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</form>Text Content
WE VALUE YOUR PRIVACY We and our partners store and/or access information on a device, such as cookies and process personal data, such as unique identifiers and standard information sent by a device for personalised ads and content, ad and content measurement, and audience insights, as well as to develop and improve products. With your permission we and our partners may use precise geolocation data and identification through device scanning. You may click to consent to our and our partners’ processing as described above. Alternatively you may click to refuse to consent or access more detailed information and change your preferences before consenting. Please note that some processing of your personal data may not require your consent, but you have a right to object to such processing. Your preferences will apply to a group of websites. You can change your preferences at any time by returning to this site or visit our privacy policy. MORE OPTIONSDISAGREEAGREE Figure - uploaded by Steve Axelrod Content may be subject to copyright. Download View publication -------------------------------------------------------------------------------- Copy reference Copy caption Embed figure PHOTOGRAPHS AND SCHEMATIC DIAGRAM OF THE MODEL S700 XOFT AXXENT™ X-RAY SOURCE. THE LEFT HAND SIDE IMAGE SHOWS THE MODEL S700 SOURCE IN OPERATION. THE BOTTOM ILLUSTRATION SHOWS THE SOURCE ENCLOSED BY A GRAY WATER COOLING SHEATH. THE SHEATH OUTER DIAMETER IS 5.3 MM , AND IS FLEXIBLE BEYOND THE DISTAL 15 MM . Source publication Calculated and measured brachytherapy dosimetry parameters in water for the Xoft Axxent X-Ray Source: An electronic brachytherapy source Article Full-text available * Nov 2006 * Mark J. Rivard * Stephen D Davis * Larry A Dewerd * [...] * Steve Axelrod A new x-ray source, the model S700 Axxent X-Ray Source (Source), has been developed by Xoft Inc. for electronic brachytherapy. Unlike brachytherapy sources containing radionuclides, this Source may be turned on and off at will and may be operated at variable currents and voltages to change the dose rate and penetration properties. The in-water dosi... Cite Download full-text CONTEXTS IN SOURCE PUBLICATION Context 1 ... small x-ray tubes have been developed that offer the prospect of electronic brachytherapy. Xoft Inc. has developed a miniature x-ray brachytherapy source called the Xoft Axxent™ X-Ray Source Source. [1][2][3][4][5] The model S700 Source consists of a disposable, microminiature x-ray tube Fig. 1 integrated into a cooled, flexible, disposable sheath which is directly attached to a treatment control console Fig. 2. Water circulating within the cooling sheath having intimate contact with the anode allows a higher power dissipation and higher dose rate, without thermal damage to the Source, surrounding probe structures, or the ... View in full-text Context 2 ... Source geometry was simulated as shown in Fig. 1, assuming symmetry about the long axis. Components included in the model S700 simulation were the x-ray anode and substrate, wall materials, and water cooling sheath 5.3 mm outer diameter. While the internal dimensions and compositions are proprietary, the primary element producing x rays in the anode is tungsten. The coordinate system ... View in full-text CITATIONS ... Benefiting from Monte Carlo method, Mark J. Reward et al. investigated the radial dose distribution and energy spectrum of the Xoft Axxent eBT system with S700 source model for different operating voltages. They reached the conclusion that the S700 source model had similar photon penetration and percent depth dose rate with the sources emitting low energy photons [33]. ... Calculated and measured radiation dose for the low energy xoft axxent eBT X-ray source Article Full-text available * Feb 2023 * BMC Res Notes * Sümeyra Can * Özge Atilla * Didem Karaçetin Purpose In this study, it was aimed to evaluate the functionality to deliver different prescription dose except 20 Gy for the Xoft Axxent Ebt (electronic Brachytherapy) system and analyzing the system in terms of radiation dosimetry in water and 0.9% isotonic Sodium Chloride (NaCl) solution. Materials and methods In the Xoft Axxent eBT, different prescription dose in single fraction were calculated for different balloon applicator volumes based on source position and irradiation times. EBT-XD Gafchromic film was calibrated at 6MV photon energy. A balloon applicator filled with 0.9% isotonic NaCl solution was used to deliver a radiation dose of 20 Gy, 16 Gy, 10 Gy on the applicator surface. Then the balloon applicator was filled with water and the same measurements were repeated. Finally, the balloon applicator was irradiated by positioning it at different distances in the water phantom to simulate the isodose contour. Results At the time the balloon applicator was filled with water and 0,9% NaCl solution, the difference between the planned dose and the absorbed dose was ~ 2% vs. 15% for 30 cc, ~ 5% vs. 14% for 35 cc and ~ 3,5% vs. 10% for 40 cc respectively. Finally, the absorbed dose at a distance of 1 cm from the applicator surface was measured as 9.63 Gy. Conclusion In this study, it was showed that different prescription dose could be possible to deliver in the Xoft Axxent eBT system based on the standard plan. In addition, the absorbed dose was higher than the planned dose depending on the effective atomic number of NaCl solution comparing to water due to photoelectric effect in low energy photons. By measuring the dose distributions at different distances from the balloon applicator surface, the absorbed dose in tissue equivalent medium was determined and the isodose contours characteristics was simulated. View ... The MC calculated radial dose and photon beam spectra were compared to the data provided by the manufacturer which was published by Rivard et al . ( 12 ).. As it can be seen in Fig. 3 a, an excellent conformity was found between calculated and reference photon spectra. ... Accelerated brachytherapy with the Xoft electronic source used in association with iodine, gold, bismuth, gadolinium, and hafnium nano-radioenhancers Article * Aug 2022 * BRACHYTHERAPY * Asghar Mesbahi * Saeed Rajabpour * Henry M. Smilowitz * James F. Hainfeld Purpose The current study was designed to calculate the dose enhancement factor (DEF) of iodine (I), gold (Au), bismuth (Bi), gadolinium (Gd), and hafnium (Hf) nanoparticles (NP)s by Monte Carlo (MC) modeling of an electronic brachytherapy source in resection cavities of breast tumors. Methods and materials The GEANT4 MC code was used for simulation of a phantom containing a water-filled balloon and a Xoft source (50 kVp) to irradiate the margins of a resected breast tumor. NPs with a diameter of 20 nm and concentrations from 1 to 5% w/w were simulated in a tumor margin with 5 mm thickness as well as a hypothetical breast model consisting of spherical island-like residual tumor-remnants. The DEFs for all NPs were calculated in both models. Results In the margin-loaded model, for the concentration of 1% w/w heavy atom, DEFs of 2.5, 2.3, 2.1, 2, and 1.7 were calculated for Bi, Au, I, Hf, and Gd NPs (descending order), which increased, almost linearly with concentration for all NPs. Moreover, normal tissue dose behind the NP-loaded margin declined significantly depending on NP type and concentration. When modeling residual tumor islands, DEF values were very close to the margin-loaded values except for Bi and I, where DEFs of 2.55 and 1.7 were seen, respectively. Conclusions Considerable dose enhancements were obtained for the heavy atom NPs studied in the partial breast brachytherapy with a Xoft electronic source. In addition, normal tissue doses were lowered in the points beyond the NP-loaded margin. The findings revealed promising outcomes and the probability of improved tumor control for NP-aided brachytherapy with the Xoft electronic source. View ... [19,20] The electronic X-ray source has the same steep depth dose behavior as brachytherapy isotopes such as I-125 or Pd-103, but at a higher dose rate and adjustable beam penetration capability. [21][22][23] However, there were only limited single site analysis of eBT published. [22][23][24][25][26] Since the introduction of eBT to Taiwan in May 2012, the Taiwan IORT study cooperative group (T-IORTSCG) has conducted a multicenter retrospective analysis, which reported a 0.8% locoregional recurrence risk at 15.6 months follow-up. ... Single institute experience of intraoperative radiation therapy in early-stage breast cancer Article Full-text available * Nov 2021 * MEDICINE * Mau-Shin Chi * Hui-Ling Ko * Chang-Cheng Chen * Chung-Hsien Hsu * Fiona Tsui-Fen Cheng Intraoperative radiation therapy (IORT) is an alternative to whole breast irradiation in selected early-stage breast cancer patients. In this single institute analysis, we report the preliminary results of IORT given by Axxent Electronic Brachytherapy (eBT) system. Patients treated with lumpectomy and eBT within a minimum follow-up period of 12 months were analyzed. Eligible criteria include being over the age of 45, having unifocal invasive ductal carcinoma (IDC) or ductal carcinoma in situ <3 cm in diameter, not exhibiting lymph node involvement on preoperative images, and negative sentinel lymph node biopsy. The eBT was given by preloaded radiation plans to deliver a single fraction of 20 Gray (Gy) right after lumpectomy. From January 2016 to April 2019, a total of 103 patients were collected. There were 78 patients with IDC and 25 with ductal carcinoma in situ. At a mean follow-up time of 31.1 months (range, 14.5–54.0 months), the local control rate was 98.1%. Two IDC patients had tumor recurrences (1 local and 1 regional failure). Post-IORT radiotherapy was given to 4 patients. There were no cancer related deaths, no distant metastases, and treatment side effects greater than grade 3 documented. We report the largest single institute analysis using the eBT system in Taiwan. The low recurrence and complication rates at a 31.1 month follow-up time support the use of the eBT system in selected early-stage breast cancer patients. View ... TG-43-based treatment planning systems (TPS) are fast and available in most clinics offering brachytherapy with radionuclides. The TG-43 formalism was previously used to characterize the Xoft Axxent source (Rivard et al. 2006, Hiatt et al. 2015. For the INTRABEAM, relative TG-43 parameters were recently reported for the bare probe (Ayala Alvarez et al. 2020). ... Monte Carlo calculation of the TG-43 dosimetry parameters for the INTRABEAM source with spherical applicators Article Full-text available * Oct 2021 * PHYS MED BIOL * David Santiago Ayala Alvarez * Peter G F Watson * Marija Popovic * Veng Jean Heng * Jan Seuntjens Objective: The relative TG-43 dosimetry parameters of the INTRABEAM (Carl Zeiss Meditec AG, Jena, Germany) bare probe were recently reported by Ayala Alvarezet al(2020Phys. Med. Biol.65245041). The current study focuses on the dosimetry characterization of the INTRABEAM source with the eight available spherical applicators according to the TG-43 formalism using Monte Carlo (MC) simulations. Approach: This report includes the calculated dose-rate conversion coefficients that determine the absolute dose rate to water at a reference point of 10 mm from the applicator surface, based on calibration air-kerma rate measurements at 50 cm from the source on its transverse plane. Since the air-kerma rate measurements are not yet provided from a standards laboratory for the INTRABEAM, the values in the present study were calculated with MC. This approach is aligned with other works in the search for standardization of the dosimetry of electronic brachytherapy sources. As a validation of the MC model, depth dose calculations along the source axis were compared with calibration data from the source manufacturer. Main results: The calculated dose-rate conversion coefficients were 434.0 for the bare probe, and 683.5, 548.3, 449.9, 376.5, 251.0, 225.6, 202.8, and 182.6 for the source with applicators of increasing diameter from 15 to 50 mm, respectively. The radial dose and the 2D anisotropy functions of the TG-43 formalism were also obtained and tabulated in this document. Significance: This work presents the data required by a treatment planning system for the characterization of the INTRABEAM system in the context of intraoperative radiotherapy applications. View ... In both Bulgarian centers, an atlas of 33 previously prepared brachytherapy plans for breast IORT was used. The plans are developed by Pacific Crest Medical Physics, Chico, CA (PCMP) using a conventional brachytherapy treatment planning system (Varian BrachyVision, incorporating parameters describing the miniature X-ray source data) [12]. The complete set of plans is based on the volume of water used to inflate 3 different sizes of balloon applicators. ... ... A well chamber (HDR-1000; Standard Imaging, Middleton, WI, USA) which comes with every Xoft Axxent ® system is calibrated by the accredited dosimetry calibration laboratory to this standard. For techniques with the balloon applicators used in breast IORT, the TG-43 data published by Rivard et al. is used [12]. With the provided well chamber, the output of the currently used individual source is measured as part of the procedure before each irradiation session with treatment times for the plans (that are calculated for nominal source strength) corrected accordingly. ... ... The Xoft Axxent ® eBx system is a balloon-based technique for IORT that uses a disposable miniature X-ray tube with a tungsten target (50 kV, tube current 0.3 mA and 0.5 mmAl HVL), delivering a higher dose rate [39]. The X-ray source has a near-field dose rate that is at least six times higher beyond the catheter and a slower decreasing depth-dose curve, compared to the Intrabeam System, for example [12]. ... Intraoperative Radiotherapy with Balloon-Based Electronic Brachytherapy System—A Systematic Review and First Bulgarian Experience in Breast Cancer Patients Article Full-text available * Oct 2021 * Desislava Kostova-Lefterova * Mariela Vasileva-Slaveva * Svilen Maslyankov * Assia Konsoulova * Ivo Petrov (1) Background: We aimed to analyze currently available studies with intraoperative radiotherapy (IORT) as a choice of treatment where the Xoft Axxent® electronic brachytherapy (eBx) system was used as a single-dose irradiation and an exclusive radiotherapy approach at the time of surgery in patients with early breast cancer (EBC). We also compared the results of the systematic review to the Bulgarian experience. (2) Methods and Materials: We performed a systematic review of the studies published before February 2021, which investigate the application of a single-fraction 20 Gy radiation treatment, delivered at the time of lumpectomy in EBC patients with the Xoft Axxent® eBx System. A systematic search in PubMed, Scopus, and ScienceDirect was performed. The results are reported following the PRISMA guidelines. The criteria on patients’ selection for IORT (the additional need for EBRT), cosmetic outcomes, and recurrence rate from the eligible studies are compared to the treatment results in Bulgarian patients. (3) Results: We searched through 1032 results to find 17 eligible studies. There are no published outcomes from randomized trials. When reported, the cosmetic outcomes in most of the studies are defined as excellent. The observed recurrence rate is low (1–5.8%). Still, the number of patients additionally referred to postoperative external breast radiotherapy (EBRT) is up to 31%. Amongst the 20 patients treated in Bulgaria, the cosmetic outcomes are also evaluated as excellent, five of which (25%) are referred for EBRT. Within median follow-up of 39 months, there was one local and one distal recurrence. (4) Conclusions: Current evidence demonstrates the Xoft Axxent® eBx system as a safe and feasible technique for IORT delivery in EBC patients. There are no randomized controlled trials conducted at this time point to prove its long-term effectiveness. Better patient selection and a reimbursement strategy have to be proposed to extend the application of this technique in Bulgaria. View ... For the purpose of this radiobiological modeling study, the physical HDR-eBT OARs doses were estimated from the ratio of each OAR dose over the tumor dose in 125 I LDR-BT. The TG-43 source parameters of Xoft Axxent (iCAD, Inc., USA) are known [46]. In contrast to the Xoft Axxent device, the TG-43 source parameters of the IntraBeam device (Carl Zeiss Meditec Inc., Germany) have not been reported mainly due to the nature of its delivery (without treatment planning.) ... Radiobiological evaluation of organs at risk for electronic high-dose-rate brachytherapy in uveal melanoma: a radiobiological modeling study Article Full-text available * Oct 2021 * Timothy J. Waldron * Bryan G. Allen * Edward Pennington * Culver Boldt * Yusung Kim Purpose: The objective of this study was to examine feasibility of single- or hypo-fraction of high-dose-rate (HDR) electronic brachytherapy (eBT) in uveal melanoma treatment. Material and methods: Biologically effective doses (BED) of organs at risk (OARs) were compared to those of iodine-125-based eye plaque low-dose-rate brachytherapy (125I LDR-BT) with vitreous replacement (VR). Single- or hypo-fractionated equivalent physical doses (SFEDs or HFEDs) for tumor were calculated from tumor BED of 125I LDR-BT using linear-quadratic (LQ) and universal survival curve (USC) models. BED OARs doses to retina opposite the implant, macula, optic disc, and lens were calculated and compared among SFED, HFED, and 125I LDR-BT. Electronic BT of 50 kVp was considered assuming dose fall-off as clinically equivalent to 125I LDR-BT. All OARs BEDs were analyzed with and without silicone oil VR. Results: For a single-fraction incorporating VR, the median/interquartile range of LQ (USC)-based BED doses of the retina opposite the implant, macula, optic disc, and lens were 16%/1.2% (33%/4%), 35%/19.5% (64%/17.7%), 37%/19% (75%/17.8%), and 27%/7.9% (68%/23.2%) of those for 125I LDR-BT, respectively. SFED tumor values were 29.8/0.2 Gy and 51.7/0.5 Gy when using LQ and USC models, respectively, which could be delivered within 1 hour. SFED can be delivered within 1 hour using a high-dose-rate eBT. Even four-fraction delivery of HFED without VR resulted in higher OARs doses in the macula, optic disc, and lens (135 ~ 159%) than when using 125I LDR-BT technique. A maximum p-value of 0.005 was observed for these distributions. Conclusions: The simulation of single-fraction eBT, including vitreous replacement, resulted in significantly reduced OARs doses (16 ~ 75%) of that achieved with 125I LDR-BT. View ... A flexible water-cooling Xoft Axxent source (Xoft Inc., USA) catheter with a 25 mm length and 5.4 mm diameter was positioned inside an applicator for early-stage breast cancer treatment in this study. We adopted the AAPM TG43 report [8][9][10][11] for dose calculation and implemented this approach to all dosimetry parameters in BrachyVi-sion™ treatment planning system (TPS) for Xoft Axxent source. A dose of 20 Gray (Gy) X-ray radiation was delivered from a generator to the balloon surface to a small very high-dose region close to the applicator, which attenuates quickly ( 1 r 3 ) from 20 Gy on the balloon surface to about 5 Gy at 1 cm from the balloon surface [12]. ... Using magnetic material to repulse electrons in Axxent eBT for skin preservation during early-stage breast cancer conservative intra-operative radiotherapy Article Full-text available * Oct 2021 * Li Wang * Jia-Ming Wu A miniature electronic X-ray source was employed in this study to deliver intra-operative radiotherapy (IORT) within breast lesions. A flexible magnetic material was used to reduce breast skin radiation damage. Total prescribed dose was 20 Gy at balloon surface, with breast tumor bed wrapped around balloon applicator. A flexible magnetic material, called ‘neodymium-iron boron’ (NdFeB) + alloy-49 was applied to cover lesion’s surface to preserve the skin and to reduce electron contamination raised from photon-induced low-energy electrons, with tissue less than 1 cm between applicator surface and breast skin. The reduction of electron contamination using NdFeB + alloy-49 with an applicator-skin distance of 20 mm, ranged from 7% to 10%, while with an applicator-skin distance of 10 mm for balloon volumes from 30 to 50 cm3, it ranged from 4% to 6% only. NdFeB + alloy-49 magnetic material was efficient in repulsing photon-induced low-energy electrons for skin preservation to compensate for deficiency of tissue over less than 1 cm gap between the surface of applicator and the breast skin. View ... It should be noted that smaller glass tubes (e.g., 17 mm × 17 mm, Sunje) have been developed [23] but these cannot be applied in dental imaging as they are only capable of lowvoltage (11 kV) applications. In the case of ceramic tubes, the smallest in the market is Xoft Inc., 50 kV miniature (10 mm × 2.25 mm) [24], [25]. The exceedingly small diameter (2.25 mm) of this ceramic tube underscores the high electrical insulation of the ceramic envelope. ... Compact X-Ray Tube With Ceramic Vacuum Seal for Portable and Robust Dental Imaging Article Full-text available * Jul 2021 * IEEE T ELECTRON DEV * Amar Prasad Gupta * Jinho Choi * Mallory Mativenga * Keunhwa Park * Jehwang Ryu A major challenge for glass X-ray tube makers is the reduction in the tube size for portable or handheld applications. Size reduction is difficult mainly due to contact size restrictions for glass-to-metal welding. In high-voltage (60-70 kV) portable applications such as dental imaging, a distance of at least 5 mm should be maintained between the anode and the glass envelope to prevent the latter from burnout, which further limits reduction in the tube's diameter. In this study, reduction in the size of a dental X-ray tube by approximately 43% is achieved by replacing the glass envelope with ceramic. Instead of welding, the ceramic body permits the use of brazing, which supports extremely small contact sizes. Additionally, due to the higher dielectric constant of ceramic, even less than 1 mm spacing is permissible between the envelope and the anode, enabling further size reduction. Despite the 43% reduction in size, limiting spatial resolutions of approximately 8 and 7 lines per mm are obtained for the ceramic and glass sealed tubes, respectively. Moreover, the two tubes obtain similar X-ray images of human teeth, verifying the potential of the compact-size ceramic X-ray tube in dental imaging. View ... The brachytherapy TPSs based on the AAPM TG-43 protocol allow a fast acquisition of 3D dose distributions in water and are available in almost all radiotherapy facilities (Nath et al. 1995, Rivard et al. 2004). This approach is parallel to that of Rivard et al. (2006) who studied the brachytherapy parameters from the Xoft Axxent R (iCAD, Inc. Nashua, NH) electronic x-ray source based on the AAPM TG-43 protocol. ... ... The specific dimensions of the INTRABEAM source are proprietary, but the effective x-ray focal spot is small (less than 1 mm). Following the approach of Rivard et al. (2006) for the Xoft system, we have used the 2D formalism of the TG-43 with a pointsource approximation to describe the geometry function, G p (r, θ) = 1/r 2 , and radial dose function, g p (r), but accounting for the 2D polar anisotropy, F (r, θ), close to the source probe. In this way, the dose rate at any point P (r, θ) in water can be determined from the dose rate at a reference point P (r 0 , θ 0 ) aṡ ... ... This volume was chosen as a representative volume since most of the dose delivery occurs near the source and the MC model can be accurately validated in this region. The scoring volume composition consisted of liquid water of mass density 1.0 g cm −3 and atomic composition 2:1 for H:O, and was immersed in a bigger spherical phantom of radius 20 cm and the same water composition to ensure full scattering conditions in the scoring volume (Rivard et al. 2006, Hiatt et al. 2015. The water phantom and scoring volume were centered at the source tip. ... Monte Carlo calculation of the relative TG-43 dosimetry parameters for the INTRABEAM electronic brachytherapy source Article Full-text available * Nov 2020 * PHYS MED BIOL * David Santiago Ayala Alvarez * Peter G F Watson * Marija Popovic * Veng Jean Heng * Jan Seuntjens The INTRABEAM system (Carl Zeiss Meditec AG, Jena, Germany) is an electronic brachytherapy device designed for intraoperative radiotherapy applications. To date, the INTRABEAM x-ray source has not been characterized according to the AAPM TG-43 specifications for brachytherapy sources. This restricts its modeling in commercial treatment planning systems (TPSs), with the consequence that the doses to organs at risk are unknown. The aim of this work is to characterize the INTRABEAM source according to the TG-43 brachytherapy dosimetry protocol. The dose distribution in water around the source was determined with Monte Carlo (MC) calculations. For the validation of the MC model, depth dose calculations along the source longitudinal axis were compared with measurements using a soft x-ray ionization chamber (PTW 34013) and two synthetic diamond detectors (microDiamond PTW TN60019). In our results, the measurements in water agreed with the MC model calculations within uncertainties. The use of the microDiamond detector yielded better agreement with MC calculations, within estimated uncertainties, compared to the ionization chamber at points of steeper dose gradients. The radial dose function showed a steep fall-off close to the INTRABEAM source (<10 mm) with a gradient higher than that of commonly used brachytherapy radionuclides (192Ir,125I and103Pd), with values of 2.510, 1.645 and 1.232 at 4, 6 and 8 mm, respectively. The radial dose function partially flattens at larger distances with a fall-off comparable to that of the Xoft Axxent®(iCAD, Inc. Nashua, NH) electronic brachytherapy system. The simulated 2D polar anisotropy close to the bare probe walls showed deviations from unity of up to 55% at 10 mm and 155°. This work presents the MC calculated TG-43 parameters for the INTRABEAM, which constitute the necessary data for the characterization of the source as required by a TPS used in clinical dose calculations. View ... The Axxent x-ray source operates at tube voltages of 20 to 50 kV and tube currents of 1-300 µA producing air kerma strength of up to 1600 Gy.cm 2 .h − 1 and it is designed for a lifetime of 2.5 h [8]. Another commercial system which uses a small form (7 cm × 11 cm × 17 cm) x-ray tube is the INTRABEAM (Carl Zeiss Surgical, Oberkochen, Germany) intraoperative radiotherapy system. ... External beam radiation therapy with kilovoltage x-rays Article * Nov 2020 * PHYS MEDICA * Dylan Y Breitkreutz * Michael D Weil * Magdalena Bazalova-Carter Kilovoltage (kV) x-rays are most commonly used for diagnostic imaging due to their sensitivity to tissue composition. In radiation therapy (RT), due to their fast attenuation, kV x-rays are typically only used for superficial irradiation of skin cancer and for intra-operative RT (IORT). Recently, however, a number of kV RT techniques have emerged. In this review article, we provide a brief overview of the use of kV x-rays for RT. Various kV x-ray source technologies suitable for RT, such as conventional x-ray tubes as well as novel x-ray sources, are first described. This x-ray source section is then followed by a section on their implementation in terms of clinical, veterinary and preclinical applications. Specifically, IORT, superficial RT and dose enhancement with iodine and gold nanoparticles, as well as microbeam RT and FLASH RT are discussed in this context. Then, a number of kV x-ray RT applications in modeling and proof-of-principle stages, such as breast external beam RT with rotational sources, kilovoltage arc therapy and the BriXS Compton pulsed x-ray sources, are reviewed. Finally, some clinical and economic considerations for the development of kV RT techniques are discussed. View Show more Get access to 30 million figures Join ResearchGate to access over 30 million figures and 135+ million publications – all in one place. 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