The introduction of new healthcare tools requires the careful navigation of social, political and economic pressures. In this interview, recorded at the 2017 National Cancer Research Institute (NCRI) Conference in Liverpool, UK, Anthony Zietman, MD, from the Massachusetts General Hospital, Boston, MA, discusses the challenges that were faced when establishing two UK centers for proton beam therapy. Dr Zietman also details the future questions that need to be explored regarding proton therapy. Furthermore, Dr Zietman provides an overview of the model of patient selection used for Denmarks emerging proton therapy system.