements are out of a rotation path of the gantry support arm  498  and the rotatable beamline section  138 . 
     Referenced Charged Particle Path 
     Referring now to  FIG. 20 , a charged particle reference beam path system  2000  is described, which starkly contrasts to an isocenter reference point of a gantry system, as described supra. The charged particle reference beam path system  2000  defines voxels in the treatment room  922 , the patient  230 , and/or the tumor  220  relative to a reference path of the positively charged particles and/or a transform thereof. The reference path of the positively charged particles comprises one or more of: a zero vector, an unredirected beamline, an unsteered beamline, a nominal path of the beamline, and/or, such as, in the case of a rotatable gantry and/or moveable nozzle, a translatable and/or a rotatable position of the zero vectors. For clarity of presentation and without loss of generality, the terminology of a reference beam path is used herein to refer to an axis system defined by the charged particle beam under a known set of controls, such as a known position of entry into the treatment room  922 , a known vector into the treatment room  922 , a first known field applied in the first axis control  143 , and/or a second known field applied in the second axis control  144 . Further, as described, supra, a reference zero point or zero point  1002  is a point on the reference beam path. More generally, the reference beam path and the reference zero point optionally refer to a mathematical transform of a calibrated reference beam path and a calibrated reference zero point of the beam path, such as a charged particle beam path defined axis system. The calibrated reference zero point is any point; however, preferably the reference zero point is on the calibrated reference beam path and as used herein, for clarity of presentation and without loss of generality, is a point on the calibrated reference beam path crossing a plane defined by a terminus of the nozzle of the nozzle system  146 . Optionally and preferably, the reference beam path is calibrated, in a prior calibration step, against one or more system position markers as a function of one or more applied fields of the first known field and the second known field and optionally energy and/or flux/intensity of the charged particle beam, such as along the treatment beam path  269 . The reference beam path is optionally and preferably implemented with a fiducial marker system and is further described infra. 
     Example I 
     In a first example, referring still to  FIG. 20 , the charged particle reference beam path system  2000  is further described using a radiation treatment plan developed using a traditional isocenter axis system  2022 . A medical doctor approved radiation treatment plan  2010 , such as a radiation treatment plan developed using the traditional isocenter axis system  2022 , is converted to a radiation treatment plan using the reference beam path-reference zero point treatment plan. The conversion step, when coupled to a calibrated reference beam path, uses an ideal isocenter point; hence, subsequent treatment using the calibrated reference beam and fiducial indicators  2040  removes the isocenter volume error. For instance, prior to tumor treatment  2070 , fiducial indicators  2040  are used to determine position of the patient  230  and/or to determine a clear treatment path to the patient  230 . For instance, the reference beam path and/or treatment beam path  269  derived therefrom is projected in software to determine if the treatment beam path  269  is unobstructed by equipment in the treatment room using known geometries of treatment room objects and fiducial indicators  2040  indicating position and/or orientation of one or more and preferably all movable treatment room objects. The software is optionally implemented in a virtual treatment system. Preferably, the software system verifies a clear treatment path, relative to the actual physical obstacles marked with the fiducial indicators  2040 , in the less than 5, 4, 3, 2, 1, and/or 0.1 seconds prior to each use of the treatment beam path  269  and/or in the less than 5, 4, 3, 2, 1, and/or 0.1 seconds following movement of the patient positioning system, patient  230 , and/or operator. 
     Example II 
     In a second example, referring again to  FIG. 20 , the charged particle reference beam path system  2000  is further described. 
     Generally, a radiation treatment plan is developed  2020 . In a first case, an isocenter axis system  2022  is used to develop the radiation treatment plan  2020 . In a second case, a system using the reference beam path of the charged particles  2024  is used to develop the radiation treatment plan. In a third case, the radiation treatment plan developed using the reference beam path  2020  is converted to an isocenter axis system  2022 , to conform with traditional formats presented to the medical doctor, prior to medical doctor approval of the radiation treatment plan  2010 , where the transformation uses an actual isocenter point and not a mechanically defined isocenter volume and errors associated with the size of the volume, as detailed supra. In any case, the radiation treatment plan is tested, in software and/or in a dry run absent tumor treatment, using the fiducial indicators  2040 . The dry run allows a real-life error check to ensure that no mechanical element crosses the treatment beam in the proposed or developed radiation treatment plan  2020 . Optionally, a physical dummy placed in a patient treatment position is used in the dry run. 
     After medical doctor approval of the radiation treatment plan  2010 , tumor treatment  2070  commences, optionally and preferably with an intervening step of verifying a clear treatment path  2052  using the fiducial indicators  2040 . In the event that the main controller  110  determines, using the reference beam path and the fiducial indicators  1140 , that the treatment beam  269  would intersect an object or operator in the treatment room  922 , multiple options exist. In a first case, the main controller  110 , upon determination of a blocked and/or obscured treatment path of the treatment beam  269 , temporarily or permanently stops the radiation treatment protocol. In a second case, optionally after interrupting the radiation treatment protocol, a modified treatment plan is developed  2054  for subsequent medical doctor approval of the modified radiation treatment plan  2010 . In a third case, optionally after interrupting the radiation treatment protocol, a physical transformation of a delivery axis system is performed  2030 , such as by moving the nozzle system  146 , rotating and/or translating the nozzle position  2034 , and/or switching to another beamline  2036 . Subsequently, tumor treatment  2070  is resumed and/or a modified treatment plan is presented to the medical doctor for approval of the radiation treatment plan. 
     Automated Cancer Therapy Imaging/Treatment System 
     Cancer treatment using positively charged particles involves multi-dimensional imaging, multi-axes tumor irradiation treatment planning, multi-axes beam particle beam control, multi-axes patient movement during treatment, and intermittently intervening objects between the patient and/or the treatment nozzle system. Automation of subsets of the overall cancer therapy treatment system using robust code simplifies working with the intermixed variables, which aids oversight by medical professionals. Herein, an automated system is optionally semi-automated, such as overseen by a medical professional. 
     Example I 
     In a first example, referring still to  FIG. 20  and referring now to  FIG. 21 , a first example of a semi-automated cancer therapy treatment system  2100  is described and the charged particle reference beam path system  2000  is further described. The charged particle reference beam path system  2000  is optionally and preferably used to automatically or semi-automatically: (1) identify an upcoming treatment beam path; (2) determine presence of an object in the upcoming treatment beam path; and/or (3) redirect a path of the charged particle beam to yield an alternative upcoming treatment beam path. Further, the main controller  110  optionally and preferably contains a prescribed tumor irradiation plan, such as provided by a prescribing doctor. In this example, the main controller  110  is used to determine an alternative treatment plan to achieve the same objective as the prescribed treatment plan. For instance, the main controller  110 , upon determination of the presence of an intervening object in an upcoming treatment beam path or imminent treatment path directs and/or controls: movement of the intervening object; movement of the patient positioning system; and/or position of the nozzle system  146  to achieve identical or substantially identical treatment of the tumor  220  in terms of radiation dosage per voxel and/or tumor collapse direction, where substantially identical is a dosage and/or direction within 90, 95, 97, 98, 99, or 99.5 percent of the prescription. Herein, an imminent treatment path is the next treatment path of the charged particle beam to the tumor in a current version of a radiation treatment plan and/or a treatment beam path/vector that is scheduled for use within the next 1, 5, 10, 30, or 60 seconds. In a first case, the revised tumor treatment protocol is sent to a doctor, such as a doctor in a neighboring control room and/or a doctor in a remote facility or outside building, for approval. In a second case, the doctor, present or remote, oversees an automated or semi-automated revision of the tumor treatment protocol, such as generated using the main controller. Optionally, the doctor halts treatment, suspends treatment pending an analysis of the revised tumor treatment protocol, slows the treatment procedure, or allows the main controller to continue along the computer suggested revised tumor treatment plan. Optionally and preferably, imaging data and/or imaging information, such as described supra, is input to the main controller  110  and/or is provided to the overseeing doctor or the doctor authorizing a revised tumor treatment irradiation plan. 
     Example II 
     Referring now to  FIG. 21 , a second example of the semi-automated cancer therapy treatment system  2100  is described. Initially, a medical doctor, such as an oncologist, provides an approved radiation treatment plan  2110 , which is implemented in a treatment step of delivering charged particles  2128  to the tumor  220  of the patient  230 . Concurrent with implementation of the treatment step, additional data is gathered, such as via an updated/new image from an imaging system and/or via the fiducial indicators  2040 . Subsequently, the main controller  110  optionally, in an automated process or semi-automated process, adjusts the provided doctor approved radiation treatment plan  2110  to form a current radiation treatment plan. In a first case, cancer treatments halts until the doctor approves the proposed/adjusted treatment plan and continues using the now, doctor approved, current radiation treatment plan. In a second case, the computer generated radiation treatment plan continues in an automated fashion as the current treatment plan. In a third case, the computer generated treatment plan is sent for approval, but cancer treatment proceeds at a reduced rate to allow the doctor time to monitor the changed plan. The reduced rate is optionally less than 100, 90, 80, 70, 60, or 50 percent of the original treatment rate and/or is greater than 0, 10, 20, 30, 40, or 50 percent of the original treatment rate. At any time, the overseeing doctor, medical professional, or staff may increase or decrease the rate of treatment. 
     Example III 
     Referring still to  FIG. 21 , a third example of the semi-automated cancer therapy treatment system  2100  is described. In this example, a process of semi-autonomous cancer treatment  2120  is implemented. In stark contrast with the previous example where a doctor provides the original cancer treatment plan  2110 , in this example the cancer therapy system  110  auto-generates a radiation treatment plan  2126 . Subsequently, the auto-generated treatment plan, now the current radiation treatment plan, is implemented, such as via the treatment step of delivering charged particles  2128  to the tumor  220  of the patient  230 . Optionally and preferably, the auto-generated radiation treatment plan  2126  is reviewed in an intervening and/or concurrent doctor oversight step  2130 , where the auto-generated radiation treatment plan  2126  is approved as the current treatment plan  2132  or approved as an alternative treatment plan  2134 ; once approved referred to as the current treatment plan. 
     Generally, the original doctor approved treatment plan  2110 , the auto generated radiation treatment plan  2126 , or the altered treatment plan  2134 , when being implemented is referred to as the current radiation treatment plan. 
     Example IV 
     Referring still to  FIG. 21 , a fourth example of the semi-automated cancer therapy treatment system  2100  is described. In this example, the current radiation treatment plan, prior to implementation of a particular set of voxels of the tumor  220  of the patient  230 , is analyzed in terms of clear path analysis, as described supra. More particularly, fiducial indicators  2040  are used in determination of a clear treatment path prior to treatment along an imminent beam treatment path to one or more voxels of the tumor  220  of the patient. Upon implementation, the imminent treatment vector is the treatment vector in the deliver charged particles step  2128 . 
     Example V 
     Referring still to  FIG. 21 , a fifth example of the semi-automated cancer therapy treatment system  2100  is described. In this example, a cancer treatment plan is generated semi-autonomously or autonomously using the main controller  110  and the process of semi-autonomous cancer treatment system. More particularly, the process of semi-autonomous cancer treatment  2120  uses input from: (1) a semi-autonomously patient positioning step  2122 ; (2) a semi-autonomous tumor imaging step  2124 , and/or for the fiducial indicators  2040 ; and/or (3) a software coded set of radiation treatment directives with optional weighting parameters. For example, the treatment directives comprise a set of criteria to: (1) treat the tumor  220 ; (2) while reducing energy delivery of the charged particle beam outside of the tumor  220 ; minimizing or greatly reducing passage of the charged particle beam into a high value element, such as an eye, nerve center, or organ, the process of semi-autonomous cancer treatment  2120  optionally auto-generates the original radiation treatment plan  2126 . The auto-generated original radiation treatment plan  2126  is optionally auto-implemented, such as via the deliver charged particles step  2126 , and/or is optionally reviewed by a doctor, such as in the doctor oversight  2130  process, described supra. Optionally and preferably, the semi-autonomous imaging step  2124  generates and/or uses data from: (1) one or more proton scans from an imaging system using protons to image the tumor  220 ; (2) one or more X-ray images using one or more X-ray imaging systems; (3) a positron emission system; (4) a computed tomography system; and/or (5) any imaging technique or system described herein. 
     The inventor notes that traditionally days pass between imaging the tumor and treating the tumor while a team of oncologists develop a radiation plan. In stark contrast, using the autonomous imaging and treatment steps described herein, such as implemented by the main controller  110 , the patient optionally remains in the treatment room and/or in a treatment position in a patient positioning system from the time of imaging, through the time of developing a radiation plan, and through at least a first tumor treatment session. 
     Example VI 
     Referring still to  FIG. 21 , a sixth example of the semi-automated cancer therapy treatment system  2100  is described. In this example, the deliver charged particle step  2128 , using a current radiation treatment plan, is adjusted autonomously or semi-autonomously using concurrent and/or interspersed images from the semi-autonomously imaging system  2124  as interpreted, such as via the process of semi-automated cancer treatment  2120  and input from the fiducial indicators  2040  and/or the semi-automated patient position system  2122 . 
     Referring now to  FIG. 22 , a system for developing a radiation treatment plan  2210  using positively charged particles is described. More particularly, a semi-automated radiation treatment plan development system  2200  is described, where the semi-automated system is optionally fully automated or contains fully automated sub-processes. 
     The computer implemented algorithm, such as implemented using the main controller  110 , in the automated radiation treatment plan development system  2200  generates a score, sub-score, and/or output to rank a set of auto-generated potential radiation treatment plans, where the score is used in determination of a best radiation treatment plan, a proposed radiation treatment plan, and/or an auto-implemented radiation treatment plan. 
     Still referring to  FIG. 22 , the semi-automated or automated radiation treatment plan development system  2200  optionally and preferably provides a set of inputs, guidelines, and/or weights to a radiation treatment development code that processes the inputs to generate an optimal radiation treatment plan and/or a preferred radiation treatment plan based upon the inputs, guidelines, and/or weights. An input is a goal specification, but not an absolute fixed requirement. Input goals are optionally and preferably weighted and/or are associated with a hard limit. Generally, the radiation treatment development code uses an algorithm, an optimization protocol, an intelligent system, computer learning, supervised, and/or unsupervised algorithmic approach to generating a proposed and/or immediately implemented radiation treatment plan, which are compared via the score described above. Inputs to the semi-automated radiation treatment plan development system  2200  include images of the tumor  220  of the patient  230 , treatment goals, treatment restrictions, associated weights to each input, and/or associated limits of each input. To facilitate description and understanding of the invention, without loss of generality, optional inputs are illustrated in  FIG. 22  and further described herein by way of a set of examples. 
     Example I 
     Still referring to  FIG. 22 , a first input to the semi-automated radiation treatment plan development system  2200 , used to generate the radiation treatment plan  2210 , is a requirement of dose distribution  2220 . Herein, dose distribution comprises one or more parameters, such as a prescribed dosage  2221  to be delivered; an evenness or uniformity of radiation dosage distribution  2222 ; a goal of reduced overall dosage  2223  delivered to the patient  230 ; a specification related to minimization or reduction of dosage delivered to critical voxels  2224  of the patient  230 , such as to a portion of an eye, brain, nervous system, and/or heart of the patient  230 ; and/or an extent of, outside a perimeter of the tumor, dosage distribution  2225 . The automated radiation treatment plan development system  2200  calculates and/or iterates a best radiation treatment plan using the inputs, such as via a computer implemented algorithm. 
     Each parameter provided to the automated radiation treatment plan development system  2200 , optionally and preferably contains a weight or importance. For clarity of presentation and without loss of generality, two cases illustrate. 
     In a first case, a requirement/goal of reduction of dosage or even complete elimination of radiation dosage to the optic nerve of the eye, provided in the minimized dosage to critical voxels  2224  input is given a higher weight than a requirement/goal to minimize dosage to an outer area of the eye, such as the rectus muscle, or an inner volume of the eye, such as the vitreous humor of the eye. This first case is exemplary of one input providing more than one sub-input where each sub-input optionally includes different weighting functions. 
     In a second case, a first weight and/or first sub-weight of a first input is compared with a second weight and/or a second sub-weight of a second input. For instance, a distribution function, probability, or precision of the even radiation dosage distribution  2222  input optionally comprises a lower associated weight than a weight provided for the reduce overall dosage  2223  input to prevent the computer algorithm from increasing radiation dosage in an attempt to yield an entirely uniform dose distribution. 
     Each parameter and/or sub-parameter provided to the automated radiation treatment plan development system  2200 , optionally and preferably contains a limit, such as a hard limit, an upper limit, a lower limit, a probability limit, and/or a distribution limit. The limit requirement is optionally used, by the computer algorithm generating the radiation treatment plan  2210 , with or without the weighting parameters, described supra. 
     Example II 
     Still referring to  FIG. 22 , a second input to the semi-automated radiation treatment plan development system  2200 , is a patient motion  2230  input. The patient motion  2230  input comprises: a move the patient in one direction  2232  input, a move the patient at a uniform speed  2233  input, a total patient rotation  2234  input, a patient rotation rate  2235  input, and/or a patient tilt  2236  input. For clarity of presentation and without loss of generality, the patient motion inputs are further described, supra, in several cases. 
     Still referring to  FIG. 22 , in a first case the automated radiation treatment plan development system  2200 , provides a guidance input, such as the move the patient in one direction  2232  input, but a further associated directive is if other goals require it or if a better overall score of the radiation treatment plan  2210  is achieved, the guidance input is optionally automatically relaxed. Similarly, the move the patient at a uniform rate  2233  input is also provided with a guidance input, such as a low associated weight that is further relaxable to yield a high score, of the radiation treatment plan  2210 , but is only relaxed or implemented an associated fixed or hard limit number of times. 
     Still referring to  FIG. 22 , in a second case the computer implemented algorithm, in the automated radiation treatment plan development system  2200 , optionally generates a sub-score. For instance, a patient comfort score optionally comprises a score combining a metric related to two or more of: the move the patient in one direction  2232  input, the move the patient at a uniform rate  2233  input, the total patient rotation  2234  input, the patient rotation rate  2235  input, and/or the reduce patient tilt  2236  input. The sub-score, which optionally has a preset limit, allows flexibility, in the computer implemented algorithm, to yield on patient movement parameters as a whole, again to result in patient comfort. 
     Still referring to  FIG. 22 , in a third case the automated radiation treatment plan development system  2200  optionally contains an input used for more than one sub-function. For example, a reduce treatment time  2231  input is optionally used as a patient comfort parameter and also links into the dose distribution  2220  input. 
     Example III 
     Still referring to  FIG. 22 , a third input to the automated radiation treatment plan development system  2200  comprises output of an imaging system, such as any of the imaging systems described herein. 
     Example IV 
     Still referring to  FIG. 22 , a fourth optional input to the automated radiation treatment plan development system  2200  is structural and/or physical elements present in the treatment room  922 . Again, for clarity of presentation and without loss of generality, two cases illustrate treatment room object information as an input to the automated development of the radiation treatment plan  2210 . 
     Still referring to  FIG. 22 , in a first case the automated radiation treatment plan development system  2200  is optionally provided with a pre-scan of potentially intervening support structures  2282  input, such as a patient support device, a patient couch, and/or a patient support element, where the pre-scan is an image/density/redirection impact of the support structure on the positively charged particle treatment beam. Preferably, the pre-scan is an actual image or tomogram of the support structure using the actual facility synchrotron, a remotely generated actual image, and/or a calculated impact of the intervening structure on the positively charge particle beam. Determination of impact of the support structure on the charged particle beam is further described, infra. 
     Still referring to  FIG. 22 , in a second case the automated radiation treatment plan development system  2200  is optionally provided with a reduce treatment through a support structure  2244  input. As described supra, an associated weight, guidance, and/or limit is optionally provided with the reduce treatment through the support structure  2244  input and, also as described supra, the support structure input is optionally compromised relative to a more critical parameter, such as the deliver prescribed dosage  2221  input or the minimize dosage to critical voxels  2224  of the patient  230  input. 
     Example V 
     Still referring to  FIG. 22 , a fifth optional input to the automated radiation treatment plan development system  2200  is a doctor input  2136 , such as provided only prior to the auto generation of the radiation treatment plan. Separately, doctor oversight  2130  is optionally provided to the automated radiation treatment plan development system  2200  as plans are being developed, such as an intervention to restrict an action, an intervention to force an action, and/or an intervention to change one of the inputs to the automated radiation treatment plan development system  2200  for a radiation plan for a particular individual. 
     Example VI 
     Still referring to  FIG. 22 , a sixth input to the automated radiation treatment plan development system  2200  comprises information related to collapse and/or shifting of the tumor  220  of the patient  230  during treatment. For instance, the radiation treatment plan  2210  is automatically updated, using the automated radiation treatment plan development system  2200 , during treatment using an input of images of the tumor  220  of the patient  230  collected concurrently with treatment using the positively charged particles. For instance, as the tumor  220  reduces in size with treatment, the tumor  220  collapses inward and/or shifts. The auto-updated radiation treatment plan is optionally auto-implemented, such as without the patient moving from a treatment position. Optionally, the automated radiation treatment plan development system  2200  tracks dosage of untreated voxels of the tumor  220  and/or tracks partially irradiated, relative to the prescribed dosage  2221 , voxels and dynamically and/or automatically adjusts the radiation treatment plan  2210  to provide the full prescribed dosage to each voxel despite movement of the tumor  220 . Similarly, the automated radiation treatment plan development system  2200  tracks dosage of treated voxels of the tumor  220  and adjusts the automatically updated tumor treatment plan to reduce and/or minimize further radiation delivery to the fully treated and shifted tumor voxels while continuing treatment of the partially treated and/or untreated shifted voxels of the tumor  220 . 
     Automated Adaptive Treatment 
     Referring now to  FIG. 23 , a system for automatically updating the radiation treatment plan  2300  and preferably automatically updating and implementing the radiation treatment plan is illustrated. In a first task  2310 , an initial radiation treatment plan is provided, such as the auto-generated radiation treatment plan  2126 , described supra. The first task is a startup task of an iterative loop of tasks and/or recurring set of tasks, described herein as comprising tasks two to four. In a second task  2320 , the tumor  220  is treated using the positively charged particles delivered from the synchrotron  130 . In a third task  2330 , changes in the tumor shape and/or changes in the tumor position relative to surrounding constituents of the patient  230  are observed, such as via any of the imaging systems described herein. The imaging optionally occurs simultaneously, concurrently, periodically, and/or intermittently with the second task while the patient remains positioned by the patient positioning system. The main controller  110  uses images from the imaging system(s) and the provided and/or current radiation treatment plan to determine if the treatment plan is to be followed or modified. Upon detected relative movement of the tumor  220  relative to the other elements of the patient  230  and/or change in a shape of the tumor  230 , a fourth task  2340  of updating the treatment plan is optionally and preferably automatically implemented and/or use of the radiation treatment plan development system  2200 , described supra, is implemented. The process of tasks two to four is optionally and preferably repeated n times where n is a positive integer of greater than 1, 2, 5, 10, 20, 50, or 100 and/or until a treatment session of the tumor  220  ends and the patient  230  departs the treatment room  922 . 
     Automated Treatment 
     Referring now to  FIG. 24 , an automated cancer therapy treatment system  2400  is illustrated. In the automated cancer therapy treatment system  2400 , a majority of tasks are implemented according to a computer based algorithm and/or an intelligent system. Optionally and preferably, a medical professional oversees the automated cancer therapy treatment system  2400  and stops or alters the treatment upon detection of an error but fundamentally observes the process of computer algorithm guided implementation of the system using electromechanical elements, such as any of the hardware and/or software described herein. Optionally and preferably, each sub-system and/or sub-task is automated. Optionally, one or more of the sub-systems and/or sub-tasks are performed by a medical professional. For instance, the patient  230  is optionally initially positioned in the patient positioning system by the medical professional and/or the nozzle system  146  inserts are loaded by the medical professional. Optional and preferably automated, such as computer algorithm implemented, sub-tasks include one or more and preferably all of:
         receiving the treatment plan input  2200 , such as a prescription, guidelines, patient motion guidelines  2230 , dose distribution guidelines  2220 , intervening object  2210  information, and/or images of the tumor  220 ;   using the treatment plan input  2200  to auto-generate a radiation treatment plan  2126 ;   auto-positioning  2122  the patient  230 ;   auto-imaging  2124  the tumor  220 ;   implementing medical profession oversight  2138  instructions;   auto-implementing the radiation treatment plan  2320 /delivering the positively charged particles to the tumor  220 ;   auto-reposition the patient  2321  for subsequent radiation delivery;   auto-rotate a nozzle position  2322  of the nozzle system  146  relative to the patient  230 ;   auto-translate a nozzle position  2323  of the nozzle system  146  relative to the patient  230 ;   auto-verify a clear treatment path using an imaging system, such as to observe presence of a metal object or unforeseen dense object via an X-ray image;   auto-verify a clear treatment path using fiducial indicators  2324 ;   auto control a state of the positively charge particle beam  2325 , such as energy, intensity, position (x,y,z), duration, and/or direction;   auto-control a particle beam path  2326 , such as to a selected beamline and/or to a selected nozzle;   auto implement positioning a tray insert and/or tray assembly;   auto-update a tumor image  2410 ;   auto-observe tumor movement  2330 ; and/or   generate an auto-modified radiation treatment plan  2340 /new treatment plan.       

     Still yet another embodiment includes any combination and/or permutation of any of the elements described herein. 
     The main controller, a localized communication apparatus, and/or a system for communication of information optionally comprises one or more subsystems stored on a client. The client is a computing platform configured to act as a client device or other computing device, such as a computer, personal computer, a digital media device, and/or a personal digital assistant. The client comprises a processor that is optionally coupled to one or more internal or external input device, such as a mouse, a keyboard, a display device, a voice recognition system, a motion recognition system, or the like. The processor is also communicatively coupled to an output device, such as a display screen or data link to display or send data and/or processed information, respectively. In one embodiment, the communication apparatus is the processor. In another embodiment, the communication apparatus is a set of instructions stored in memory that is carried out by the processor. 
     The client includes a computer-readable storage medium, such as memory. The memory includes, but is not limited to, an electronic, optical, magnetic, or another storage or transmission data storage medium capable of coupling to a processor, such as a processor in communication with a touch-sensitive input device linked to computer-readable instructions. Other examples of suitable media include, for example, a flash drive, a CD-ROM, read only memory (ROM), random access memory (RAM), an application-specific integrated circuit (ASIC), a DVD, magnetic disk, an optical disk, and/or a memory chip. The processor executes a set of computer-executable program code instructions stored in the memory. The instructions may comprise code from any computer-programming language, including, for example, C originally of Bell Laboratories, C++, C#, Visual Basic® (Microsoft, Redmond, Wash.), Matlab® (MathWorks, Natick, Mass.), Java® (Oracle Corporation, Redwood City, Calif.), and JavaScript® (Oracle Corporation, Redwood City, Calif.). 
     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. 
     Herein, an element and/or object is optionally manually and/or mechanically moved, such as along a guiding element, with a motor, and/or under control of the main controller. 
     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.