Patent Publication Number: US-11648420-B2

Title: Imaging assisted integrated tomography—cancer treatment apparatus 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. 14/216,788 filed Mar. 17, 2014,
           which is a continuation-in-part of U.S. patent application Ser. No. 13/087,096 filed Apr. 14, 2011, which claims benefit of U.S. provisional patent application No. 61/324,776 filed Apr. 16, 2010; and   is a continuation-in-part of U.S. patent application Ser. No. 13/788,890 filed Mar. 7, 2013;   
           is a continuation-in-part of U.S. patent application Ser. No. 14/952,817 filed Nov. 25, 2015 is a continuation-in-part of U.S. patent application Ser. No. 14/293,861 filed Jun. 2, 2014, which is a continuation-in-part of U.S. patent application Ser. No. 12/985,039 filed Jan. 5, 2011, which claims the benefit of U.S. provisional patent application No. 61/324,776, filed Apr. 16, 2010;   is a continuation-in-part of U.S. patent application Ser. No. 14/860,577 filed Sep. 21, 2015, which is a continuation of U.S. patent application Ser. No. 14/223,289 filed Mar. 24, 2014, which is a continuation-in-part of U.S. patent application Ser. No. 14/216,788 filed Mar. 17, 2014, which is a continuation-in-part of U.S. patent application Ser. No. 12/985,039 filed Jan. 5, 2011, which claims the benefit of U.S. provisional patent application No. 61/324,776, filed Apr. 16, 2010; and   is a continuation-in-part U.S. patent application Ser. No. 15/073,471 filed Mar. 17, 2016, which claims benefit of U.S. provisional patent application No. 62/304,839 filed Mar. 7, 2016,   all of which are incorporated herein in their entirety by this reference thereto.       

    
    
     BACKGROUND OF THE INVENTION 
     Field of the Invention 
     This invention relates generally to treatment of solid cancers. More particularly, the invention relates to a treatment delivery control system for controlling subsystems of a multi-axis and/or multi-field charged particle cancer therapy method and apparatus. 
     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. 
     Synchrotron 
     Patents related to the current invention are summarized here. 
     Proton Beam Therapy System 
     F. Cole, et. al. of Loma Linda University Medical Center “Multi-Station Proton Beam Therapy System”, U.S. Pat. No. 4,870,287 (Sep. 26, 1989) describe a proton beam therapy system for selectively generating and transporting proton beams from a single proton source and accelerator to a selected treatment room of a plurality of patient treatment rooms. 
     Imaging 
     P. Adamee, et. al. “Charged Particle Beam Apparatus and Method for Operating the Same”, U.S. Pat. No. 7,274,018 (Sep. 25, 2007) and P. Adamee, et. al. “Charged Particle Beam Apparatus and Method for Operating the Same”, U.S. Pat. No. 7,045,781 (May 16, 2006) describe a charged particle beam apparatus configured for serial and/or parallel imaging of an object. 
     K. Hiramoto, et. al. “Ion Beam Therapy System and its Couch Positioning System”, U.S. Pat. No. 7,193,227 (Mar. 20, 2007) describe an ion beam therapy system having an X-ray imaging system moving in conjunction with a rotating gantry. 
     C. Maurer, et. al. “Apparatus and Method for Registration of Images to Physical Space Using a Weighted Combination of Points and Surfaces”, U.S. Pat. No. 6,560,354 (May 6, 2003) described a process of X-ray computed tomography registered to physical measurements taken on the patient&#39;s body, where different body parts are given different weights. Weights are used in an iterative registration process to determine a rigid body transformation process, where the transformation function is used to assist surgical or stereotactic procedures. 
     M. Blair, et. al. “Proton Beam Digital Imaging System”, U.S. Pat. No. 5,825,845 (Oct. 20, 1998) describe a proton beam digital imaging system having an X-ray source that is movable into a treatment beam line that can produce an X-ray beam through a region of the body. By comparison of the relative positions of the center of the beam in the patient orientation image and the isocentre in the master prescription image with respect to selected monuments, the amount and direction of movement of the patient to make the best beam center correspond to the target isocentre is determined. 
     S. Nishihara, et. al. “Therapeutic Apparatus”, U.S. Pat. No. 5,039,867 (Aug. 13, 1991) describe a method and apparatus for positioning a therapeutic beam in which a first distance is determined on the basis of a first image, a second distance is determined on the basis of a second image, and the patient is moved to a therapy beam irradiation position on the basis of the first and second distances. 
     Problem 
     There exists in the art of charged particle irradiation therapy a need to accurately and precisely deliver an effective and uniform radiation dose to all positions of a tumor. There further exists a need for accurately, precisely, and timely locating and targeting a tumor in a patient. There still further exists a need in the art to control the charged particle cancer therapy system in terms of patient translation position, patient rotation position, specified energy, specified intensity, timing of charged particle delivery, and/or distribution of radiation striking healthy tissue. There yet still further exists a need for an integrated control system to control and/or to directly control subsystems of a cancer treatment process for enhanced efficacy and safety. Preferably, the system would operate in conjunction with a negative ion beam source, synchrotron, patient positioning, imaging, and/or targeting method and apparatus. 
     SUMMARY OF THE INVENTION 
     The invention comprises a charged particle treatment delivery control system. 
    
    
     
       DESCRIPTION OF THE FIGURES 
       A more complete understanding of the present invention is derived by referring to the detailed description and claims when considered in connection with the Figures, wherein like reference numbers refer to similar items throughout the Figures. 
         FIG.  1    illustrates component connections of a charged particle beam therapy system; 
         FIG.  2    illustrates a charged particle therapy system; 
         FIG.  3    illustrates an ion beam generation system; 
         FIG.  4    illustrates a negative ion beam source; 
         FIG.  5    illustrates an ion beam focusing system; 
         FIGS.  6   (A-D) illustrate focusing electrodes about a negative ion beam path; 
         FIG.  7 A  illustrates a negative ion beam path vacuum system;  FIG.  7 B  illustrates a support structure and foil;  FIG.  7 C  illustrates a support structure; 
         FIG.  8    is a particle beam therapy control flowchart; 
         FIG.  9    illustrates straight and turning sections of a synchrotron 
         FIG.  10    illustrates bending magnets of a synchrotron; 
         FIG.  11    provides a perspective view of a bending magnet; 
         FIG.  12    illustrates a cross-sectional view of a bending magnet; 
         FIG.  13    illustrates a cross-sectional view of a bending magnet; 
         FIG.  14    illustrates magnetic field concentration in a bending magnet; 
         FIG.  15    illustrates correction coils in a bending magnet; 
         FIG.  16    illustrates a magnetic turning section of a synchrotron; 
         FIG.  17 A  and  FIG.  17 B  illustrate an RF accelerator and an RF accelerator subsystem, respectively; 
         FIG.  18    illustrates a charged particle extraction system; 
         FIG.  19    illustrates a charged particle extraction and intensity control system; 
         FIG.  20 A  and  FIG.  20 B  illustrate proton beam position verification systems; 
         FIG.  21 A  and  FIG.  21 B  illustrate a patient positioning system from: (A) a front view and (B) a top view, respectively; 
         FIG.  22    provides X-ray and proton beam dose distributions; 
         FIGS.  23   (A-E) illustrate controlled scanning and depth of focus irradiation; 
         FIGS.  24   (A-E) illustrate multi-field irradiation; 
         FIG.  25    illustrates dose efficiency enhancement via use of multi-field irradiation; 
         FIGS.  26   (A-C) and  FIG.  26 E  illustrate distal irradiation of a tumor from varying rotational directions and  FIG.  26 D  illustrates integrated radiation resulting from distal radiation; 
         FIG.  27 A  and  FIG.  27 B  illustrate multi-dimensional scanning of a charged particle beam spot scanning system operating on: (A) a 2-D slice or (B) a 3-D volume of a tumor, respectively; 
         FIG.  28 A  and  FIG.  28 B  illustrate (A) irradiating varying depths within a tumor and (B) changes in irradiation intensity correlating with the varying depths in the tumor, respectively; 
         FIG.  29    illustrates an electron gun source used in generating X-rays coupled with a particle beam therapy system; 
         FIG.  30    illustrates an X-ray source proximate a particle beam path; 
         FIG.  31    illustrates an expanded X-ray beam path; 
         FIG.  32    provides an X-ray tomography system; 
         FIG.  33    illustrates a semi-vertical patient positioning system; 
         FIG.  34    provides an example of a sitting patient positioning system; 
         FIG.  35    illustrates a laying patient positioning system; 
         FIG.  36    illustrates a head restraint system; 
         FIG.  37    illustrates hand and head supports; 
         FIG.  38    provides a method of positioning, imaging, and irradiating a tumor; 
         FIG.  39    provides a method of imaging a tumor with rotation of the patient; 
         FIG.  40    provides a method of coordinating X-ray collection with patient respiration; 
         FIG.  41    provides a method of charged particle beam control; 
         FIG.  42    provides a method of multi-axis charged particle beam irradiation control; 
         FIG.  43    illustrates a patient positioning, immobilization, and repositioning system; 
         FIG.  44    shows particle field acceleration timed to a patient&#39;s respiration cycle; 
         FIG.  45    illustrates adjustable particle field acceleration timing; 
         FIG.  46    illustrates charged particle cancer therapy controllers; 
         FIG.  47    illustrates a charged particle tomography system; and 
         FIG.  48    illustrates a treatment delivery control 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 relates generally to a charged particle treatment delivery control system and method of operation therefor. 
     In one embodiment, a treatment delivery control system (TDCS) or main controller is used to control multiple aspects of the cancer therapy system, including one or more of: an imaging system, such as a CT or PET; a positioner, such as a couch or patient interface module; an injector or injection system; a radio-frequency quadrupole system; a ring accelerator or synchrotron; an extraction system; an irradiation plan; and a display system. The TDCS is preferably a control system for automated cancer therapy once the patient is positioned. The TDCS integrates output of one or more of the below described cancer therapy system elements with inputs of one or more of the below described cancer therapy system elements. More generally, the TDCS controls or manages input and/or output of imaging, an irradiation plan, and charged particle delivery. 
     In another embodiment, the charged particle tomography apparatus is used in combination with a charged particle cancer therapy system. For example, tomographic imaging of a cancerous tumor is performed using charged particles generated with an injector, accelerator, and guided with a delivery system. The cancer therapy system uses the same injector, accelerator, and guided delivery system in delivering charged particles to the cancerous tumor. For example, the tomography apparatus and cancer therapy system use a common raster beam method and apparatus for treatment of solid cancers. More particularly, the invention comprises a multi-axis and/or multi-field raster beam charged particle accelerator used in tomography and cancer therapy. Optionally, the system independently controls patient translation position, patient rotation position, two-dimensional beam trajectory, delivered radiation beam energy, delivered radiation beam intensity, beam velocity, timing of charged particle delivery, and/or distribution of radiation striking healthy tissue. The system operates in conjunction with a negative ion beam source, synchrotron, patient positioning, imaging, and/or targeting method and apparatus to deliver an effective and uniform dose of radiation to a tumor while distributing radiation striking healthy tissue. 
     In various embodiments, the charged particle tomography system optionally includes any of:
         charged particle imaging at the same time or within seconds of delivery of charged particles for cancer therapy;   ability to image the tumor by rotation of the patient;   ability to collect tens or hundreds of rotationally independent images to construct the three-dimensional image of the tumor and the patient;   adaptive charged particle therapy; and/or   imaging of the patient in an upright position.       

     Herein, common elements of the tomography system are first described using a cancer therapy system. Any of the cancer therapy elements are optionally used in the later described charged particle tomography system. 
     Used in combination with the invention, novel design features of a charged particle beam cancer therapy system are described. Particularly, a negative ion beam source with novel features in the negative ion source, ion source vacuum system, ion beam focusing lens, and tandem accelerator is described. Additionally, the synchrotron includes: turning magnets, edge focusing magnets, magnetic field concentration magnets, winding and correction coils, flat magnetic field incident surfaces, and extraction elements, which minimize the overall size of the synchrotron, provide a tightly controlled proton beam, directly reduce the size of required magnetic fields, directly reduce required operating power, and allow continual acceleration of protons in a synchrotron even during a process of extracting protons from the synchrotron. The ion beam source system and synchrotron are preferably computer integrated with a patient imaging system and a patient interface including respiration monitoring sensors and patient positioning elements. Further, the system is integrated with intensity control of a charged particle beam, acceleration, extraction, and/or targeting method and apparatus. More particularly, intensity, energy, and timing control of a charged particle stream of a synchrotron is coordinated with patient positioning and tumor treatment. The synchrotron control elements allow tight control of the charged particle beam, which compliments the tight control of patient positioning to yield efficient treatment of a solid tumor with reduced tissue damage to surrounding healthy tissue. In addition, the system reduces the overall size of the synchrotron, provides a tightly controlled proton beam, directly reduces the size of required magnetic fields, directly reduces required operating power, and allows continual acceleration of protons in a synchrotron even during a process of extracting protons from the synchrotron. All of these systems are preferably used in conjunction with an X-ray system capable of collecting X-rays of a patient: (1) in a positioning, immobilization, and automated repositioning system for proton treatment; (2) at a specified moment of the patient&#39;s respiration cycle; and (3) using coordinated translation and rotation of the patient. Combined, the systems provide for efficient, accurate, and precise noninvasive tumor treatment with minimal damage to surrounding healthy tissue. 
     In various embodiments, the charged particle cancer therapy system incorporates any of:
         an injection system having a central magnetic member and a magnetic field separating high and low temperature plasma regions;   a dual vacuum system creating a first partial pressure region on a plasma generation system side of a foil in a tandem accelerator and a second lower partial pressure region on the synchrotron side of the foil;   a negative ion beam focusing system having a conductive mesh axially crossing the negative ion beam;   a synchrotron having four straight sections and four turning sections;   a synchrotron having no hexapole magnets;   four bending magnets in each turning section of the synchrotron;   a winding coil wrapping multiple bending magnets;   a plurality of bending magnets that are beveled and charged particle focusing in each turning section;   a magnetic field concentrating geometry approaching the gap through which the charged particles travel;   correction coils for rapid magnetic field changes;   magnetic field feedback sensors providing signal to the correction coils;   integrated RF-amplifier microcircuits providing currents through loops about accelerating coils;   a low density foil for charged particle extraction;   a feedback sensor for measuring particle extraction allowing intensity control;   a synchrotron independently controlling charged particle energy and intensity;   a layer, after synchrotron extraction and before the tumor, for imaging the particle beam x-, y-axis position;   a rotatable platform for turning the subject allowing multi-field imaging and/or multi-field proton therapy;   a radiation plan dispersing ingress Bragg profile energy 360 degrees about the tumor;   a long lifetime X-ray source;   an X-ray source proximate the charged particle beam path;   a multi-field X-ray system;   positioning, immobilizing, and repositioning systems;   respiratory sensors;   simultaneous and independent control of:
           x-axis beam control;   y-axis beam control;   irradiation beam energy;   irradiation beam intensity;   patient translation; and/or   patient rotation; and   
           a system timing charged particle therapy to one or more of:
           patient translation;   patient rotation; and   patient respiration.   
               

     In another embodiment, safety systems for a charged particle system are implemented. For example, the safety system includes any of: multiple X-ray images from multiple directions, a three-dimensional X-ray image, a proton beam approximating a path of an X-ray beam, tight control of a proton beam cross-sectional area with magnets, ability to control proton beam energy, ability to control proton beam energy, a set of patient movement constrains, a patient controlled charged particle interrupt system, distribution of radiation around a tumor, and timed irradiation in terms of respiration. 
     In yet another embodiment, the tumor is imaged from multiple directions in phase with patient respiration. For example, a plurality of two-dimensional pictures are collected that are all in the about the same phase of respiration. The two-dimensional pictures are combined to produce a three-dimensional picture of the tumor relative to the patient. One or more safety features are optionally used in the charged particle cancer therapy system independently and/or in combination with the three-dimensional imaging system, as described infra. 
     In still yet another embodiment, the system independently controls patient translation position, patient rotation position, two-dimensional beam trajectory, delivered radiation beam energy, delivered radiation beam intensity, timing of charged particle delivery, beam velocity, 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. 
     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. Any of the techniques described herein are equally applicable to any charged particle beam system. 
     Referring now to  FIG.  1   , a charged particle beam system  100  is illustrated. The charged particle beam preferably comprises a number of subsystems including any of: a main controller  110 ; an injection system  120 ; a synchrotron  130  that typically includes: (1) an accelerator system  132  and (2) an extraction system  134 ; a scanning/targeting/delivery system  140 ; a patient interface module  150 ; a display system  160 ; and/or an imaging system  170 . 
     An exemplary method of use of the charged particle beam system  100  is provided. The main controller  110  controls one or more of the subsystems to accurately and precisely deliver protons to a tumor of a patient. For example, the main controller  110  obtains an image, such as a portion of a body and/or of a tumor, from the imaging system  170 . The main controller  110  also obtains position and/or timing information from the patient interface module  150 . The main controller  110  then optionally controls the injection system  120  to inject a proton into a synchrotron  130 . The synchrotron typically contains at least an accelerator system  132  and an extraction system  134 . The main controller  110  preferably controls the proton beam within the accelerator system, such as by controlling speed, trajectory, and timing of the proton beam. The main controller then controls extraction of a proton beam from the accelerator through the extraction system  134 . For example, the controller controls timing, energy, and/or intensity of the extracted beam. The controller  110  also preferably controls targeting of the proton beam through the scanning/targeting/delivery system  140  to the patient interface module  150 . One or more components of the patient interface module  150 , such as translational and rotational position of the patient, are preferably controlled by the main controller  110 . Further, display elements of the display system  160  are preferably controlled via the main controller  110 . Displays, such as display screens, are typically provided to one or more operators and/or to one or more patients. In one embodiment, the main controller  110  times the delivery of the proton beam from all systems, such that protons are delivered in an optimal therapeutic manner to the tumor of the patient. 
     Herein, the main controller  110  refers to a single system controlling the charged particle beam system  100 , to a single controller controlling a plurality of subsystems controlling the charged particle beam system  100 , or to a plurality of individual controllers controlling one or more sub-systems of the charged particle beam system  100 . 
     Referring now to  FIG.  2   , an illustrative exemplary embodiment of one version of the charged particle beam system  100  is provided. The number, position, and described type of components is illustrative and non-limiting in nature. In the illustrated embodiment, the injection system  120  or ion source or charged particle beam source generates protons. The protons are delivered into a vacuum tube that runs into, through, and out of the synchrotron. The generated protons are delivered along an initial path  262 . Focusing magnets  230 , such as quadrupole magnets or injection quadrupole magnets, are used to focus the proton beam path. A quadrupole magnet is a focusing magnet. An injector bending magnet  232  bends the proton beam toward the plane of the synchrotron  130 . The focused protons having an initial energy are introduced into an injector magnet  240 , which is preferably an injection Lamberson magnet. Typically, the initial beam path  262  is along an axis off of, such as above, a circulating plane of the synchrotron  130 . The injector bending magnet  232  and injector magnet  240  combine to move the protons into the synchrotron  130 . Main bending magnets, dipole magnets, turning magnets, or circulating magnets  250  are used to turn the protons along a circulating beam path  264 . A dipole magnet is a bending magnet. The main bending magnets  250  bend the initial beam path  262  into a circulating beam path  264 . In this example, the main bending magnets  250  or circulating magnets are represented as four sets of four magnets to maintain the circulating beam path  264  into a stable circulating beam path. However, any number of magnets or sets of magnets are optionally used to move the protons around a single orbit in the circulation process. The protons pass through an accelerator  270 . The accelerator accelerates the protons in the circulating beam path  264 . As the protons are accelerated, the fields applied by the magnets are increased. Particularly, the speed of the protons achieved by the accelerator  270  are synchronized with magnetic fields of the main bending magnets  250  or circulating magnets to maintain stable circulation of the protons about a central point or region  280  of the synchrotron. At separate points in time the accelerator  270 /main bending magnet  250  combination is used to accelerate and/or decelerate the circulating protons while maintaining the protons in the circulating path or orbit. An extraction element of the inflector/deflector system  290  is used in combination with a Lamberson extraction magnet  292  to remove protons from their circulating beam path  264  within the synchrotron  130 . One example of a deflector component is a Lamberson magnet. Typically the deflector moves the protons from the circulating plane to an axis off of the circulating plane, such as above the circulating plane. Extracted protons are preferably directed and/or focused using an extraction bending magnet  237  and extraction focusing magnets  235 , such as quadrupole magnets along a transport path  268  into the scanning/targeting/delivery system  140 . Two components of a scanning system  140  or targeting system typically include a first axis control  142 , such as a vertical control, and a second axis control  144 , such as a horizontal control. In one embodiment, the first axis control  142  allows for about 100 mm of vertical or y-axis scanning of the proton beam  268  and the second axis control  144  allows for about 700 mm of horizontal or x-axis scanning of the proton beam  268 . A nozzle system  146  is used for imaging the proton beam 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. Each of the above listed elements are further described, infra. 
     Ion Beam Generation System 
     An ion beam generation system generates a negative ion beam, such as a hydrogen anion or H −  beam; preferably focuses the negative ion beam; converts the negative ion beam to a positive ion beam, such as a proton or H +  beam; and injects the positive ion beam  262  into the synchrotron  130 . Portions of the ion beam path are preferably under partial vacuum. Each of these systems are further described, infra. 
     Referring now to  FIG.  3   , an exemplary ion beam generation system  300  is illustrated. As illustrated, the ion beam generation system  300  has four major subsections: a negative ion source  310 , a first partial vacuum system  330 , an optional ion beam focusing system  350 , and a tandem accelerator  390 . 
     Still referring to  FIG.  3   , the negative ion source  310  preferably includes an inlet port  312  for injection of hydrogen gas into a high temperature plasma chamber  314 . In one embodiment, the plasma chamber includes a magnetic material  316 , which provides a magnetic field  317  between the high temperature plasma chamber  314  and a low temperature plasma region on the opposite side of the magnetic field barrier. An extraction pulse is applied to a negative ion extraction electrode  318  to pull the negative ion beam into a negative ion beam path  319 , which proceeds through the first partial vacuum system  330 , through the ion beam focusing system  350 , and into the tandem accelerator  390 . 
     Still referring to  FIG.  3   , the first partial vacuum system  330  is an enclosed system running from the hydrogen gas inlet port  312  to a foil  395  in the tandem accelerator  390 . The foil  395  is preferably sealed directly or indirectly to the edges of the vacuum tube  320  providing for a higher pressure, such as about 10 −5  torr, to be maintained on the first partial vacuum system side of the foil  395  and a lower pressure, such as about 10 −7  torr, to be maintained on the synchrotron side of the foil. By only pumping first partial vacuum system  330  and by only semi-continuously operating the ion beam source vacuum based on sensor readings, the lifetime of the semi-continuously operating pump is extended. The sensor readings are further described, infra. 
     Still referring to  FIG.  3   , the first partial vacuum system  330  preferably includes: a first pump  332 , such as a continuously operating pump and/or a turbo molecular pump; a large holding volume  334 ; and a semi-continuously operating pump  336 . Preferably, a pump controller  340  receives a signal from a pressure sensor  342  monitoring pressure in the large holding volume  334 . Upon a signal representative of a sufficient pressure in the large holding volume  334 , the pump controller  340  instructs an actuator  345  to open a valve  346  between the large holding volume and the semi-continuously operating pump  336  and instructs the semi-continuously operating pump to turn on and pump to atmosphere residual gases out of the vacuum line  320  about the charged particle stream. In this fashion, the lifetime of the semi-continuously operating pump is extended by only operating semi-continuously and as needed. In one example, the semi-continuously operating pump  336  operates for a few minutes every few hours, such as 5 minutes every 4 hours, thereby extending a pump with a lifetime of about 2,000 hours to about 96,000 hours. 
     Further, by isolating the inlet gas from the synchrotron vacuum system, the synchrotron vacuum pumps, such as turbo molecular pumps can operate over a longer lifetime as the synchrotron vacuum pumps have fewer gas molecules to deal with. For example, the inlet gas is primarily hydrogen gas but may contain impurities, such as nitrogen and carbon dioxide. By isolating the inlet gases in the negative ion source system  310 , first partial vacuum system  330 , ion beam focusing system  350 , and negative ion beam side of the tandem accelerator  390 , the synchrotron vacuum pumps can operate at lower pressures with longer lifetimes, which increases operating efficiency of the synchrotron  130 . 
     Still referring to  FIG.  3   , the optimal ion beam focusing system  350  preferably includes two or more electrodes where one electrode of each electrode pair partially obstructs the ion beam path with conductive paths  372 , such as a conductive mesh. In the illustrated example, two ion beam focusing system sections are illustrated, a two electrode ion beam focusing section  360  and a three electrode ion beam focusing section  370 . For a given electrode pair, electric field lines, running between the conductive mesh of a first electrode and a second electrode, provide inward forces focusing the negative ion beam. Multiple such electrode pairs provide multiple negative ion beam focusing regions. Preferably the two electrode ion focusing section  360  and the three electrode ion focusing section  370  are placed after the negative ion source and before the tandem accelerator and/or cover a space of about 0.5, 1, or 2 meters along the ion beam path  319 . Ion beam focusing systems are further described, infra. 
     Still referring to  FIG.  3   , the tandem accelerator  390  preferably includes a foil  395 , such as a carbon foil. The negative ions in the negative ion beam path  319  are converted to positive ions, such as protons, and the initial ion beam path  262  results. The foil  395  is preferably sealed directly or indirectly to the edges of the vacuum tube  320  providing for a higher pressure, such as about 10 −5  torr, to be maintained on the side of the foil  395  having the negative ion beam path  319  and a lower pressure, such as about 10 −7  torr, to be maintained on the side of the foil  390  having the proton ion beam path  262 . Having the foil  395  physically separating the vacuum chamber  320  into two pressure regions allows for a system having fewer and/or smaller pumps to maintain the lower pressure system in the synchrotron  130  as the inlet hydrogen and its residuals are extracted in a separate contained and isolated space by the first partial vacuum system  330 . 
     Negative Ion Source 
     An example of the negative ion source  310  is further described herein. Referring now to  FIG.  4   , a cross-section of an exemplary negative ion source system  400  is provided. The negative ion beam  319  is created in multiple stages. During a first stage, hydrogen gas is injected into a chamber. During a second stage, a negative ion is created by application of a first high voltage pulse, which creates a plasma about the hydrogen gas to create negative ions. During a third stage, a magnetic field filter is applied to components of the plasma. During a fourth stage, the negative ions are extracted from a low temperature plasma region, on the opposite side of the magnetic field barrier, by application of a second high voltage pulse. Each of the four stages are further described, infra. While the chamber is illustrated as a cross-section of a cylinder, the cylinder is exemplary only and any geometry applies to the magnetic loop containment walls, described infra. 
     In the first stage, hydrogen gas  440  is injected through the inlet port  312  into a high temperature plasma region  490 . The injection port  312  is open for a short period of time, such as less than about 1, 5, or 10 microseconds to minimize vacuum pump requirements to maintain vacuum chamber  320  requirements. The high temperature plasma region is maintained at reduced pressure by the partial vacuum system  330 . The injection of the hydrogen gas is optionally controlled by the main controller  110 , which is responsive to imaging system  170  information and patient interface module  150  information, such as patient positioning and period in a respiration cycle. 
     In the second stage, a high temperature plasma region is created by applying a first high voltage pulse across a first electrode  422  and a second electrode  424 . For example a 5 kV pulse is applied for about 20 microseconds with 5 kV at the second electrode  424  and about 0 kV applied at the first electrode  422 . Hydrogen in the chamber is broken, in the high temperature plasma region  490 , into component parts, such as any of: atomic hydrogen, H 0 , a proton, H + , an electron, e − , and a hydrogen anion, H − . 
     In the third stage, the high temperature plasma region  490  is at least partially separated from a low temperature plasma region  492  by the magnetic field  317  or in this specific example a magnetic field barrier  430 . High energy electrons are restricted from passing through the magnetic field barrier  430 . In this manner, the magnetic field barrier  430  acts as a filter between, zone A and zone B, in the negative ion source. Preferably, a central magnetic material  410 , which is an example of the magnetic material  316 , is placed within the high temperature plasma region  490 , such as along a central axis of the high temperature plasma region  490 . Preferably, the first electrode  422  and second electrode  424  are composed of magnetic materials, such as iron. Preferably, the outer walls  450  of the high temperature plasma region, such as cylinder walls, are composed of a magnetic material, such as a permanent magnet, ferric or iron based material, or a ferrite dielectric ring magnet. In this manner a magnetic field loop is created by: the central magnetic material  410 , first electrode  422 , the outer walls  450 , the second electrode  424 , and the magnetic field barrier  430 . Again, the magnetic field barrier  430  restricts high energy electrons from passing through the magnetic field barrier  430 . Low energy electrons interact with atomic hydrogen, H 0 , to create a hydrogen anion, H − , in the low temperature plasma region  492 . 
     In the fourth stage, a second high voltage pulse or extraction pulse is applied at a third electrode  426 . The second high voltage pulse is preferentially applied during the later period of application of the first high voltage pulse. For example, an extraction pulse of about 25 kV is applied for about the last 5 microseconds of the first creation pulse of about 20 microseconds. The potential difference, of about 20 kV, between the third electrode  426  and second electrode  424  extracts the negative ion, H − , from the low temperature plasma region  492  and initiates the negative ion beam  319 , from zone B to zone C. 
     The magnetic field barrier  430  is optionally created in number of ways. An example of creation of the magnetic field barrier  430  using coils is provided. In this example, the elements described, supra, in relation to  FIG.  4    are maintained with several differences. First, the magnetic field is created using coils. An isolating material is preferably provided between the first electrode  422  and the cylinder walls  450  as well as between the second electrode  424  and the cylinder walls  450 . The central material  410  and/or cylinder walls  450  are optionally metallic. In this manner, the coils create a magnetic field loop through the first electrode  422 , isolating material, outer walls  450 , second electrode  424 , magnetic field barrier  430 , and the central material  410 . Essentially, the coils generate a magnetic field in place of production of the magnetic field by the magnetic material  410 . The magnetic field barrier  430  operates as described, supra. Generally, any manner that creates the magnetic field barrier  430  between the high temperature plasma region  490  and low temperature plasma region  492  is functionally applicable to the ion beam extraction system  400 , described herein. 
     Ion Beam Focusing System 
     Referring now to  FIG.  5   , the ion beam focusing system  350  is further described. In this example, three electrodes are used. In this example, a first electrode  510  and third electrode  530  are both negatively charged and each is a ring electrode circumferentially enclosing or at least partially enclosing the negative ion beam path  319 . A second electrode  520  is positively charged and is also a ring electrode at least partially and preferably substantially circumferentially enclosing the negative ion beam path. In addition, the second electrode includes one or more conducting paths  372  running through the negative ion beam path  319 . For example, the conducting paths are a wire mesh, a conducting grid, or a series of substantially parallel conducting lines running across the second electrode. In use, electric field lines run from the conducting paths of the positively charged electrode to the negatively charged electrodes. For example, in use the electric field lines  540  run from the conducting paths  372  in the negative ion beam path  319  to the negatively charged electrodes  510 ,  530 . Two ray trace lines  550 ,  560  of the negative ion beam path are used to illustrate focusing forces. In the first ray trace line  550 , the negative ion beam encounters a first electric field line at point M. Negatively charged ions in the negative ion beam  550  encounter forces running up the electric field line  572 , illustrated with an x-axis component vector  571 . The x-axis component force vectors  571  alters the trajectory of the first ray trace line to a inward focused vector  552 , which encounters a second electric field line at point N. Again, the negative ion beam  552  encounters forces running up the electric field line  574 , illustrated as having an inward force vector with an x-axis component  573 , which alters the inward focused vector  552  to a more inward focused vector  554 . Similarly, in the second ray trace line  560 , the negative ion beam encounters a first electric field line at point O. Negatively charged ions in the negative ion beam encounter forces running up the electric field line  576 , illustrated as having a force vector with an x-axis force  575 . The inward force vector  575  alters the trajectory of the second ray trace line  560  to an inward focused vector  562 , which encounters a second electric field line at point P. Again, the negative ion beam encounters forces running up the electric field line  578 , illustrated as having force vector with an x-axis component  577 , which alters the inward focused vector  562  to a more inward focused vector  564 . The net result is a focusing effect on the negative ion beam. Each of the force vectors  572 ,  574 ,  576 ,  578  optionally has x and/or y force vector components resulting in a 3-dimensional focusing of the negative ion beam path. Naturally, the force vectors are illustrative in nature, many electric field lines are encountered, and the focusing effect is observed at each encounter resulting in integral focusing. The example is used to illustrate the focusing effect. 
     Still referring to  FIG.  5   , optionally any number of electrodes are used, such as 2, 3, 4, 5, 6, 7, 8, or 9 electrodes, to focus the negative ion beam path where every other electrode, in a given focusing section, is either positively or negatively charged. For example, three focusing sections are optionally used. In the first ion focusing section  360 , a pair of electrodes is used where the first electrode encountered along the negative ion beam path is negatively charged and the second electrode is positively charged, resulting in focusing of the negative ion beam path. In the second ion focusing section  370 , two pairs of electrodes are used, where a common positively charged electrode with a conductive mesh running through the negatively ion beam path  319  is used. Thus, in the second ion focusing section  370 , the first electrode encountered along the negative ion beam path is negatively charged and the second electrode is positively charged, resulting in focusing of the negative ion beam path. Further, in the second ion focusing section, moving along the negative ion beam path, a second focusing effect is observed between the second positively charged electrode and a third negatively charged electrode. In this example, a third ion focusing section is used that again has three electrodes, which acts in the fashion of the second ion focusing section, described supra. 
     Referring now to  FIGS.  6   (A-D), the central region of the electrodes in the ion beam focusing system  350  is further described. Referring now to  FIG.  6 A , the central region of the negatively charged ring electrode  510  is preferably void of conductive material. Referring now to  FIGS.  6   (B-D), the central region of positively charged electrode ring  520  preferably contains conductive paths  372 . Preferably, the conductive paths  372  or conductive material within the positively charged electrode ring  520  blocks about 1, 2, 5, or 10 percent of the area and more preferably blocks about five percent of the cross-sectional area of the negative ion beam path  319 . Referring now to  FIG.  6 B , one option is a conductive mesh  610 . Referring now to  FIG.  6 C , a second option is a series of conductive lines  620  running substantially in parallel across the positively charged electrode ring  520  that surrounds a portion of the negative ion beam path  319 . Referring now to  FIG.  6 D , a third option is to have a foil  630  or metallic layer cover all of the cross-sectional area of the negative ion beam path with holes punched through the material, where the holes take up about 90-99 percent and more preferably about 95 percent of the area of the foil. More generally, the pair of electrodes  510 ,  520  are configured to provide electric field lines that provide focusing force vectors to the negative ion beam  319  when the ions in the negative ion beam  319  translate through the electric field lines, as described supra. 
     In an example of a two electrode negative beam ion focusing system having a first cross-sectional diameter, d 1 , the negative ions are focused to a second cross-sectional diameter, d 2 , where d 1 &gt;d 2 . Similarly, in an example of a three electrode negative beam ion focusing system having a first ion beam cross-sectional diameter, d 1 , the negative ions are focused using the three electrode system to a third negative ion beam cross-sectional diameter, d 3 , where d 1 &gt;d 3 . For like potentials on the electrodes, the three electrode system provides tighter or stronger focusing compared to the two-electrode system, d 3 &lt;d 2 . 
     In the examples provided, supra, of a multi-electrode ion beam focusing system, the electrodes are rings. More generally, the electrodes are of any geometry sufficient to provide electric field lines that provide focusing force vectors to the negative ion beam when the ions in the negative ion beam  319  translate through the electric field lines, as described supra. For example, one negative ring electrode is optionally replaced by a number of negatively charged electrodes, such as about 2, 3, 4, 6, 8, 10, or more electrodes placed about the outer region of a cross-sectional area of the negative ion beam probe. Generally, more electrodes are required to converge or diverge a faster or higher energy beam. 
     In another embodiment, by reversing the polarity of electrodes in the above example, the negative ion beam is made to diverge. Thus, the negative ion beam path  319  is optionally focused and/or expanded using combinations of electrode pairs. For example, if the electrode having the mesh across the negative ion beam path is made negative, then the negative ion beam path is made to defocus. Hence, combinations of electrode pairs are used for focusing and defocusing a negative ion beam path, such as where a first pair includes a positively charged mesh for focusing and a where a second pair includes a negatively charged mesh for defocusing. 
     Tandem Accelerator 
     Referring now to  FIG.  7 A , the tandem accelerator  390  is further described. The tandem accelerator accelerates ions using a series of electrodes  710 ,  711 ,  712 ,  713 ,  714 ,  715 . For example, negative ions, such as H − , in the negative ion beam path are accelerated using a series of electrodes having progressively higher voltages relative to the voltage of the extraction electrode  426 , or third electrode  426 , of the negative ion beam source  310 . For instance, the tandem accelerator  390  optionally has electrodes ranging from the 25 kV of the extraction electrode  426  to about 525 kV near the foil  395  in the tandem accelerator  390 . Upon passing through the foil  395 , the negative ion, H − , loses two electrons to yield a proton, H + , according to equation 1.
 
H − →H + 2 e   −   (eq. 1)
 
     The proton is further accelerated in the tandem accelerator using appropriate voltages at a multitude of further electrodes  713 ,  714 ,  715 . The protons are then injected into the synchrotron  130  as described, supra. 
     Still referring to  FIG.  7 A , the foil  395  in the tandem accelerator  390  is further described. The foil  395  is preferably a very thin carbon film of about thirty to two hundred angstroms in thickness. The foil thickness is designed to both: (1) not block the ion beam and (2) allow the transfer of electrons yielding protons to form the proton beam path  262 . The foil  395  is preferably substantially in contact with a support layer  720 , such as a support grid. The support layer  720  provides mechanical strength to the foil  395  to combine to form a vacuum blocking element  725 . The foil  395  blocks nitrogen, carbon dioxide, hydrogen, and other gases from passing and thus acts as a vacuum barrier. In one embodiment, the foil  395  is preferably sealed directly or indirectly to the edges of the vacuum tube  320  providing for a higher pressure, such as about 10 −5  torr, to be maintained on the side of the foil  395  having the negative ion beam path  319  and a lower pressure, such as about 10 −7  torr, to be maintained on the side of the foil  395  having the proton ion beam path  262 . Having the foil  395  physically separating the vacuum chamber  320  into two pressure regions allows for a vacuum system having fewer and/or smaller pumps to maintain the lower pressure system in the synchrotron  130  as the inlet hydrogen and its residuals are extracted in a separate contained and isolated space by the first partial vacuum system  330 . The foil  395  and support layer  720  are preferably attached to the structure  750  of the tandem accelerator  390  or vacuum tube  320  to form a pressure barrier using any mechanical means, such as a metal, plastic, or ceramic ring  730  compressed to the walls with an attachment screw  740 . Any mechanical means for separating and sealing the two vacuum chamber sides with the foil  395  are equally applicable to this system. Referring now to  FIG.  7 B  and  FIG.  7 C , the support structure  720  and foil  395  are, respectively, individually viewed in the x-, y-plane. 
     Referring now to  FIG.  8   , another exemplary method of use of the charged particle beam system  100  is provided. The main controller  110 , or one or more sub-controllers, controls one or more of the subsystems to accurately and precisely deliver protons to a tumor of a patient. For example, the main controller sends a message to the patient indicating when or how to breathe. The main controller  110  obtains a sensor reading from the patient interface module, such as a temperature breath sensor or a force reading indicative of where in a respiration cycle the subject is. Coordinated at a specific and reproducible point in the respiration cycle, the main controller collects 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  then optionally controls the injection system  120  to inject hydrogen gas into a negative ion beam source  310  and controls timing of extraction of the negative ion from the negative ion beam source  310 . Optionally, the main controller controls ion beam focusing using the ion beam focusing lens system  350 ; acceleration of the proton beam with the tandem accelerator  390 ; and/or injection of the proton into the synchrotron  130 . The synchrotron typically contains at least an accelerator system  132  and an extraction system  134 . The synchrotron preferably contains one or more of: turning magnets, edge focusing magnets, magnetic field concentration magnets, winding and correction coils, and flat magnetic field incident surfaces, some of which contain elements under control by the main controller  110 . The main controller preferably controls the proton beam within the accelerator system, such as by controlling speed, trajectory, and/or 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 main controller  110  also preferably controls targeting of the proton beam through the targeting/delivery system  140  to the patient interface module  150 . One or more components of the patient interface module  150  are preferably controlled by the main controller  110 , such as vertical position of the patient, rotational position of the patient, and patient chair positioning/stabilization/immobilization/control elements. 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. 
     A radio frequency quadrupole (RFQ) accelerator  4850  is optionally used as an injector of charged particles to the synchrotron. For example, the RFQ accelerator is a 1.6 MeV RFQ accelerator used as an injector for a synchrotron and a buncher/debuncher cavity as necessary. The RFQ accelerator optionally operates at 425±0.05 MHz, has an ion injector output energy of about 30 keV, has an RFQ output energy of nominally 1/60±0.01 MeV, has a maximum pulsed output current of f10 mA, an output beam pulse flat-top width of 1-5 microseconds, and a beam pulse repetition rate of 0.1 to 20 Hz. 
     Synchrotron 
     Herein, the term synchrotron is used to refer to a system maintaining the charged particle beam in a circulating path. Further, the charged particle beam is referred to herein as circulating along a circulating path about a central point of the synchrotron. The circulating path is alternatively referred to as an orbiting path; however, the orbiting path does not refer to a perfect circle or ellipse, rather it refers to cycling of the protons around a central point or region  280 . 
     Circulating System 
     Referring now to  FIG.  9   , the synchrotron  130  preferably comprises a combination of straight sections  910  and ion beam turning sections  920 . Hence, the circulating path of the protons is not circular in a synchrotron, but is rather a polygon with rounded corners. 
     In one illustrative embodiment, the synchrotron  130 , which is also referred to as an accelerator system, has four straight sections or elements and four turning sections. Examples of straight sections  910  include the: inflector  240 , accelerator  270 , extraction system  290 , and deflector  292 . Along with the four straight sections are four ion beam turning sections  920 , which are also referred to as magnet sections or turning sections. Turning sections are further described, infra. 
     Referring still to  FIG.  9   , an exemplary synchrotron is illustrated. In this example, protons delivered along the initial proton beam path  262  are inflected into the circulating beam path with the inflector  240  and after acceleration are extracted via a deflector  292  to the beam transport path  268 . In this example, the synchrotron  130  comprises four straight sections  910  and four bending or turning sections  920  where each of the four turning sections use one or more magnets to turn the proton beam about ninety degrees. As is further described, infra, the ability to closely space the turning sections and efficiently turn the proton beam results in shorter straight sections. Shorter straight sections allow for a synchrotron design without the use of focusing quadrupoles in the circulating beam path of the synchrotron. The removal of the focusing quadrupoles from the circulating proton beam path results in a more compact design. In this example, the illustrated synchrotron has about a five meter diameter versus eight meter and larger cross-sectional diameters for systems using a quadrupole focusing magnet in the circulating proton beam path. 
     Referring now to  FIG.  10   , additional description of the first bending or turning section  920  is provided. Each of the turning sections preferably comprise multiple magnets, such as about 2, 4, 6, 8, 10, or 12 magnets. In this example, four turning magnets  1010 ,  1020 ,  1030 ,  1040  in the first turning section  920  are used to illustrate key principles, which are the same regardless of the number of magnets in a turning section  920 . The turning magnets  1010 ,  1020 ,  1030 ,  1040  are particular types of main bending or circulating magnets  250 . 
     In physics, the Lorentz force is the force on a point charge due to electromagnetic fields. The Lorentz force is given by equation 2 in terms of magnetic fields with the electron field terms not included.
 
 F=q ( v×B )  (eq. 2)
 
     In equation 2, F is the force in newtons; q is the electric charge in coulombs; B is the magnetic field in Teslas; and v is the instantaneous velocity of the particles in meters per second. 
     Referring now to  FIG.  11   , an example of a single magnet bending or turning section  1010  is expanded. The turning section includes a gap  1110  through which protons circulate. The gap  1110  is preferably a flat gap, allowing for a magnetic field across the gap  1110  that is more uniform, even, and intense. A magnetic field enters the gap  1110  through a magnetic field incident surface and exits the gap  1110  through a magnetic field exiting surface. The gap  1110  runs in a vacuum tube between two magnet halves. The gap  1110  is controlled by at least two parameters: (1) the gap  1110  is kept as large as possible to minimize loss of protons and (2) the gap  1110  is kept as small as possible to minimize magnet sizes and the associated size and power requirements of the magnet power supplies. The flat nature of the gap  1110  allows for a compressed and more uniform magnetic field across the gap  1110 . One example of a gap dimension is to accommodate a vertical proton beam size of about two centimeters with a horizontal beam size of about five to six centimeters. 
     As described, supra, a larger gap size requires a larger power supply. For instance, if the gap  1110  size doubles in vertical size, then the power supply requirements increase by about a factor of four. The flatness of the gap  1110  is also important. For example, the flat nature of the gap  1110  allows for an increase in energy of the extracted protons from about 250 to about 330 MeV. More particularly, if the gap  1110  has an extremely flat surface, then the limits of a magnetic field of an iron magnet are reachable. An exemplary precision of the flat surface of the gap  1110  is a polish of less than about five microns and preferably with a polish of about one to three microns. Unevenness in the surface results in imperfections in the applied magnetic field. The polished flat surface spreads unevenness of the applied magnetic field. 
     Still referring to  FIG.  11   , the charged particle beam moves through the gap  1110  with an instantaneous velocity, v. A first magnetic coil  1120  and a second magnetic coil  1130  run above and below the gap  1110 , respectively. Current running through the coils  1120 ,  1130  results in a magnetic field, B, running through the single magnet turning section  1010 . In this example, the magnetic field, B, runs upward, which results in a force, F, pushing the charged particle beam inward toward a central point of the synchrotron, which turns the charged particle beam in an arc. 
     Still referring to  FIG.  11   , a portion of an optional second magnet bending or turning section  1020  is illustrated. The coils  1120 ,  1130  typically have return elements  1140 ,  1150  or turns at the end of one magnet, such as at the end of the first magnet turning section  1010 . The turns  1140 ,  1150  take space. The space reduces the percentage of the path about one orbit of the synchrotron that is covered by the turning magnets. This leads to portions of the circulating path where the protons are not turned and/or focused and allows for portions of the circulating path where the proton path defocuses. Thus, the space results in a larger synchrotron. Therefore, the space between magnet turning sections  1160  is preferably minimized. The second turning magnet is used to illustrate that the coils  1120 ,  1130  optionally run along a plurality of magnets, such as 2, 3, 4, 5, 6, or more magnets. Coils  1120 ,  1130  running across multiple turning section magnets allows for two turning section magnets to be spatially positioned closer to each other due to the removal of the steric constraint of the turns, which reduces and/or minimizes the space  1160  between two turning section magnets. 
     Referring now to  FIG.  12    and  FIG.  13   , two illustrative 90 degree rotated cross-sections of single magnet bending or turning sections  1010  are presented. The magnet assembly has a first magnet  1210  and a second magnet  1220 . A magnetic field induced by coils, described infra, runs between the first magnet  1210  to the second magnet  1220  across the gap  1110 . Return magnetic fields run through a first yoke  1212  and second yoke  1222 . The combined cross-section area of the return yokes roughly approximates the cross-sectional area of the first magnet  1210  or second magnet  1220 . The charged particles run through the vacuum tube in the gap  1110 . As illustrated, protons run into  FIG.  12    through the gap  1110  and the magnetic field, illustrated as vector B, applies a force F to the protons pushing the protons towards the center of the synchrotron, which is off page to the right in  FIG.  12   . The magnetic field is created using windings. A first coil is used to form a first winding coil  1250  and a second coil of wire is used to form a second winding coil  1260 . Isolating or concentrating gaps  1230 ,  1240 , such as air gaps, isolate the iron based yokes from the gap  1110 . The gap  1110  is approximately flat to yield a uniform magnetic field across the gap  1110 , as described supra. 
     Still referring to  FIG.  13   , the ends of a single bending or turning magnet are preferably beveled. Nearly perpendicular or right angle edges of a turning magnet  1010  are represented by dashed lines  1374 ,  1384 . The dashed lines  1374 ,  1384  intersect at a point  1390  beyond the center of the synchrotron  280 . Preferably, the edge of the turning magnet is beveled at angles alpha, α, and beta, β, which are angles formed by a first line  1372 ,  1382  going from an edge of the turning magnet  1010  and the center  280  and a second line  1374 ,  1384  going from the same edge of the turning magnet and the intersecting point  1390 . The angle alpha is used to describe the effect and the description of angle alpha applies to angle beta, but angle alpha is optionally different from angle beta. The angle alpha provides an edge focusing effect. Beveling the edge of the turning magnet  1010  at angle alpha focuses the proton beam. 
     Multiple turning magnets provide multiple magnet edges that each have edge focusing effects in the synchrotron  130 . If only one turning magnet is used, then the beam is only focused once for angle alpha or twice for angle alpha and angle beta. However, by using smaller turning magnets, more turning magnets fit into the turning sections  920  of the synchrotron  130 . For example, if four magnets are used in a turning section  920  of the synchrotron, then for a single turning section there are eight possible edge focusing effect surfaces, two edges per magnet. The eight focusing surfaces yield a smaller cross-sectional beam size, which allows the use of a smaller gap. 
     The use of multiple edge focusing effects in the turning magnets results in not only a smaller gap  1110 , but also the use of smaller magnets and smaller power supplies. For a synchrotron  130  having four turning sections  920  where each turning sections has four turning magnets and each turning magnet has two focusing edges, a total of thirty-two focusing edges exist for each orbit of the protons in the circulating path of the synchrotron  130 . Similarly, if 2, 6, or 8 magnets are used in a given turning section, or if 2, 3, 5, or 6 turning sections are used, then the number of edge focusing surfaces expands or contracts according to equation 3. 
                   TFE   =     NTS   *     M   NTS     *     FE   M               (     eq   .           ⁢   3     )               
where TFE is the number of total focusing edges, NTS is the number of turning sections, M is the number of magnets, and FE is the number of focusing edges. Naturally, not all magnets are necessarily beveled and some magnets are optionally beveled on only one edge.
 
     The inventors have determined that multiple smaller magnets have benefits over fewer larger magnets. For example, the use of 16 small magnets yields 32 focusing edges whereas the use of 4 larger magnets yields only 8 focusing edges. The use of a synchrotron having more focusing edges results in a circulating path of the synchrotron built without the use of focusing quadrupole magnets. All prior art synchrotrons use quadrupoles in the circulating path of the synchrotron. Further, the use of quadrupoles in the circulating path necessitates additional straight sections in the circulating path of the synchrotron. Thus, the use of quadrupoles in the circulating path of a synchrotron results in synchrotrons having larger diameters, larger circulating beam pathlengths, and/or larger circumferences. 
     In various embodiments of the system described herein, the synchrotron has any combination of:
         at least four and preferably six, eight, ten, or more edge focusing edges per 90 degrees of turn of the charged particle beam in a synchrotron having four turning sections;   at least about sixteen and preferably about twenty-four, thirty-two, or more edge focusing edges per orbit of the charged particle beam in the synchrotron;   only four turning sections where each of the turning sections includes at least four and preferably eight edge focusing edges;   an equal number of straight sections and turning sections;   exactly four turning sections;   at least four focusing edges per turning section;   no quadrupoles in the circulating path of the synchrotron;   a rounded corner rectangular polygon configuration;   a circumference of less than sixty meters;   a circumference of less than sixty meters and thirty-two edge focusing surfaces; and/or   any of about eight, sixteen, twenty-four, or thirty-two non-quadrupole magnets per circulating path of the synchrotron, where the non-quadrupole magnets include edge focusing edges.
 
Flat Gap Surface
       

     While the gap surface is described in terms of the first turning magnet  1010 , the discussion applies to each of the turning magnets in the synchrotron. Similarly, while the gap  1110  surface is described in terms of the magnetic field incident surface  1270 , the discussion additionally optionally applies to the magnetic field exiting surface  1280 . 
     Referring again to  FIG.  12   , the incident magnetic field surface  1270  of the first magnet  1210  is further described.  FIG.  12    is not to scale and is illustrative in nature. Local imperfections or unevenness in quality of the finish of the incident surface  1270  results in inhomogeneities or imperfections in the magnetic field applied to the gap  1110 . The magnetic field incident surface  1270  and/or exiting surface  1280  of the first magnet  1210  is preferably about flat, such as to within about a zero to three micron finish polish or less preferably to about a ten micron finish polish. By being very flat, the polished surface spreads the unevenness of the applied magnetic field across the gap  1110 . The very flat surface, such as about 0, 1, 2, 4, 6, 8, 10, 15, or 20 micron finish, allows for a smaller gap size, a smaller applied magnetic field, smaller power supplies, and tighter control of the proton beam cross-sectional area. 
     Referring now to  FIG.  14   , additional optional magnet elements, of the magnet cross-section illustratively represented in  FIG.  12   , are described. The first magnet  1210  preferably contains an initial cross-sectional distance  1410  of the iron based core. The contours of the magnetic field are shaped by the magnets  1210 ,  1220  and the yokes  1212 ,  1222 . The iron based core tapers to a second cross-sectional distance  1420 . The shape of the magnetic field vector  1440  is illustrative only. The magnetic field in the magnet preferentially stays in the iron based core as opposed to the gaps  1230 ,  1240 . As the cross-sectional distance decreases from the initial cross-sectional distance  1410  to the final cross-sectional distance  1420 , the magnetic field concentrates. The change in shape of the magnet from the longer distance  1410  to the smaller distance  1420  acts as an amplifier. The concentration of the magnetic field is illustrated by representing an initial density of magnetic field vectors  1430  in the initial cross-section  1410  to a concentrated density of magnetic field vectors  1440  in the final cross-section  1420 . The concentration of the magnetic field due to the geometry of the turning magnets results in fewer winding coils  1250 ,  1260  being required and also a smaller power supply to the coils being required. 
     In one example, the initial cross-section distance  1410  is about fifteen centimeters and the final cross-section distance  1420  is about ten centimeters. Using the provided numbers, the concentration of the magnetic field is about 15/10 or 1.5 times at the incident surface  1270  of the gap  1110 , though the relationship is not linear. The taper  1460  has a slope, such as about twenty, forty, or sixty degrees. The concentration of the magnetic field, such as by 1.5 times, leads to a corresponding decrease in power consumption requirements to the magnets. 
     Referring now to  FIG.  15   , an additional example of geometry of the magnet used to concentrate the magnetic field is illustrated. As illustrated in  FIG.  14   , the first magnet  1210  preferably contains an initial cross-sectional distance  1410  of the iron based core. The contours of the magnetic field are shaped by the magnets  1210 ,  1220  and the yokes  1212 ,  1222 . In this example, the core tapers to a second cross-sectional distance  1420  with a smaller angle theta, θ. As described, supra, the magnetic field in the magnet preferentially stays in the iron based core as opposed to the gaps  1230 ,  1240 . As the cross-sectional distance decreases from the initial cross-sectional distance  1410  to the final cross-sectional distance  1420 , the magnetic field concentrates. The smaller angle, theta, results in a greater amplification of the magnetic field in going from the longer distance  1410  to the smaller distance  1420 . The concentration of the magnetic field is illustrated by representing an initial density of magnetic field vectors  1430  in the initial cross-section  1410  to a concentrated density of magnetic field vectors  1440  in the final cross-section  1420 . The concentration of the magnetic field due to the geometry of the turning magnets results in fewer winding coils  1250 ,  1260  being required and also a smaller power supply to the winding coils  1250 ,  1260  being required. 
     Still referring to  FIG.  15   , optional correction coils  1510 ,  1520  are illustrated that are used to correct the strength of one or more turning magnets. The correction coils  1520 ,  1530  supplement the winding coils  1250 ,  1260 . The correction coils  1510 ,  1520  have correction coil power supplies that are separate from winding coil power supplies used with the winding coils  1250 ,  1260 . The correction coil power supplies typically operate at a fraction of the power required compared to the winding coil power supplies, such as about 1, 2, 3, 5, 7, or 10 percent of the power and more preferably about 1 or 2 percent of the power used with the winding coils  1250 ,  1260 . The smaller operating power applied to the correction coils  1510 ,  1520  allows for more accurate and/or precise control of the correction coils. The correction coils are used to adjust for imperfection in the turning magnets. Optionally, separate correction coils are used for each turning magnet allowing individual tuning of the magnetic field for each turning magnet, which eases quality requirements in the manufacture of each turning magnet. 
     Referring now to  FIG.  16   , an example of winding coils  1630  and correction coils  1620  about a plurality of turning magnets  1010 ,  1020  in an ion beam turning section  920  is illustrated. The winding coils preferably cover 1, 2, or 4 turning magnets. One or more high precision magnetic field sensors  1650  are placed into the synchrotron and are used to measure the magnetic field at or near the proton beam path. For example, the magnetic sensors are optionally placed between turning magnets and/or within a turning magnet, such as at or near the gap  1110  or at or near the magnet core or yoke. The sensors are part of a feedback system to the correction coils, which is optionally run by the main controller. Thus, the system preferably stabilizes the magnetic field in the synchrotron rather than stabilizing the current applied to the magnets. Stabilization of the magnetic field allows the synchrotron to come to a new energy level quickly. This allows the system to be controlled to an operator or algorithm selected energy level with each pulse of the synchrotron and/or with each breath of the patient. 
     The winding and/or correction coils correct one, two, three, or four turning magnets, and preferably correct a magnetic field generated by two turning magnets. Optionally, a correction coil  1640  winds a single magnet section  1010  or a correction coil  1620  winds two or more magnet turning sections  1010 ,  1020 . A winding or correction coil covering multiple magnets reduces space between magnets as fewer winding or correction coil ends are required, which occupy space. Reduction of space between turning magnets allows operation of the turning magnets with smaller power supplies and optionally without quadrupole magnet focusing sections. 
     Space  1160  at the end of a turning magnets  1010 ,  1040  is optionally further reduced by changing the cross-sectional shape of the winding coils. For example, when the winding coils are running longitudinally along the length of the circulating path or along the length of the turning magnet, the cross-sectional dimension is thick and when the winding coils turn at the end of a turning magnet to run axially across the winding coil, then the cross-sectional area of the winding coils is preferably thin. For example, the cross-sectional area of winding coils as measured by an m×n matrix is 3×2 running longitudinally along the turning magnet and 6×1 running axially at the end of the turning magnet, thereby reducing the width of the coils, n, while keeping the number of coils constant. Preferably, the turn from the longitudinal to axial direction of the winding coil approximates ninety degrees by cutting each winding and welding each longitudinal section to the connecting axial section at about a ninety degree angle. The nearly perpendicular weld further reduces space requirements of the turn in the winding coil, which reduces space in circulating orbit not experiencing focusing and turning forces, which reduces the size of the synchrotron. 
     Still referring to  FIG.  16    and now additionally referring to  FIG.  2   ,  FIG.  9   , and  FIG.  10   , an optional modular magnet system is described. As illustrated in  FIG.  2   , the synchrotron  130  optionally uses sixteen main bending magnets  250 . As illustrated in  FIG.  9    and  FIG.  10   , in one case, the sixteen main bending magnets are organized into four beam turning sections  920 , where each of the four beam turning sections, as described supra, contain a group of four turning magnets  1010 ,  1020 ,  1030 ,  1040 . Now referring to  FIG.  16   , the winding coil  1630  is illustrated as optionally connecting a sub-group of two turning magnets  1010 ,  1020 . The sub-group of two turning magnets optionally uses a common winding coil for the two turning magnets. The sub-group using a common coil for two magnets is optionally repeated twice in one turning section to form four magnets, is repeated eight times in the synchrotron to form eight groups of two magnets, where two sub-groups of two turning magnets are used in each turning section  920 , and/or is repeated n times where n is a positive integer. Generally, the sub-group of two magnets wound with a common winding coil is a building block used to build a synchrotron. Having one sub-group of magnets that is used multiple times in the synchrotron reduces manufacturing costs, simplifies quality control and/or quality assurance procedures, and simplifies inspection. 
     Referring now to  FIG.  17 A  and  FIG.  17 B , the accelerator system  270 , such as a radio-frequency (RF) accelerator system, is further described. The accelerator includes a series of coils  1710 - 1719 , such as iron or ferrite coils, each circumferentially enclosing the vacuum system  320  through which the proton beam  264  passes in the synchrotron  130 . Referring now to  FIG.  17 B , the first coil  1710  is further described. A loop of standard wire  1730  completes at least one turn about the first coil  1710 . The loop attaches to a microcircuit  1720 . 
     Referring again to  FIG.  17 A , an RF synthesizer  1740 , which is preferably connected to the main controller  110 , provides a low voltage RF signal that is synchronized to the period of circulation of protons in the proton beam path  264 . The RF synthesizer  1740 , microcircuit  1720 , loop  1730 , and coil  1710  combine to provide an accelerating voltage to the protons in the proton beam path  264 . For example, the RF synthesizer  1740  sends a signal to the microcircuit  1720 , which amplifies the low voltage RF signal and yields an acceleration voltage, such as about 10 volts. The actual acceleration voltage for a single microcircuit/loop/coil combination is about five, ten, fifteen, or twenty volts, but is preferably about ten volts. Preferably, the RF-amplifier microcircuit and accelerating coil are integrated. 
     Still referring to  FIG.  17 A , the integrated RF-amplifier microcircuit and accelerating coil presented in  FIG.  17 B  is repeated, as illustrated as the set of coils  1711 - 1719  surrounding the vacuum tube  320 . For example, the RF-synthesizer  1740 , under main controller  130  direction, sends an RF-signal to the microcircuits  1720 - 1729  connected to coils  1710 - 1719 , respectively. Each of the microcircuit/loop/coil combinations generates a proton accelerating voltage, such as about ten volts each. Hence, a set of five coil combinations generates about fifty volts for proton acceleration. Preferably about five to twenty microcircuit/loop/coil combinations are used and more preferably about nine or ten microcircuit/loop/coil combinations are used in the accelerator system  270 . 
     As a further clarifying example, the RF synthesizer  1740  sends an RF-signal, with a period equal to a period of circulation of a proton about the synchrotron  130 , to a set of ten microcircuit/loop/coil combinations, which results in about 100 volts for acceleration of the protons in the proton beam path  264 . The 100 volts is generated at a range of frequencies, such as at about one MHz for a low energy proton beam to about fifteen MHz for a high energy proton beam. The RF-signal is optionally set at an integer multiple of a period of circulation of the proton about the synchrotron circulating path. Each of the microcircuit/loop/coil combinations are optionally independently controlled in terms of acceleration voltage and frequency. 
     Integration of the RF-amplifier microcircuit and accelerating coil, in each microcircuit/loop/coil combination, results in three considerable advantages. First, for synchrotrons, the prior art does not use microcircuits integrated with the accelerating coils but rather uses a set of long cables to provide power to a corresponding set of coils. The long cables have an impedance/resistance, which is problematic for high frequency RF control. As a result, the prior art system is not operable at high frequencies, such as above about ten MHz. The integrated RF-amplifier microcircuit/accelerating coil system is operable at above about ten MHz and even fifteen MHz where the impedance and/or resistance of the long cables in the prior art systems results in poor control or failure in proton acceleration. Second, the long cable system, operating at lower frequencies, costs about $50,000 and the integrated microcircuit system costs about $1000, which is fifty times less expensive. Third, the microcircuit/loop/coil combinations in conjunction with the RF-amplifier system results in a compact low power consumption design allowing production and use of a proton cancer therapy system in a small space, as described supra, and in a cost effective manner. 
     Referring again to  FIG.  16   , an example of a winding coil  1630  that covers two turning magnets  1010 ,  1020  is provided. Optionally, a first winding coil  1640  covers two magnets  1010 ,  1020  and a second winding coil, not illustrated, covers another two magnets  1030 ,  1040 . As described, supra, this system reduces space between turning section allowing more magnetic field to be applied per radian of turn. A first correction coil  1640  is illustrated that is used to correct the magnetic field for the first turning magnet  1010 . A second correction coil  1620  is illustrated that is used to correct the magnetic field for a winding coil  1630  about two turning magnets. Individual correction coils for each turning magnet are preferred and individual correction coils yield the most precise and/or accurate magnetic field in each turning section. Particularly, an individual correction coil is preferably used to compensate for imperfections in the individual magnet of a given turning section. Hence, with a series of magnetic field sensors, corresponding magnetic fields are individually adjustable in a series of feedback loops, via a magnetic field monitoring system, as an independent coil is used for each turning section. Alternatively, a multiple magnet correction coil is used to correct the magnetic field for a plurality of turning section magnets. 
     Proton Beam Extraction 
     Referring now to  FIG.  18   , an exemplary proton beam extraction process  1800  from the synchrotron  130  is illustrated. For clarity,  FIG.  18    removes elements represented in  FIG.  2   , such as the turning magnets, which allows for greater clarity of presentation of the proton beam path as a function of time. Generally, protons are extracted from the synchrotron  130  by slowing the protons. As described, supra, the protons were initially accelerated in a circulating path  264 , which is maintained with a plurality of main bending magnets  250 . The circulating path is referred to herein as an original central beamline  264 . The protons repeatedly cycle around a central point in the synchrotron  280 . The proton path traverses through a radio frequency (RF) cavity system  1910 . To initiate extraction, an RF field is applied across a first blade  1912  and a second blade  1914 , in the RF cavity system  1910 . The first blade  1912  and second blade  1914  are referred to herein as a first pair of blades. 
     In the proton extraction process, an RF voltage is applied across the first pair of blades, where the first blade  1912  of the first pair of blades is on one side of the circulating proton beam path  264  and the second blade  1914  of the first pair of blades is on an opposite side of the circulating proton beam path  264 . The applied RF field applies energy to the circulating charged-particle beam. The applied RF field alters the orbiting or circulating beam path slightly of the protons from the original central beamline  264  to an altered circulating beam path  265 . Upon a second pass of the protons through the RF cavity system, the RF field further moves the protons off of the original proton beamline  264 . For example, if the original beamline is considered as a circular path, then the altered beamline is slightly elliptical. The applied RF field is timed to apply outward or inward movement to a given band of protons circulating in the synchrotron accelerator. Each orbit of the protons is slightly more off axis compared to the original circulating beam path  264 . Successive passes of the protons through the RF cavity system are forced further and further from the original central beamline  264  by altering the direction and/or intensity of the RF field with each successive pass of the proton beam through the RF field. 
     The RF voltage is frequency modulated at a frequency about equal to the period of one proton cycling around the synchrotron for one revolution or at a frequency than is an integral multiplier of the period of one proton cycling about the synchrotron. The applied RF frequency modulated voltage excites a betatron oscillation. For example, the oscillation is a sine wave motion of the protons. The process of timing the RF field to a given proton beam within the RF cavity system is repeated thousands of times with each successive pass of the protons being moved approximately one micrometer further off of the original central beamline  264 . For clarity, the approximately 1000 changing beam paths with each successive path of a given band of protons through the RF field are illustrated as the altered beam path  265 . 
     With a sufficient sine wave betatron amplitude, the altered circulating beam path  265  touches and/or traverses a material  1930 , such as a foil or a sheet of foil. The foil is preferably a lightweight material, such as beryllium, a lithium hydride, a carbon sheet, or a material having low nuclear charge components. Herein, a material of low nuclear charge is a material composed of atoms consisting essentially of atoms having six or fewer protons. The foil is preferably about 10 to 150 microns thick, is more preferably about 30 to 100 microns thick, and is still more preferably about 40 to 60 microns thick. In one example, the foil is beryllium with a thickness of about 50 microns. When the protons traverse through the foil, energy of the protons is lost and the speed of the protons is reduced. Typically, a current is also generated, described infra. Protons moving at a slower speed travel in the synchrotron with a reduced radius of curvature  266  compared to either the original central beamline  264  or the altered circulating path  265 . The reduced radius of curvature  266  path is also referred to herein as a path having a smaller diameter of trajectory or a path having protons with reduced energy. The reduced radius of curvature  266  is typically about two millimeters less than a radius of curvature of the last pass of the protons along the altered proton beam path  265 . 
     The thickness of the material  1930  is optionally adjusted to created a change in the radius of curvature, such as about ½, 1, 2, 3, or 4 mm less than the last pass of the protons  265  or original radius of curvature  264 . Protons moving with the smaller radius of curvature travel between a second pair of blades. In one case, the second pair of blades is physically distinct and/or is separated from the first pair of blades. In a second case, one of the first pair of blades is also a member of the second pair of blades. For example, the second pair of blades is the second blade  1914  and a third blade  1916  in the RF cavity system  1910 . A high voltage DC signal, such as about 1 to 5 kV, is then applied across the second pair of blades, which directs the protons out of the synchrotron through an extraction magnet  292 , such as a Lamberson extraction magnet, into a transport path  268 . 
     Control of acceleration of the charged particle beam path in the synchrotron with the accelerator and/or applied fields of the turning magnets in combination with the above described extraction system allows for control of the intensity of the extracted proton beam, where intensity is a proton flux per unit time or the number of protons extracted as a function of time. For example, when a current is measured beyond a threshold, the RF field modulation in the RF cavity system is terminated or reinitiated to establish a subsequent cycle of proton beam extraction. This process is repeated to yield many cycles of proton beam extraction from the synchrotron accelerator. 
     In another embodiment, instead of moving the charged particles to the material  1930 , the material  1930  is mechanically moved to the circulating charged particles. Particularly, the material  1930  is mechanically or electromechanically translated into the path of the circulating charged particles to induce the extraction process, described supra. 
     In either case, because the extraction system does not depend on any change in magnetic field properties, it allows the synchrotron to continue to operate in acceleration or deceleration mode during the extraction process. Stated differently, the extraction process does not interfere with synchrotron acceleration. In stark contrast, traditional extraction systems introduce a new magnetic field, such as via a hexapole, during the extraction process. More particularly, traditional synchrotrons have a magnet, such as a hexapole magnet, that is off during an acceleration stage. During the extraction phase, the hexapole magnetic field is introduced to the circulating path of the synchrotron. The introduction of the magnetic field necessitates two distinct modes, an acceleration mode and an extraction mode, which are mutually exclusive in time. The herein described system allows for acceleration and/or deceleration of the proton during the extraction step without the use of a newly introduced magnetic field, such as by a hexapole magnet. 
     Charged Particle Beam Intensity Control 
     Control of applied field, such as a radio-frequency (RF) field, frequency and magnitude in the RF cavity system  1910  allows for intensity control of the extracted proton beam, where intensity is extracted proton flux per unit time or the number of protons extracted as a function of time. 
     Referring now to  FIG.  19   , an intensity control system  1900  is illustrated. In this example, an intensity control feedback loop is added to the extraction system, described supra. When protons in the proton beam hit the material  1930  electrons are given off resulting in a current. The resulting current is converted to a voltage and is used as part of a ion beam intensity monitoring system or as part of an ion beam feedback loop for controlling beam intensity. The voltage is optionally measured and sent to the main controller  110  or to an intensity controller subsystem  1940 , which is preferably in communication or under the direction of the main controller  110 . More particularly, when protons in the charged particle beam path pass through the material  1930 , some of the protons lose a small fraction of their energy, such as about one-tenth of a percent, which results in a secondary electron. That is, protons in the charged particle beam push some electrons when passing through material  1930  giving the electrons enough energy to cause secondary emission. The resulting electron flow results in a current or signal that is proportional to the number of protons going through the target material  1930 . The resulting current is preferably converted to voltage and amplified. The resulting signal is referred to as a measured intensity signal. 
     The amplified signal or measured intensity signal resulting from the protons passing through the material  1930  is optionally used in monitoring the intensity of the extracted protons and is preferably used in controlling the intensity of the extracted protons. For example, the measured intensity signal is compared to a goal signal, which is predetermined in an irradiation of the tumor plan. The difference between the measured intensity signal and the planned for goal signal is calculated. The difference is used as a control to the RF generator. Hence, the measured flow of current resulting from the protons passing through the material  1930  is used as a control in the RF generator to increase or decrease the number of protons undergoing betatron oscillation and striking the material  1930 . Hence, the voltage determined off of the material  1930  is used as a measure of the orbital path and is used as a feedback control to control the RF cavity system. 
     In one example, the intensity controller subsystem  1940  preferably additionally receives input from: (1) a detector  1950 , which provides a reading of the actual intensity of the proton beam and (2) an irradiation plan  1960 . The irradiation plan provides the desired intensity of the proton beam for each x, y, energy, and/or rotational position of the patient/tumor as a function of time. Thus, the intensity controller  1940  receives the desired intensity from the irradiation plan  1950 , the actual intensity from the detector  1950  and/or a measure of intensity from the material  1930 , and adjusts the radio-frequency field in the RF cavity system  1910  to yield an intensity of the proton beam that matches the desired intensity from the irradiation plan  1960 . 
     As described, supra, the photons striking the material  1930  is a step in the extraction of the protons from the synchrotron  130 . Hence, the measured intensity signal is used to change the number of protons per unit time being extracted, which is referred to as intensity of the proton beam. The intensity of the proton beam is thus under algorithm control. Further, the intensity of the proton beam is controlled separately from the velocity of the protons in the synchrotron  130 . Hence, intensity of the protons extracted and the energy of the protons extracted are independently variable. 
     For example, protons initially move at an equilibrium trajectory in the synchrotron  130 . An RF field is used to excite the protons into a betatron oscillation. In one case, the frequency of the protons orbit is about 10 MHz. In one example, in about one millisecond or after about 10,000 orbits, the first protons hit an outer edge of the target material  130 . The specific frequency is dependent upon the period of the orbit. Upon hitting the material  130 , the protons push electrons through the foil to produce a current. The current is converted to voltage and amplified to yield a measured intensity signal. The measured intensity signal is used as a feedback input to control the applied RF magnitude, RF frequency, or RF field. Preferably, the measured intensity signal is compared to a target signal and a measure of the difference between the measured intensity signal and target signal is used to adjust the applied RF field in the RF cavity system  1910  in the extraction system to control the intensity of the protons in the extraction step. Stated again, the signal resulting from the protons striking and/or passing through the material  130  is used as an input in RF field modulation. An increase in the magnitude of the RF modulation results in protons hitting the foil or material  130  sooner. By increasing the RF, more protons are pushed into the foil, which results in an increased intensity, or more protons per unit time, of protons extracted from the synchrotron  130 . 
     In another example, a detector  1950  external to the synchrotron  130  is used to determine the flux of protons extracted from the synchrotron and a signal from the external detector is used to alter the RF field or RF modulation in the RF cavity system  1910 . Here the external detector generates an external signal, which is used in a manner similar to the measured intensity signal, described in the preceding paragraphs. Preferably, an algorithm or irradiation plan  1960  is used as an input to the intensity controller  1940 , which controls the RF field modulation by directing the RF signal in the betatron oscillation generation in the RF cavity system  1910 . The irradiation plan  1960  preferably includes the desired intensity of the charged particle beam as a function of time, energy of the charged particle beam as a function of time, for each patient rotation position, and/or for each x-, y-position of the charged particle beam. 
     In yet another example, when a current from material  130  resulting from protons passing through or hitting material is measured beyond a threshold, the RF field modulation in the RF cavity system is terminated or reinitiated to establish a subsequent cycle of proton beam extraction. This process is repeated to yield many cycles of proton beam extraction from the synchrotron accelerator. 
     In still yet another embodiment, intensity modulation of the extracted proton beam is controlled by the main controller  110 . The main controller  110  optionally and/or additionally controls timing of extraction of the charged particle beam and energy of the extracted proton beam. 
     The benefits of the system include a multi-dimensional scanning system. Particularly, the system allows independence in: (1) energy of the protons extracted and (2) intensity of the protons extracted. That is, energy of the protons extracted is controlled by an energy control system and an intensity control system controls the intensity of the extracted protons. The energy control system and intensity control system are optionally independently controlled. Preferably, the main controller  110  controls the energy control system and the main controller  110  simultaneously controls the intensity control system to yield an extracted proton beam with controlled energy and controlled intensity where the controlled energy and controlled intensity are independently variable. Thus the irradiation spot hitting the tumor is under independent control of:
         time;   energy;   intensity;   x-axis position, where the x-axis represents horizontal movement of the proton beam relative to the patient, and   y-axis position, where the y-axis represents vertical movement of the proton beam relative to the patient.       

     In addition, the patient is optionally independently translated and/or rotated relative to a translational axis of the proton beam at the same time. 
     Referring now to  FIG.  20 A  and  FIG.  20 B , a proton beam position verification system  2000  is described. A nozzle  2010  provides an outlet for the second reduced pressure vacuum system initiating at the foil  395  of the tandem accelerator  390  and running through the synchrotron  130  to a nozzle foil  2020  covering the end of the nozzle  2010 . The nozzle 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- and y-axes by the vertical control element  142  and horizontal control element  144 , respectively. The nozzle foil  2020  is preferably mechanically supported by the outer edges of an exit port of the nozzle  2010 . An example of a nozzle foil  2020  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  2020  from the low pressure region, such as about 10 −5  to 10 −7  torr region, on the synchrotron  130  side of the nozzle foil  2020 . The low pressure region is maintained to reduce scattering of the proton beam  264 ,  268 . 
     Still referring to  FIG.  20 A  and  FIG.  20 B , the proton beam verification system  2000  is a system that allows for monitoring of the actual proton beam position  268 ,  269  in real-time without destruction of the proton beam. The proton beam verification system  2000  preferably includes a proton beam position verification layer  2030 , which is also referred to herein as a coating, luminescent, fluorescent, phosphorescent, radiance, or viewing layer. The verification layer or coating layer  2030  is preferably a coating or thin layer substantially in contact with an inside surface of the nozzle foil  2020 , where the inside surface is on the synchrotron side of the nozzle foil  2020 . Less preferably, the verification layer or coating layer  2030  is substantially in contact with an outer surface of the nozzle foil  2020 , where the outer surface is on the patient treatment side of the nozzle foil  2020 . Preferably, the nozzle foil  2020  provides a substrate surface for coating by the coating layer. Optionally, a binding layer is located between the coating layer  2030  and the nozzle foil  2020 . Optionally a separate coating layer support element, on which the coating  2030  is mounted, is placed anywhere in the proton beam path  268 . 
     Referring now to  FIG.  20 B , the coating  2030  yields a measurable spectroscopic response, spatially viewable by the detector  2040 , as a result of transmission by the proton beam  268 . The coating  2030  is preferably a phosphor, but is optionally any material that is viewable or imaged by a detector where the material changes spectroscopically as a result of the proton beam path  268  hitting or transmitting through the coating  2030 . A detector or camera  2040  views the coating layer  2030  and determines the current position of the proton beam  269  by the spectroscopic differences resulting from protons passing through the coating layer. For example, the camera  2040  views the coating surface  2030  as the proton beam  268  is being scanned by the horizontal  144  and vertical  142  beam position control elements during treatment of the tumor  2120 . The camera  2040  views the current position of the proton beam  269  as measured by spectroscopic response. The coating layer  2030  is preferably a phosphor or luminescent material that glows 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 proton beam  268 . Optionally, a plurality of cameras or detectors  2040  are used, where each detector views all or a portion of the coating layer  2030 . For example, two detectors  2040  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  2040  is mounted into the nozzle  2010  to view the proton beam position after passing through the first axis and second axis controllers  142 ,  144 . Preferably, the coating layer  2030  is positioned in the proton beam path  268  in a position prior to the protons striking the patient  2130 . 
     Still referring to  FIG.  20 B , the main controller  130 , connected to the camera or detector  2040  output, compares the actual proton beam position  269  with the planned proton beam position and/or a calibration reference to determine if the actual proton beam position  269  is within tolerance. The proton beam verification system  2000  preferably is used in at least two phases, a calibration phase and a proton beam treatment phase. The calibration phase is used to correlate, as a function of x-, y-position of the glowing response the actual x-, y-position of the proton beam at the patient interface. During the proton beam treatment phase, the proton beam position is monitored and compared to the calibration and/or treatment plan to verify accurate proton delivery to the tumor  2120  and/or as a proton beam shutoff safety indicator. 
     Patient Positioning 
     Referring now to  FIG.  21 A  and  FIG.  21 B , the patient is preferably positioned on or within a patient translation and rotation positioning system  2110  of the patient interface module  150 . The patient translation and rotation positioning system  2110  is used to translate the patient and/or rotate the patient into a zone where the proton beam can scan the tumor using a scanning system  140  or proton targeting system, described infra. Essentially, the patient positioning system  2110  performs large movements of the patient to place the tumor near the center of a proton beam path  268  and the proton scanning or targeting system  140  performs fine movements of the momentary beam position  269  in targeting the tumor  2120 . To illustrate,  FIG.  21 A  shows the momentary proton beam position  269  and a range of scannable positions  2140  using the proton scanning or targeting system  140 , where the scannable positions  2140  are about the tumor  2120  of the patient  2130 . In this example, the scannable positions are scanned along the x- and y-axes; however, scanning is optionally simultaneously performed along the z-axis as described infra. This illustratively shows that the y-axis movement of the patient occurs on a scale of the body, such as adjustment of about 1, 2, 3, or 4 feet, while the scannable region of the proton beam  268  covers a portion of the body, such as a region of about 1, 2, 4, 6, 8, 10, or 12 inches. The patient positioning system and its rotation and/or translation of the patient combines with the proton targeting system to yield precise and/or accurate delivery of the protons to the tumor. 
     Referring still to  FIG.  21 A  and  FIG.  21 B , the patient positioning system  2110  optionally includes a bottom unit  2112  and a top unit  2114 , such as discs or a platform. Referring now to  FIG.  21 A , the patient positioning unit  2110  is preferably y-axis adjustable  2116  to allow vertical shifting of the patient relative to the proton therapy beam  268 . Preferably, the vertical motion of the patient positioning unit  2110  is about 10, 20, 30, or 50 centimeters per minute. Referring now to  FIG.  21 B , the patient positioning unit  2110  is also preferably rotatable  2117  about a rotation axis, such as about the y-axis running through the center of the bottom unit  2112  or about a y-axis running through the tumor  2120 , to allow rotational control and positioning of the patient relative to the proton beam path  268 . Preferably the rotational motion of the patient positioning unit  2110  is about 360 degrees per minute. Optionally, the patient positioning unit rotates about 45, 90, or 180 degrees. Optionally, the patient positioning unit  2110  rotates at a rate of about 45, 90, 180, 360, 720, or 1080 degrees per minute. The rotation of the positioning unit  2117  is illustrated about the rotation axis at two distinct times, t 1  and t 2 . Protons are optionally delivered to the tumor  2120  at n times where each of the n times represent a different relative direction of the incident proton beam  269  hitting the patient  2130  due to rotation of the patient  2117  about the rotation axis. 
     Any of the semi-vertical, sitting, or laying patient positioning embodiments described, infra, are optionally vertically translatable along the y-axis or rotatable about the rotation or y-axis. 
     Preferably, the top and bottom units  2112 ,  2114  move together, such that they rotate at the same rates and translate in position at the same rates. Optionally, the top and bottom units  2112 ,  2114  are independently adjustable along the y-axis to allow a difference in distance between the top and bottom units  2112 ,  2114 . Motors, power supplies, and mechanical assemblies for moving the top and bottom units  2112 ,  2114  are preferably located out of the proton beam path  269 , such as below the bottom unit  2112  and/or above the top unit  2114 . This is preferable as the patient positioning unit  2110  is preferably rotatable about 360 degrees and the motors, power supplies, and mechanical assemblies interfere with the protons if positioned in the proton beam path  269   
     Proton Delivery Efficiency 
     Referring now to  FIG.  22   , a common distribution of relative doses for both X-rays and proton irradiation is presented. As shown, X-rays deposit their highest dose near the surface of the targeted tissue and then deposited doses exponentially decrease as a function of tissue depth. The deposition of X-ray energy near the surface is non-ideal for tumors located deep within the body, which is usually the case, as excessive damage is done to the soft tissue layers surrounding the tumor  2120 . The advantage of protons is that they deposit most of their energy near the end of the flight trajectory as the energy loss per unit path of the absorber transversed by a proton increases with decreasing particle velocity, giving rise to a sharp maximum in ionization near the end of the range, referred to herein as the Bragg peak. Furthermore, since the flight trajectory of the protons is variable by increasing or decreasing the initial kinetic energy or initial velocity of the proton, then the peak corresponding to maximum energy is movable within the tissue. Thus z-axis control of the proton depth of penetration is allowed by the acceleration/extraction process, described supra. As a result of proton dose-distribution characteristics, using the algorithm described, infra, a radiation oncologist can optimize dosage to the tumor  2120  while minimizing dosage to surrounding normal tissues. 
     Herein, the term ingress refers to a place charged particles enter into the patient  2130  or a place of charged particles entering the tumor  2120 . The ingress region of the Bragg energy profile refers to the relatively flat dose delivery portion at shallow depths of the Bragg energy profile. Similarly, herein the terms proximal or the clause proximal region refer to the shallow depth region of the tissue that receives the relatively flat radiation dose delivery portion of the delivered Bragg profile energy. Herein, the term distal refers to the back portion of the tumor located furthest away from the point of origin where the charged particles enter the tumor. In terms of the Bragg energy profile, the Bragg peak is at the distal point of the profile. Herein, the term ventral refers to the front of the patient and the term dorsal refers to the back of the patient. As an example of use, when delivering protons to a tumor in the body, the protons ingress through the healthy tissue and if delivered to the far side of the tumor, the Bragg peak occurs at the distal side of the tumor. For a case where the proton energy is not sufficient to reach the far side of the tumor, the distal point of the Bragg energy profile is the region of furthest penetration into the tumor. 
     The Bragg peak energy profile shows that protons deliver their energy across the entire length of the body penetrated by the proton up to a maximum penetration depth. As a result, energy is being delivered, in the proximal portion of the Bragg peak energy profile, to healthy tissue, bone, and other body constituents before the proton beam hits the tumor. It follows that the shorter the pathlength in the body prior to the tumor, the higher the efficiency of proton delivery efficiency, where proton delivery efficiency is a measure of how much energy is delivered to the tumor relative to healthy portions of the patient. Examples of proton delivery efficiency include: (1) a ratio of proton energy delivered to the tumor over proton energy delivered to non-tumor tissue; (2) pathlength of protons in the tumor versus pathlength in the non-tumor tissue; and/or (3) damage to a tumor compared to damage to healthy body parts. Any of these measures are optionally weighted by damage to sensitive tissue, such as a nervous system element, heart, brain, or other organ. To illustrate, for a patient in a laying position where the patient is rotated about the y-axis during treatment, a tumor near the heart would at times be treated with protons running through the head-to-heart path, leg-to-heart path, or hip-to-heart path, which are all inefficient compared to a patient in a sitting or semi-vertical position where the protons are all delivered through a shorter chest-to-heart; side-of-body-to-heart, or back-to-heart path. Particularly, compared to a laying position, using a sitting or semi-vertical position of the patient, a shorter pathlength through the body to a tumor is provided to a tumor located in the torso or head, which results in a higher or better proton delivery efficiency. 
     Herein proton delivery efficiency is separately described from time efficiency or synchrotron use efficiency, which is a fraction of time that the charged particle beam apparatus is in a tumor treating operation mode. 
     Depth Targeting 
     Referring now to  FIGS.  23   (A-E), x-axis scanning of the proton beam is illustrated while z-axis energy of the proton beam undergoes controlled variation  2300  to allow irradiation of slices of the tumor  2120 . For clarity of presentation, the simultaneous y-axis scanning that is performed is not illustrated. In  FIG.  23 A , irradiation is commencing with the momentary proton beam position  269  at the start of a first slice. Referring now to  FIG.  23 B , the momentary proton beam position is at the end of the first slice. Importantly, during a given slice of irradiation, the proton beam energy is preferably continuously controlled and changed according to the tissue mass and density in front of the tumor  2120 . The variation of the proton beam energy to account for tissue density thus allows the beam stopping point, or Bragg peak, to remain inside the tissue slice. The variation of the proton beam energy during scanning or during x-, y-axes scanning is possible due to the acceleration/extraction techniques, described supra, which allow for acceleration of the proton beam during extraction.  FIG.  23 C ,  FIG.  23 D , and  FIG.  23 E  show the momentary proton beam position in the middle of the second slice, two-thirds of the way through a third slice, and after finalizing irradiation from a given direction, respectively. Using this approach, controlled, accurate, and precise delivery of proton irradiation energy to the tumor  2120 , to a designated tumor subsection, or to a tumor layer is achieved. Efficiency of deposition of proton energy to tumor, as defined as the ratio of the proton irradiation energy delivered to the tumor relative to the proton irradiation energy delivered to the healthy tissue is further described infra. 
     Multi-Field Irradiation 
     It is desirable to maximize efficiency of deposition of protons to the tumor  2120 , as defined by maximizing the ratio of the proton irradiation energy delivered to the tumor  2120  relative to the proton irradiation energy delivered to the healthy tissue. Irradiation from one, two, or three directions into the body, such as by rotating the body about 90 degrees between irradiation sub-sessions results in proton irradiation from the proximal portion of the Bragg peak concentrating into one, two, or three healthy tissue volumes, respectively. It is desirable to further distribute the proximal portion of the Bragg peak energy evenly through the healthy volume tissue surrounding the tumor  2120 . 
     Multi-field irradiation is proton beam irradiation from a plurality of entry points into the body. For example, the patient  2130  is rotated and the radiation source point is held constant. For example, the patient  2130  is rotated through 360 degrees and proton therapy is applied from a multitude of angles resulting in the ingress or proximal radiation being circumferentially spread about the tumor yielding enhanced proton irradiation efficiency. In one case, the body is rotated into greater than 3, 5, 10, 15, 20, 25, 30, or 35 positions and proton irradiation occurs with each rotation position. Rotation of the patient is preferably performed using the patient positioning system  2110  and/or the bottom unit  2112  or disc, described supra. Rotation of the patient  2130  while keeping the delivery proton beam  268  in a relatively fixed orientation allows irradiation of the tumor  2120  from multiple directions without use of a new collimator for each direction. Further, as no new setup is required for each rotation position of the patient  2130 , the system allows the tumor  2120  to be treated from multiple directions without reseating or positioning the patient, thereby minimizing tumor  2120  regeneration time, increasing the synchrotrons efficiency, and increasing patient throughput. 
     The patient is optionally centered on the bottom unit  2112  or the tumor  2120  is optionally centered on the bottom unit  2112 . If the patient is centered on the bottom unit  2112 , then the first axis control element  142  and second axis control element  144  are programmed to compensate for the off central axis of rotation position variation of the tumor  2120 . 
     Referring now to  FIGS.  24   (A-E), an example of multi-field irradiation  2400  is presented. In this example, five patient rotation positions are illustrated; however, the five rotation positions are discrete rotation positions of about thirty-six rotation positions, where the body is rotated about ten degrees with each position. Referring now to  FIG.  24 A , a range of irradiation beam positions  269  is illustrated from a first body rotation position, illustrated as the patient  2130  facing the proton irradiation beam where the tumor receives the bulk of the Bragg profile energy while a first healthy volume  2411  is irradiated by the less intense ingress portion of the Bragg profile energy. Referring now to  FIG.  24 B , the patient  2130  is rotated about forty degrees and the irradiation is repeated. In the second position, the tumor  2120  again receives the bulk of the irradiation energy and a second healthy tissue volume  2412  receives the smaller ingress portion of the Bragg profile energy. Referring now to  FIG.  24 C ,  FIG.  24 D , and  FIG.  24 E , the patient  2130  is rotated a total of about 90, 130, and 180 degrees, respectively. For each of the third, fourth, and fifth rotation positions, the tumor  2120  receives the bulk of the irradiation energy and the third, fourth, and fifth healthy tissue volumes  2413 ,  2414 ,  1415  receive the smaller ingress portion of the Bragg peak energy, respectively. Thus, the rotation of the patient during proton therapy results in the proximal or ingress energy of the delivered proton energy to be distributed about the tumor  2120 , such as to regions one to five  2411 - 2415 , while along a given axis, at least about 75, 80, 85, 90, or 95 percent of the energy is delivered to the tumor  2120 . 
     For a given rotation position, all or part of the tumor is irradiated. For example, in one embodiment only a distal section or distal slice of the tumor  2120  is irradiated with each rotation position, where the distal section is a section furthest from the entry point of the proton beam into the patient  2130 . For example, the distal section is the dorsal side of the tumor when the patient  2130  is facing the proton beam and the distal section is the ventral side of the tumor when the patient  2130  is facing away from the proton beam. 
     Referring now to  FIG.  25   , a second example of multi-field irradiation  2500  is presented where the proton source is stationary and the patient  2130  is rotated. For ease of presentation, the stationary but scanning proton beam path  269  is illustrated as entering the patient  2130  from varying sides at times t 1 , t 2 , t 3 , . . . , t n , t n+1  as the patient is rotated. At a first time, t 1 , the ingress side or proximal region of the Bragg peak profile hits a first area, A 1 . Again, the proximal end of the Bragg peak profile refers to the relatively shallow depths of tissue where Bragg energy profile energy delivery is relatively flat. The patient is rotated and the proton beam path is illustrated at a second time, t 2 , where the ingress energy of the Bragg energy profile hits a second area, A 2 . Thus, the low radiation dosage of the ingress region of the Bragg profile energy is delivered to the second area. At a third time, the ingress end of the Bragg energy profile hits a third area, A 3 . This rotation and irradiation process is repeated n times, where n is a positive number greater than five and preferably greater than about 10, 20, 30, 100, or 300. As illustrated, at an n th  time, t n , if the patient  2130  is rotated further, the scanning proton beam  269  would hit a sensitive body constituent  2150 , such as the spinal cord or eyes. Irradiation is preferably suspended until the sensitive body constituent is rotated out of the scanning proton beam  269  path. Irradiation is resumed at a time, t n+1 , after the sensitive body constituent  2150  is rotated out of the proton beam path. In this manner:
         the distal Bragg peak energy is always within the tumor;   the radiation dose delivery of the distal region of the Bragg energy profile is spread over the tumor;   the ingress or proximal region of the Bragg energy profile is distributed in healthy tissue about the tumor  2120 ; and   sensitive body constituents  2150  receive minimal or no proton beam irradiation.
 
Proton Delivery Efficiency
       

     Herein, charged particle or proton delivery efficiency is radiation dose delivered to the tumor compared to radiation dose delivered to the healthy regions of the patient. 
     A proton delivery enhancement method is described where proton delivery efficiency is enhanced, optimized, or maximized. In general, multi-field irradiation is used to deliver protons to the tumor from a multitude of rotational directions. From each direction, the energy of the protons is adjusted to target the distal portion of the tumor, where the distal portion of the tumor is the volume of the tumor furthest from the entry point of the proton beam into the body. 
     For clarity, the process is described using an example where the outer edges of the tumor are initially irradiated using distally applied radiation through a multitude of rotational positions, such as through 360 degrees. This results in a symbolic or calculated remaining smaller tumor for irradiation. The process is then repeated as many times as necessary on the smaller tumor. However, the presentation is for clarity. In actuality, irradiation from a given rotational angle is performed once with z-axis proton beam energy and intensity being adjusted for the calculated smaller inner tumors during x- and y-axis scanning. 
     Referring now to  FIG.  26 A  and  FIG.  26 B , the proton delivery enhancement method is further described. Referring now to  FIG.  26 A , at a first point in time protons are delivered to the tumor  2120  of the patient  2130  from a first direction. From the first rotational direction, the proton beam is scanned  269  across the tumor. As the proton beam is scanned across the tumor the energy of the proton beam is adjusted to allow the Bragg peak energy to target the distal portion of the tumor. Again, distal refers to the back portion of the tumor located furthest away from where the charged particles enter the tumor. As illustrated, the proton beam is scanned along an x-axis across the patient. This process allows the Bragg peak energy to fall within the tumor, for the middle area of the Bragg peak profile to fall in the middle and proximal portion of the tumor, and for the small intensity ingress portion of the Bragg peak to hit healthy tissue. In this manner, the maximum radiation dose is delivered to the tumor or the proton dose efficiency is maximized for the first rotational direction. 
     After irradiation from the first rotational position, the patient is rotated to a new rotational position. Referring now to  FIG.  26 B , the scanning of the proton beam is repeated. Again, the distal portion of the tumor is targeted with adjustment of the proton beam energy to target the Bragg peak energy to the distal portion of the tumor. Naturally, the distal portion of the tumor for the second rotational position is different from the distal portion of the tumor for the first rotational position. Referring now to  FIG.  26 C , the process of rotating the patient and then irradiating the new distal portion of the tumor is further illustrated at an n th  rotational position. Preferably, the process of rotating the patient and scanning along the x- and y-axes with the Z-axes energy targeting the new distal portion of the tumor is repeated, such as with more than 5, 10, 20, or 30 rotational positions or with about 36 rotational positions. 
     For clarity,  FIGS.  26   (A-C) and  FIG.  26    E show the proton beam as having moved, but in actuality, the proton beam is stationary and the patient is rotated, such as via use of rotating the bottom unit  2112  of the patient positioning system  2110 . Also,  FIGS.  26   (A-C) and  FIG.  26 E  show the proton beam being scanned across the tumor along the x-axis. Though not illustrated for clarity, the proton beam is additionally scanned up and down the tumor along the y-axis of the patient. Combined, the distal portion or volume of the tumor is irradiated along the x- and y-axes with adjustment of the z-axis energy level of the proton beam. In one case, the tumor is scanned along the x-axis and the scanning is repeated along the x-axis for multiple y-axis positions. In another case, the tumor is scanned along the y-axis and the scanning is repeated along the y-axis for multiple x-axis positions. In yet another case, the tumor is scanned by simultaneously adjusting the x- and y-axes so that the distal portion of the tumor is targeted. In all of these cases, the z-axis or energy of the proton beam is adjusted along the contour of the distal portion of the tumor to target the Bragg peak energy to the distal portion of the tumor. 
     Referring now to  FIG.  26 D , after targeting the distal portion of the tumor from multiple directions, such as through 360 degrees, the outer perimeter of the tumor has been strongly irradiated with peak Bragg profile energy, the middle of the Bragg peak energy profile energy has been delivered along an inner edge of the heavily irradiated tumor perimeter, and smaller dosages from the ingress portion of the Bragg energy profile are distributed throughout the tumor and into some healthy tissue. The delivered dosages or accumulated radiation flux levels are illustrated in a cross-sectional area of the tumor  2120  using an iso-line plot. 
     After a first full rotation of the patient, symbolically, the darkest regions of the tumor are nearly fully irradiated and the regions of the tissue having received less radiation are illustrated with a gray scale with the whitest portions having the lowest radiation dose. 
     Referring now to  FIG.  26 E , after completing the distal targeting multi-field irradiation, a smaller inner tumor is defined, where the inner tumor is already partially irradiated. The smaller inner tumor is indicated by the dashed line  2630 . The above process of irradiating the tumor is repeated for the newly defined smaller tumor. The proton dosages to the outer or distal portions of the smaller tumor are adjusted to account for the dosages delivered from other rotational positions. After the second tumor is irradiated, a yet smaller third tumor is defined. The process is repeated until the entire tumor is irradiated at the prescribed or defined dosage. 
     As described at the onset of this example, the patient is preferably only rotated to each rotational position once. In the above described example, after irradiation of the outer perimeter of the tumor, the patient is rotationally positioned, such as through 360 degrees, and the distal portion of the newest smaller tumor is targeted as described, supra. However, the irradiation dosage to be delivered to the second smaller tumor and each subsequently smaller tumor is known a-priori. Hence, when at a given angle of rotation, the smaller tumor or multiple progressively smaller tumors, are optionally targeted so that the patient is only rotated to the multiple rotational irradiation positions once. 
     The goal is to deliver a treatment dosage to each position of the tumor, to preferably not exceed the treatment dosage to any position of the tumor, to minimize ingress radiation dosage to healthy tissue, to circumferentially distribute ingress radiation hitting the healthy tissue, and to further minimize ingress radiation dosage to sensitive areas. Since the Bragg energy profile is known, it is possible to calculated the optimal intensity and energy of the proton beam for each rotational position and for each x- and y-axis scanning position. These calculation result in slightly less than threshold radiation dosage to be delivered to the distal portion of the tumor for each rotational position as the ingress dose energy from other positions bring the total dose energy for the targeted position up to the threshold delivery dose. 
     Referring again to  FIG.  26 A  and  FIG.  26 C , the intensity of the proton beam is preferably adjusted to account for the cross-sectional distance or density of the healthy tissue. An example is used for clarity. Referring now to  FIG.  26 A , when irradiating from the first position where the healthy tissue has a small area  2610 , the intensity of the proton beam is preferably increased as relatively less energy is delivered by the ingress portion of the Bragg profile to the healthy tissue. Referring now to  FIG.  26 C , in contrast when irradiating from the n th  rotational position where the healthy tissue has a large cross-sectional area  2620 , the intensity of the proton beam is preferably decreased as a greater fraction the proton dose is delivered to the healthy tissue from this orientation. 
     In one example, for each rotational position and/or for each z-axis distance into the tumor, the efficiency of proton dose delivery to the tumor is calculated. The intensity of the proton beam is made proportional to the calculated efficiency. Essentially, when the scanning direction has really good efficiency, the intensity is increased and vise-versa. For example, if the tumor is elongated, generally the efficiency of irradiating the distal portion by going through the length of the tumor is higher than irradiating a distal region of the tumor by going across the tumor with the Bragg energy distribution. Generally, in the optimization algorithm:
         distal portions of the tumor are targeted for each rotational position;   the intensity of the proton beam is largest with the largest cross-sectional area of the tumor;   intensity is larger when the intervening healthy tissue volume is smallest; and   intensity is minimized or cut to zero when the intervening healthy tissue volume includes sensitive tissue, such as the spinal cord or eyes.       

     Using an algorithm so defined, the efficiency of radiation dose delivery to the tumor is maximized. More particularly, the ratio of radiation dose delivered to the tumor versus the radiation dose delivered to surrounding healthy tissue approaches a maximum. Further, integrated radiation dose delivery to each x, y, and z-axis volume of the tumor as a result of irradiation from multiple rotation directions is at or near the preferred dose level. Still further, ingress radiation dose delivery to healthy tissue is circumferentially distributed about the tumor via use of multi-field irradiation where radiation is delivered from a plurality of directions into the body, such as more than 5, 10, 20, or 30 directions. 
     Multi-Field Irradiation 
     In one multi-field irradiation example, the particle therapy system with a synchrotron ring diameter of less than six meters includes ability to:
         rotate the patient through about 360 degrees;   extract radiation in about 0.1 to 10 seconds;   scan vertically about 100 millimeters;   scan horizontally about 700 millimeters;   vary beam energy from about 30 to 330 MeV/second during irradiation;   vary the proton beam intensity independently of varying the proton beam energy;   focus the proton beam with a cross-sectional distance from about 2 to 20 millimeters at the tumor; and/or   complete multi-field irradiation of a tumor in less than about 1, 2, 4, or 6 minutes as measured from the time of initiating proton delivery to the patient  2130 .       

     Two multi-field irradiation methods are described. In the first method, the main controller  110  rotationally positions the patient  2130  and subsequently irradiates the tumor  2120 . The process is repeated until a multi-field irradiation plan is complete. In the second method, the main controller  110  simultaneously rotates and irradiates the tumor  2120  within the patient  2130  until the multi-field irradiation plan is complete. More particularly, the proton beam irradiation occurs while the patient  2130  is being rotated. 
     The 3-dimensional scanning system of the proton spot focal point, described herein, is preferably combined with a rotation/raster method. The method includes layer wise tumor irradiation from many directions. During a given irradiation slice, the proton beam energy is continuously changed according to the tissue&#39;s density in front of the tumor to result in the beam stopping point, defined by the Bragg peak, always being inside the tumor and inside the irradiated slice. The novel method allows for irradiation from many directions, referred to herein as multi-field irradiation, to achieve the maximal effective dose at the tumor level while simultaneously significantly reducing possible side-effects on the surrounding healthy tissues in comparison to existing methods. Essentially, the multi-field irradiation system distributes dose-distribution at tissue depths not yet reaching the tumor. 
     Proton Beam Position Control 
     Referring now to  FIG.  27 A  and  FIG.  27 B , a beam delivery and tissue volume scanning system is illustrated. Presently, the worldwide radiotherapy community uses a method of dose field forming using a pencil beam scanning system. In stark contrast,  FIG.  27 A  and  FIG.  27 B  illustrate a spot scanning system or tissue volume scanning system. In the tissue volume scanning system, the proton beam is controlled, in terms of transportation and distribution, using an inexpensive and precise scanning system. The scanning system is an active system, where the beam is focused into a spot focal point of about one-half, one, two, or three millimeters in diameter. The focal point is translated along two axes while simultaneously altering the applied energy of the proton beam, which effectively changes the third dimension of the focal point. The system is applicable in combination with the above described rotation of the body, which preferably occurs in-between individual moments or cycles of proton delivery to the tumor. Optionally, the rotation of the body by the above described system occurs continuously and simultaneously with proton delivery to the tumor. 
     For example, in the illustrated system in  FIG.  27 A , the spot is translated horizontally, is moved down a vertical y-axis, and is then back along the horizontal axis. In this example, current is used to control a vertical scanning system having at least one magnet. The applied current alters the magnetic field of the vertical scanning system to control the vertical deflection of the proton beam. Similarly, a horizontal scanning magnet system controls the horizontal deflection of the proton beam. The degree of transport along each axes is controlled to conform to the tumor cross-section at the given depth. The depth is controlled by changing the energy of the proton beam. For example, the proton beam energy is decreased, so as to define a new penetration depth, and the scanning process is repeated along the horizontal and vertical axes covering a new cross-sectional area of the tumor. Combined, the three axes of control allow scanning or movement of the proton beam focal point over the entire volume of the cancerous tumor. The time at each spot and the direction into the body for each spot is controlled to yield the desired radiation does at each sub-volume of the cancerous volume while distributing energy hitting outside of the tumor. 
     The focused beam spot volume dimension is preferably tightly controlled to a diameter of about 0.5, 1, or 2 millimeters, but is alternatively several centimeters in diameter. Preferred design controls allow scanning in two directions with: (1) a vertical amplitude of about 100 mm amplitude and frequency up to about 200 Hz; and (2) a horizontal amplitude of about 700 mm amplitude and frequency up to about 1 Hz. 
     Proton Beam Energy Control 
     In  FIG.  27 A , the proton beam is illustrated along a z-axis controlled by the beam energy, the horizontal movement is along an x-axis, and the vertical direction is along a y-axis. The distance the protons move along the z-axis into the tissue, in this example, is controlled by the kinetic energy of the proton. This coordinate system is arbitrary and exemplary. Referring now to  FIG.  27 B , preferably control of the proton beam is controlled in 3-dimensional space using two scanning magnet systems and by simultaneously varying and controlling the kinetic energy of the proton beam. The use of the extraction system, described supra, allows for different scanning patterns. Particularly, the system allows simultaneous adjustment of the x-, y-, and z-axes in the irradiation of the solid tumor. Stated again, instead of scanning along an x,y-plane and then adjusting energy of the protons, such as with a range modulation wheel, the system allows for moving along the z-axes while simultaneously adjusting the x- and or y-axes. Hence, rather than irradiating slices of the tumor, the tumor is optionally irradiated in three simultaneous dimensions. For example, the tumor is irradiated around an outer edge of the tumor in three dimensions. Then the tumor is irradiated around an outer edge of an internal section of the tumor. This process is repeated until the entire tumor is irradiated. The outer edge irradiation is preferably coupled with simultaneous rotation of the subject, such as about a vertical y-axis. This system allows for maximum efficiency of deposition of protons to the tumor, as defined as the ratio of the proton irradiation energy delivered to the tumor relative to the proton irradiation energy delivered to the healthy tissue. 
     Combined, the system allows for multi-axes control of the charged particle beam system in a small space with a low or small power supply. For example, the system uses multiple magnets where each magnet has at least one edge focusing effect in each turning section of the synchrotron and/or multiple magnets having concentrating magnetic field geometry, as described supra. The multiple edge focusing effects in the circulating beam path of the synchrotron combined with the concentration geometry of the magnets and described extraction system yields a synchrotron having:
         a small circumference system, such as less than about 50 meters;   a vertical proton beam size gap of about 2 cm;   corresponding reduced power supply requirements associated with the reduced gap size;   an extraction system not requiring a newly introduced magnetic field;   acceleration or deceleration of the protons during extraction; and   control of z-axis energy during extraction.       

     The result is a 3-dimensional scanning system, x-, y-, and z-axes control, where the z-axes control resides in the synchrotron and where the z-axes energy is variably controlled during the extraction process inside the synchrotron. 
     Proton Beam Intensity Control 
     Referring now to  FIG.  28 A  and  FIG.  28 B , an intensity modulated 3-dimensional scanning system  2800  is described. Referring now to  FIG.  28 A , a proton beam is being scanned across and x- and/or y-axis as a function of time. With each time, the z-axis energy is optionally adjusted. In this case, from the first time, t 1 , to the third time, t 3 , the energy is increased, and from the third time, t 3 , to the fifth time, t 5 , the energy is decreased. Thus, the system is scanning in 3-dimensions along the x-, y-, and/or z-axes. Notably, the radiation energy delivery efficiency is increasing from t 1  to t 3  and decreasing from t 3  to t 5 , where efficiency refers to the percentage of radiation delivered to the tumor. For example, at the third time, t 3 , the Bragg peak energy is located at the distal, or back, portion of the tumor located furthest away from the point of origin where the charged particles enter the tumor  2120 . Delivered Bragg peak energy increases exponentially up to the maximum distance of proton energy penetration into the body. Hence, as illustrated the percentage of the delivered Bragg peak energy in the tumor is greatest at the third time period t 3 , which has the largest tumor cross-section pathlength, less at the second and fourth time periods, t 2  and t 4 , and still less at the first and fifth time periods, t 1  and t 5 , which have the smallest tumor cross-section pathlength Referring now to  FIG.  28 B , the intensity of the proton beam is also changing with time in a manner correlated with the radiation energy delivery efficiency. In this case, the intensity of the proton beam is greatest at the third time period t 3 , less at the second and fourth time periods, t 2  and t 4 , and still less at the first and fifth time periods, t 1  and t 5 . The intensity of the proton beam is adjusted to be more intense when radiation delivery efficiency increases using the proton beam extraction process  1800  and intensity control system  1900 , described supra. Intensity is generally positively correlated with tumor cross-sectional pathlength, proton beam energy, and/or radiation delivery efficiency. Preferably, the distal portion of the tumor is targeted with each rotational position of the patient  2130  using the multi-field irradiation  2500 , described supra, allowing repeated use of increased intensity at changing distal portions of the tumor  2120  as the patient  2130  is rotated in the multi-field irradiation system  2500 . 
     As an example, the intensity controller subsystem  1940  adjusts the radio-frequency field in the RF cavity system  1910  to yield an intensity to correlate with radiation delivery efficiency and/or with the irradiation plan  1960 . Preferably, the intensity controller subsystem adjusts the intensity of the radiation beam using a reading of the actual intensity of the proton beam  1950  or from the feedback current from the extraction material  1930 , which is proportional to the extracted beam intensity, as described supra. Thus, independent of the x- and y-axes targeting system and independent of the z-axis energy of the proton beam, the intensity of the proton beam is controlled, preferably in coordination with the multi-field irradiation system  2500 , to yield peak intensities with greatest radiation delivery efficiency. The independent control of beam parameters allows use of a raster beam scanning system. Often, the greatest radiation delivery efficiency occurs, for a given rotational position of the patient, when the energy of the proton beam is largest. Hence, the intensity of the proton beam optionally correlates with the energy of the proton beam. The system is optionally timed with the patient&#39;s respiration cycle, as described infra. The system optionally operates in a raster beam scanning mode, as described infra. 
     Proton Beam Position, Energy, and Intensity Control 
     An example of a proton scanning or targeting system  140  used to direct the protons to the tumor with 4-dimensional scanning control is provided, where the 4-dimensional scanning control is along the x-, y-, and z-axes along with intensity control, as described supra. A fifth controllable axis is time. A sixth controllable axis is patient rotation. Typically, charged particles traveling along the transport path  268  are directed through a first axis control element  142 , such as a vertical control, and a second axis control element  144 , such as a horizontal control and into a tumor  2120 . As described, supra, the extraction system also allows for simultaneous variation in the z-axis. Further, as described, supra, the intensity or dose of the extracted beam is optionally simultaneously and independently controlled and varied. Thus instead of irradiating a slice of the tumor, as in  FIG.  27 A , all four dimensions defining the targeting spot of the proton delivery in the tumor are simultaneously variable. The simultaneous variation of the proton delivery spot is illustrated in  FIG.  27 B  by the spot delivery path  269  and in  FIG.  28 A , where the intensity is controlled as a function of efficiency of radiation delivery. 
     In one example, the protons are initially directed around an outer edge of the tumor and are then directed around an inner radius of the tumor. Combined with rotation of the subject about a vertical axis, a multi-field irradiation process is used where a not yet irradiated portion of the tumor is preferably irradiated at the further distance of the tumor from the proton entry point into the body. This yields the greatest percentage of the proton delivery, as defined by the Bragg peak, into the tumor and minimizes damage to peripheral healthy tissue. 
     Raster Scanning 
     Raster beam scanning is optionally used. In traditional spot targeting systems, a spot of the tumor is targeted, then the radiation beam is turned off, a new spot is targeted, and the radiation beam is turned on. The cycle is repeated with changes in the x- and/or y-axis position. In stark contrast, in the raster beam scanning system, the proton beam is scanned from position to position in the tumor without turning off the radiation beam. In the raster scanning system, the irradiation is not necessarily turned off between spots, rather the irradiation of the tumor is optionally continuous as the beam scans between 3-dimensional locations in the tumor. The velocity of the scanning raster beam is optionally independently controlled. Velocity is change in the x, y, z position of the spot of the scanning beam with time. Hence, in a velocity control system, the rate of movement of the proton beam from coordinate to coordinate optionally varies with time or has a mathematical change in velocity with time. Stated again, the movement of the spot of the scanning beam with time is optionally not constant as a function of time. Further, the raster beam scanning system optionally uses the simultaneous and/or independent control of the x- and/or y-axes position, energy of the proton beam, intensity of the proton beam, and rotational position of the patient using the acceleration, extraction systems, and rotation systems, described supra. 
     In one example, a charged particle beam system for irradiation of a tumor of a patient, includes: a synchrotron configured with an extraction foil, where a timing controller times the charged particle beam striking the extraction foil in an acceleration period in the synchrotron resulting in extraction of the charged particle beam at a selected energy and a raster beam scanning system configured to scan the charged particle beam across delivery positions while both (1) constantly delivering the charged particle beam at and between the delivery positions and (2) simultaneously varying the selected energy level of the charged particle beam across the delivery positions. Preferably, an intensity controller is used that is configured to measure a current resulting from the charged particle beam striking the extraction foil, the current used as a feedback control to a radio-frequency cavity system, wherein an applied radio frequency, using the feedback control, in the radio-frequency cavity system controls the number of particles in the charged particle beam striking the extraction foil resulting in intensity control of the charged particle beam. Preferably, a velocity controller is configured to change a rate of movement of the charged particle beam between the delivery position along x- and/or y-axes in the tumor as a function of time. 
     Imaging/X-Ray System 
     Herein, an X-ray system is used to illustrate an imaging system. 
     Timing 
     An X-ray is preferably collected either (1) just before or (2) concurrently with treating a subject with proton therapy for a couple of reasons. First, movement of the body, described supra, changes the local position of the tumor in the body relative to other body constituents. If the patient or subject  2130  has an X-ray taken and is then bodily moved to a proton treatment room, accurate alignment of the proton beam to the tumor is problematic. Alignment of the proton beam to the tumor  2120  using one or more X-rays is best performed at the time of proton delivery or in the seconds or minutes immediately prior to proton delivery and after the patient is placed into a therapeutic body position, which is typically a fixed position or partially immobilized position. Second, the X-ray taken after positioning the patient is used for verification of proton beam alignment to a targeted position, such as a tumor and/or internal organ position. 
     Positioning 
     An X-ray is preferably taken just before treating the subject to aid in patient positioning. For positioning purposes, an X-ray of a large body area is not needed. In one embodiment, an X-ray of only a local area is collected. When collecting an X-ray, the X-ray has an X-ray path. The proton beam has a proton beam path. Overlaying the X-ray path with the proton beam path is one method of aligning the proton beam to the tumor. However, this method involves putting the X-ray equipment into the proton beam path, taking the X-ray, and then moving the X-ray equipment out of the beam path. This process takes time. The elapsed time while the X-ray equipment moves has a couple of detrimental effects. First, during the time required to move the X-ray equipment, the body moves. The resulting movement decreases precision and/or accuracy of subsequent proton beam alignment to the tumor. Second, the time required to move the X-ray equipment is time that the proton beam therapy system is not in use, which decreases the total efficiency of the proton beam therapy system. 
     X-Ray Source Lifetime 
     Preferably, components in the particle beam therapy system require minimal or no maintenance over the lifetime of the particle beam therapy system. For example, it is desirable to equip the proton beam therapy system with an X-ray system having a long lifetime source, such as a lifetime of about 20 years. 
     In one system, described infra, electrons are used to create X-rays. The electrons are generated at a cathode where the lifetime of the cathode is temperature dependent. Analogous to a light bulb, where the filament is kept in equilibrium, the cathode temperature is held in equilibrium at temperatures at about 200, 500, or 1000 degrees Celsius. Reduction of the cathode temperature results in increased lifetime of the cathode. Hence, the cathode used in generating the electrons is preferably held at as low of a temperature as possible. However, if the temperature of the cathode is reduced, then electron emissions also decrease. To overcome the need for more electrons at lower temperatures, a large cathode is used and the generated electrons are concentrated. The process is analogous to compressing electrons in an electron gun; however, here the compression techniques are adapted to apply to enhancing an X-ray tube lifetime. 
     Referring now to  FIG.  29   , an example of an X-ray generation device  2900  having an enhanced lifetime is provided. Electrons  2920  are generated at a cathode  2910 , focused with a control electrode  2912 , and accelerated with a series of accelerating electrodes  2940 . The accelerated electrons  2950  impact an X-ray generation source  2948  resulting in generated X-rays that are then directed along an X-ray path  3070  to the subject  2130 . The concentrating of the electrons from a first diameter  2915  to a second diameter  2916  allows the cathode to operate at a reduced temperature and still yield the necessary amplified level of electrons at the X-ray generation source  2948 . In one example, the X-ray generation source  2948  is the anode coupled with the cathode  2910  and/or the X-ray generation source is substantially composed of tungsten. 
     Still referring to  FIG.  29   , a more detailed description of an exemplary X-ray generation device  2900  is described. An anode  2914 /cathode  2910  pair is used to generated electrons. The electrons  2920  are generated at the cathode  2910  having a first diameter  2915 , which is denoted d 1 . The control electrodes  2912  attract the generated electrons  2920 . For example, if the cathode is held at about −150 kV and the control electrode is held at about −149 kV, then the generated electrons  2920  are attracted toward the control electrodes  2912  and focused. A series of accelerating electrodes  2940  are then used to accelerate the electrons into a substantially parallel path  2950  with a smaller diameter  2916 , which is denoted d 2 . For example, with the cathode held at −150 kV, a first, second, third, and fourth accelerating electrodes  2942 ,  2944 ,  2946 ,  2948  are held at about −120, −90, −60, and −30 kV, respectively. If a thinner body part is to be analyzed, then the cathode  2910  is held at a smaller level, such as about −90 kV and the control electrode, first, second, third, and fourth electrode are each adjusted to lower levels. Generally, the voltage difference from the cathode to fourth electrode is less for a smaller negative voltage at the cathode and vise-versa. The accelerated electrons  2950  are optionally passed through a magnetic lens  2960  for adjustment of beam size, such as a cylindrical magnetic lens. The electrons are also optionally focused using quadrupole magnets  2970 , which focus in one direction and defocus in another direction. The accelerated electrons  2950 , which are now adjusted in beam size and focused strike the X-ray generation source  2948 , such as tungsten, resulting in generated X-rays that pass through an optional blocker  3062  and proceed along an X-ray path  3070  to the subject. The X-ray generation source  2948  is optionally cooled with a cooling element  2949 , such as water touching or thermally connected to a backside of the X-ray generation source  2948 . The concentrating of the electrons from a first diameter  2915  to a second diameter  2916  allows the cathode to operate at a reduced temperature and still yield the necessary amplified level of electrons at the X-ray generation source  2948 . 
     More generally, the X-ray generation device  2900  produces electrons having initial vectors. One or more of the control electrode  2912 , accelerating electrodes  2940 , magnetic lens  2960 , and quadrupole magnets  2970  combine to alter the initial electron vectors into parallel vectors with a decreased cross-sectional area having a substantially parallel path, referred to as the accelerated electrons  2950 . The process allows the X-ray generation device  2900  to operate at a lower temperature. Particularly, instead of using a cathode that is the size of the electron beam needed, a larger electrode is used and the resulting electrons  2920  are focused and/or concentrated into the required electron beam needed. As lifetime is roughly an inverse of current density, the concentration of the current density results in a larger lifetime of the X-ray generation device. A specific example is provided for clarity. If the cathode has a fifteen mm radius or d 1  is about 30 mm, then the area (π r 2 ) is about 225 mm 2  times pi. If the concentration of the electrons achieves a radius of five mm or d 2  is about 10 mm, then the area (π r 2 ) is about 25 mm 2  times pi. The ratio of the two areas is about nine (225π/25π). Thus, there is about nine times less density of current at the larger cathode compared to the traditional cathode having an area of the desired electron beam. Hence, the lifetime of the larger cathode approximates nine times the lifetime of the traditional cathode, though the actual current through the larger cathode and traditional cathode is about the same. Preferably, the area of the cathode  2910  is about 2, 4, 6, 8, 10, 15, 20, or 25 times that of the cross-sectional area of the substantially parallel electron beam  2950 . 
     In another embodiment of the invention, the quadrupole magnets  2970  result in an oblong cross-sectional shape of the electron beam  2950 . A projection of the oblong cross-sectional shape of the electron beam  2950  onto the X-ray generation source  2948  results in an X-ray beam  3070  that has a small spot in cross-sectional view, which is preferably substantially circular in cross-sectional shape, that is then passed through the patient  2930 . The small spot is used to yield an X-ray having enhanced resolution at the patient. 
     Referring now to  FIG.  30   , in one embodiment, an X-ray is generated close to, but not in, the proton beam path. A proton beam therapy system and an X-ray system combination  3000  is illustrated in  FIG.  30   . The proton beam therapy system has a proton beam  268  in a transport system after the Lamberson extraction magnet  292  of the synchrotron  130 . The proton beam is directed by the scanning/targeting/delivery system  140  to a tumor  2120  of a patient  2130 . The X-ray system  3005  includes an electron beam source  2905  generating an electron beam  2950 . The electron beam is directed to an X-ray generation source  2948 , such as a piece of tungsten. Preferably, the tungsten X-ray source is located about 1, 2, 3, 5, 10, 15, or 20 millimeters from the proton beam path  268 . When the electron beam  2950  hits the tungsten, X-rays are generated in all directions. X-rays are blocked with a port  3062  and are selected for an X-ray beam path  3070 . The X-ray beam path  3070  and proton beam path  268  run substantially in parallel as they progress to the tumor  2120 . The distance between the X-ray beam path  3070  and proton beam path  269  preferably diminishes to near zero and/or the X-ray beam path  3070  and proton beam path  269  overlap by the time they reach the tumor  2120 . Simple geometry shows this to be the case given the long distance, of at least a meter, between the tungsten and the tumor  2120 . The distance is illustrated as a gap  3080  in  FIG.  30   . The X-rays are detected at an X-ray detector  3090 , which is used to form an image of the tumor  2120  and/or position of the patient  2130 . 
     As a whole, the system generates an X-ray beam that lies in substantially the same path as the proton therapy beam. The X-ray beam is generated by striking a tungsten or equivalent material with an electron beam. The X-ray generation source is located proximate to the proton beam path. Geometry of the incident electrons, geometry of the X-ray generation material, and/or geometry of the X-ray beam blocker  262  yield an X-ray beam that runs either substantially in parallel with the proton beam or results in an X-ray beam path that starts proximate the proton beam path an expands to cover and transmit through a tumor cross-sectional area to strike an X-ray detector array or film allowing imaging of the tumor from a direction and alignment of the proton therapy beam. The X-ray image is then used to control the charged particle beam path to accurately and precisely target the tumor, and/or is used in system verification and validation. 
     Referring now to  FIG.  31   , additional geometry of the electron beam path  2950  and X-ray beam path  3070  is illustrated. Particularly, the electron beam  2950  is shown as an expanded electron beam path  2952 ,  2954 . Also, the X-ray beam path  3070  is shown as an expanded X-ray beam path  3072 ,  3074 . 
     Referring now to  FIG.  32   , a 3-dimensional (3-D) X-ray tomography system  3200  is presented. In a typical X-ray tomography system, the X-ray source and detector rotationally translate about a stationary subject. In the X-ray tomography system described herein, the X-ray source and detector are stationary and the patient  2130  rotates. The stationary X-ray source allows a system where the X-ray source  2948  is proximate the proton therapy beam path  268 , as described supra. In addition, the rotation of the patient  2130  allows the proton dosage to be distributed around the body, rather than being concentrated on one static entrance side of the body. Further, the 3-D X-ray tomography system allows for simultaneous updates of the tumor position relative to body constituents in real-time during proton therapy treatment of the tumor  2120  in the patient  2130 . The X-ray tomography system is further described, infra. 
     Patient Imaging with Rotation 
     In a first step of the X-ray tomography system  3200 , the patient  2130  is positioned relative to the X-ray beam path  3070  and proton beam path  268  using a patient semi-immobilization/placement system, described infra. After patient  2130  positioning, a series of reference 2-D X-ray images are collected, on a detector array  3090  or film, of the patient  2130  and tumor  2120  as the subject is rotated about a y-axis  2117 . For example, a series of about 50, 100, 200, or 400 X-ray images of the patient are collected as the patient is rotated. In a second example, an X-ray image is collected with each n degrees of rotation of the patient  2130 , where n is about ½, 1, 2, 3, 5, 10, or 20 degrees of rotation. Preferably, about 200 images are collected during one full rotation of the patient through 360 degrees. Subsequently, using the reference 2-D X-ray images, an algorithm produces a reference 3-D picture of the tumor  2120  relative to the patient&#39;s constituent body parts. A tumor  2120  irradiation plan is made using the 3-D picture of the tumor  2120  and the patient&#39;s constituent body parts. Creation of the proton irradiation plan is optionally performed after the patient has moved from the X-ray imaging area. 
     In a second step, the patient  2130  is repositioned relative to the X-ray beam path  3070  and proton beam path  268  using the patient semi-immobilization/placement system. Just prior to implementation of the proton irradiation plan, a few comparative X-ray images of the patient  2130  and tumor  2120  are collected at a limited number of positions using the X-ray tomography system  2600  setup. For example, a single X-ray image is collected with the patient positioned straight on, at angles of plus/minus forty-five degrees, and/or at angles of plus/minus ninety degrees relative to the proton beam path  268 . The actual orientation of the patient  2130  relative to the proton beam path  268  is optionally any orientation. The actual number of comparative X-ray images is also optionally any number of images, though the preferable number of comparative X-ray images is about 2 to 5 comparative images. The comparative X-ray images are compared to the reference X-ray images and differences are detected. A medical expert or an algorithm determines if the difference between the reference images and the comparative images is significant. Based upon the differences, the medical expert or algorithm determines if: proton treatment should commence, be halted, or adapted in real-time. For example, if significant differences in the X-ray images are observed, then the treatment is preferably halted and the process of collecting a reference 3-D picture of the patient&#39;s tumor is reinitiated. In a second example, if the differences in the X-ray images are observed to be small, then the proton irradiation plan commences. In a third example, the algorithm or medical expert can adapt the proton irradiation plan in real-time to adjust for differences in tumor location resulting from changes in position of the tumor  2120  in the patient  2130  or from differences in the patient  2130  placement. In the third example, the adaptive proton therapy increases patient throughput and enhances precision and accuracy of proton irradiation of the tumor  2120  relative to the healthy tissue of the patient  2130 . 
     Patient Immobilization 
     Accurate and precise delivery of a proton beam to a tumor of a patient requires: (1) positioning control of the proton beam and (2) positioning control of the patient. As described, supra, the proton beam is controlled using algorithms and magnetic fields to a diameter of about 0.5, 1, or 2 millimeters. This section addresses partial immobilization, restraint, and/or alignment of the patient to insure the tightly controlled proton beam efficiently hits a target tumor and not surrounding healthy tissue as a result of patient movement. 
     Herein, an x-, y-, and z-axes coordinate system and rotation axis is used to describe the orientation of the patient relative to the proton beam. The z-axis represent travel of the proton beam, such as the depth of the proton beam into the patient. When looking at the patient down the z-axis of travel of the proton beam, the x-axis refers to moving left or right across the patient and the y-axis refers to movement up or down the patient. A first rotation axis is rotation of the patient about the y-axis and is referred to herein as a rotation axis, bottom unit  2112  rotation axis, or y-axis of rotation  2117 . In addition, tilt is rotation about the x-axis, yaw is rotation about the y-axis, and roll is rotation about the z-axis. In this coordinate system, the proton beam path  269  optionally runs in any direction. As an illustrative matter, the proton beam path running through a treatment room is described as running horizontally through the treatment room. 
     In this section, three examples of positioning systems are provided: (1) a semi-vertical partial immobilization system  3300 ; (2) a sitting partial immobilization system  3400 ; and (3) a laying position  3500 . Elements described for one immobilization system apply to other immobilization systems with small changes. For example, a headrest, a head support, or head restraint will adjust along one axis for a reclined position, along a second axis for a seated position, and along a third axis for a laying position. However, the headrest itself is similar for each immobilization position. 
     Vertical Patient Positioning/Immobilization 
     Referring now to  FIG.  33   , the semi-vertical patient positioning system  3300  is preferably used in conjunction with proton therapy of tumors in the torso. The patient positioning and/or immobilization system controls and/or restricts movement of the patient during proton beam therapy. In a first partial immobilization embodiment, the patient is positioned in a semi-vertical position in a proton beam therapy system. As illustrated, the patient is reclining at an angle alpha, α, about 45 degrees off of the y-axis as defined by an axis running from head to foot of the patient. More generally, the patient is optionally completely standing in a vertical position of zero degrees off the of y-axis or is in a semi-vertical position alpha that is reclined about 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, or 65 degrees off of the y-axis toward the z-axis. 
     Patient positioning constraints  3315  that are used to maintain the patient in a treatment position, include one or more of: a seat support  3320 , a back support  3330 , a head support  3340 , an arm support  3350 , a knee support  3360 , and a foot support  3370 . The constraints are optionally and independently rigid or semi-rigid. Examples of a semi-rigid material include a high or low density foam or a visco-elastic foam. For example the foot support is preferably rigid and the back support is preferably semi-rigid, such as a high density foam material. One or more of the positioning constraints  3315  are movable and/or under computer control for rapid positioning and/or immobilization of the patient. For example, the seat support  3320  is adjustable along a seat adjustment axis  3322 , which is preferably the y-axis; the back support  3330  is adjustable along a back support axis  3332 , which is preferably dominated by z-axis movement with a y-axis element; the head support  3340  is adjustable along a head support axis  3342 , which is preferably dominated by z-axis movement with a y-axis element; the arm support  3350  is adjustable along an arm support axis  3352 , which is preferably dominated by z-axis movement with a y-axis element; the knee support  3360  is adjustable along a knee support axis  3362 , which is preferably dominated by z-axis movement with a y-axis element; and the foot support  3370  is adjustable along a foot support axis  3372 , which is preferably dominated by y-axis movement with a z-axis element. 
     If the patient is not facing the incoming proton beam, then the description of movements of support elements along the axes change, but the immobilization elements are the same. 
     An optional camera  3380  is used with the patient immobilization system. The camera views the patient/subject  2130  creating a video image. The image is provided to one or more operators of the charged particle beam system and allows the operators a safety mechanism for determining if the subject has moved or desires to terminate the proton therapy treatment procedure. Based on the video image, the operators optionally suspend or terminate the proton therapy procedure. For example, if the operator observes via the video image that the subject is moving, then the operator has the option to terminate or suspend the proton therapy procedure. 
     An optional video display or display monitor  3390  is provided to the patient. The video display optionally presents to the patient any of: operator instructions, system instructions, status of treatment, or entertainment. 
     Motors for positioning the patient positioning constraints  3315 , the camera  3380 , and/or video display  3390  are preferably mounted above or below the proton transport path  268  or momentary proton scanning path  269 . 
     Respiration control is optionally performed by using the video display. As the patient breathes, internal and external structures of the body move in both absolute terms and in relative terms. For example, the outside of the chest cavity and internal organs both have absolute moves with a breath. In addition, the relative position of an internal organ relative to another body component, such as an outer region of the body, a bone, support structure, or another organ, moves with each breath. Hence, for more accurate and precise tumor targeting, the proton beam is preferably delivered at a point in time where the position of the internal structure or tumor is well defined, such as at the bottom or top of each breath. The video display is used to help coordinate the proton beam delivery with the patient&#39;s respiration cycle. For example, the video display optionally displays to the patient a command, such as a hold breath statement, a breathe statement, a countdown indicating when a breath will next need to be held, or a countdown until breathing may resume. 
     Sitting Patient Positioning/Immobilization 
     In a second partial immobilization embodiment, the patient is partially restrained in a seated position  3400 . The sitting restraint system uses support structures similar to the support structures in the semi-vertical positioning system, described supra, with an exception that the seat support is replaced by a chair and the knee support is not required. The seated restraint system generally retains the adjustable support, rotation about the y-axis, camera, video, and breath control parameters described in the semi-vertical embodiment, described supra. 
     Referring now to  FIG.  34   , a particular example of a sitting patient semi-immobilization system  3400  is provided. The sitting system is preferably used for treatment of head and/or neck tumors. As illustrated, the patient is positioned in a seated position on a chair  3410  for particle therapy. The patient is further immobilized using any of the: the head support  3340 , the back support  3330 , the hand support  3350 , the knee support  3360 , and the foot support  3370 . The supports  3320 ,  3330 ,  3340 ,  3350 ,  3360 ,  3370  preferably have respective axes of adjustment  3322 ,  3332 ,  3342 ,  3352 ,  3362 ,  3372  as illustrated. The chair  3410  is either readily removed to allow for use of a different patient constraint system or adapts under computer control to a new patient position, such as the semi-vertical system. 
     Laying Patient Positioning/Immobilization 
     In a third partial immobilization embodiment, the patient is partially restrained in a laying position. Referring now to  FIG.  34   , the laying restraint system  3500  has support structures that are similar to the support structures used in the sitting positioning system  3400  and semi-vertical positioning system  3300 , described supra. In the laying position, optional restraint, support, or partial immobilization elements include one or more of: the head support  3340  and the back support, hip, and shoulder  3330  support. The supports preferably have respective axes of adjustment that are rotated as appropriate for a laying position of the patient. The laying position restraint system generally retains the adjustable supports, rotation about the y-axis, camera, video, and breath control parameters described in the semi-vertical embodiment, described supra. 
     If the patient is very sick, such as the patient has trouble standing for a period of about one to three minutes required for treatment, then being in a partially supported system can result in some movement of the patient due to muscle strain. In this and similar situations, treatment of a patient in a laying position on a support table  3520  is preferentially used. The support table has a horizontal platform to support the bulk of the weight of the patient. Preferably, the horizontal platform is detachable from a treatment platform. In a laying positioning system  3500 , the patient is positioned on a platform  3510 , which has a substantially horizontal portion for supporting the weight of the body in a horizontal position. Optional hand grips are used, described infra. In one embodiment, the platform  3510  affixes relative to the table  3520  using a mechanical stop or lock element  3530  and matching key element  3535  and/or the patient  2130  is aligned or positioned relative to a placement element  3560 . 
     Additionally, upper leg support  3544 , lower leg support  3540 , and/or arm support  3550  elements are optionally added to raise, respectively, an arm or leg out of the proton beam path  269  for treatment of a tumor in the torso or to move an arm or leg into the proton beam path  269  for treatment of a tumor in the arm or leg. This increases proton delivery efficiency, as described supra. The leg supports  3540 ,  3544  and arm support  3550  are each optionally adjustable along support axes or arcs  3542 ,  3546 ,  3552 . One or more leg support elements are optionally adjustable along an arc to position the leg into the proton beam path  269  or to remove the leg from the proton beam path  269 , as described infra. An arm support element is preferably adjustable along at least one arm adjustment axis or along an arc to position the arm into the proton beam path  269  or to remove the arm from the proton beam path  269 , as described infra. 
     Preferably, the patient is positioned on the platform  3510  in an area or room outside of the proton beam path  268  and is wheeled or slid into the treatment room or proton beam path area. For example, the patient is wheeled into the treatment room on a gurney where the top of the gurney, which is the platform, detaches and is positioned onto a table. The platform is preferably lifted onto the table or slid onto the table so that the gurney or bed need not be lifted onto the table. 
     The semi-vertical patient positioning system  3300  and sitting patient positioning system  3400  are preferentially used to treatment of tumors in the head or torso due to efficiency. The semi-vertical patient positioning system  3300 , sitting patient positioning system  3400 , and laying patient positioning system  3500  are all usable for treatment of tumors in the patient&#39;s limbs. 
     Support System Elements 
     Positioning constraints  3315  include all elements used to position the patient, such as those described in the semi-vertical positioning system  3300 , sitting positioning system  3400 , and laying positioning system  3500 . Preferably, positioning constraints or support system elements are aligned in positions that do not impede or overlap the proton beam path  269 . However, in some instances the positioning constraints are in the proton beam path  269  during at least part of the time of treatment of the patient. For instance, a positioning constraint element may reside in the proton beam path  269  during part of a time period where the patient is rotated about the y-axis during treatment. In cases or time periods that the positioning constraints or support system elements are in the proton beam path, then an upward adjustment of proton beam energy is preferably applied that increases the proton beam energy to offset the positioning constraint element impedance of the proton beam. This time period and energy is a function of rotational orientation of the patient. In one case, the proton beam energy is increased by a separate measure of the positioning constraint element impedance determined during a reference scan of the positioning constraint system element or set of reference scans of the positioning constraint element as a function of rotation about the y-axis. 
     For clarity, the positioning constraints  3315  or support system elements are herein described relative to the semi-vertical positioning system  3300 ; however, the positioning elements and descriptive x-, y-, and z-axes are adjustable to fit any coordinate system, to the sitting positioning system  3400 , or the laying positioning system  3500 . 
     An example of a head support system is described to support, align, and/or restrict movement of a human head. The head support system preferably has several head support elements including any of: a back of head support, a right of head alignment element, and a left of head alignment element. The back of head support element is preferably curved to fit the head and is optionally adjustable along a head support axis, such as along the z-axis. Further, the head supports, like the other patient positioning constraints, is preferably made of a semi-rigid material, such as a low or high density foam, and has an optional covering, such as a plastic or leather. The right of head alignment element and left of head alignment elements or head alignment elements, are primarily used to semi-constrain movement of the head or to fully immobilize the head. The head alignment elements are preferably padded and flat, but optionally have a radius of curvature to fit the side of the head. The right and left head alignment elements are preferably respectively movable along translation axes to make contact with the sides of the head. Restricted movement of the head during proton therapy is important when targeting and treating tumors in the head or neck. The head alignment elements and the back of head support element combine to restrict tilt, rotation or yaw, roll and/or position of the head in the x-, y-, z-axes coordinate system. 
     Referring now to  FIG.  36    another example of a head support system  3600  is described for positioning and/or restricting movement of a human head  2102  during proton therapy of a solid tumor in the head or neck. In this system, the head is restrained using 1, 2, 3, 4, or more straps or belts, which are preferably connected or replaceably connected to a back of head support element  3610 . In the example illustrated, a first strap  3620  pulls or positions the forehead to the head support element  3610 , such as by running predominantly along the z-axis. Preferably a second strap  3630  works in conjunction with the first strap  3620  to prevent the head from undergoing tilt, yaw, roll or moving in terms of translational movement on the x-, y-, and z-axes coordinate system. The second strap  3630  is preferably attached or replaceable attached to the first strap  3620  at or about: (1) a forehead position  3632 ; (2) at a position on one or both sides of the head  3634 ; and/or (3) at or about a position on the support element  3636 . A third strap  3640  preferably orientates the chin of the subject relative to the support element  3610  by running dominantly along the z-axis. A fourth strap  3650  preferably runs along a predominantly y- and z-axes to hold the chin relative to the head support element  3610  and/or proton beam path. The third  3640  strap preferably is attached to or is replaceably attached to the fourth strap  3650  during use at or about the patient&#39;s chin position  3642 . The second strap  3630  optionally connects  3636  to the fourth strap  3650  at or about the support element  3610 . The four straps  3620 ,  3630 ,  3640 ,  3650  are illustrative in pathway and interconnection. Any of the straps optionally hold the head along different paths around the head and connect to each other in separate fashion. Naturally, a given strap preferably runs around the head and not just on one side of the head. Any of the straps  3620 ,  3630 ,  3640 , and  3650  are optionally used independently or in combinations and permutations with the other straps. The straps are optionally indirectly connected to each other via a support element, such as the head support element  3610 . The straps are optionally attached to the head support element  3610  using hook and loop technology, a buckle, or fastener. Generally, the straps combine to control position, front-to-back movement of the head, side-to-side movement of the head, tilt, yaw, roll, and/or translational position of the head. 
     The straps are preferably of known impedance to proton transmission allowing a calculation of peak energy release along the z-axis to be calculated. For example, adjustment to the Bragg peak energy is made based on the slowing tendency of the straps to proton transport. 
     Referring now to  FIG.  37   , still another example of a head support system  3340  is described. The head support  3340  is preferably curved to fit a standard or child sized head. The head support  3340  is optionally adjustable along a head support axis  3342 . Further, the head supports, like the other patient positioning constraints, is preferably made of a semi-rigid material, such as a low or high density foam, and has an optional covering, such as a plastic or leather. 
     Elements of the above described head support, head positioning, and head immobilization systems are optionally used separately or in combination. 
     Still referring to  FIG.  37   , an example of the arm support  3350  is further described. The arm support preferably has a left hand grip  3710  and a right hand grip  3720  used for aligning the upper body of the patient  2130  through the action of the patient  2130  gripping the left and right hand grips  3710 ,  3720  with the patient&#39;s hands  2134 . The left and right hand grips  3710 ,  3720  are preferably connected to the arm support  3350  that supports the mass of the patient&#39;s arms. The left and right hand grips  3710 ,  3720  are preferably constructed using a semi-rigid material. The left and right hand grips  3710 ,  3720  are optionally molded to the patient&#39;s hands to aid in alignment. The left and right hand grips optionally have electrodes, as described supra. 
     Patient Respiration Monitoring 
     Preferably, the patient&#39;s respiration pattern is monitored. When a subject or patient  2130  is breathing many portions of the body move with each breath. For example, when a subject breathes the lungs move as do relative positions of organs within the body, such as the stomach, kidneys, liver, chest muscles, skin, heart, and lungs. Generally, most or all parts of the torso move with each breath. Indeed, the inventors have recognized that in addition to motion of the torso with each breath, various motion also exists in the head and limbs with each breath. Motion is to be considered in delivery of a proton dose to the body as the protons are preferentially delivered to the tumor and not to surrounding tissue. Motion thus results in an ambiguity in where the tumor resides relative to the beam path. To partially overcome this concern, protons are preferentially delivered at the same point in each of a series of respiration cycles. 
     Initially a rhythmic pattern of breathing of a subject is determined. The cycle is observed or measured. For example, an X-ray beam operator or proton beam operator can observe when a subject is breathing or is between breaths and can time the delivery of the protons to a given period of each breath. Alternatively, the subject is told to inhale, exhale, and/or hold their breath and the protons are delivered during the commanded time period. 
     Preferably, one or more sensors are used to determine the respiration cycle of the individual. Two examples of a respiration monitoring system  4010  are provided: (1) a thermal monitoring system and (2) a force monitoring system. 
     Referring again to  FIG.  35   , a first example of the thermal respiration monitoring system is provided. In the thermal respiration monitoring system, a sensor is placed by the nose and/or mouth of the patient. As the jaw of the patient is optionally constrained, as described supra, the thermal respiration monitoring system is preferably placed by the patient&#39;s nose exhalation path. To avoid steric interference of the thermal sensor system components with proton therapy, the thermal respiration monitoring system is preferably used when treating a tumor not located in the head or neck, such as a when treating a tumor in the torso or limbs. In the thermal monitoring system, a first thermal resistor  3670  is used to monitor the patient&#39;s respiration cycle and/or location in the patient&#39;s respiration cycle. Preferably, the first thermal resistor  3670  is placed by the patient&#39;s nose, such that the patient exhaling through their nose onto the first thermal resistor  3670  warms the first thermal resistor  3670  indicating an exhale. Preferably, a second thermal resistor  3660  operates as an environmental temperature sensor. The second thermal resistor  3660  is preferably placed out of the exhalation path of the patient but in the same local room environment as the first thermal resistor  3670 . Generated signal, such as current from the thermal resistors  3670 ,  3660 , is preferably converted to voltage and communicated with the main controller  110  or a sub-controller of the main controller. Preferably, the second thermal resistor  3660  is used to adjust for the environmental temperature fluctuation that is part of a signal of the first thermal resistor  3670 , such as by calculating a difference between the values of the thermal resistors  3670 ,  3660  to yield a more accurate reading of the patient&#39;s respiration cycle. 
     Referring again to  FIG.  34   , a second example of a monitoring system is provided. In an example of a force respiration monitoring system, a sensor is placed by the torso. To avoid steric interference of the force sensor system components with proton therapy, the force respiration monitoring system is preferably used when treating a tumor located in the head, neck, or limbs. In the force monitoring system, a belt or strap  3450  is placed around an area of the patient&#39;s torso that expands and contracts with each respiration cycle of the patient. The belt  3450  is preferably tight about the patient&#39;s chest and is flexible. A force meter  3452  is attached to the belt and senses the patients respiration pattern. The forces applied to the force meter  3452  correlate with periods of the respiration cycle. The signals from the force meter  3452  are preferably communicated with the main controller  110  or a sub-controller of the main controller. 
     Coordinated Charged Particle Beam Control 
     In this section, charged particle beam control systems, described supra, are coordinated for cancer therapy. 
     Positioning, Imaging, and Irradiation 
     Referring now to  FIG.  38   , a method of cancer therapy is provided. In this method, the patient is first positioned  3810 , then the tumor is imaged  3820 , subsequently a charged particle irradiation plan is developed  3830 , and then the charged particle irradiation plan is implemented  3840 . Further examples of the steps provided in  FIG.  38    are described, infra, along with additional optional steps. For example, the positioning, imaging, and irradiation steps are optionally integrated with patient translation control, patient rotation control, and/or patient respiration control. Additionally, any of the steps described herein are optionally coordinated with charged particle beam generation, acceleration, extraction, and/or delivery. Additionally, any of the steps are optionally coordinated with x-, y-axis beam trajectory control, delivered energy control, delivered intensity control, timing of charged particle delivery, and/or distribution of radiation striking healthy tissue. 
     Tumor Imaging 
     Referring now to  FIG.  39   , a method of tumor imaging is provided. In a first step, the patient is positioned  3810 , such as with the patient immobilization and/or positioning systems described supra. Subsequently, the tumor is imaged  3820 , such as with the imaging/X-ray system described supra. Preferably, each image is a 2-dimensional image. If the image is not complete  3910 , then the patient is rotated  3920 , such as with the multi-field irradiation rotatable platform described supra. For instance, the image is collected with rotation of the patient about the y-axis  2117 . After rotation of n degrees of rotation of the patient  2130 , where n is about ½, 1, 2, 3, 5, 10, or 20 degrees, another image is collected  3820 . The imaging  3820  and rotation  3920  processes are repeated until the tumor  2120  is suitably imaged. A 3-dimensional image is created  3930  using the two-dimensional images collected as a function of patient rotation. 
     Respiration Control 
     Referring now to  FIG.  40   , a patient is positioned  3810  and once the rhythmic pattern of the subject&#39;s breathing or respiration cycle is determined  4010 , a signal is optionally delivered to the patient, such as via the display monitor  3390 , to more precisely control the breathing frequency  4020 . For example, the display screen  3390  is placed in front of the patient and a message or signal is transmitted to the display screen  3390  directing the subject when to hold their breath and when to breathe. Typically, a respiration control module uses input from one or more of the respiration sensors. For example, the input is used to determine when the next breath exhale is to complete. At the bottom of the breath, the control module displays a hold breath signal to the subject, such as on a monitor, via an oral signal, digitized and automatically generated voice command, or via a visual control signal. Preferably, a display monitor  3390  is positioned in front of the subject and the display monitor displays breathing commands to the subject. Typically, the subject is directed to hold their breath for a short period of time, such as about ½, 1, 2, 3, 5, or 10 seconds. The period of time the breath is held is preferably synchronized to the delivery time of the proton beam to the tumor, which is about ½, 1, 2, or 3 seconds. While delivery of the protons at the bottom of the breath is preferred, protons are optionally delivered at any point in the respiration cycle, such as upon full inhalation. Delivery at the top of the breath or when the patient is directed to inhale deeply and hold their breath by the respiration control module is optionally performed as at the top of the breath the chest cavity is largest and for some tumors the distance between the tumor and surrounding tissue is maximized or the surrounding tissue is rarefied as a result of the increased volume. Hence, protons hitting surrounding tissue is minimized. Optionally, the display screen tells the subject when they are about to be asked to hold their breath, such as with a 3, 2, 1, second countdown so that the subject is aware of the task they are about to be asked to perform. 
     X-Ray Synchronization with Patient Respiration 
     In one embodiment, X-ray images are collected in synchronization with patient respiration. The synchronization enhances X-ray image clarity by removing position ambiguity due to the relative movement of body constituents during a patient respiration cycle. 
     In a second embodiment, an X-ray system is orientated to provide X-ray images of a patient in the same orientation as viewed by a proton therapy beam, is synchronized with patient respiration, is operable on a patient positioned for proton therapy, and does not interfere with a proton beam treatment path. Preferably, the synchronized system is used in conjunction with a negative ion beam source, synchrotron, and/or targeting method and apparatus to provide an X-ray timed with patient respiration. Preferably, X-ray images are collected immediately prior to and/or concurrently with particle beam therapy irradiation to ensure targeted and controlled delivery of energy relative to a patient position resulting in efficient, precise, and/or accurate in-vivo treatment of a solid cancerous tumor with minimization of damage to surrounding healthy tissue. 
     An X-ray delivery control algorithm is used to synchronize delivery of the X-rays to the patient  2130  within a given period of each breath, such as at the top or bottom of a breath, and/or when the subject is holding their breath. For clarity of combined X-ray images, the patient is preferably both accurately positioned and precisely aligned relative to the X-ray beam path  3070 . The X-ray delivery control algorithm is preferably integrated with the respiration control module. Thus, the X-ray delivery control algorithm knows when the subject is breathing, where in the respiration cycle the subject is, and/or when the subject is holding their breath. In this manner, the X-ray delivery control algorithm delivers X-rays at a selected period of the respiration cycle. Accuracy and precision of patient alignment allow for (1) more accurate and precise location of the tumor  2120  relative to other body constituents and (2) more accurate and precise combination of X-rays in generation of a 3-dimensional X-ray image of the patient  2130  and tumor  2120 . 
     Referring again to  FIG.  40   , an example of generating an X-ray image of the patient  2130  and tumor  2120  using the X-ray generation device  3000  or 3-dimensional X-ray generation device  3000  as a known function of time of the patient&#39;s respiration cycle is provided. In one embodiment, as a first step the main controller  110  instructs, monitors, and/or is informed of patient positioning  3810 . In a first example of patient positioning  3810 , the automated patient positioning system, described supra, under main controller  110  control, is used to align the patient  2130  relative to the X-ray beam path  3070 . In a second example of patient positioning, the main controller  110  is told via sensors or human input that the patient  2130  is aligned. In a second step, patient respiration is then monitored  4010 , as described infra. As a first example of respiration monitoring, an X-ray is collected  4030  at a known point in the patient respiration cycle. In a second example of respiration monitoring, the patient&#39;s respiration cycle is first controlled in a third step of controlling patient respiration  4020  and then as a fourth step an X-ray is collected  4030  at a controlled point in the patient respiration cycle. Preferably, the cycle of patient positioning  3810 , patient respiration monitoring  4010 , patient respiration control  4020 , and collecting an X-ray  4030  is repeated with different patient positions. For example, the patient  2130  is rotated about an axis  2117  and X-rays are collected as a function of the rotation. In a fifth step, a 3-dimensional X-ray image  4040  is generated of the patient  2130 , tumor  2120 , and body constituents about the tumor using the collected X-ray images, such as with the 3-dimensional X-ray generation device  3000 , described supra. The patient respiration monitoring and control steps are further described, infra. 
     An X-ray timed with patient respiration where the X-ray is preferably collected immediately prior to and/or concurrently with particle beam therapy irradiation to ensure targeted and controlled delivery of energy relative to a patient position resulting in efficient, precise, and/or accurate treatment of a solid cancerous tumor with minimization of damage to surrounding healthy tissue in a patient using the proton beam position verification system. 
     Proton Beam Therapy Synchronization with Respiration 
     In one embodiment, charged particle therapy and preferably multi-field proton therapy is coordinated and synchronized with patient respiration via use of the respiration feedback sensors, described supra, used to monitor and/or control patient respiration. Preferably, the charged particle therapy is performed on a patient in a partially immobilized and repositionable position and the proton delivery to the tumor  2120  is timed to patient respiration via control of charged particle beam injection, acceleration, extraction, and/or targeting methods and apparatus. The synchronization enhances proton delivery accuracy by removing position ambiguity due to the relative movement of body constituents during a patient respiration cycle. Synchrotron control to deliver protons at a desired point in the respiration cycle is described infra. 
     In a second embodiment, the X-ray system, described supra, is used to provide X-ray images of a patient in the same orientation as viewed by a proton therapy beam and both the X-ray system and the proton therapy beam are synchronized with patient respiration. Again, synchrotron control to deliver protons at a desired point in the respiration cycle is described infra. 
     A proton delivery control algorithm is used to synchronize delivery of the protons to the tumor within a given period of each breath, such as at the top of a breath, at the bottom of a breath, and/or when the subject is holding their breath. The proton delivery control algorithm is preferably integrated with the respiration control module. Thus, the proton delivery control algorithm knows when the subject is breathing, where in the respiration cycle the subject is, and/or when the subject is holding their breath. The proton delivery control algorithm controls when protons are injected and/or inflected into the synchrotron, when an RF signal is applied to induce an oscillation, as described supra, and when a DC voltage is applied to extract protons from the synchrotron, as described supra. Typically, the proton delivery control algorithm initiates proton inflection and subsequent RF induced oscillation before the subject is directed to hold their breath or before the identified period of the respiration cycle selected for a proton delivery time. In this manner, the proton delivery control algorithm delivers protons at a selected period of the respiration cycle by simultaneously or nearly simultaneously delivering the high DC voltage to the second pair of plates, described supra, which results in extraction of the protons from the synchrotron and subsequent delivery to the subject at the selected time point. Since the period of acceleration of protons in the synchrotron is constant or known for a desired energy level of the proton beam, the proton delivery control algorithm is used to set an AC RF signal that matches the respiration cycle or directed respiration cycle of the subject. 
     The above described charged particle therapy elements are combined in combinations and/or permutations in developing and implementing a tumor treatment plan, described infra. 
     Proton Beam Generation, Injection, Acceleration, Extraction, and Delivery 
     Referring now to  FIG.  41   , an example of implementation of the irradiation plan  3840  is provided. The multi-axis and/or multi-field charged particle cancer therapy system elements described herein are preferably coordinated with charged particle delivery  4100 . After patient positioning  3810  and reading the irradiation plan instructions  4110 , hydrogen is injected  4115  into the negative ion source  310 , plasma is generated  4120 , a negative ion is extracted  4125 , and the negative ion is accelerated  4130 , converted into a positive ion  4140 , and injected into the synchrotron  4145 . Subsequently, the positive ion is accelerated  4150 , extraction is initiated  4155 , intensity of the irradiation beam is controlled  4160 , extraction of the charged particle beam is performed  4165 , and the tumor is irradiated  4170 . Preferably, one or more elements of the charged particle delivery  4100  system are timed with patient respiration. After tumor irradiation  4170 , the patient is preferably rotated  3920  and the irradiation sequence is repeated yielding multi-field irradiation of the tumor  2120 . The entire sequence is optionally performed using the intensity modulated 3-dimensional scanning system  2800 , described supra. 
     Multi-Axis Charged Particle Irradiation 
     Referring now to  FIG.  42   , another example of implementation of the irradiation plan  3840  is provided. In this example, a multi-axis charged particle beam therapy system is provided, where multi-axis refers to independent control of: x-axis beam control, y-axis beam control, delivered beam energy, and/or delivered beam intensity. The multi-axis control is preferably implemented with multi-field charge particle irradiation, such as via use of independent control of rotation and/or translation of the patient. In this example, the main controller  110  independently adjusts x-axis targeting of the proton beam  4210 , y-axis targeting of the proton beam  4220 , rotational position of the patient  4230 , delivered energy of the proton beam  4240 , and/or delivered intensity of the proton beam in the step of irradiating the tumor  3840 . The process is optionally repeated or iterated using a continuously irradiating and scanning charged particle irradiation system as described using the 3-dimensional scanning system  2800 . 
     Developing and Implementing a Tumor Irradiation Plan 
     A series of steps are performed to design and execute a radiation treatment plan for treating a tumor  2120  in a patient  2130 . The steps include one or more of:
         positioning and immobilizing the patient;   recording the patient position;   monitoring patient respiration;   controlling patient respiration;   collecting multi-field images of the patient to determine tumor location relative to body constituents;   developing a radiation treatment plan;   repositioning the patient;   verifying tumor location; and   irradiating the tumor.       

     In this section, an overview of developing the irradiation plan and subsequent implementation of the irradiation plan is initially presented, the individual steps are further described, and a more detailed example of the process is then described. 
     Referring now to  FIG.  43   , an overview of a system for development of an irradiation plan and subsequent implementation of the irradiation plan  4300  is provided. Preferably, all elements of the positioning, respiration monitoring, imaging, and tumor irradiation system  4300  are under main controller  110  control. 
     Initially, the tumor containing volume of the patient  2130  is positioned and immobilized  3810  in a controlled and reproducible position. The process of positioning and immobilizing  3810  the patient  2310  is preferably iterated  4312  until the position is accepted. The position is preferably digitally recorded  4315  and is later used in a step of computer controlled repositioning of the patient  4317  in the minutes or seconds prior to implementation of the irradiation element  3840  of the tumor treatment plan. The process of positioning the patient in a reproducible fashion and reproducibly aligning the patient  2310  to the controlled position is further described, infra. 
     Subsequent to patient positioning  3810 , the steps of monitoring  4010  and preferably controlling  4020  the respiration cycle of the patient  2130  are preferably performed to yield more precise positioning of the tumor  2120  relative to other body constituents, as described supra. Multi-field images of the tumor are then collected  4340  in the controlled, immobilized, and reproducible position. For example, multi-field X-ray images of the tumor  2120  are collected using the X-ray source proximate the proton beam path, as described supra. The multi-field images are optionally from three or more positions and/or are collected while the patient is rotated, as described supra. 
     At this point the patient  2130  is either maintained in the treatment position or is allowed to move from the controlled treatment position while an oncologist processes the multi-field images  4345  and generates a tumor treatment plan  4350  using the multi-field images. Optionally, the tumor irradiation plan is implemented  3840  at this point in time. 
     Typically, in a subsequent treatment center visit, the patient  2130  is repositioned  4317 . Preferably, the patient&#39;s respiration cycle is again monitored  4012  and/or controlled  4022 , such as via use of the thermal monitoring respiration sensors, force monitoring respiration sensor, and/or via commands sent to the display monitor  3390 , described supra. Once repositioned, verification images are collected  4360 , such as X-ray location verification images from 1, 2, or 3 directions. For example, verification images are collected with the patient facing the proton beam and at rotation angles of 90, 180, and 270 degrees from this position. At this point, comparing the verification images to the original multi-field images used in generating the treatment plan, the algorithm or preferably the oncologist determines if the tumor  2120  is sufficiently repositioned  4365  relative to other body parts to allow for initiation of tumor irradiation using the charged particle beam. Essentially, the step of accepting the final position of the patient  4365  is a safety feature used to verify that that the tumor  2120  in the patient  2130  has not shifted or grown beyond set specifications. At this point the charged particle beam therapy commences  3840 . Preferably the patient&#39;s respiration is monitored  4014  and/or controlled  4024 , as described supra, prior to commencement of the charged particle beam treatment  3840 . 
     Optionally, simultaneous X-ray imaging  4390  of the tumor  2120  is performed during the multi-field proton beam irradiation procedure and the main controller  110  uses the X-ray images to adapt the radiation treatment plan in real-time to account for small variations in movement of the tumor  2120  within the patient  2130 . 
     Herein the steps of monitoring  4010 ,  4012 ,  4014  and controlling  4020 ,  4022 ,  4024  the patient&#39;s respiration are optional, but preferred. The steps of monitoring and controlling the patient&#39;s respiration are performed before and/or during the multi-filed imaging  4340 , position verification  4360 , and/or tumor irradiation  3840  steps. The patient positioning  3810  and patient repositioning  4317  steps are further described, infra. 
     Coordinated Charged Particle Acceleration and Respiration Rate 
     In yet another embodiment, the charged particle accelerator is synchronized to the patient&#39;s respiration cycle. More particularly, synchrotron acceleration cycle usage efficiency is enhanced by adjusting the synchrotron&#39;s acceleration cycle to correlate with a patient&#39;s respiration rate. Herein, efficiency refers to the duty cycle, the percentage of acceleration cycles used to deliver charged particles to the tumor, and/or the fraction of time that charged particles are delivered to the tumor from the synchrotron. The system senses patient respiration and controls timing of negative ion beam formation, injection of charged particles into a synchrotron, acceleration of the charged particles, and/or extraction to yield delivery of the particles to the tumor at a predetermine period of the patient&#39;s respiration cycle. Preferably, one or more magnetic fields in the synchrotron  130  are stabilized through use of a feedback loop, which allows rapid changing of energy levels and/or timing of extraction from pulse to pulse. Further, the feedback loop allows control of the acceleration/extraction to correlate with a changing patient respiration rate. Independent control of charged particle energy and intensity is maintained during the timed irradiation therapy. Multi-field irradiation ensures efficient delivery of Bragg peak energy to the tumor while spreading ingress energy about the tumor. 
     In one example, a sensor, such as the first thermal sensor  3670  or the second thermal sensor  3660 , is used to monitor a patient&#39;s respiration. A controller, such as the main controller  110 , then controls charged particle formation and delivery to yield a charged particle beam delivered at a determined point or duration period of the respiration cycle, which ensures precise and accurate delivery of radiation to a tumor that moves during the respiration process. Optional charged particle therapy elements controlled by the controller include the injector  120 , accelerator  132 , and/or extraction  134  system. Elements optionally controlled in the injector system  120  include: injection of hydrogen gas into a negative ion source  310 , generation of a high energy plasma within the negative ion source, filtering of the high energy plasma with a magnetic field, extracting a negative ion from the negative ion source, focusing the negative ion beam  319 , and/or injecting a resulting positive ion beam  262  into the synchrotron  130 . Elements optionally controlled in the accelerator  132  include: accelerator coils, applied magnetic fields in turning magnets, and/or applied current to correction coils in the synchrotron. Elements optionally controlled in the extraction system  134  include: radio-frequency fields in an extraction element and/or applied fields in an extraction process. By using the respiration sensor to control delivery of the charged particle beam to the tumor during a set period of the respiration cycle, the period of delivery of the charged particle to the tumor is adjustable to a varying respiration rate. Thus, if the patient breathes faster, the charged particle beam is delivered to the tumor more frequently and if the patient breathes slower, then the charged particle beam is delivered to the tumor less frequently. Optionally, the charged particle beam is delivered to the tumor with each breath of the patient regardless of the patient&#39;s changing respiration rate. This lies in stark contrast with a system where the charged particle beam delivers energy at a fixed time interval and the patient must adjust their respiration rate to match the period of the accelerator delivering energy and if the patient&#39;s respiration rate does not match the fixed period of the accelerator, then that accelerator cycle is not delivered to the tumor and the acceleration usage efficiency is reduced. 
     Typically, in an accelerator the current is stabilized. A problem with current stabilized accelerators is that the magnets used have memories in terms of both magnitude and amplitude of a sine wave. Hence, in a traditional system, in order to change the circulation frequency of the charged particle beam in a synchrotron, slow changes in current must be used. However, in a second example, the magnetic field controlling the circulation of the charged particles about the synchrotron is stabilized. The magnetic field is stabilized through use of: (1) magnetic field sensors  1650  sensing the magnetic field about the circulating charged particles and (2) a feedback loop through a controller or main controller  110  controlling the magnetic field about the circulating charged particles. The feedback loop is optionally used as a feedback control to the first winding coil  1250  and the second winding coil  1260 . However, preferably the feedback loop is used to control the correction coils  1510 ,  1520 , described supra. With the use of the feedback loop described herein using the magnetic field sensors, the frequency and energy level of the synchrotron are rapidly adjustable and the problem is overcome. Further, the use of the smaller correction coils  1510 ,  1520  allows for rapid adjustment of the accelerator compared to the use of the larger winding coils  1250 ,  1260 , described supra. More particularly, the feedback control allows an adjustment of the accelerator energy from pulse to pulse in the synchrotron  130 . 
     In this section, the first example yielded delivery of the charged particle beam during a particular period of the patient&#39;s respiration cycle even if the patient&#39;s respiration period is varying. In this section, the second example used a magnetic field sensor  1650  and a feedback loop to the correction coils  1510 ,  1520  to rapidly adjust the energy of the accelerator from pulse to pulse. In a third example, the respiration sensor of the first example is combined with the magnetic field sensor of the second example to control both the timing of the delivery of the charged particle beam from the accelerator and the energy of the charged particle beam from the accelerator. More particularly, the timing of the charged particle delivery is controlled using the respiration sensor, as described supra, and the energy of the charged particle beam is controlled using the magnetic field sensors and feedback loop, as described supra. Still more particularly, a magnetic field controller, such as the main controller  110 , takes the input from the respiration sensor and uses the input as: (1) a feedback control to the magnetic fields controlling the circulating charged particles energy and (2) as a feedback control to time the pulse of the charged particle accelerator to the respiration cycle of the patient. This combination allows delivery of the charged particle beam to the tumor with each breath of the patient even if the breathing rate of the patient varies. In this manner, the accelerator efficiency is increased as the cancer therapy system does not need to lose cycles when the patient&#39;s breathing is not in phase with the synchrotron charged particle generation rate. 
     Referring now to  FIG.  44   , the combined use of the respiration sensor and magnetic field sensor  4400  to deliver charged particles at varying energy and at varying time intervals is further described. The main controller  110  controls the injection system  120 , charged particle acceleration system  132 , extraction system  134 , and targeting/delivery system  140 . In this embodiment, the previously described respiration monitoring system  4410  of the patient interface module  150  is used as an input to a magnetic field controller  4420 . A second input to the magnetic field controller  4420  is a magnetic field sensor  1650 . In one case, the respiration rates from the respiration monitoring system  4410  are fed to the main controller  130 , which controls the injection system  120  and/or components of the acceleration system  132  to yield a charged particle beam at a chosen period of the respiration cycle, as described supra. In a second case, the respiration data from the respiration monitoring system is used as an input to the magnetic field controller  4420 . The magnetic field controller also receives feedback input from the magnetic field sensor  1650 . The magnetic field controller thus times charged particle energy delivery to correlate with sensed respiration rates and delivers energy levels of the charged particle beam that are rapidly adjustable with each pulse of the accelerator using the feedback loop through the magnetic field sensor  1650 . 
     Referring still to  FIG.  44    and now additionally referring to  FIG.  45   , a further example is used to clarify the magnetic field control using a feedback loop  4400  to change delivery times and/or periods of proton pulse delivery. In one case, a respiratory sensor  4410  senses the respiration cycle of the patient. The respiratory sensor sends the patient&#39;s respiration pattern or information to an algorithm in the magnetic field controller  4420 , typically via the patient interface module  150  and/or via the main controller  110  or a subcomponent thereof. The algorithm predicts and/or measures when the patient is at a particular point in the respiration cycle, such as at the top or bottom of a breath. One or more magnetic field sensors  1650  are used as inputs to the magnetic field controller  4420 , which controls a magnet power supply for a given magnetic, such as within a first turning magnet  1010  of a synchrotron  130 . The control feedback loop is thus used to dial the synchrotron to a selected energy level and to deliver protons with the desired energy at a selected point in time, such as at a particular point in the respiration cycle. The selected point in the respiration cycle is optionally anywhere in the respiration cycle and/or for any duration during the respiration cycle. As illustrated in  FIG.  45   , the selected time period is at the top of a breath for a period of about 0.1, 0.5, 1 seconds. More particularly, the main controller  110  controls injection of hydrogen into the injection system, formation of the negative ion  310 , controls extraction of negative ions from negative ion source  310 , controls injection  120  of protons into the synchrotron  130 , and/or controls acceleration of the protons in a manner that combined with extraction  134  delivers the protons  140  to the tumor at a selected point in the respiration cycle. Intensity of the proton beam is also selectable and controllable by the main controller  130  at this stage, as described supra. The feedback control from the magnetic field controller  4420  is optionally to a power or power supplies for one or both of the main bending magnet  250 , described supra, or to the correction coils  1520  within the main bending magnet  250 . Having smaller applied currents, the correction coils  1510 ,  1520  are rapidly adjustable to a newly selected acceleration frequency or corresponding charged particle energy level. Particularly, the magnetic field controller  4420  alters the applied fields to the main bending magnets or correction coils that are tied to the patient&#39;s respiration cycle. This system is in stark contrast to a system where the current is stabilized and the synchrotron delivers pulses with a fixed period. Preferably, the feedback of the magnetic field design coupled with the correction coils allows for the extraction cycle to match the varying respiratory rate of the patient, such as where a first respiration period  4510 , P 1 , does not equal a second respiration period  4520 , P 2 . 
     Referring now to  FIG.  46   , an example of a charged particle cancer therapy system  100  is provided. A main controller receives input from one, two, three, or four of a respiration monitoring and/or controlling controller  4610 , a beam controller  4615 , a rotation controller  4650 , and/or a timing to a time period in a respiration cycle controller  4660 . The beam controller  4615  preferably includes one or more or a beam energy controller  4620 , the beam intensity controller  1940 , a beam velocity controller  4630 , and/or a horizontal/vertical beam positioning controller  4640 . The main controller  110  controls any element of the injection system  120 ; the synchrotron  130 ; the scanning/targeting/delivery system  140 ; the patient interface module  150 ; the display system  160 ; and/or the imaging system  170 . For example, the respiration monitoring/controlling controller  4610  controls any element or method associated with the respiration of the patient; the beam controller  4615  controls any of the elements controlling acceleration and/or extraction of the charged particle beam; the rotation controller  4650  controls any element associated with rotation of the patient  2130  or gantry; and the timing to a period in respiration cycle controller  4660  controls any aspects affecting delivery time of the charged particle beam to the patient. As a further example, the beam controller  4615  optionally controls any magnetic and/or electric field about any magnet in the charged particle cancer therapy system  100 . 
     Computer Controlled Patient Repositioning 
     One or more of the patient positioning unit components and/or one of more of the patient positioning constraints are preferably under computer control. For example, the computer records or controls the position of the patient positioning elements  3315 , such as via recording a series of motor positions connected to drives that move the patient positioning elements  3315 . For example, the patient is initially positioned  3810  and constrained by the patient positioning constraints  3315 . The position of each of the patient positioning constraints is recorded and saved by the main controller  110 , by a sub-controller of the main controller  110 , or by a separate computer controller. Then, imaging systems are used to locate the tumor  2120  in the patient  2130  while the patient is in the controlled position of final treatment. Preferably, when the patient is in the controlled position, multi-field imaging is performed, as described herein. The imaging system  170  includes one or more of: MRI&#39;s, X-rays, CT&#39;s, proton beam tomography, and the like. Time optionally passes at this point while images from the imaging system  170  are analyzed and a proton therapy treatment plan is devised. The patient optionally exits the constraint system during this time period, which may be minutes, hours, or days. Upon, and preferably after, return of the patient and initial patient placement into the patient positioning unit, the computer returns the patient positioning constraints to the recorded positions. This system allows for rapid repositioning of the patient to the position used during imaging and development of the multi-field charged particle irradiation treatment plan, which minimizes setup time of patient positioning and maximizes time that the charged particle beam system  100  is used for cancer treatment. 
     Reproducing Patient Positioning and Immobilization 
     In one embodiment, using a patient positioning and immobilization system  4000 , a region of the patient  2130  about the tumor  2120  is reproducibly positioned and immobilized, such as with the motorized patient translation and rotation positioning system  2110  and/or with the patient positioning constraints  3315 . For example, one of the above described positioning systems, such as (1) the semi-vertical partial immobilization system  3300 ; (2) the sitting partial immobilization system  3400 ; or (3) the laying position system  3500  is used in combination with the patient translation and rotation system  2110  to position the tumor  2120  of the patient  2130  relative to the proton beam path  268 . Preferably, the position and immobilization system controls position of the tumor  2120  relative to the proton beam path  268 , immobilizes position of the tumor  2120 , and facilitates repositioning the tumor  2120  relative to the proton beam path  268  after the patient  2130  has moved away from the proton beam path  268 , such as during development of the irradiation treatment plan  4345 . 
     Preferably, the tumor  2120  of the patient  2130  is positioned in terms of 3-D location and in terms of orientation attitude. Herein, 3-D location is defined in terms of the x-, y-, and z-axes and orientation attitude is the state of pitch, yaw, and roll. Roll is rotation of a plane about the z-axis, pitch is rotation of a plane about the x-axis, and yaw is the rotation of a plane about the y-axis. Tilt is used to describe both roll and pitch. Preferably, the positioning and immobilization system controls the tumor  2120  location relative to the proton beam path  268  in terms of at least three of and preferably in terms of four, five, or six of: pitch, yaw, roll, x-axis location, y-axis location, and z-axis location. 
     Chair 
     The patient positioning and immobilization system  4000  is further described using a chair positioning example. For clarity, a case of positioning and immobilizing a tumor in a shoulder is described using chair positioning. Using the semi-vertical immobilization system  3300 , the patient is generally positioned using the seat support  3320 , knee support  3360 , and/or foot support  3370 . To further position the shoulder, a motor in the back support  3330  pushes against the torso of the patient. Additional arm support  3350  motors align the arm, such as by pushing with a first force in one direction against the elbow of the patient and the wrist of the patient is positioned using a second force in a counter direction. This restricts movement of the arm, which helps to position the shoulder. Optionally, the head support is positioned to further restrict movement of the shoulder by applying tension to the neck. Combined, the patient positioning constraints  3315  control position of the tumor  2120  of the patient  2130  in at least three dimensions and preferably control position of the tumor  2120  in terms of all of yaw, roll, and pitch movement as well as in terms of x-, y-, and z-axis position. For instance, the patient positioning constraints position the tumor  2120  and restricts movement of the tumor, such as by preventing patient slumping. Optionally, sensors in one or more of the patient positioning constraints  3315  record an applied force. In one case, the seat support senses weight and applies a force to support a fraction of the patient&#39;s weight, such as about 50, 60, 70, or 80 percent of the patient&#39;s weight. In a second case, a force applied to the neck, arm, and/or leg is recorded. 
     Generally, the patient positioning and immobilization system  4000  removes movement degrees of freedom from the patient  2130  to accurately and precisely position and control the position of the tumor  2120  relative to the X-ray beam path  3070 , proton beam path  268 , and/or an imaging beam path. Further, once the degrees of freedom are removed, the motor positions for each of the patient positioning constraints are recorded and communicated digitally to the main controller  110 . Once the patient moves from the immobilization system  4000 , such as when the irradiation treatment plan is generated  4350 , the patient  2130  must be accurately repositioned in a patient repositioning system  4300  before the irradiation plan is implemented. To accomplish this, the patient  2130  sits generally in the positioning device, such as the chair, and the main controller sends the motor position signals and optionally the applied forces back to motors controlling each of the patient positioning constraints  3315  and each of the patient positioning constraints  3315  are automatically moved back to their respective recorded positions. Hence, re-positioning and re-immobilizing the patient  2130  is accomplished from a time of sitting to fully controlled position in less than about 10, 30, 60, 120, or 600 seconds. 
     Using the computer controlled and automated patient positioning system, the patient is re-positioned in the positioning and immobilization system  4300  using the recalled patient positioning constraint  3315  motor positions; the patient  2130  is translated and rotated using the patient translation and rotation system  2120  relative to the proton beam  268 ; and the proton beam  268  is scanned to its momentary beam position  269  by the main controller  110 , which follows the generated irradiation treatment plan  4350 . 
     Tomography 
     In one embodiment, the charged particle tomography apparatus is used to image a tumor in a patient. 
     In another embodiment, 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 embodiments, the tomography imaging system is optionally simultaneously operational with a charged particle cancer therapy system using common elements, allows tomographic imaging with rotation of the patient, is operational on a patient in an upright, semi-upright, and/or horizontal position, is simultaneously operational with X-ray imaging, and/or allows use of adaptive charged particle cancer therapy. Further, the common tomography and cancer therapy apparatus elements are optionally operational in a multi-axis and/or multi-field raster beam mode. 
     In conventional medical X-ray tomography, a sectional image through a body is made by moving one or both of an X-ray source and the X-ray film in opposite directions during the exposure. By modifying the direction and extent of the movement, operators can select different focal planes, which contain the structures of interest. More modern variations of tomography involve gathering projection data from multiple directions by moving the X-ray source and feeding the data into a tomographic reconstruction software algorithm processed by a computer. Herein, in stark contrast to known methods, the radiation source is a charged particle, such as a proton ion beam or a carbon ion beam. A proton beam is used herein to describe the tomography system, but the description applies to a heavier ion beam, such as a carbon ion beam. Further, in stark contrast to known techniques, herein the radiation source is preferably stationary while the patient is rotated. 
     Referring now to  FIG.  47   , an example of a tomography apparatus is described. In one example, the tomography system  4700  uses elements in common with the charged particle beam system  100 , including elements of one or more of the injection system  120 , accelerator  130 , targeting/delivery system  140 , patient interface module  150 , display system  160 , and/or imaging system  170 , such as the X-ray imaging system. Preferably, a scintillation plate  4710 , such as a scintillating plastic is positioned behind the patient  2130  relative to the targeting/delivery system  140  elements. 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. The intensity or count of protons hitting the plate as a function of position is used to create an image. The patient  2130  is rotated  2117  about the y-axis and a new image is collected. Preferably, a new image is collected with about every one degree of rotation of the patient resulting in about 360 images that are combined into a tomogram using tomographic reconstruction software. 
     The tomographic reconstruction software uses overlapping rotationally varied images in the reconstruction. Optionally, a new image is collected at about every 2, 3, 4, 5, 10, 15, 30, or 45 degrees of rotation of the patient. 
     In one embodiment, a tomogram or an individual tomogram section image is collected at about the same time as cancer therapy occurs using the charged particle beam system. For example, an tomogram is collected and cancer therapy is subsequently performed: without the patient moving from the positioning systems, such as the above described semi-vertical partial immobilization system  3300 , the sitting partial immobilization system  3400 , or the a laying position  3500 . 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  2120  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  2130  within about 5, 10, 15, 30, or 60 seconds of subsequent tumor irradiation therapy. 
     In another embodiment, the independent control of the tomographic imaging process and X-ray collection process allows simultaneous single and/or multi-field collection of X-ray images and tomographic images easing interpretation of multiple images. Indeed, the X-ray and tomographic images are optionally overlaid to from a hybrid X-ray/proton beam tomographic image as the patient is optionally in the same position for each image. 
     In still another embodiment, the tomogram is collected with the patient  2130  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  2120  to be separated from surrounding organs or tissue of the patient  2130  better than in a laying position. Positioning of the scintillation plate  4710  behind the patient  2130  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. 
     In yet still another embodiment, initially a three-dimensional tomographic proton based reference image is collected, such as with hundreds of individual rotation images of the tumor  2120  and patient  2130 . Subsequently, just prior to proton treatment of the cancer, just a few 2-dimensional control tomographic images of the patient are collected, such as with a stationary patient or at just a few rotation positions, such as an image straight on to the patient, with the patient rotated about 45 degrees each way, and/or the patient rotated about 90 degrees each way about the y-axis. The individual control images are compared with the 3-dimensional reference image. An adaptive proton therapy is subsequently performed where: (1) the proton cancer therapy is not used for a given position based on the differences between the 3-dimensional reference image and one or more of the 2-dimensional control images and/or (2) the proton cancer therapy is modified in real time based on the differences between the 3-dimensional reference image and one or more of the 2-dimensional control images 
     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.  48   , a centralized charged particle treatment system  4800  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.  48   , an example of the centralized charged particle treatment system  4800  is provided. Initially, a doctor, such as an oncologist, prescribes  4810  or recommends tumor therapy using charged particles. Subsequently, treatment planning  4820  is initiated and output of the treatment planning step  4820  is sent to an oncology information system  4830  and/or is directly sent to the treatment delivery system  112 , which is an example of the main controller  110 . 
     Still referring to  FIG.  48   , the treatment planning step  4820  is further described. Generally, radiation treatment planning is a process where a team of oncologist, radiation therapists, medical physicists, and/or medical dosimetrists plan appropriate charged particle treatment of a cancer in a patient. Typically, one or more imaging systems  170  are used to image the tumor and/or the patient, described infra. Planning is optionally: (1) forward planning and/or (2) inverse planning. Cancer therapy plans are optionally assessed with the aid of a dose-volume histogram, which allows the clinician to evaluate the uniformity of the dose to the tumor and surrounding healthy structures. Typically, treatment planning is almost entirely computer based using patient computed tomography data sets using multimodality image matching, image coregistration, or fusion. 
     Forward Planning 
     In forward planning, a treatment oncologist places beams into a radiotherapy treatment planning system including: how many radiation beams to use and which angles to deliver each of the beams from. This type of planning is used for relatively simple cases where the tumor has a simple shape and is not near any critical organs. 
     Inverse Planning 
     In inverse planning, a radiation oncologist defines a patient&#39;s critical organs and tumor and gives target doses and importance factors for each. Subsequently, an optimization program is run to find the treatment plan which best matches all of the input criteria. 
     Oncology Information System 
     Still referring to  FIG.  48   , the oncology information system  4830  is further described. Generally, the oncology information system  4830  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  4830  interfaces with commercial charged particle treatment systems. 
     Safety System/Treatment Delivery Control System 
     Still referring to  FIG.  48   , 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  4820  and/or from the oncology information system  4830  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  4820  or direction of the oncology information system  4830 . 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  4840  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  4850 , a radio frequency quadrupole linear accelerator, the injection system  120 , the synchrotron  130 , the accelerator system  132 , the extraction system  134 , any controllable or monitorable element of the beam line  268 , the targeting/delivery system  140 , the nozzle  146 , a gantry  4860  or an element of the gantry  4860 , the patient interface module  150 , a patient positioner  152 , the display system  160 , the imaging system  170 , a patient position verification system  172 , any element described supra, and/or any subsystem element. 
     Still yet another embodiment includes any combination and/or permutation of any of the elements described herein. 
     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. 
     Herein, any integral number is optionally at least the integral number or less than the integral number. 
     Herein, any integral number is optionally the number plus or minus 1, 2, 5, 10, or 20 percent of the integral number. 
     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.