Proton radiation therapy involves accurate delivery of proton beams to targets inside the body without direct visual control of the internal anatomy. Targeting of the tumor and avoidance of critical structures within the patient have to be both accurate and precise to achieve the desired therapeutic results. Good understanding of proton radiation delivery and patient alignment concepts in the treatment room is essential to achieve this goal. This overview article presents treatment room concepts that will ensure precise proton beam delivery and, at the same time, guarantee an efficient patient throughput. Concepts discussed include effective patient immobilization, image-guided alignment verification, appropriate training of radiotherapists, and the physician?s integrative role in understanding the complex spatial relationships between tumor, organs at risk, treatment beam configuration, and application of proton radiation dose. It will be demonstrated that in addition to the technical armamentarium, now commonplace in modern radiation oncology departments, the interaction between radiation oncologist, medical physicist and radiotherapist is important for efficient operation of a proton treatment facility.

Key words: Proton therapy; Treatment room concepts; and Image guidance.