Verhaegen, F. and Reniers, B. Microdosimetric Analysis of Various Mammography Spectra: Lineal Energy Distributions and Ionization Cluster Analysis. Radiat. Res. 162, 592–599 (2004).

In view of recent recommendations on the frequency and the starting age of mammography screening in healthy women, it is desirable to quantify the enhanced relative biological effectiveness (RBE) of mammography X rays compared to hard X rays. While there is little doubt that the former are more potent in inducing biological damage than the latter, the magnitude of the effect is still hotly debated in the literature. We used Monte Carlo simulations and track structure analysis in micrometer and nanometer volumes to investigate differences in distributions of lineal energy and ionization clusters for a range of mammography X-ray qualities. Dose-averaged lineal energies, ⟨y_D⟩, in breast tissue for various mammography qualities were found to result in quality factors about 40% higher than unity. Among the various mammography qualities studied, the popular molybdenum/molybdenum target/filter combination was found to have the highest ⟨y_D⟩ in 1-μm spheres (about 5.0 keV/μm near the entrance surface of breast tissue). In 10-nm radius spheres, the mean ionization cluster order was found to be about 35% higher in mammography X rays compared to 300 keV electrons (roughly representing ⁶⁰Co or ¹⁹²Ir photon radiation). In even smaller spheres (2 nm radius), no significant differences were observed for the mean ionization cluster order between mammography X rays and 300 keV electrons. We conclude that the potential of mammography X rays to induce biological damage is probably not much higher than a factor of two compared to hard X rays.