Interlaced proton grid therapy – Linear energy transfer and relative biological effectiveness distributions

PurposeInterlaced beams have previously been proposed for delivering proton grid therapy. This study aims to assess dose-averaged LET (LET_d) and RBE-weighted dose (D_RBE) distributions of such beam geometries, and compare them with conventional intensity modulated proton therapy (IMPT).MethodsIMPT plans and four different interlaced proton grid therapy plans were generated for five patient cases (esophagus, lung, liver, prostate, anus). The constant RBE = 1.1 was assumed for optimization. The LET_d was subsequently Monte Carlo calculated for each plan and used as input for two LET-dependent variable RBE models. The fulfilment of clinical goals, along with DVH and spatial distribution evaluations, were then assessed and compared.ResultsAll plans fulfilled the clinical target goals assuming RBE = 1.1. The target coverage was slightly compromised for some grid plans when assuming the variable RBE models. All IMPT plans, and 18 of 20 grid plans, fulfilled all clinical goals for the organs at risk when assuming RBE = 1.1, whereas most plans failed at least one goal when assuming the variable RBE models. Compared with the IMPT plans, the grid plans demonstrated substantially different LET_d distributions due to the fundamentally different beam geometries. However, D_RBE distributions in the target were similar.ConclusionsDespite the unconventional beam geometries of interlaced proton grid plans, with resulting alternating dose and LET_d patterns, the fulfillment of realistic clinical goals seems to be comparable to regular IMPT plans, both assuming RBE = 1.1 and variable RBE models. In addition, the alternating grid patterns do not seem to give rise to unexpected D_RBE hot-spots.     

Phantom design and dosimetric characterization for multiple simultaneous cell irradiations with active pencil beam scanning

A new phantom was designed for in vitro studies on cell lines in horizontal particle beams. The phantom enables simultaneous irradiation at multiple positions along the beam path. The main purpose of this study was the detailed dosimetric characterization of the phantom which consists of various heterogeneous structures. The dosimetric measurements described here were performed under non-reference conditions. The experiment involved a CT scan of the phantom, dose calculations performed with the treatment planning system (TPS) RayStation employing both the Pencil Beam (PB) and Monte Carlo (MC) algorithms, and proton beam delivery. Two treatment plans reflecting the typical target location for head and neck cancer and prostate cancer treatment were created. Absorbed dose to water and dose homogeneity were experimentally assessed within the phantom along the Bragg curve with ionization chambers (ICs) and EBT3 films. LET_d distributions were obtained from the TPS. Measured depth dose distributions were in good agreement with the Monte Carlo-based TPS data. Absorbed dose calculated with the PB algorithm was 4% higher than the absorbed dose measured with ICs at the deepest measurement point along the spread-out Bragg peak. Results of experiments using melanoma (SKMel) cell line are also presented. The study suggested a pronounced correlation between the relative biological effectiveness (RBE) and LET_d, where higher LET_d leads to elevated cell death and cell inactivation. Obtained RBE values ranged from 1.4 to 1.8 at the survival level of 10% (RBE₁₀). It is concluded that dosimetric characterization of a phantom before its use for RBE experiments is essential, since a high dosimetric accuracy contributes to reliable RBE data and allows for a clearer differentiation between physical and biological uncertainties.

     

Parameterization of electron beam output factor

Electron beam dose distribution is dependent on the beam energy and complicated trajectory of particles. Recent treatment planning systems using Monte Carlo calculation algorithm provide accurate dose calculation. However, double check of monitor units (MUs) based on an independent algorithm is still required. In this study, we have demonstrated single equation that reproduces the measured relative output factor (ROF) that can be used for MU calculation for electron radiotherapy. Electron beams generated by an iX (Varian Medical Systems) and a PRIMUS (Siemens) accelerator were investigated. For various energies of electron beams, the ROF at respective d_max were measured using diode detector in a water phantom at SSD of 100 cm. Curve fitting was performed with an exponential generalized equation ROF = α(β – e^−γR) including three variables (α, β, γ) as a function of field radius and electron energy. The correlation coefficients between the ROF measured and that calculated by the equation were greater than 0.998. For ROF of Varian electron beams, the average values of all fitting formulas were applied for two of the constants; α and β. The parameter γ showed good agreement with the quadratic approximation as a function of mean energy at surface (E₀). The differences between measured and calculated ROF values were within ±3% for beams with cutout radius of ≥1.5 cm for electron beams with energies from 6 MeV to 15 MeV. The proposed formula will be helpful for double-check of MUs, as it requires minimal efforts for MU calculation.     

The FLUKA Monte Carlo code coupled with an OER model for biologically weighted dose calculations in proton therapy of hypoxic tumors

IntroductionThe increased radioresistance of hypoxic cells compared to well-oxygenated cells is quantified by the oxygen enhancement ratio (OER). In this study we created a FLUKA Monte Carlo based tool for inclusion of both OER and relative biological effectiveness (RBE) in biologically weighted dose (ROWD) calculations in proton therapy and applied this to explore the impact of hypoxia.MethodsThe RBE-weighted dose was adapted for hypoxia by making RBE model parameters dependent on the OER, in addition to the linear energy transfer (LET). The OER depends on the partial oxygen pressure (pO₂) and LET. To demonstrate model performance, calculations were done with spread-out Bragg peaks (SOBP) in water phantoms with pO₂ ranging from strongly hypoxic to normoxic (0.01–30 mmHg) and with a head and neck cancer proton plan optimized with an RBE of 1.1 and pO₂ estimated voxel-by-voxel using [¹⁸F]-EF5 PET. An RBE of 1.1 and the Rørvik RBE model were used for the ROWD calculations.ResultsThe SOBP in water had decreasing ROWD with decreasing pO₂. In the plans accounting for oxygenation, the median target doses were approximately a factor 1.1 lower than the corresponding plans which did not consider the OER. Hypoxia adapted target ROWDs were considerably more heterogeneous than the RBE_1.1-weighted doses.ConclusionWe realized a Monte Carlo based tool for calculating the ROWD. Read-in of patient pO₂ and estimation of ROWD with flexibility in choice of RBE model was achieved, giving a tool that may be useful in future clinical applications of hypoxia-guided particle therapy.     

An in-vivo dosimetry procedure for Elekta step and shoot IMRT

PurposeThe aim of this work was to extend an in-vivo dosimetry (IVD) method, previously developed by the authors for 3D-conformal radiotherapy, to step and shoot IMRT treatments for pelvic tumors delivered by Elekta linacs.Materials and methodsThe algorithm is based on correlation functions to convert EPID transit signals into in-vivo dose values at the isocenter point, D_iso. The EPID images were obtained by the so-called “IMRT Dosimetric Weighting” mode as a superposition of many segment fields. This way each integral dosimetric image could be acquired in about 10 s after the end of beam delivery and could be processed while delivering the successive IMRT beams. A specific algorithm for D_iso reconstruction especially featured for step and shoot IMRT was implemented using a fluence inhomogeneity index, FI, introduced to describe the degree of beam modulation with respect to open beams. A γ-analysis of 2D-EPID images obtained day to day, resulted rapid enough to verify the plan delivery reproducibility.ResultsFifty clinical IMRT beams, planned for patients undergoing radiotherapy of pelvic tumors, were used to irradiate a homogeneous phantom. For each beam the agreement between the reconstructed dose, D_iso, and the TPS computed dose, D_iso,TPS, was well within 5%, while the mean ratio R = D_iso/D_iso,TPS resulted for 250 tests equal to 1.006 ± 0.036. The same beams were checked in vivo, i.e. during patient treatment delivery, obtaining 500 tests whose average R ratio resulted equal to 1.011 ± 0.042. The γ-analysis of the EPID images with 5% 3 mm criteria supplied 85% of the tests with pass rates γ_mean ≤ 0.5 and P_γ<1 ≥ 90%.     

Evaluation of Gafchromic® EBT3 films characteristics in therapy photon,electron and proton beams

PurposeTo evaluate the uncertainties and characteristics of radiochromic film-based dosimetry system using the EBT3 model Gafchromic^® film in therapy photon, electron and proton beams.Material and methodsEBT3 films were read using an EPSON Expression 10000XL/PRO scanner. They were irradiated in five beams, an Elekta SL25 6 MV and 18 MV photon beam, an IBA 100 MeV 5 × 5 cm² proton beam delivered by pencil-beam scanning, a 60 MeV fixed proton beam and an Elekta SL25 6 MeV electron beam. Reference dosimetry was performed using a FC65-G chamber (Elekta beam), a PPC05 (IBA beam) and both Markus 1916 and PPC40 Roos ion-chambers (60 MeV proton beam). Calibration curves of the radiochromic film dosimetry system were acquired and compared within a dose range of 0.4–10 Gy. An uncertainty budget was estimated on films irradiated by Elekta SL25 by measuring intra-film and inter-film reproducibility and uniformity; scanner uniformity and reproducibility; room light and film reading delay influences.ResultsThe global uncertainty on acquired optical densities was within 0.55% and could be reduced to 0.1% by placing films consistently at the center of the scanner. For all beam types, the calibration curves are within uncertainties of measured dose and optical densities. The total uncertainties on calibration curve due to film reading and fitting were within 1.5% for photon and proton beams. For electrons, the uncertainty was within 2% for dose superior to 0.8 Gy.ConclusionsThe low combined uncertainty observed and low beam and energy-dependence make EBT3 suitable for dosimetry in various applications.     

New ester derivatives of dehydroepiandrosterone as 5α-reductase inhibitors

The aim of this study was to synthesize different ester derivatives of dehydroepiandrosterone with therapeutic potential as antiandrogens.The biological effect of these steroids was demonstrated in in vivo as well as in vitro experiments. In the in vivo experiments, we measured the activity of seven steroids on the weight of the prostate and seminal vesicles of gonadectomized hamsters treated with testosterone. For the in vitro studies, we determined the IC₅₀ values by measuring the concentration of the steroidal derivatives that inhibits 50% of the activity of 5α-reductase present in human prostate and also its binding capacity to the androgen receptors (AR) obtained from rat’s prostate cytosol. The results from these experiments indicated that compounds 7 5α,6β-dibromo-3β-propanoyloxyandrostan-17-one, 8 5α,6β-dibromo-3β-butanoyloxyandrostan-17-one and 9 5α,6β-dibromo-3β-(3′-oxapentanoyloxy)-androstan-17-one, significantly decreased the weight of the prostate and seminal vesicles as compared to testosterone treated animals; this reduction of the weight of these glands was comparable to that produced by Finasteride 11. On the other hand, compounds 4 3β-acetoxyandrost-5-en-17-one, 5 3β-hexanoyloxyandrost-5-en-17-one 6 3β-(3′-oxapentanoyloxy)-androst-5-en-17-one, 7 and 12 dehydroepiandrosterone, (commercially available) inhibited the enzyme 5α-reductase. Compounds 4, 5, 6, 8 and 9 (IC₅₀ values of 5.2 ± 1.2, 0.049 ± 0.002, 6.4 ± 1.1, 0.10 ± 0.045, and 6.8 ± 0.9 nM, respectively) exhibited the highest inhibitory activity. However, none of these compounds binds to the AR.     

Triterpenoid saponins from Aesculus sylvatica W. Bartram

16 triterpenoid saponins including two new compounds were isolated from the seeds of A esculus sylvatica W. Bartram. The two new saponins were assigned as 3-O-[β-D-glucopyranosyl-(1 → 2)]-α-L-arabinofuranosyl-(1 → 3)-β-D-glucuronopyranosyl-21,22-O-ditigloyl-3β,16α,21β,22α,24,28 hexahydroxyolean-12-ene (aesculioside S1, 1) and 3-O-[β-D-glucopyranosyl-(1 → 2)]-α-L-arabinofuranosyl-(1 → 3)-β-D-glucuronopyranosyl-21-O-tigloyl-22-O-angeloyl 3β,16α,21β,22α,24,28-hexahydroxyolean-12-ene (aesculioside S2, 2). Aesculioside S1 and S2 displayed moderate cytotoxicity against human non-small cell lung cancer cells (A549) and prostate cancer cells (PC3) (GI₅₀ ranged from 8.7 to 18.2 μM). The structural analysis of the saponins isolated from Aesculus supports the taxonomic placement of A. sylvatica under the section Pavia of Aesculus genus.     

A machine learning-based framework for delivery error prediction in proton pencil beam scanning using irradiation log-files

PurposeThis study aims to investigate the use of machine learning models for delivery error prediction in proton pencil beam scanning (PBS) delivery.MethodsA dataset of planned and delivered PBS spot parameters was generated from a set of 20 prostate patient treatments. Planned spot parameters (spot position, MU and energy) were extracted from the treatment planning system (TPS) for each beam. Delivered spot parameters were extracted from irradiation log-files for each beam delivery following treatment. The dataset was used as a training dataset for three machine learning models which were trained to predict delivered spot parameters based on planned parameters. K-fold cross validation was employed for hyper-parameter tuning and model selection where the mean absolute error (MAE) was used as the model evaluation metric. The model with lowest MAE was then selected to generate a predicted dose distribution for a test prostate patient within a commercial TPS.ResultsAnalysis of the spot position delivery error between planned and delivered values resulted in standard deviations of 0.39 mm and 0.44 mm for x and y spot positions respectively. Prediction error standard deviation values of spot positions using the selected model were 0.22 mm and 0.11 mm for x and y spot positions respectively. Finally, a three-way comparison of dose distributions and DVH values for select OARs indicates that the random-forest-predicted dose distribution within the test prostate patient was in closer agreement to the delivered dose distribution than the planned distribution.ConclusionsPBS delivery error can be accurately predicted using machine learning techniques.     

Dosimetric impacts of beam-hardening filter removal for the CyberKnife system

PurposeEquipment refurbishment was performed to remove the beam-hardening filter (BHF) from the CyberKnife system (CK). This study aimed to confirm the change in the beam characteristics between the conventional CK (present-BHF CK) and CK after the BHF was removed (absent-BHF CK) and evaluate the impact of BHF removal on the beam quality correction factors k_Q.MethodsThe experimental measurements of the beam characteristics of the present- and absent-BHF CKs were compared. The CKs were modeled using Monte Carlo simulations (MCs). The energy fluence spectra were calculated using MCs. Finally, k_Q were estimated by combining the MC results and analytic calculations based on the TRS-398 and TRS-483 approaches.ResultsAll gamma values for percent depth doses and beam profiles between each CK were less than 0.5 following the 3%/1 mm criteria. The percentage differences for tissue-phantom ratios at depths of 20 and 10 cm and percentage depth doses at 10 cm between each CK were −1.20% and −0.97%, respectively. The MC results demonstrated that the photon energy fluence spectrum of the absent-BHF CK was softer than that of the present-BHF CK. The k_Q values for the absent-BHF CK were in agreement within 0.02% with those for the present-BHF CK.ConclusionsThe photon energy fluence spectrum was softened by the removal of BHF. However, no remarkable impact was observed for the measured beam characteristics and k_Q. Therefore, the previous findings of the k_Q values for the present-BHF CK can be directly used for the absent-BHF CK.     

Design of commissioning process for Halcyon™ linac with a new rigid board: A clinical experience

PurposeThis study performed the accurate measurements of beam profiles with a new rigid board, which was consistent with the supplied reference beam profiles (RBPs) for clinical Halcyon model.MethodsPercentage depth doses (PDDs), lateral and diagonal dose profiles were measured and compared with RBPs. A water tank was set on the rigid board bridged Halcyon bore without sagging and source-to-surface distance was 90.0 cm. Field sizes were from 2.0 to 28.0 cm squares and depths of lateral and diagonal dose profiles were 1.3, 5.0, 10.0, and 20.0 cm. For the PDD, the depth of maximum dose (d_max), PDD value at depth of 10.0 cm (PDD₁₀), and absolute dose difference (DD) between RBP and measured beam profiles (MBP) were evaluated. For lateral and diagonal dose profiles, DDs for the whole and divided areas (central, shoulder, and extended areas) defined by third derivative, and distance-to-agreement (DTA) in the penumbra area were evaluated.ResultsFor PDDs, the differences of d_max and PDD₁₀ and DD beyond the d_max were within 1.0 mm, 0.3%, and 1.0%, respectively. For lateral and diagonal dose profiles, the DDs reached approximately 5.0% in the whole area because of penumbra area, while the DDs in the central, shoulder, and extended areas were within 1.0%, 2.0%, and 1.0%, respectively. The DTAs in the penumbra area were within 0.8 mm.ConclusionsThe supplied RBPs can be used clinically owing to the good agreement with the accurate MBPs with rigid board.     

Evaluations of a flat-panel based compact daily quality assurance device for proton pencil beam scanning (PBS) system

PurposeTo evaluate the flat-panel detector quenching effect and clinical usability of a flat-panel based compact QA device for PBS daily constancy measurements.Materials & MethodThe QA device, named Sphinx Compact, is composed of a 20x20 cm² flat-panel imager mounted on a portable frame with removable plastic modules for constancy checks of proton energy (100 MeV, 150 MeV, 200 MeV), Spread-Out-Bragg-Peak (SOBP) profile, and machine output. The potential quenching effect of the flat-panel detector was evaluated. Daily PBS QA tests of X-ray/proton isocenter coincidence, the constancy of proton spot position and sigma as well as the energy of pristine proton beam, and the flatness of SOBP proton beam through the 'transformed' profile were performed and analyzed. Furthermore, the sensitivity of detecting energy changes of pristine proton beam was also evaluated.ResultsThe quenching effect was observed at depths near the pristine peak regions. The flat-panel measured range of the distal 80% is within 0.9 mm to the defined ranges of the delivered proton beams. X-ray/proton isocenter coincidence tests demonstrated maximum mismatch of 0.3 mm between the two isocenters. The device can detect 0.1 mm change of spot position and 0.1 MeV energy changes of pristine proton beams. The measured transformed SOBP beam profile through the wedge module rendered as flat.ConclusionsEven though the flat-panel detector exhibited quenching effect at the Bragg peak region, the proton range can still be accurately measured. The device can fulfill the requirements of the daily QA tests recommended by the AAPM TG224 Report.     

Synthesis and characterization of 1H-phenanthro[9,10-d]imidazole derivatives as multifunctional agents for treatment of Alzheimer's disease

BackgroundAlzheimer's disease (AD) is a progressive neurodegenerative brain disorder that is characterized by dementia, cognitive impairment, and memory loss. Diverse factors are related to the development of AD, such as increased level of β-amyloid (Aβ), acetylcholine, metal ion deregulation, hyperphosphorylated tau protein, and oxidative stress.MethodsThe following methods were used: organic syntheses of 1H-phenanthro[9,10-d]imidazole derivatives, inhibition of self-mediated and metal-induced Aβ_1–42 aggregation, inhibition studies for acetylcholinesterase and butyrylcholinesterase, anti-oxidation activity studies, CD, MTT assay, transmission electron microscopy, dot plot assay, gel electrophoresis, Western blot, and molecular docking studies.ResultsWe synthesized and characterized a new type of 1H-phenanthro[9,10-d]imidazole derivatives as multifunctional agents for AD treatment. Our results showed that most of these derivatives exhibited strong Aβ aggregation inhibitory activity. Compound 9g had 74% Aβ_1–42 aggregation inhibitory effect at 10 μM concentration with its IC₅₀ value of 6.5 μM for self-induced Aβ_1–42 aggregation. This compound also showed good inhibition of metal-mediated (Cu^2 + and Fe^2 +) and acetylcholinesterase-induced Aβ_1–42 aggregation, as indicated by using thioflavin T assay, transmission electron microscopy, gel electrophoresis, and Western blot. Besides, compound 9g exhibited cholinesterase inhibitory activity, with its IC₅₀ values of 0.86 μM and 0.51 μM for acetylcholinesterase and butyrylcholinesterase, respectively. In addition, compound 9g showed good anti-oxidation effect with oxygen radical absorbance capacity (ORAC) value of 2.29.ConclusionsCompound 9g was found to be a potent multi-target-directed agent for Alzheimer's disease.General significanceCompound 9g could become a lead compound for further development as a multi-target-directed agent for AD treatment.     

Measurement of stray neutron doses inside the treatment room from a proton pencil beam scanning system

PurposeTo measure the environmental doses from stray neutrons in the vicinity of a solid slab phantom as a function of beam energy, field size and modulation width, using the proton pencil beam scanning (PBS) technique.MethodMeasurements were carried out using two extended range WENDI-II rem-counters and three tissue equivalent proportional counters. Detectors were suitably placed at different distances around the RW3 slab phantom. Beam irradiation parameters were varied to cover the clinical ranges of proton beam energies (100–220 MeV), field sizes ((2 × 2)–(20 × 20) cm²) and modulation widths (0–15 cm).ResultsFor pristine proton peak irradiations, large variations of neutron H¹(10)/D were observed with changes in beam energy and field size, while these were less dependent on modulation widths. H¹(10)/D for pristine proton pencil beams varied between 0.04 μSv Gy⁻¹ at beam energy 100 MeV and a (2 × 2) cm² field at 2.25 m distance and 90° angle with respect to the beam axis, and 72.3 μSv Gy⁻¹ at beam energy 200 MeV and a (20 × 20) cm² field at 1 m distance along the beam axis.ConclusionsThe obtained results will be useful in benchmarking Monte Carlo calculations of proton radiotherapy in PBS mode and in estimating the exposure to stray radiation of the patient. Such estimates may be facilitated by the obtained best-fitted simple analytical formulae relating the stray neutron doses at points of interest with beam irradiation parameters.     

Impact of physiological breathing motion for breast cancer radiotherapy with proton beam scanning – An in silico study

This study investigates the impact of breathing motion on proton breast treatment plans. Twelve patients with CT datasets acquired during breath-hold-at-inhalation (BHI), breath-hold-at-exhalation (BHE) and in free-breathing (FB) were included in the study. Proton plans were designed for the left breast for BHI and subsequently recalculated for BHE or designed for FB and recalculated for the extreme breath-hold phases. The plans were compared from the point of view of their target coverage and doses to organs-at-risk. The median amplitude of breathing motion determined from the positions of the sternum was 4.7 mm (range 0.5–14.6 mm). Breathing motion led to a degradation of the dose coverage of the target (heterogeneity index increased from 4–7% to 8–11%), but the degraded values of the dosimetric parameters of interest fulfilled the clinical criteria for plan acceptance. Exhalation decreased the lung burden [average dose 3.1–4.5 Gy (RBE)], while inhalation increased it [average dose 5.8–6.8 Gy (RBE)]. The individual values depended on the field arrangement. Smaller differences were seen for the heart [average dose 0.1–0.2 Gy (RBE)] and the LAD [1.9–4.6 Gy (RBE)]. Weak correlations were generally found between changes in dosimetric parameters and respiratory motion. The differences between dosimetric parameters for various breathing phases were small and their expected clinical impact is consequently quite small. The results indicated that the dosimetric parameters of the plans corresponding to the extreme breathing phases are little affected by breathing motion, thus suggesting that this motion might have little impact for the chosen beam orientations with scanned proton beams.     

Comparison of oxygen mass transfer coefficient in simple and extractive fermentation systems

Aeration and agitation are important variables to ensure effective oxygen transfer rate during aerobic bioprocesses; therefore, the knowledge of the volumetric mass transfer coefficient (k_La) is required. In view of selecting the optimum oxygen requirements for extractive fermentation in aqueous two-phase system (ATPS), the k_La values in a typical ATPS medium were compared in this work with those in distilled water and in a simple fermentation medium, in the absence of biomass. Aeration and agitation were selected as the independent variables using a 2² full factorial design. Both variables showed statistically significant effects on k_La, and the highest values of this parameter in both media for simple fermentation (241 s⁻¹) and extractive fermentation with ATPS (70.3 s⁻¹) were observed at the highest levels of aeration (5 vvm) and agitation (1200 rpm). The k_La values were then used to establish mathematical correlations of this response as a function of the process variables. The exponents of the power number (N³D²) and superficial gas velocity (V_s) determined in distilled water (α = 0.39 and β = 0.47, respectively) were in reasonable agreement with the ones reported in the literature for several aqueous systems and close to those determined for a simple fermentation medium (α = 0.38 and β = 0.41). On the other hand, as expected by the increased viscosity in the presence of polyethylene glycol, their values were remarkably higher in a typical medium for extractive fermentation (α = 0.50 and β = 1.0). A reasonable agreement was found between the experimental data of k_La for the three selected systems and the values predicted by the theoretical models, under a wide range of operational conditions.     

The influence of reference radiation photon energy on high-LET RBE: comparison of human peripheral lymphocytes and human–hamster hybrid A<Subscript>L</Subscript> cells

The relative biological effectiveness (RBE) based on the induction of dicentrics in any cell type is principally an important information for the increasing application of high-LET radiation in cancer therapy. Since the standard system of human lymphocytes for measuring dicentrics are not compatible with our microbeam irradiation setup where attaching cells are essential, we used human–hamster hybrid A_L cells which do attach on foils and fulfil the special experimental requirement for microbeam irradiations. In this work, the dose–response of A_L cells to photons of different energy, 70 and 200 kV X-rays and ⁶⁰Co γ-rays, is characterized and compared to human lymphocytes. The total number of induced dicentrics in A_L cells is approximately one order of magnitude smaller. Despite the smaller α and β parameters of the measured linear–quadratic dose–response relationship, the α/β-ratio versus photon energy dependence is identical within the accuracy of measurement for A_L cells and human lymphocytes. Thus, the influence of the reference radiation used for RBE determination is the same. For therapy relevant doses of 2 Gy (⁶⁰Co equivalent), the difference in RBE is around 20% only. These findings indicate that the biological effectiveness in A_L cells can give important information for human cells, especially for studies where attaching cells are essential.