X-ray and DNA Damage: Limitations of the Dose as a Parameter for In Vitro Studies

A century of studies has demonstrated that the magnitude of a radiation dose determines the extent of its biological effect. However, different types of radiation show different levels of effectiveness. Although all types of X-rays are usually considered to be equivalent, several authors have demonstrated an inverse relationship between photon energy and the biological effectiveness of the X-ray. Nonetheless, the differences among 50–100 keV X-rays are usually considered absent. However, comparing different types of X-rays with different energies is not easy since they are often used with different dose rates, and the latter can be a confounding factor. We compared the biological effectiveness of X-rays with different photon energies but with the same dose rate. Moreover, we also studied X-ray with different dose rates but the same photon energy. Biological effectiveness was assessed measuring DNA damage and cell survival. We confirmed that both the dose rate and photon energy influence the effectiveness of an X-ray. Moreover, we observed that differences in the 50–100 keV range are detectable after controlling for dose-rate variations. Our results, confirming those of previous studies in a more consistent way (and accompanied by hypotheses on the importance of the number of incident photons), underline the limitations of using the dose as the sole parameter for in vitro studies.