X rays may be twice as potent as gamma rays for malignant transformation at low doses.

The introduction in the 1950s of 60Co teletherapy units and megavoltage X-ray accelerators for radiotherapy prompted several studies which showed that the relative biological effectiveness (RBE) of orthovoltage X rays, compared with 60Co gamma rays, was approximately 1.1-1.2 (refs 1, 2). Subsequently, radiation therapists confirmed that the effect of established treatment protocols using orthovoltage X rays could be duplicated with the higher energy radiation by increasing the dose by approximately 10%, when radiation doses are of the order of tens of grays (or thousands of rads). The dependence of biological effectiveness on photon energy led to recommendations in which the quality factor, Q, which is an RBE for radiation protection purposes, was set at unity for X and gamma rays as well as for electrons or other directly ionizing particles having a linear energy transfer (LET) of less than 3.5 ke V microns-1. Over the past decade, however, several studies have shown differences in RBE between various low-LET radiations having LET values within the range designated for standard radiation. Underbrink et al. found an RBE for orthovoltage X rays relative to 60Co gamma rays of approximately 2 at 0.04 Gy, for induction of pink mutations in the stamen hairs of Tradescantia. Schmidt et al. scored chromosome aberrations in human lymphocytes, and at 0.25 Gy found the RBE of 200-k Vp X rays relative to 3-MeV electrons to be also approximately 2. Here we have compared 60Co gamma rays and orthovoltage X rays over the dose range 0.03-1.5 Gy using malignant transformation in mammalian cells in vitro as an end point. Our findings indicate that whereas the transformation incidence seems similar for X and gamma rays at high doses, the malignant potential of X rays is about twice that of gamma rays at 0.03 Gy.