and is a mature technology. as with all medical knowledge, understanding of the interaction of radiations with tumor and normal tissue is still imperfect. costs historically, proton therapy has been expensive. an analysis published in 2003 found that the cost of proton therapy is ~2.4 times that of x-ray therapies. newer, less expensive, and dozens more proton treatment centers are driving costs down and they offer more accurate three-dimensional targeting. higher proton dosage over fewer treatments sessions (1/3 fewer or less) is also driving costs down. thus the cost is expected to reduce as better proton technology becomes more widely available. an analysis published in 2005 determined that the cost of proton therapy is not unrealistic and should not be the reason for denying patients access to the technology. in some clinical situations, proton beam therapy is clearly superior to the alternatives. a study in 2007 expressed concerns about the effectiveness of proton therapy for prostate cancer, but with the advent of new developments in the technology, such as improved scanning techniques and more precise dose delivery ('pencil beam scanning'), this situation may change considerably. amitabh chandra, a health economist at harvard university, said, "proton-beam therapy is like the death star of american medical technology... it's a metaphor for all the problems we have in american medicine." proton therapy is cost-effective for some types of cancer, but not all. in particular, some other treatments offer better overall value for treatment of prostate cancer. as of 2018, the cost of a single-room particle therapy system is us$40 million, with multi-room systems costing up to us$200 million. treatment centers control panel of the synchrocyclotron at the orsay proton therapy center, france as of august 2020, there are over 89 particle therapy facilities worldwide, with at least 41 others under construction. as of august 2020, there are 34 operational proton therapy centers in the united states. as of the end of 2015 more than 154,203 patients had been treated worldwide. one hindrance to universal use of the proton in cancer treatment is the size and cost of the cyclotron or synchrotron equipment necessary. several industrial teams are working on development of comparatively small accelerator systems to deliver the proton therapy to patients. among the technologies being investigated are superconducting synchrocyclotrons (also known as fm cyclotrons), ultra-compact synchrotrons, dielectric wall accelerators, and linear particle accelerators. united states proton treatment centers in the united states as of 2020 (in chronological order of first treatment date) include: institution location year of first treatment comments loma linda university medical center loma linda, ca 1990 first hospital-based facility in usa; uses spread out bragg's peak (sobp) crocker nuclear laboratory davis, ca 1994 ocular treatments only (low energy accelerator); at university of california, davis francis h. burr proton center boston, ma 2001 at massachusetts general hospital and formerly known as nptc; continuation of harvard cyclotron laboratory/mgh treatment program that began in 1961; manufactured by ion beam applications university of florida health proton therapy institute-jacksonville jacksonville, fl 2006 the uf health proton therapy institute is a part of a non-profit academic medical research facility affiliated with the university of florida college of medicine-jacksonville. it is the first treatment center in the southeast u.s. to offer proton therapy. manufactured by ion beam applications university of texas md anderson cancer center houston, tx oklahoma proton center oklahoma city, ok 2009 4 treatment rooms, proteus plus system manufactured by ion beam applications northwestern medicine chicago proton center warrenville, il 2010 4 treatment rooms, proteus plus system manufactured by ion beam applications roberts proton therapy center philadelphia, pa the largest proton therapy center in the world, the roberts proton therapy center, which is a part of penn's abramson cancer center, university of pennsylvania health system; 5 treatment rooms, proteus plus system manufactured by ion beam applications hampton university proton therapy institute hampton, va 5 treatment rooms, proteus plus system manufactured by ion beam applications procure proton therapy center somerset, nj 2012 4 treatment rooms, proteus plus system manufactured by ion beam applications scca proton therapy center seattle, wa 2013 at seattle cancer care alliance; part of fred hutchinson cancer research center; 4 treatment rooms, proteus plus system manufactured by ion beam applications siteman cancer center st. louis, mo first of the new single suite, ultra-compact, superconducting synchrocyclotron, lower cost facilities to treat a patient using the mevion medical system's s250. provision proton therapy center knoxville, tn 2014 3 treatment rooms, proteus plus system manufactured by ion beam applications california protons cancer therapy center san diego, ca 5 treatment rooms, manufactured by varian medical systems ackerman cancer center jacksonville, fl 2015 ackerman cancer center is the world's first private, physician-owned practice to provide proton therapy, in addition to conventional radiation therapy and on-site diagnostic services. the laurie proton therapy center new brunswick, nj the laurie proton therapy center, part of robert wood johnson university hospital, is home to the world's third mevion s250 proton therapy system. texas center for proton therapy dallas fort worth, tx a collaboration by "texas oncology and the us oncology network, supported by mckesson specialty health, and baylor health enterprises"; three pencil beam rooms and cone beam ct imaging. 3 treatment rooms, proteus plus system manufactured by ion beam applications mayo clinic jacobson building rochester, mn 4 treatment rooms. manufactured by hitachi. st. jude red frog events proton therapy center memphis, tn 3 treatment rooms mayo clinic cancer center phoenix, az 2016 4 treatment rooms. manufactured by hitachi. the marjorie and leonard williams center for proton therapy orlando, fl http://www.ufhealthcancerorlando.com/centers/proton-therapy-center cancer and blood diseases institute liberty township, oh collaboration of university of cincinnati cancer institute and cincinnati children's hospital medical center, manufactured by varian medical systems maryland proton treatment center baltimore, md 5 treatment rooms, affiliated with the university of maryland greenebaum comprehensive cancer center, manufactured by varian medical systems. proton therapy center at university hospitals seidman cancer center cleveland, oh only proton therapy center in northern ohio. one treatment room with the mevion s250 proton therapy system. part of the nci-designated case comprehensive cancer center, university hospitals seidman cancer center is one of the nation's leading freestanding cancer hospitals. miami cancer institute miami, fl 2017 3 treatment rooms, all using pencil-beam scanning manufactured by ion beam applications beaumont proton therapy center royal oak, mi single treatment room, proteus one system manufactured by ion beam applications emory proton therapy center atlanta, ga 2018 five treatment rooms, probeam superconducting cyclotron manufactured by varian medical systems provision cares proton therapy center nashville, tn three treatment rooms, two gantries and one fixed beam, all pencil beam scanning, manufactured by pronova solutions, llc mclaren proton therapy center flint, mi the mclaren proton therapy system uses the industry's highest energy 330 mev proton synchrotron to accelerate and deliver proton beam to two treatment rooms, with an opportunity to extend into a planned third room. both operating treatment rooms are equipped with proton pencil beam scanning, cone beam computed tomography for image guidance, patient positioning system with 6-degrees of freedom that coupled with 180-degree partial gantry allows for complete flexibility of treatment angles. new york proton center new york, ny 2019 a partnership between memorial sloan kettering, montefiore health, and mount sinai health system. 4 treatment rooms, manufactured by varian medical systems johns hopkins proton therapy center washington, dc 3 treatment rooms and 1 research gantry. manufactured by hitachi. south florida proton therapy institute delray beach, fl one treatment room, manufactured by varian medical systems uab proton therapy center birmingham, al 2020 one treatment room, manufactured by varian medical systems dwoskin ptc - university of miami miami, fl one treatment room, manufactured by varian medical systems the inova mather proton therapy center fairfax, va two treatment rooms, manufactured by ion beam applications the university of kansas cancer center kansas city, ks 2022 announced feb 2019 penn medicine lancaster general health ann b. barshinger cancer institute lancaster, pa one treatment room, manufactured by varian medical systems penn medicine virtua health voorhees, nj one treatment room, manufactured by varian medical systems mayo clinic florida jacksonville, fl 2023 (estimated) announced june 2019 ohio state, nationwide children's hospital columbus, oh three treatment rooms, manufactured by varian medical systems froedtert hospital wauwatosa, wi 2024 (estimated) announced may 2022 the indiana university health proton therapy center in bloomington, indiana opened in 2004 and ceased operations in 2014. outside the us proton therapy centres (partial list) institution maximum energy (mev) year of first treatment location paul scherrer institute 250 1984 villigen, switzerland clatterbridge cancer centre nhs foundation trust, low-energy for ocular 62 1989 liverpool, united kingdom centre de protonthérapie de l'institut curie 235 1991 orsay, france centre antoine lacassagne 63 1991 nice, france research center for charged particle therapy 350–400 1994 chiba, japan triumf 74 1995 vancouver, canada helmholtz-zentrum berlin 72 1998 berlin, germany proton medical research center university of tsukuba 250 2001 tsukuba, japan centro di adroterapia oculare 60 2002 catania, italy wanjie proton therapy center 230 2004 zibo, china proton therapy center, korea national cancer center 230 2007 seoul, korea heidelberg ion-beam therapy center (hit) 230 2009 heidelberg, germany medipolis proton therapy and research center 235 2011 kagoshima, japan instytut fizyki jądrowej 230 2011 kraków, poland centro nazionale di adroterapia oncologica 250 2011 pavia, italy protonové centrum v praze (ptc, prague) 230 2012 prague, czech republic westdeutsches protonentherapiezentrum essen 230 2013 essen, germany ptc uniklinikum dresden 230 2014 dresden, germany centro di protonterapia, apss trento 230 2014 trento, italy shanghai proton and heavy ion center 230 2014 shanghai, china centrum cyklotronowe bronowice 230 2015 kraków, poland samsung medical center proton therapy center 230 2015 seoul, korea proton and radiation therapy center, linkou chang gung memorial hospital 230 2015 taipei, taiwan yung-ching proton center, kaohsiung chang gung memorial hospital 230 2018 kaohsiung, taiwan skandionkliniken 230 2015 uppsala, sweden a. tsyb medical radiological research centre 250 2016 obninsk, russia medaustron 250 2016 wiener neustadt, austria clinical proton therapy center dr. berezin medical institute 250 2017 saint-petersburg, russia holland proton therapy center 250 2018 delft, netherlands umc groningen protonen therapie centrum 230 2018 groningen, netherlands the christie 250 2018 manchester, united kingdom danish centre for particle therapy 250 2019 aarhus, denmark apollo proton cancer centre 230 2019 chennai, india maastro clinic proton therapy 230 2019 maastricht, netherlands clínica universidad de navarra 230 2019 madrid, spain centro de protonterapia de quirónsalud 230 2019 madrid, spain king chulalongkorn memorial hospital 250 2021 bangkok, thailand university college london hospitals 250 2021 london, united kingdom singapore institute of advanced medicine 250 tba singapore hefei ion medical center 250 2021 hefei, china proton clinical research center of the shandong cancer hospital 250 2022 jinan, china mount elizabeth proton therapy centre 230 2023 singapore national cancer centre singapore - goh cheng liang proton therapy centre tba singapore australian bragg centre for proton therapy & research 330 2023–2025 adelaide, australia australia in july 2020, construction began for "sahmri 2", the second building for the south australian health and medical research institute. the building will house the australian bragg centre for proton therapy & research, a a$500+ million addition to the largest health and biomedical precinct in the southern hemisphere, adelaide's biomed city. the proton therapy unit is being supplied by protom international, which will install its radiance 330 proton therapy system, the same system used at massachusetts general hospital. when in full operation, it will have the ability to treat approximately 600-700 patients per year with around half of these expected to be children and young adults. the facility is expected to be completed in late 2023, with its first patients treated in 2025. india apollo proton cancer centre (apcc) in chennai, tamil nadu, a unit under apollo hospitals, is a cancer specialty hospital. apcc is the only cancer hospital in india with joint commission international accreditation. israel in january 2020, it was announced that a proton therapy center would be built in ichilov hospital, at the tel aviv sourasky medical center. the project's construction was fully funded by donations. it will have two treatment rooms. spain in october 2021, the amancio ortega foundation arranged with the spanish government and several autonomous communities to donate 280 million euros to install ten proton accelerators in the public health system. united kingdom prince charles and dr. yen-ching chang at the university college london hospitals nhs foundation trust proton centre opening ceremony in