External beam radiation therapy with kilovoltage x-rays.

Area of Science:

• Medical Physics
• Radiation Oncology
• Radiological Sciences

Background:

• Kilovoltage (kV) x-rays are standard in diagnostic imaging due to tissue sensitivity.
• Their use in radiation therapy (RT) has been limited to superficial treatments and intra-operative RT (IORT) because of rapid attenuation.

Purpose of the Study:

• To provide a comprehensive review of emerging kilovoltage (kV) x-ray radiation therapy (RT) techniques.
• To explore advancements in kV x-ray source technologies and their clinical, veterinary, and preclinical applications.

Main Methods:

• Review of existing literature on kV x-ray sources and their applications in RT.
• Discussion of various kV RT techniques, including IORT, superficial RT, dose enhancement, microbeam RT, and FLASH RT.
• Exploration of modeling and proof-of-principle applications like breast external beam RT and kilovoltage arc therapy.

Main Results:

• Several novel kV x-ray source technologies are suitable for RT.
• Diverse clinical, veterinary, and preclinical applications of kV x-ray RT are emerging.
• Advanced techniques such as microbeam RT, FLASH RT, and nanoparticle-based dose enhancement show promise.

Conclusions:

• Kilovoltage (kV) x-ray radiation therapy (RT) is a rapidly developing field with potential to expand beyond current applications.
• Further development of kV RT techniques requires consideration of clinical and economic factors.