changes and organ motion. The current clinical approach is to increase the high dose volume to ensure target coverage, counteracting the primary advantage of CIRT. Novel strategies for image guidance and beam [...] ion beams that enable concurrent treatment and image guidance. Carbon ions deliver the dose to the target while Helium ions, simultaneously accelerated to the same velocity, traverse the patient and monitor [...] location and beam range. PROMISE realizes true portal imaging, providing real-time information on the target anatomy as seen by the treatment beam. Coupled with innovative detectors, AI-based image recognition