# Carbon-ion synchrotrons and facilities

Source: https://onco.cc/technologies/carbon-ion-synchrotrons/  
OnCo record `carbon-ion-synchrotrons` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Carbon ions are twelve times heavier than protons, so every clinical facility uses a synchrotron ring tens of metres across and fixed or huge rotating beamlines. Only about a dozen centres exist, in Japan, Germany, Italy, Austria, China, South Korea and Taiwan.

## Summary

The Heavy Ion Medical Accelerator in Chiba (HIMAC) treated the first carbon-ion patients in 1994 and remains the reference facility. Carbon nuclei need far higher magnetic rigidity than protons at the same depth, so cyclotrons are impractical and each centre is built around a synchrotron with an injector linac, delivering pulses of a chosen energy to fixed horizontal and vertical beamlines or, at Heidelberg and at HIMAC, to a rotating gantry (the HIMAC gantry uses superconducting magnets built by Toshiba). Siemens built the Heidelberg, Marburg and Shanghai facilities before leaving the field; Toshiba supplied Kanagawa, Yamagata, Yonsei in Seoul and others; Hitachi supplied Osaka and Taipei Veterans General Hospital; CNAO in Pavia and MedAustron in Wiener Neustadt were built from CERN and INFN designs. Japan's QST is developing a compact superconducting design it calls the quantum scalpel to shrink the footprint to a hospital room.

Carbon's dense ionisation gives a higher biological effect per gray than photons or protons, which is the argument for radioresistant tumours such as sacral chordoma, adenoid cystic carcinoma, bone and soft-tissue sarcoma, locally advanced pancreatic cancer and some liver and prostate cancers, but the clinical evidence is mostly from single-arm series and the machines cost several times a proton centre.

## Fields

- Kind: Technology
- Status: established
- Last checked: 2026-09-17
- Tags: machines-wave
- Principle: An injector linac and synchrotron accelerate carbon-12 ions to therapeutic energies and deliver them through fixed beamlines or a superconducting gantry; the ions' dense ionisation track raises biological effectiveness at the Bragg peak.
- Since: 1994
- Strengths: Higher biological effect for radioresistant tumours; Sharper lateral fall-off than protons; Short hypofractionated courses
- Limitations: About a dozen facilities worldwide; Several times the cost of a proton centre; Mostly single-arm evidence

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Particle_therapy
- PTCOG: particle therapy facilities in operation: https://www.ptcog.site/index.php/facilities-in-operation-public
- Malouff et al., Carbon ion therapy: a modern review of an emerging technology (Frontiers in Oncology 2020): https://doi.org/10.3389/fonc.2020.00082

## Connected records

- technologies: [Accelerator-based BNCT systems (NeuCure, nuBeam, NeuPex)](https://onco.cc/technologies/bnct-accelerator-systems/), [Boron neutron capture therapy](https://onco.cc/technologies/bnct/), [Carbon-ion therapy](https://onco.cc/technologies/carbon-ion/), [Hypofractionated radiotherapy](https://onco.cc/technologies/hypofractionated-radiotherapy/), [Pencil-beam scanning and intensity-modulated proton therapy](https://onco.cc/technologies/intensity-modulated-proton-therapy/), [Proton therapy](https://onco.cc/technologies/proton-therapy/), [Proton therapy machines: cyclotrons, synchrotrons and single-room systems](https://onco.cc/technologies/proton-therapy-systems/)
- cancers: [Chordoma](https://onco.cc/cancers/chordoma/), [Head and neck squamous cell carcinoma](https://onco.cc/cancers/head-and-neck/), [Hepatocellular carcinoma](https://onco.cc/cancers/hcc/), [Osteosarcoma](https://onco.cc/cancers/osteosarcoma/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/), [Prostate cancer](https://onco.cc/cancers/prostate/), [Sarcomas (soft tissue, bone, GIST)](https://onco.cc/cancers/sarcoma/)
- fronts: [Devices & Physical Therapies](https://onco.cc/fronts/devices/), [Radiation Therapy](https://onco.cc/fronts/radiation/)
- companies: [Hitachi (particle therapy)](https://onco.cc/companies/hitachi/), [Toshiba Energy Systems & Solutions](https://onco.cc/companies/toshiba-energy-systems/)
- institutions: [Fudan University Shanghai Cancer Center](https://onco.cc/institutions/fuscc/), [Gunma University Heavy Ion Medical Center](https://onco.cc/institutions/gunma-heavy-ion-medical-center/), [Heidelberg University Hospital / NCT / DKFZ](https://onco.cc/institutions/heidelberg-nct/), [QST Hospital (National Institutes for Quantum Science and Technology)](https://onco.cc/institutions/qst-hospital/), [Severance Hospital, Yonsei University](https://onco.cc/institutions/severance/), [Taipei Veterans General Hospital](https://onco.cc/institutions/taipei-veterans-general-hospital/)

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