In fixed-beam treatment rooms the beam is directed with an array of magnets to the nozzle which is fixed in space. Then, the patient is rotated and translated with a robotic system to enable beam incidence from various angles for optimal target coverage. Fixed-beam rooms are about three times smaller than gantry rooms; therefore the size of the volume to be shielded is significantly reduced. Fixed-beam

rooms can be used for many treatment sites [2], although the full applicability for all tumour sites has not yet been investigated. Goiten [3] argued Idasanutlin order that replacement of gantries by one or a few fixed beams in order to reduce the cost of a facility would be likely to result in sub-optimal treatments in a significant proportion of cases, but this depends on the kind of LY2228820 technology adopted for positioning. Smith et al. [4] suggested some project solutions to improve efficiency with lower costs, such as:

a) using treatment setup rooms outside the treatment room, which should improve the patient outcome, especially PXD101 in vivo for paediatric patients who need to spend more time in the treatment setup room, also due to anaesthesia procedures; b) using faster, automated imaging techniques for patient positioning both outside and inside the treatment room; c) using robotics for transferring and positioning patients both outside and inside the treatment room, for moving imaging devices, and for handling treatment appliance. Patient Resveratrol positioning systems In modern X-ray radiotherapy, patients can be positioned in the treatment room by automatic couches with 6 degrees of freedom (i.e. allowing translation and rotations). In isocentric gantry treatment rooms, the combination of gantry and couch movement provides greater flexibility in delivering multiple beams, from different directions, to optimize the dose distribution. Recently, robots have been introduced into particle

therapy applications to be used for holding and positioning imaging systems or to replace traditional patient couches. Accuracy and reproducibility of these devices are very important in their design and development. Moreover, lasers and imaging devices (x-ray tubes and image receptors) need to be included in each treatment and/or setup room. The lasers are used for initial patient set up (to get the patient close to the treatment position) and the imaging systems provide orthogonal (or in some cases three-dimensional) images of the patients to be compared with digitally planning images generated by treatment planning systems. Modern technology could again improve the evaluation of correct patient or beam positioning. This could lead to new positioning and immobilization solutions for initial setup and for patient/organ motion management [5]. The Midwest Proton Radiotherapy Institute (MPRI) At MPRI (Bloomington, IN, USA) protons are produced in an accelerator and are transported by magnetic beam lines to one or more treatment rooms.