{"id":"particle-therapy-machines-roadmap","name":"Particle therapy machines: from Loma Linda to proton rooms in a linac vault, carbon gantries and FLASH","route":"/roadmaps/particle-therapy-machines-roadmap/","eras":[{"era":"1988-2001","title":"A proton centre inside a hospital","description":"Loma Linda's proton beam therapy system was cleared by the FDA in February 1988 (K872369, product code synchrotron) and its accelerator team reported that treatments began in October 1990. Massachusetts General's Northeast Proton Therapy Center (K983332) and IBA's proton therapy system (K983024) were cleared in 2001.","status":"historic","refs":[{"id":"proton-therapy-systems","kind":"technology","name":"Proton therapy machines: cyclotrons, synchrotrons and single-room systems","route":"/technologies/proton-therapy-systems/","status":"established","tldr":"Proton centres are built around one of three accelerators, a cyclotron, a synchrotron or a compact synchrocyclotron, feeding one or several treatment rooms through magnets and a rotating gantry the size of a house. Single-room systems have cut the price of entry, and upright treatment chairs may shrink the building again."},{"id":"proton-therapy","kind":"technology","name":"Proton therapy","route":"/technologies/proton-therapy/","status":"established","tldr":"Radiation using protons, which stop inside the tumour instead of passing through, so tissue behind it gets no dose."},{"id":"mgh","kind":"institution","name":"Massachusetts General Hospital Cancer Center","route":"/institutions/mgh/","tldr":"Harvard's largest hospital; leaders in lung cancer targeted therapy, proton therapy, and ctDNA research."},{"id":"iba","kind":"company","name":"IBA (Ion Beam Applications)","route":"/companies/iba/","tldr":"IBA (Ion Beam Applications), of Louvain-la-Neuve, Belgium, is the largest supplier of proton therapy equipment: its Proteus One and Proteus Plus systems equip proton centres worldwide, and it also builds cyclotrons for PET isotope production. Proton therapy's capital cost is the problem its compact systems try to answer."}],"trials":[],"papers":[]},{"era":"2006-2014","title":"Multi-room centres and pencil-beam scanning","description":"Hitachi's PROBEAT synchrotron (K053280, 2006) and its discrete spot scanning (K073059, 2007), Varian's superconducting cyclotron system (K101294, 2010; named ProBeam in K133191, 2014), Sumitomo's cyclotron (K130426, 2013, scanning added in K160612, 2016) and ProTom's Radiance 330 synchrotron (K134052, 2014) built the multi-room centres, and scanning replaced scattered beams.","status":"historic","refs":[{"id":"proton-therapy-systems","kind":"technology","name":"Proton therapy machines: cyclotrons, synchrotrons and single-room systems","route":"/technologies/proton-therapy-systems/","status":"established","tldr":"Proton centres are built around one of three accelerators, a cyclotron, a synchrotron or a compact synchrocyclotron, feeding one or several treatment rooms through magnets and a rotating gantry the size of a house. Single-room systems have cut the price of entry, and upright treatment chairs may shrink the building again."},{"id":"intensity-modulated-proton-therapy","kind":"technology","name":"Pencil-beam scanning and intensity-modulated proton therapy","route":"/technologies/intensity-modulated-proton-therapy/","status":"established","tldr":"Modern proton machines paint the tumour spot by spot with a magnetically steered pencil beam, so the dose can be shaped in three dimensions and the proton's stop-point is put to full use."},{"id":"hitachi","kind":"company","name":"Hitachi (particle therapy)","route":"/companies/hitachi/","tldr":"Hitachi builds synchrotron-based proton therapy systems for centres such as MD Anderson, Mayo Clinic, St. Jude, Johns Hopkins and Hokkaido University, and carbon-ion facilities in Osaka and Taipei."},{"id":"varian","kind":"company","name":"Varian (Siemens Healthineers)","route":"/companies/varian/","tldr":"Varian is the largest radiotherapy equipment maker and is running the first human FLASH proton trials."},{"id":"sumitomo-heavy-industries","kind":"company","name":"Sumitomo Heavy Industries","route":"/companies/sumitomo-heavy-industries/","tldr":"Sumitomo Heavy Industries builds cyclotron-based proton therapy systems for centres including Samsung Medical Center and Chang Gung Memorial Hospital, medical cyclotrons for PET isotopes, and the first approved accelerator for boron neutron capture therapy."},{"id":"protom","kind":"company","name":"ProTom International","route":"/companies/protom/","tldr":"ProTom International makes the Radiance 330, a compact synchrotron-based proton therapy system installed at Massachusetts General Hospital and McLaren in Michigan."}],"trials":[],"papers":[]},{"era":"2012-2022","title":"Compact single-room systems","description":"Mevion's S250 (K120676, 2012), described in its summary as \"a low cost, one-room integrated device\", mounted the accelerator on the gantry; the S250i (K172848, 2017) added scanning with an adaptive aperture. IBA's Proteus ONE (K152224, 2016) used a superconducting synchrocyclotron, \"a compact and more affordable alternative to the isochronous cyclotron\". Varian's ProBeam 360 (K221791, 2022) brought a smaller gantry, a compact beam line, a 226 MeV cyclotron and cone-beam CT; Hitachi's PROBEAT-CR (2019) and PROBEAT-FR (2024) added a 360-degree gantry and faster imaging.","status":"historic","refs":[{"id":"proton-therapy-systems","kind":"technology","name":"Proton therapy machines: cyclotrons, synchrotrons and single-room systems","route":"/technologies/proton-therapy-systems/","status":"established","tldr":"Proton centres are built around one of three accelerators, a cyclotron, a synchrotron or a compact synchrocyclotron, feeding one or several treatment rooms through magnets and a rotating gantry the size of a house. Single-room systems have cut the price of entry, and upright treatment chairs may shrink the building again."},{"id":"mevion","kind":"company","name":"Mevion Medical Systems","route":"/companies/mevion/","tldr":"Mevion Medical Systems, of Littleton, Massachusetts, makes the MEVION S250-FIT, a compact single-room proton therapy system meant to bring protons within reach of community cancer centres. Whether smaller, cheaper proton machines widen access without diluting the evidence base is the open question."},{"id":"iba","kind":"company","name":"IBA (Ion Beam Applications)","route":"/companies/iba/","tldr":"IBA (Ion Beam Applications), of Louvain-la-Neuve, Belgium, is the largest supplier of proton therapy equipment: its Proteus One and Proteus Plus systems equip proton centres worldwide, and it also builds cyclotrons for PET isotope production. Proton therapy's capital cost is the problem its compact systems try to answer."},{"id":"varian","kind":"company","name":"Varian (Siemens Healthineers)","route":"/companies/varian/","tldr":"Varian is the largest radiotherapy equipment maker and is running the first human FLASH proton trials."},{"id":"hitachi","kind":"company","name":"Hitachi (particle therapy)","route":"/companies/hitachi/","tldr":"Hitachi builds synchrotron-based proton therapy systems for centres such as MD Anderson, Mayo Clinic, St. Jude, Johns Hopkins and Hokkaido University, and carbon-ion facilities in Osaka and Taipei."}],"trials":[],"papers":[]},{"era":"2023-2026","title":"No gantry: upright treatment","description":"P-Cure (K221996, 2023) treats a seated patient in front of a fixed beam; Leo Cancer Care's Marie (K250970, 2025) positions and images upright patients; Mevion's S250-FIT (K250986, 2025) pairs Marie with its compact cyclotron, and Mevion states it fits a standard 110 square metre linac vault. The first S250-FIT patient was treated at Stanford in June 2026, and the system is also CE-marked.","status":"current","refs":[{"id":"upright-radiotherapy-positioning","kind":"technology","name":"Upright radiotherapy positioning (Leo Cancer Care Marie, P-Cure, Mevion S250-FIT)","route":"/technologies/upright-radiotherapy-positioning/","status":"emerging","tldr":"Instead of lying on a couch under a rotating machine, the patient sits or perches on a chair that turns in front of a fixed beam. Because the heavy beam line no longer has to rotate, a proton machine can fit in an ordinary radiotherapy room."},{"id":"p-cure","kind":"company","name":"P-Cure","route":"/companies/p-cure/","tldr":"P-Cure makes a compact proton therapy system in which the patient sits upright in a rotating chair in front of a fixed beam, so the treatment fits inside an ordinary radiotherapy room instead of a purpose-built multi-storey building."},{"id":"leo-cancer-care","kind":"company","name":"Leo Cancer Care","route":"/companies/leo-cancer-care/","tldr":"Leo Cancer Care builds radiotherapy equipment that treats patients sitting upright instead of lying down, so the beam can stay fixed and the room, machine and building can be far smaller and cheaper."},{"id":"mevion","kind":"company","name":"Mevion Medical Systems","route":"/companies/mevion/","tldr":"Mevion Medical Systems, of Littleton, Massachusetts, makes the MEVION S250-FIT, a compact single-room proton therapy system meant to bring protons within reach of community cancer centres. Whether smaller, cheaper proton machines widen access without diluting the evidence base is the open question."},{"id":"stanford","kind":"institution","name":"Stanford Health Care / Stanford Cancer Institute","route":"/institutions/stanford/","tldr":"Stanford is home to CAR-T innovation (Mackall, Majzner), the CD47 discovery (Weissman), and AI in medicine."}],"trials":[],"papers":[]},{"era":"2017-2026","title":"Carbon ions: smaller gantries, new countries","description":"Japan's national institute and Toshiba installed a superconducting rotating gantry about 11 m in diameter and 13 m long, against 25 m long for the conventional design, in 2017; Toshiba's Yonsei system began treating with a fixed beam in April 2023 and its first gantry room in May 2024. Hitachi's first heavy-ion system began treatment in Osaka in October 2018. China's NMPA approved the first domestically developed carbon-ion system, at Wuwei, in 2019. Siemens discontinued its proton and carbon facility at Kiel in 2011; its IONTRIS system remains in clinical use in Shanghai. Toshiba has orders from Asan Medical Center and Cleveland Clinic Abu Dhabi.","status":"current","refs":[{"id":"carbon-ion-synchrotrons","kind":"technology","name":"Carbon-ion synchrotrons and facilities","route":"/technologies/carbon-ion-synchrotrons/","status":"established","tldr":"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."},{"id":"carbon-ion","kind":"technology","name":"Carbon-ion therapy","route":"/technologies/carbon-ion/","status":"established","tldr":"Heavier charged particles that kill even radiation-resistant tumours, available at only a handful of centres worldwide."},{"id":"toshiba-energy-systems","kind":"company","name":"Toshiba Energy Systems & Solutions","route":"/companies/toshiba-energy-systems/","tldr":"Toshiba builds carbon-ion therapy facilities, including the superconducting rotating gantry at HIMAC in Chiba and the heavy-ion centres in Kanagawa, Yamagata and at Yonsei in Seoul."},{"id":"hitachi","kind":"company","name":"Hitachi (particle therapy)","route":"/companies/hitachi/","tldr":"Hitachi builds synchrotron-based proton therapy systems for centres such as MD Anderson, Mayo Clinic, St. Jude, Johns Hopkins and Hokkaido University, and carbon-ion facilities in Osaka and Taipei."},{"id":"qst-hospital","kind":"institution","name":"QST Hospital (National Institutes for Quantum Science and Technology)","route":"/institutions/qst-hospital/","tldr":"The world's first carbon-ion therapy hospital (HIMAC, 1994), which established the clinical evidence base for heavy-ion radiotherapy."},{"id":"severance","kind":"institution","name":"Severance Hospital, Yonsei University","route":"/institutions/severance/","tldr":"Severance Hospital houses Yonsei Cancer Center and Korea's first heavy-ion (carbon) therapy centre (2023)."},{"id":"fuscc","kind":"institution","name":"Fudan University Shanghai Cancer Center","route":"/institutions/fuscc/","tldr":"Fudan University Shanghai Cancer Center is China's leading breast cancer centre and the site of first-in-human TROP2 PET imaging."},{"id":"asan-medical-center","kind":"institution","name":"Asan Medical Center","route":"/institutions/asan-medical-center/","tldr":"Asan Medical Center is Korea's largest hospital and a global leader in liver transplantation and gastric cancer surgery."},{"id":"cleveland-clinic-abu-dhabi","kind":"institution","name":"Cleveland Clinic Abu Dhabi","route":"/institutions/cleveland-clinic-abu-dhabi/","tldr":"The Gulf's most advanced private academic hospital, whose Fatima bint Mubarak Center opened in 2023 as the UAE's first integrated cancer centre with proton therapy planned."}],"trials":[],"papers":[]},{"era":"2020-2026","title":"FLASH reaches patients, not yet the market","description":"FAST-01 (10 patients, 2020 to 2022) and FAST-02 (10 treated) delivered proton FLASH at 40 Gy per second or more on a modified ProBeam for painful bone metastases, with mild side effects. IBA says its ConformalFLASH and DynamicARC are in development and not cleared; IntraOp says Mobetron FLASH is investigational; THERYQ's FLASHKNiFE is a research device and its very-high-energy electron FLASHDEEP is in development.","status":"emerging","refs":[{"id":"fast-01","kind":"trial","name":"FAST-01 (proton FLASH for bone metastases)","route":"/trials/fast-01/","status":"completed","tldr":"The first clinical trial of ultra-fast proton radiotherapy, in ten patients with painful bone metastases in the limbs. Treatment ran without technical problems and side effects were like those of ordinary radiotherapy."},{"id":"fast-02","kind":"trial","name":"FAST-02 (proton FLASH for thoracic bone metastases)","route":"/trials/fast-02/","status":"active","tldr":"The second human study of ultra-fast proton radiotherapy, this time for painful bone metastases in the chest wall, close to the lungs and heart. Ten patients were treated with no moderate or worse side effects."},{"id":"flash-rt","kind":"technology","name":"FLASH radiotherapy","route":"/technologies/flash-rt/","status":"phase-1","tldr":"Delivering an entire dose in under a second, which in animals spares healthy tissue while still killing the tumour."},{"id":"flash-research-accelerators","kind":"technology","name":"FLASH research accelerators (Oriatron, Mobetron FLASH, ProBeam FLASH)","route":"/technologies/flash-research-accelerators/","status":"phase-1","tldr":"Machines built or modified to deliver a whole radiation dose in a fraction of a second, so scientists can test whether ultra-fast dosing spares healthy tissue in people the way it does in animals."},{"id":"proton-arc-therapy","kind":"technology","name":"Proton arc therapy","route":"/technologies/proton-arc-therapy/","status":"phase-1","tldr":"Rotating the proton beam continuously around the patient instead of firing from a few fixed angles, to spread the entrance dose and sharpen the target dose."},{"id":"vhee-radiotherapy","kind":"technology","name":"Very-high-energy electron therapy","route":"/technologies/vhee-radiotherapy/","status":"preclinical","tldr":"VHEE radiotherapy fires electrons at 100 to 250 MeV, energies that reach deep tumours and can be steered by magnets, aiming to deliver FLASH-speed radiation from a machine smaller and cheaper than a proton facility. It is still at the accelerator-development and preclinical stage: no patient had been treated by September 2026."},{"id":"theryq","kind":"company","name":"THERYQ","route":"/companies/theryq/","tldr":"THERYQ, part of the French industrial group ALCEN, builds linear accelerators for FLASH radiotherapy, which delivers a whole radiation dose in under 100 milliseconds; its FLASHDEEP produces 100 to 200 MeV electron beams that reach tumours about 20 cm deep. It is still preclinical, with a 38 million euro France 2030 programme to reach a CE mark."},{"id":"iba","kind":"company","name":"IBA (Ion Beam Applications)","route":"/companies/iba/","tldr":"IBA (Ion Beam Applications), of Louvain-la-Neuve, Belgium, is the largest supplier of proton therapy equipment: its Proteus One and Proteus Plus systems equip proton centres worldwide, and it also builds cyclotrons for PET isotope production. Proton therapy's capital cost is the problem its compact systems try to answer."},{"id":"intraop-medical","kind":"company","name":"IntraOp Medical","route":"/companies/intraop-medical/","tldr":"IntraOp makes the Mobetron, a mobile electron-beam machine that can be wheeled into an operating theatre to give a single, targeted dose of radiation to the tumour bed during cancer surgery, and it is also being used in the first human trials of ultra-fast FLASH radiotherapy."}],"trials":[],"papers":[]},{"era":"Next","title":"Cost per patient and proof of benefit","description":"The unmet need is cost and footprint relative to photon radiotherapy, and randomised evidence of which adults benefit. OnCo carries proposals for compact FLASH and proton systems priced like a linac, for pooled coverage with evidence, and for a registry comparing upright and supine treatment.","status":"emerging","refs":[{"id":"idea-moon-compact-flash-proton","kind":"idea","name":"Compact FLASH and proton systems at the price of a conventional linac","route":"/ideas/idea-moon-compact-flash-proton/","tldr":"Ultra-fast FLASH radiotherapy and proton beams may spare healthy tissue dramatically, but the machines cost tens of millions. Engineer versions that any hospital can afford."},{"id":"idea-fund-proton-coverage-with-evidence","kind":"idea","name":"Pooled coverage-with-evidence for proton therapy across all centres","route":"/ideas/idea-fund-proton-coverage-with-evidence/","tldr":"Proton therapy costs far more than standard radiotherapy and, for most adult cancers, nobody knows whether it is better. Payers would cover it only inside trials or registries that answer that question, across every centre at once."},{"id":"idea-mach-upright-versus-supine-registry","kind":"idea","name":"A shared registry comparing upright and lying-down radiotherapy","route":"/ideas/idea-mach-upright-versus-supine-registry/","tldr":"Upright proton machines are being installed, cleared mainly for the head, neck and upper chest, without any head-to-head comparison with lying down. A proposal: every centre records set-up accuracy, comfort and side effects the same way so the comparison exists."},{"id":"b-drug-pricing","kind":"bottleneck","name":"Prices and value","route":"/bottlenecks/b-drug-pricing/","tldr":"New cancer drugs routinely cost over $150,000 a year, often for months of benefit. Systems cannot afford them and patients go bankrupt."}],"trials":[],"papers":[]}],"watch":[]}