In this study, we performed on-beam monitoring of 511 keV annihilation gamma emissions using a Compton camera. Beam monitoring experiments were conducted using carbon ion beams of 290 MeV/u irradiated on a polymethyl methacrylate (PMMA) phantom. The intensity of the beams was 3 × 109 particles per pulse, with 20 pulses per minute. A Compton camera based on a silicon/cadmium telluride (Si/CdTe) detector was used to monitor the annihilation gamma rays emitted from the phantom. We successfully reconstructed the energy events of 511 keV annihilation gamma rays and developed Compton images using a simple back-projection method. The distribution of the annihilation gamma ray generation traced the beam trajectory and the peak intensity position was a few millimeters shorter than the Bragg peak position. Moreover, the effect of the beam range shifter with 30, 60, and 90 mm water equivalent thickness (WET) was clearly visualized in the reconstructed Compton images. The experimentally measured values of the corresponding range shifts in the PMMA phantom (28.70 mm, 52.49 mm, and 76.77 mm, respectively) were consistent with the shifts of the Bragg peak position (25.50 mm, 51.30 mm and 76.70 mm, respectively) evaluated by Monte Carlo simulation. The results show that the Si/CdTe Compton camera has strong potential for on-beam monitoring of annihilation gamma rays in particle therapy in clinical situations.