DNA double-strand break yield and radiation quality of diagnostic X-rays from 40 to 120 kV: a scale-resolved microdosimetric and track-structure study

Reported relative biological effectiveness (RBE) values for low-energy X-rays disagree, assays scoring initial DNA double-strand breaks (DSBs) returning about 1.1 and chromosome-level assays 2 to 4. Whether radiation quality varies within the diagnostic range, and how its comparison with a megavoltage reference depends on target scale, has not been quantified on a tube-potential series. A tungsten-anode tube with 1 mm Be and 2.5 mm Al filtration, with copper added in some cases, was modelled in PHITS for 40 to 200 kV. The spectra were transported into a water phantom in which absorbed dose, lineal-energy densities and cluster size distributions were scored for target diameters of 3 nm to 1 micrometre against a cobalt-60 reference; DSB yields were computed in the electron track-structure mode with the PHITS DNA damage tally. Between 40 and 120 kV the depth-dose ratio changed by a factor of 5.7 and the tube output by a factor of 42, whereas the dose-mean lineal energy varied by 2.5 % at 1 micrometre and 1.2 % at 3 nm against a reproducibility of 0.3 %. Relative to cobalt-60 it was 2.05 times larger at 1 micrometre but only 1.08 times larger at 3 nm, while DSB yields per unit dose were 5 to 7 % higher and constant across the range within the 2 % bound set by the statistics. Tube potential therefore changes the amount and distribution of dose but not its physical quality, and a stated RBE is incomplete without the target scale implied by the endpoint.