How does proton radiation therapy work?

A cancer diagnosis can be a devastating thing to hear, but new treatments are greatly improving a person’s chance of being cured. In this video, Fermilab’s Dr. Don Lincoln explains the physics of an exciting treatment option, called proton radiation therapy, which is far superior to traditional therapy, at least in some cases.

[@donnahall1511]

I had 33 straight days of proton radiation therapy, that has got to be the coolest thing I have ever seen or experienced. The side effects were zero.

[@arpeggio22]

Thank you, Dr. Lincoln, that was a great explanation. I just started proton radiation therapy at the Chicago Center shown in the video and I marvel at the technology. During each session I think about all the incredibly intelligent people that led up to the machine I'm in that's killing the cancer that's trying to kill me. I'm humbled and deeply appreciative of their life's work, both Doctors and Useful Doctors, alike! Thank you for saving my life.

[@EliSantana]

Radiation therapy was used to save my brother's life from a rare eye cancer by the brilliant folks at MGH. Thanks to everyone involved in developing revolutionary medicine to make our lives better :)

[@philippenachtergal6077]

Yeah. Eye cancer is one of the best applications of proton therapy. There is even a chance of saving the eye which you can never hope for with X rays. I hope your brother did manage to keep his.

[@jemc750gmail]

What was the cancer? We're in Houston with my son for treatment for adenoid cystic carcinoma behind his eye

[@icinaantoine7924]

What is worms

[@Thedirtylittlesecret]

Any updates on any of these cases?

[@fcfp14A]

Dear Dr Lincoln, Thanks for you practical info..... I will refer my patients to your video...very clear and concise. We use the proton beam a lot in our area to treat prostate cancer. Aunt Margaret was wrong; you are the "smarter" type of doctor. : )

[@GiacomodellaSvezia]

This year, a friend of mine needed radiation therapy for the most malignant brain tumor known. He's doing fine for now, thanks to professional medics, AND scientists who paved the way. To say you're not a useful doctor is a grave underestimation. These bits of knowledge you present us with are very nutritious to the brain.

[@robynward8503]

I love how you take complex knowledge and translate it into simple layman terms! Thanks!

[@Les537]

You make youtube a better place, Dr. Don. Keep them coming.

[@khalidakram]

This is an excellent video. I am due to start volunteering at a Proton Beam Therapy hospital in London in November this year. Excellent background information for me. Thank you.

[@MonoCap]

Of course you are a real doctor ;) the best one!

[@jamespurks1694]

Quite correct Peter. He has a Ph.D in physics while a physician has an MD degree after completing 4 years of medical school after 4 years of college. They then go through 3 to 7 years of residency in a hospital, with the length of residency depends on what specialty. For example, a neurosurgery residency last 6 to 7 years to complete.

[@mipeach5982]

Love your humor and explanation! Thank you!

[@melissawiedefeld251]

Great way to explain proton therapy. I'm currently in treatment using this type of therapy You explained this way better than I was told!

[@EmpyreanCapital]

How was it

[@user-nq1uf7nt9v]

I love him inspecting the cooling lines on the magnet when he was in the vault with the cyclo like it was something very interesting.

[@stevegovea1]

Thank you for continuing to upload educational videos.

[@ytashu33]

Very cool, very informative. More please! Thanks!!

[@marcopastrana909]

Excelente, me encanta el canal y cada uno de los vídeos que hacen. Solo un detalle, en el minuto 2:30, la máquina que sale ahí no es una fuente de radiación gamma, es un acelerador lineal que produce haces de rayos X de alta energía (MV), que también son utilizados en Radioterapia, incluso, hoy en día, se utilizan más que la radiación gamma. Cabe destacar que los aceleradores lineales también puede generar haces de electrones usados para tratamientos de lesiones más superficiales. ¡Saludos desde México!

[@francineganmor9952]

Thank you so much Dr. Extremely informative.

[@SpaghettiToaster]

Dr. Lincoln, would you consider making a video on the interpretation of amplitude in the context of a lightwave? Specifically, how would one think about the amplitude of a single photon? Would this even make sense? This question doesn't seem to have an easy answer, but I feel like it would be perfectly suited to this video series! Thank you very much!

[@joeglennaz]

Thank you for the video it was a very great simplistic yeah detailed overview. I have been told I need a biopsy of the prostate. So I’ve been looking up information online

[@pguti778]

Thank you Don! You're the best!!!

[@fasdr]

as a medical physicist working in the radiation oncology field for quite few years I both really like the explanation of in the video and hate it at the same time because it's a very nice explanation of the physics and theory behind both technologies but wen you get to the practical aspect of things proton therapy does not have that much pluses compared to conventional photon or gamma ray therapy.... protons are much more expensive much more dangerous need much higher level of competence of the staff and are much more harder to work with with the higher energies (20 to 40 times the energy of normal radiotherapy) you have a not more other effects that are still not well studied how they affect the patient long term, yeas they spare 20-30% more the healthy tissues compared to standard radiotherapy but coverage of the tumor is not that much better if at all better and it has limitations because it has problems with high density structures at the end of the day both technologies are good and work and are much less destructive to normal tissues than few years back one is good for certain things the other is good for other things and we as specialists need to choose the right one for the specific patient go give him the best chance of survival with minimum side effects not to choose based on what's modern and cool or what we get more money from...... both technologies have their place and are better than the other one in specific cases

[@rafascd12]

Really like your videos!! Nice job Doctor!!

[@mariarodriguez5608]

Will definitely ask my doctor for this procedure.

[@gailflanagan1214]

Thank you so much for a simple explanation of the different treatments. I was just diagnosed with tonsil cancer so I want to see if Proton Therapy will work for me. I understand there are less side effects. As you suggested, I will ask my doctor. Unfortunately, we do not have a Proton Therapy facility in my area but I'm willing to travel.

[@kevinmoore2501]

The way SRT/SRS is similar to this, with the area the beams cross being the area that get the most radiation. Great video by the way. Liked.

[@pamelamaidens9835]

Great video. Very helpful.

[@orhantokur7811]

Awesome explanation!

[@ganganaboinasuresh195]

clear information abt proton therapy....thnku

[@jsfbr]

Thanks, Professor.

[@VictorHugoCA93]

Please, do more of this videos. I mean, medical physics videos!

[@datapro007]

Great video Don.

[@MistressGlowWorm]

A wonderful presentation, and I have an Aunt Margaret too.

[@alphahelix5526]

great video Sir.

[@karinalbaugh7785]

My 15 y old son got 5 weeks of treatment and his tumor is GONE. Proton therapy is my new best friend. Much better use of atoms than proton bombs.

[@Thedirtylittlesecret]

Any update? i wish for a miracle.

[@astropredo]

I LOVE THIS MAN!!

[@hekk_tech5975]

the video is a bomb! very entertaining and helpful! thanks

[@anubhav21dec]

You are THE doctor!

[@jamespurks1694]

A very interesting and informative video Dr. Lincoln. I would to know if the interesting tee/sweat can be purchased from Fermilab and if so, how does one order them. Thank you for your time.

[@robertrpenny]

Dr Don, great video on proton RT. Your aunt M seems to be missing the point since you are 'the bomb'. Maybe got her FOR's all confused in your relativity videos. Haha. But really I wish I had a communicator of your quality when I struggled through my BSc many years ago. Physics becomes much easier if a concept is well delivered before the math sets in. Thanks for sharing your phenomenal talent with world. Bob

[@manuelmoraleda9285]

Very clear. Now I have to be educated on the Bragg Effect. Thank you.

[@rja7420]

Thank you Dr.

[@constpegasus]

A different kind of work here for sure but as usual great. Keep them coming. Also, how about a video on identical particles. How can fields be so perfect to produce electrons identical including their charges. Something perfect producing perfect particles. That seems more unlikely than than being at the mercy of straying too much or little of the cosmological constant.

[@dennyoconnor8680]

Excellent presentation for the general public. My compliments. dr o

[@Zheeraffa1]

5:29 Is it really a coincidence that Robert R. Wilson looks like he could be Don Lincoln's grandfather?

[@jannoottenburghs5121]

They used gamma rays back in the days when they used Cobalt sources, but these days conventional radiotherapy are high energetic x rays produced by a linear accelerator Also the photons that past through the person have a build up effect so the first 2 centimeters of the surface aren't getting the full dose

[@dwayneholmes8498]

Thank you. That's what I was thinking. Full dose at Dmax ranges from .5 to several cm under the surface.

[@inertia186]

So, maybe you're not a real doctor. But you did something no real doctor has done for me. I've heard those radio and tv ads for a while and I never bothered to investigate the physics. I had a feeling it was real, but I never knew for sure if it wasn't just another one of those pseudo-science topics. Now I know it's real.

[@Markle2k]

On the other hand, the guy over in the Recommended column to the right, claiming to have a cure for stage 4 cancer using baking soda? You shouldn't listen to him. He's not even a PhD, let alone and MD.

[@spagbowlsparmacheese629]

Great vid You’re a cool cat.. I’m following.. science and physics interests me so much as well as targeting cancer cells by “marking” them.

[@julzbell1963]

Thank you

[@goodwillhart]

Very interesting video. However, I would have found it interesting to hear why the Bragg effect happens, in qualitative terms of course.

[@bruinflight1]

I know how youtube therapy works, and a healthy dose of Fermilab videos prescribed by Dr. Lincoln is the medicine for science!

[@DrumNut927]

You’re da bomb Doc.

[@Uncut_With_Hritu]

Thanks

[@Majinant]

Why do your videos have horizontal interlacing issues? You using an old camera?

[@patricks.7814]

Thank you for this video! My cousin is having a brain tumor treated by this method and I wanted to know how it differed from traditional gamma radiation.

[@blackmatterlives9865]

How is your cousin doing now? Hope the best for yall.

[@ranjkurdish]

My friend nedd this , have cancer in maind , where this have form ?

[@prakashthanekar8766]

Is this useful for peri toneal cancer .

[@lomeranger]

Can the “Bragg” area be tuned? Do you know the percentage of energy delivered to the target area vs the entry beam? Excellent video. My wife is about to undergo this therapy and I want to know as much as I can. Thank you.

[@Zeusdie0]

Yep, you can tune the area where the bragg peak (where the protons stop and relay the most energy) by adjusting the kinetic energy, essentially speed, of the protons, which is fairly easy. Not so sure about the energy delivered, I'd say about 20% (tissue) to 80% (tumor), but I might be wrong and you might wanna check wikipedia on that... Hope your wife gets better!

[@stagepyro]

Next video on heavy ion therapy, please. Heidelberg (Germany) for example.

[@locutusdborg126]

I wonder if using neutrons would work as well. Great presentation.

[@KohuGaly]

neutrons work a little bit differently, because they are not charged, but radioactive. If you accelerate neutrons at the right speed and from right distance, you can time it so that most of the neutrons decay when inside the tumour, and very little of them before and after the tumour.

[@kunhimoideenkv4531]

Is IMRT treatment actually Proton therapy OR Photon therapy either X Ray or Gama ?

[@arindamchaudhary9]

Why Bragg peak occur?Please do answer as I will be sitting for MD Radiotherapy final exams within 3 months.

[@carlw]

The 11 down votes must be Aunt Margaret.

[@nbfresh00]

Sir actually because of 'Build-up effect' surface tissue will not get maximum dose

[@cortster12]

3:52 I was just thinking that that would fix the problem... Not suprised they actually do it, as it sounded too perfect not to be the case.

[@anupamniraula6339]

@1:43 Alpha particle doesn't posses electrical charge? But what i had always read is, alpha particles are helium nuclei with +2 charge and a proton has +1 charge.

[@Lethmyr_]

Due to ionized electrons having enough energy to ionize other electrons the dosis maximum with gamma rays actually is not at its maximum at the surface. With rising energy, the dosepeak gets shifted deeper into the tissue (we call that Aufbaueffekt in germany, no idea how it's called in english), one of the reasons why radiotherapists use energies at 6-20MeV.

[@EyeOfAllah]

How can you prevent the anti-protons in your body from destroying the protons injected for therapy?

[@robertlunsford1350]

The device you show for conventinoal radiation therapy is an accelerator. It accelerates electrons via a linac and either uses them directly with the specific energy achived with an electromagnet filter or it slams them into a gold or tungsten target releasing high energy xrays in the 6 to 20 Mev range. I do not think those are high energy enough to be called gamma.

[@mitzvahgolem8366]

I am a survivor....gamma saved me. 26yrs now. Proton therapy is promising. Focused gamma camera multiple beam awesome idea. שלום

[@Thedirtylittlesecret]

How old are you?

[@fcfp14A]

PS: Love your videos !

[@CaptTerrific]

I learned all about this on the tour a few months ago - everyone should go check out the Fermilab accelerator!!!

[@CaptTerrific]

+ScienceNinjaDude They don't anymore (iirc), but they used to - there is literally an old room off of one of the accelerators where a number of doctors did this for years! It was called the Fermilab Cancer Therapy Facility

[@angelaarrow4123]

fantastic

[@minutebrainperson8324]

I picture Deshawn Raw's "but I'm not a rapper" every time Don says "but I'm not a real doctor"

[@Twins0302]

So today we took my sister in law to the Miami Cancer Center and there is a Proton Unit, so was diagnosed ca of pancreas...besides which I am giving her to make Graviola shakes (soursop) and and antioxidant from 4Life..Rio Vida...Emergen C; and plant protein for shakes...We have hope...

[@dvanillagorilla8955]

I read somewhere about inserting gold nano-particles into a tumor and hitting it with radio waves. Somehow it cooks the tumor. Do you have you any idea how that would work?

[@KohuGaly]

put aluminium into a microwave and you'll see exactly how it works... Only reason why gold nano-particles are used is because gold is non-toxic, but in principle any conductor works.

[@Mekratrig]

Just out of curjousity, is there such a thing as neutron therapy?

[@4draven418]

@Mekratrig The first reply didn't say much except implying that it might be on the Fermilab site. Yes, it is. I am not an MD but worked in labs of all sorts during my working like. If a tumor has a high Oxygen content then conventional EM radiation will have a chance of killing the tumor by producing ions from the Oxygen. But some tumors are low in oxygen and therefore have a chance of recovering from EM radiation. Neutron therapy doesn't require Oxygen because a Neutron has no charge but attacks the nucleus of cancer cells. That's just a basic outline but I hope it helps.

[@TheDisabledGamersChannel]

Could you fine people at Fermilab do a show on LFTR, Liquid Flouride Thorium Reactors, better known as MSR's Molten Salt Reactors.

[@1997CWR]

Why don't we use some smart Interference patterns to localize the Gamma Radiation?q

[@janetw9430]

My daughters skin was burnt black from radiation, her black skin rubbed off when I tried to put the medicated cream on and she was in so much pain she screamed.

[@chrisbamford2196]

Dr Lincoln! what does it say on your Tshirt?

[@chrisbamford2196]

Thanks.

[@harryandruschak2843]

I hear advertisements from Loma Linda on the radio, when I tune to 1070 here in Los Angeles for the traffic reports.

[@PeterDavid7KQ201]

Loma Linda is the oldest clinical proton site in the world. They're the granddaddy of all proton therapy!

[@cjheaford]

Dr. Wilson is my hero. He is the BEST kind of doctor. One that knows, loves, and celebrates the secrets of physics and is excited to tell us in layman’s terms all about it. You will know a wise man because he will be the first to admit the limits of his expertise. Unlike crackpots that will give you unlimited “answers” until pseudoscience exhausts them.

[@cjheaford]

I meant Dr. Lincoln. I’m stupid.

[@PacoOtis]

Excellently presented for a "non-Doctor!!" LOL Best of luck and thanks for sharing.

[@BC3012]

Doc you show a graphic with absorption in shades of blue. What % of the total beam strength/whatever are we talking here? 50%, 10%, 0.00000001%?

[@Biga101011]

Depends on beam energy and field size, but it would be over 50% beam intensity for even a deep brain tumor. Also the dose can be spread out in three dimensions by using noncoplanar fields creating a very sharp dose fall off outside the treatment region for photons as well.

[@philippenachtergal6077]

It depends on how deep the tumor is. The deeper it is, the less % goes into the tumor, even with proton therapy. slideplayer.com/slide/9374651/ This is why the gains from proton therapy are so more visible in cancers near the skin like eye cancer and spine cancer.

[@Doping1234]

What's the mechanism of the therapy? Is it purely DNA damage or also rupturing cell/organelle membranes ect

[@Biga101011]

Doping1234 Primarily DNA double strand breaks. Single strand damage can be repaired by reading the other side. This is not specifically through direct interaction of the incident radiation with DNA though. The incident radiation will create secondary electrons or harmful particles that interact with the DNA.

[@anar6961]

Hello. I belive I was expose to radiation at work hospital because when I went to dispose the trash the radiation alarm went crazie loud and I was carrying that bag for almost 8 hours. I have never had suffer from cosntipation in my whole life but now I am. I am wondering if this expose its the cause of it. Can anybody help me please.

[@deboraferauche]

Doc, we use X-rays (MV, megavolts), produced by LINACs. Not gamma rays anymore... but sure, proton beam has a better delivered dose! The problem is the cost...

[@93Aneetteee]

Just wanted to let you know that its not doctors, but radiation therapists that operate the linac and administer the radiation. The doctors, medical physicists and radiation therapists do however work together to make the best "recipe".

[@TardisRepairService]

Would neutron therapy have the same impact?

[@Biga101011]

tardisrepairservice Neatrons have no charge, so there would be no Bragg peak. They do however transfer their energy at a high rate (high LET, linear energy transfer) so they have a greater biological effect for the the same absorbed dose than photons or protons.

[@h0ll0wm9n]

The gamma technique discussed is also known as Gamma Knife radiosurgery.

[@Les537]

King Gizzard and the Lizard Wizard agree completely.

[@anthonyholland8549]

But there was almost no detail on why proton beams are different. How is the fact that they have charge used? Why is there this Bragg bump? How does the beam know to stop just where the tumor is? This is the first time I've been disappointed by one of Dr Lincoln's videos. Follow up video please!

[@PeterDavid7KQ201]

Anthony: A rather imperfect and crude analogy would be something like this: A conventional radiation treatment is like a bullet ripping the body, damaging everything in its path. A Proton beam is like a laser-guided smart bomb with a delayed-action fuse: It damages only what the doctor wants it to damage. The beam can be controlled via a variety of means to stop exactly where it needs to stop. The older technology involves physical blocks of brass (apertures) and Lucite (depth compensators), precisely cut via CNC machine to the exact needs of each individual patient. These blocks of material prevent the protons from going where they shouldn't. Here's a good visual of them 2.bp.blogspot.com/-0szuyyE7B9c/UVBSJOJZohI/AAAAAAAACaw/GsV0f2w7c9I/s1600/UFPTI+-+Aperture+and+Compensator.jpg The newer technology is called "pencil beam scanning". In this case, those brass and Lucite pieces are now unneeded because a metric ton of computers and software control the beam, "painting" the tumor like this kzbin.info/www/bejne/m6TciZqYZ9Smibc (no volume)

[@jahdagod5563]

Decent video. He likes himself a lot...

[@GiacomoVeteran]

I was Diagnosed with Throat cancer in February 2020 and have been going through a terrible time figuring this all out since. I felt alone, as many cancer Patients do, at first. I didn't want my family to know or for this to hurt them in any way. However, I slowly learned we are ALL INVOLVED. We ALL get hurt. The Psychological impact is huge! Especially for VOICE ACTORS or anyone in the Entertainment industry who has been told cancer is in your throat, tongue, #2 lymph nodes out of #28 removed etc. My goodness, what the he** does one do with this information? None of us are doctors, oncologists, radiologists, 'ENT's', surgeons, robotic surgeons....AND WE LEARNED WE WILL NEED THEM ALL. And we have. Dr. Gernon MD (performed 3 cancer surgeries 2020) , Dr. Arya Amini, Dr. Menzel, Dr. who first brought up 'Proton Therapy' due to my horrific SKIN CANCER PROBLEM since 1989 having had 100+ Basal cell surgeries. 2 Melanoma's. And more BCC where I used UFUDEX, FLOUROOUCIL. Etc. Radiation would do 'Great Harm' to me! Gorlin-Goltz Syndrome per D. Wayne Grody, MD - UCLA. Dr. Donald Morton, MD, UCLA who died himself of Melanoma. Sad. Now we must move quickly on a 'Plan of Action for Proton Therapy Vs Radiation?' and if Chemo is needed? and which hospital? City of Hope, Duarte, CA best option due to 33 miles from home issue.....However, Do they have this Therapy? Other professionals needed - Speech, Nutrition, Rides, ready for emergencies if breathing becomes a problem? Swelling of Tongue LESS than Radiation? Cyst of left nostril causing breathing issues NOW....It gets 'complicated with each new day and new problem/ISSUE' . Thank you, seeing Dr. Gernon, MD 4/20/2020 City of Hope, Duarte, CA CT SCAN #3 - Then plan. This is a scary time. Bless you all. Here we go.....Psalms 46:10

[@gailflanagan1214]

How are you now? I was just diagnosed with tonsil cancer and going through everything that you described above. What did you decide to do? Proton Therapy or Radiation? I would love to hear from you.

[@reinhardschulte4825]

Being both a "useless" physicist and a "real" doctor, I decided to work in proton therapy. I realized that one problem is that we do not know exactly where the Bragg peak occurs in the patient. Have been working on a solution of that problem.

[@reinhardschulte4825]

ScienceNinjaDude it is them with the system we developed within the pCT collaboration

[@Wheau]

Something weird is happening. Any motion (e.g., Dr. Lincoln's hands) seems to be exhibiting some kind of tearing. Anyone else observing this? EDIT: I'm watching the video in 1080p.

[@janetw9430]

Does radiation therapy cause/spread cancer?

[@zodiacfml]

How does it determine that the tumor is the Bragg Peak?

[@Biga101011]

zodiacfml The depth of the Bragg peak depends on the proton energy. The protons are accelerated to the same energy, then that ous decayed to the treatment energy by passing through a material in the beam. This way the treatment energy can be defined so the protons stop at the correct depth.

[@philippenachtergal6077]

You need a model of the brain (in the case of brain cancer) of the patient. A model that shows the density of matter inside. And then a whole bunch of maths to compute the energy required to hit the target. I have seen those models. I don't know how they make them but I guess they used IRM or something like that (I'm no doctor either). The energy going out of the nozzle is of course monitored.

[@dramac11]

Philippe Nachtergal Great answer. I was treated for prostate cancer using proton therapy and the doctors inserts 2 gold seeds into your prostate. After that they take MRI pictures and physics to determine the depth for the braggs peak.

[@yummybeers]

@@Biga101011 That's true if a cyclotron is the accelerator (which most proton therapy systems use). Some use synchrotrons, where you can simply dial up the energy you want, no degrader needed.

[@TheyCallMeNewb]

The diagnostician makes use of the fruits borne of a physicists' labours. I'm altogether reliant day-to-day, upon the imaging techniques unlocked by the natural philosophers.

[@lgrizzly]

I don’t know of any radiation treatment machine that uses gamma radiation. The overwhelming majority use linear accelerators in the low single digit MV up to 20MV. Yes the units are MV not MeV since it is not single energy.

[@mirijason]

What happens then to the protons? Wouldn't they just build up in the patient body and cause damages? Because photons can just disappear but not protons. I guess one could fire electrons to cancel their charge but they would turn into hydrogen atoms which would be chemically super reactive wouldn't they? I mean I'm sure it shouldn't be that bad (or at least less bad than cancer itself) but I wonder how bad it is anyway.

[@PeterDavid7KQ201]

Nope, the protons expend all of their energy at a certain distance (a certain *controlled* distance, the case of proton therapy). That's the Bragg Peak he was talking about. And, that's the advantage of proton therapy: The damage to the body is very very minimal.

[@davesmith9430]

If I were President - and God knows I would have to be an improvement - Dr. Lincoln would be in my cabinet, maybe Secretary of Explaining Complicated Stuff.