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These clinical needs, together with the unique physical and biological characteristics of carbon ion beams, form the foundation of the design philosophy for the Mayo Clinic Florida (MCF) CIRT program. The program remains under active development, with clinical deployment planned for 2028. Building upon the clinical rationale and anticipated U.S. patient population discussed in Part I of this two\u2010part review, this Vision Article describes how MCF intends to develop an integrated CIRT treatment system. The program is guided by two overarching principles: fast, accurate, and safe beam delivery and accurate treatment planning and treatment delivery, supported by an integrated patient\u2010specific quality assurance framework. Key elements include high\u2010dose\u2010rate dose\u2010driven continuous scanning with advanced beam monitoring and irradiation control, delivery\u2010aware treatment planning, the Monte Carlo\u2010based BioPhys computational platform integrating physical and biological dose modeling, a hierarchical adaptive workflow, and patient\u2010specific quality assurance spanning pretreatment, on\u2010treatment, and post\u2010treatment verification. This framework provides a technical roadmap for the integrated clinical implementation of CIRT at MCF.<\/jats:p>","DOI":"10.1002\/acm2.70866","type":"journal-article","created":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T16:00:04Z","timestamp":1792512004000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Vision and implementation for the first U.S. carbon ion therapy center part II: Design philosophy and clinical implementation"],"prefix":"10.1002","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6688-1045","authenticated-orcid":false,"given":"Xiaoying","family":"Liang","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Mayo Clinic  Jacksonville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris J","family":"Beltran","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Mayo Clinic  Jacksonville Florida 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