Proton and carbon beam therapy are rapidly spreading treatment options for neoplasms and are clinically accepted for various tumor modalities. With state-of-the-art imaging and immobilization devices higher target conformation can be achieved and – in the case of carbon beam therapy – often a differentially increased biological effect that allows further dose escalation in the target volume. Currently, ideas spread that aim to explore new treatment options both technically and from a clinical perspective. These include combined imaging and treatment settings by using a high-energetic beam penetrating the patient to allow online monitoring and applications in non-cancerous diseases.