Charged particle therapy is generally regarded as cutting-edge technology in oncology. Many proton therapy centres are active in the USA, Europe, and Asia, but only a few centres use heavy ions, even though these ions are much more effective than x-rays owing to the special radiobiological properties of densely ionising radiation. The National Institute of Radiological Sciences (NIRS) Chiba, Japan, has been treating cancer with high-energy carbon ions since 1994. So far, more than 8000 patients have had this treatment at NIRS, and the centre thus has by far the greatest experience in carbon ion treatment worldwide. A panel of radiation oncologists, radiobiologists, and medical physicists from the USA and Europe recently completed peer review of the carbon ion therapy at NIRS. The review panel had access to the latest developments in treatment planning and beam delivery and to all updated clinical data produced at NIRS. A detailed comparison with the most advanced results obtained with x-rays or protons in Europe and the USA was then possible. In addition to those tumours for which carbon ions are known to produce excellent results, such as bone and soft-tissue sarcoma of the skull base, head and neck, and pelvis, promising data were obtained for other tumours, such as locally recurrent rectal cancer and pancreatic cancer. The most serious impediment to the worldwide spread of heavy ion therapy centres is the high initial capital cost. The 20 years of clinical experience at NIRS can help guide strategic decisions on the design and construction of new heavy ion therapy centres.

Clinical trials using accelerated heavy charged-particle beams for treating cancer and other diseases have been performed for nearly four decades. Recently there have been worldwide efforts to construct hospital-based medically dedicated proton or light-ion accelerator facilities. To make such accelerated heavy charged-particle beams clinically useful, specialized instruments must be developed to modify the physical characteristics of the particle beams in order to optimize their biological and clinical effects. This article reviews the beam modifying devices and associated dosimetric equipment developed specifically for controlling and monitoring the clinical beams.

A system for spreading relativistic heavy ion beams into large uniform radiation fields has been developed. The charged particles passing through the system are deflected into azimuthally symmetric distributions which can then be superimposed to produce dose distributions as large as 30 cm in diameter with less than +/- 3.5% variation in uniformity.